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State-of-the-Art Technology Can Even Image Tissue Stiffness

Diagnostic ultrasound scanners are used for a range of purposes in the diagnostic process. Hitachi has achieved the world’s first technology for imaging the stiffness of tissue. It is expected to contribute to the early detection of carcinomas such as breast cancer and liver cancer.

Seeing something invisible from outside the body

Example of a fetal 3D examination

True to its name, ultrasound is a method of examining the body using ultrasonic waves. The examiner places a probe (a sensor part to put on the patient’s body) on the surface of the body of the examinee, which transmits ultrasonic waves into the body. The imaging of the reflection (echoes) from the tissue enables to display the section image of body. This diagnostic method causes barely any discomfort and does not place too great a burden on patients. Additionally, the state of examination part can be checked by movie in real time. For these reasons, ultrasound is used for many different examinations.

Diagnostic ultrasound scanners are used for prenatal screening of pregnant women as well as disease diagnosis. They enable the real-time judgment of the position of a fetus (breech or not), facilitate the estimation of the fetal body weight, and show a 3D image of the baby’s face. Prenatal cardiac function examination of fetuses also uses diagnostic ultrasound scanners. The examinations allow expectant mothers to check the health of their baby and feel relieved.

As a pioneer of diagnostic ultrasound scanners, Hitachi developed the first technology in the world for imaging the stiffness of lumps in the body and commercialized it in 2003. It is called Elastography.

Visualizes the stiffness of tissue and distinguishes breast cancer

It is known that the stiffness of cancerous tissue increases as the density of the blood vessels/cells increases in its early stages. This means that the visualization of stiffness helps in determining whether the tissue is benign or malignant. Elastography (Real-time Tissue Elastography, abbreviated to RTE) was developed to image the stiffness of tissue. The technology is utilized for the diagnostic imaging of a range of body parts, starting from breast.

Elastography OFF

Elastography ON

A lump imaged using Elastography (right)
The gradation of color from red to blue shows the stiffness of the tissue
(Blue indicates the stiffest part).

 

To understand how Elastography and other diagnostic ultrasound scanners are used in clinical practice for judging whether the breast tissue is benign or malignant, we interviewed Dr. Sadako Akashi, Showa University Hospital. She is an experienced specialist in breast cancer surgery, having performed over 2,000 operations.

“Approximately 90,000 women develop breast cancer each year in Japan. It is the most prevalent cancer in women. However, more than 90% of patients can recover from this disease if the tumor is detected early in a diameter of 2 mm or less, before it metastasizes to the lymph nodes. Mammography is generally used for breast cancer screening. It can cause pain in some women. In addition, it is difficult to identify cancer in some Japanese and other Asian women in their 40s or younger due to whitened mammary gland display caused by the dense breast. Ultrasound is an appropriate solution for these women. To judge whether or not lumps are malignant, both ultrasound and mammography are conducted to obtain data prior to the final examination with the collection of tissue for cytologic diagnosis or needle biopsy. Elastography enables to narrow the subject cases further. It is good that Elastography permits a detailed examination and provides real-time image data without placing a psychological burden on patients or causing them pain.”

Dr. Sadako Akashi, Associate Professor,
Department of Breast Surgical Oncology,
School of Medicine, Showa University

Breast cancer screening has been changing, while medical devices have become highly sophisticated. What future does Dr. Akashi picture for advanced technology?

“Elastography would further introduce state-of-the-art technologies. For example, I would like an automated diagnostic ultrasound scanner that can obtain an image of the entire breast while eliminating the work involved in having a surgeon or technician move a probe. However, such a device may provide too much information, which may cause an examiner to overlook the necessary information. I really would like Hitachi to use AI and big data to develop a system that allows surgeons to pick up accurate information.”

The new body-friendly technology that will support future liver examinations

The liver is called as a silent organ, because subjective symptoms are less obvious even if inflammations and carcinomas exist. Inflammations tend to become chronic when they are not detected. If this occurs, it is difficult to heal them. That is why early detection is important. If an inflammation continues, the fibrosis of the liver may advance, resulting in the development of cancer. The diagnosis of liver fibrosis generally involves a hepatic biopsy in which a sample of the hepatic tissue is collected. However, some problems exist for it: bleeding and pain are inevitable, and testing cannot be performed frequently or repeatedly.

To decrease such problems, Hitachi developed Shear Wave Measurement (SWM) as a new technology for Elastography in 2015. It is a technology for transmitting ultrasonic waves into lesions in the liver and the surroundings to visualize the difference in the velocity of propagation as the stiffness of the tissue. It does not harm the body, but enables hepatic pathology examinations without causing pain or bleeding by simply placing a probe on the body.
In addition, Hitachi developed Combi-Elasto, a new function that permits RTE and SWM to be carried out simultaneously. RTE judges the pathology of a lesion based on the degree of deformation of a lump. SWM uses the velocity of the propagation of the ultrasonic waves in a lump and its surroundings to judge the pathology. The combined use of RTE and SWM is expected to enhance the precision of the diagnosis.

Dr. Nobuharu Tamaki,
Department of Gastroenterology,
Japanese Red Cross Musashino Hospital

““Hepatic biopsy, which collects hepatic tissue for examination, was conducted mainly in liver examinations,. It was a very painful examination for patients due to pain and bleeding. However, Combi-Elasto may become a mainstream for examinations. Research has revealed that Combi-Elasto provides a greater degree of precision in diagnostic examinations than single use of RTE or SWM. As a result, Combi-Elasto is expected to enable non-invasive examinations that have the same precision as a hepatic biopsy.” (Dr. Nobuharu Tamaki, Department of Gastroenterology, Japanese Red Cross Musashino Hospital)

The body-friendly technology supports the early detection of diseases in hospitals.
Hitachi will contribute to society so that people around the world can live healthily by continuing to promote healthcare innovations.

See something invisible on a real-time basis
-Ultrasound further develops imaging technology
Akifumi Otake
Hitachi, Ltd.
Healthcare Business Unit
Diagnostic Systems Division
Division Manager
See something invisible on a real-time basis -Ultrasound further develops imaging technology  Akifumi Otake Hitachi, Ltd. Healthcare Business Unit Diagnostic Systems Division Division Manager

Having commercialized the world’s first diagnostic ultrasound scanner in 1960, as a pioneer, Hitachi has developed new technologies and functions that can contribute to a range of needs in diagnosis and examinations. With “the ability to see” as a key phrase, Hitachi undertakes research and development to provide support to medical doctors in diagnosis and alleviate the burden for patients.

As a pioneer of ultrasound, Hitachi has made a range of achievements in this field. The latest ultrasound sees a baby in its mother. It sees the blood flow within the heart. It also sees the stiffness of a lump in the breast. Hitachi has developed a variety of features for the ability to see, and has delivered innovative products constantly.
Today, there are greater needs to respond to the aging society and appropriate medical spending as well as the progress of healthcare. Quality should be secured and efficiency should be increased in medical care with limited medical resources. Advanced technology is progressing steadily, such as genetic diagnosis and regenerative medicine. Hitachi considers that preventive medicine with early accurate diagnosis is important in order to maintain day-to-day health. In particular, ultrasound is an indispensable device for prevention because it permits repeated testing without causing pain or exposure to radiation.

The ultimate goal is to enhance image quality performance and reduce patient dependency; that is, to enhance the quality of examinations as well as enhancing the throughput of examinations. We believe that simply listening to the opinions of medical professionals eventually contributes to society in a way, although our contribution to medicine in general may be limited.

We make efforts to listen to the opinions of medical doctors, examiners and patients, share issues and challenges, and convert the information obtained into input for the development of devices. The function to check the degree of inflammation in the liver is one of the examples of the technology developed based on the opinions of medical professionals. It is a result of the fusion of Elastography (Real-time Tissue Elastography or RTE) and Shear Wave Measurement (SWM). The function has promoted clinical practice to introduce another high-quality ultrasound examination for prevention. It should help to further motivate our development team.