Category: Uncategorised

10 Sep 2018

Radiology Today Magazine: More With Less

Advanced software reduces dose without sacrificing image quality.


Although the direct health risk of medical diagnostic scanning is not unequivocally clear, it is important for patients as well as health care professionals to mitigate the risks of radiation dose. While most of the concern regarding overexposure and cumulative dose has historically been focused on CT, which generally delivers much higher dose levels to patients than standard X-rays, the issue has raised awareness of a patient’s cumulative lifetime dose across all modalities that use ionizing radiation—CT, radiography, and angiography.

Most original equipment manufacturers have a strategy centered on improving the quality and safety of patient care through a commitment to lower radiation across a suite of medical imaging products. The challenge is doing so without sacrificing quality images or impacting care.

Less Dose, Same Quality
An example is Samsung’s GC85A premium fully digital X-ray system, which provides the same image quality with one-half the radiation. Deborah Chung, marketing manager of health care at Samsung Electronics America, says Samsung’s image postprocessing engine, S-Vue3.02, provides spatially adaptive multiscale processing and advanced denoising technology.

“The new system delivers the same image quality as the predicate device but with half the radiation exposure,” Chung says. “The key is Samsung’s cutting-edge denoising processing, adopted for the new engine, which reduces noise from the noisy low-dose data while preserving the details of the object being imaged.”

The dose reduction in digital chest radiography is based on limited phantom and clinical study results for Samsung’s GC85A and GM85 systems. Hetal Patel, MD, a radiologist at Alamance Hospital in Burlington, North Carolina, says the low-dose image quality on the GC85A equipment is excellent.

“The retro cardiac region is well visualized with excellent penetration, and the rest of the anatomical structures are clearly demarcated,” Patel says. “Also, bony structures were well delineated. Low-dose imaging has a similar or better image quality than regular-dose images.”

EOS Imaging develops and markets the EOS system, an X-ray-based modality for musculoskeletal imaging that captures simultaneous anteroposterior/lateral (AP/LAT) full-body images of patients in functional positions at significantly reduced radiation doses.

“The value of the EOS system is multiple: value in patient safety through a dose reduction that can be two-fold to 10-fold, compared with DR and CT; value in efficiency through a much faster exam—up to 75% savings in exam time; and value from a better-informed treatment thanks to our unique weight-bearing 3D data,” says Marie Meynadier, CEO of EOS imaging.

As a result, an EOS exam provides high-quality, full-body, low-dose AP/LAT radiographs, a 3D model of the skeleton, and a comprehensive report of automatically calculated clinical parameters in 2D and 3D in less exam time.

“Reducing health care-related radiation exposure is a metaphorical cornerstone in medical ethics and the standards exhibited in the Hippocratic Oath,” says Christopher J. Smith, CNMT, RT(N), administrative director of radiology and imaging at the Hospital for Special Surgery (HSS) in New York. “While incidental exposure from X-rays has minimal to no patient risk, there are patient populations, such as adolescent idiopathic scoliosis patients, that may receive serial X-rays for many years.”

Moreover, the aggregation of these exposures is yet to be fully evaluated and can be anxiety inducing. Smith utilizes the EOS imaging system, which he notes offers significant dose reduction for the imaging life of the patient.

“At HSS, we see dose reductions equal to approximately 50% of comparable digital X-rays,” Smith says. “EOS also offers a microdose feature that can further reduce patient exposure to near-background levels, which HSS will be exploring to offer for some patient cohorts.”

Two key factors that allow EOS to provide a reduced dose and clinical image quality are an innovative gas detector and a collimated X-ray beam to reduce scatter and unnecessary X-rays. The EOS detector has extremely high sensitivity and a very high gain, which is automatically adjusted for each exposure. This preserves contrast from the denser parts of the anatomy, such as bones, to the less dense parts, such as soft tissues and lungs.

“The outcome is an X-ray image with good resolution, sharpness, and 65,000 gray values,” Smith says. “This means that the X-ray images can be windowed similar to the way radiologists do for specific body parts in CT. Next, the X-ray beam is collimated just after the X-ray tube and passes through a shielded horizontal slot that is 500 microns high. The resultant fan-shaped X-ray beam limits the volume of the body exposed at each moment and, thus, drastically limits the total number of aberrant X-rays, the ‘scatter,’ exiting the patient and entering the gas detector, where it would degrade the image sharpness.”

DR Detail
Steven Eisner, senior product manager for Konica Minolta Healthcare Americas, Inc, says the company’s AeroDR family of digital flat panel detectors—AeroDR HD, AeroDR XE, and AeroDR LT—utilize a combination of high detective quantum efficiency, high spatial resolution, and REALISM image processing software to contribute to improved dose efficiency.

“REALISM is our next-generation advanced image processing software that provides superior visualization of structures within soft tissue and bone within the same image,” Eisner says. “It delivers a new level of clarity and detail in X-ray imaging that improves the sharpness of fine details, enhances visibility of hard-to-penetrate structures, and delivers excellent visibility of high-contrast images. This translates to the ability to generate more information with fewer exposures per exam as well as avoid the need to retake images due to poor image quality.”

At Cuero Regional Hospital in Cuero, Texas, Tyler Lemke, director of radiology, has been using REALISM and AeroDR.

“In the wrist, where there are many small bones, I immediately noticed the fine details and sharper images allowing me to see the fine details of each bone,” Lemke says. “The images were so crisp the bones just popped [off the image] and the edges and trabeculae of every bone were very clear.”

Lemke also tracks repeat exposures. He had previously noticed that technologists were performing repeat exposures because they were not optimizing exposure levels. In the first month after installing REALISM and AeroDR, Lemke worked with this staff to ensure a higher attention to detail with the new DR system; as a result, repeat exposures have dropped by 20%.

“Department managers are concerned with dose, and AeroRemote Insights provides the analytics, via interactive dashboards, they need to manage their AeroDR assets and deliver a better experience for patients,” Eisner says. “Over the last decade, with the increase in system connectivity and the more recent emergence of [the Internet of Things], we’ve tapped into our experience and expertise to be the first to deliver analytics in DR to our customers.”

Lung Imaging
A new preclinical scanner from 4Dx Limited, a Melbourne, Australia-based medical technology company, focuses on lung disease and reductions in radiation dose. Andreas Fouras, PhD, a mechanical engineer, is the inventor of the tech. He was working at a university doing wind tunnel imaging and developing algorithms to measure and quantify movement when he thought this capability could be used to measure motion in the lungs.

“The first layer is we measure in fine detail how the lungs move as the subject breathes, and then, once we have that information as to how the lung tissue is moving, it’s actually a relatively simple step to then calculate what the air flow is that creates that lung tissue motion,” he says. “So, we can create high-resolution maps of airflow, of ventilation in the lungs. We think of this as a brand-new modality, but we just use older X-ray equipment so we can do low-dose X-rays and apply the algorithm and generate this new, rich data.”

The whole procedure has a dose cost of about 0.2 milligrays—about two chest X-rays worth of dose—but it provides highly detailed data at no capital cost and no upfront cost to a site, a doctor, or a radiologist.

“We create a 3D image of this lung tissue motion,” Fouras says. “The old sort of CT way works by taking hundreds of images around the outside of a patient to reconstruct the 3D CT image. We’re actually able to do that with as few as three views. The closest sort of competing technology in this space would be a 40-slice CT, which is going to be substantially more dose than two chest films.”

CT Scanning
Waseem Bhatti, MD, medical director of imaging at Summit Medical Group MD Anderson Cancer Center in Florham Park, New Jersey, says by utilizing a combination of clinical decision tools, hardware, and software technology innovations, along with purposeful scanning, the industry can optimize medical imaging for patients.

“Reducing dose for our patients begins before the scan. Software and the ‘cloud’ are increasingly playing a role in limiting the number of unnecessary scans and repeated scans within a short time interval,” Bhatti says. “From what we know about Moore’s law—the observation that the number of transistors in a computer chip double about every two years—we have seen dramatic improvements in CT scanners.”

In the early 2000s, most CT scanners used a single slice to scan. At Summit Medical Group MD Anderson Cancer Center, most of its current scanners use at least 160 slices.

“Customization of radiation dose using automated exposure control software on our CT scanners helps decrease unnecessary dose,” Bhatti says. “The patient’s size and shape is measured and calculated for the specified scan protocol, and the dose delivered through the 360 degrees of the scan may be modulated depending on soft tissue thickness at a given slice level.”

A large part of the dose depends on the clinical question posed by the referring physician. For example, a contrast-enhanced pancreatic protocol CT scan will require a higher dose than a noncontrast scan for detecting kidney stones.

“Unfortunately, the more we decrease the dose, the more noise or blurriness we encounter,” Bhatti says. “To deal with noise, postscan reconstruction software is used to produce diagnostic quality images by improving spatial resolution.”

The center’s Canon Aquilion CT scanners select the dose based on patient size, exposure settings, and type of scan being performed. Iterative reconstruction software on these scanners optimizes the images.

“When a patient undergoes a CT scan, they deserve to have the highest-quality scan using the lowest dose possible. The ALARA principle of responsible dose management guides our approach,” Bhatti says. “We also fully participate in the Image Gently campaign to reduce pediatric CT dose. Our equipment helps us adhere to these principles by giving us the tools necessary to limit dose while producing high-quality images.”

To view the original article, please click here

19 Feb 2017


Melbourne, Australia, 20 February, 2017: Dr. Andreas Fouras, founder and CEO of medical technology company 4Dx Limited, will present preliminary clinical data at the prestigious World Lung Imaging Workshop on the 2nd of March at the University of Pennsylvania.

The software technology developed by 4Dx provides richer information, allowing for earlier detection of respiratory related disease.  Dr. Fouras, who founded the company in 2012, says that “presenting the first 4Dx in human clinical data is a great milestone for the company and we are excited to share these results to many of the world’s leading lung imaging experts at such a prestigious event”.

4Dx technology enables clinicians to capture images that effectively visualise and quantify motion of airflow at high resolution within the breathing lungs.  Currently more than 162 million respiratory diagnostic procedures are performed each year, at a cost of $25 billion per annum.

4Dx limited currently has a range of formal engagements with some of the leading institutions across the United States and is moving rapidly towards a commercial product in the United States by 2018.

21 Sep 2016

Appointment of General Manager – Notting Hill Devices

4Dx is excited to announce that Paul Cooke will be taking on the role of General Manager of 4Dx’s specialist hardware subsidiary, Notting Hill Devices. As Paul moves into this role, he will be stepping aside from his role as Non-Executive Director, effective 1st September. During his tenure as Non-Executive Director, Paul played a key role in lifting 4Dx’s profile during our recent capital raising endeavours.


02 Sep 2016

Andreas Fouras, CEO of 4Dx, says backing bright people is a bright idea

Andreas Fouras, Founder and CEO of 4Dx, spoke with Nature Index on the recent call from the National Health and Medical Research Council (NHMRC) for public consultation on the structural review of their grant program.

m1Following criticism that current funding models are failing to support researchers across all stages of their careers, the NHMRC have opened the debate around three proposed alternative models to review research grant submissions: two based largely on funding people, as individuals or teams; and one that supports ideas.

Andreas joins the camp to support funding people, stating that the disadvantage of funding projects or ideas is that review panels struggle to evaluate projects that draw on multidisciplinary expertise, “there are no panels for research identified as belonging to ‘other’ fields, ” he says.

To read the full article click here.



01 Sep 2016

4Dx retail round closes with full subscription

Scan-room-with-4dx-reportWe are pleased to announce that our recent retail offer of shares is now fully subscribed after successfully raising AU$500,000.

It is very encouraging to gain backing so enthusiastically from retail investors committed to seeing our technology come to market as fast as possible.

These funds take us a step closer to commercialising our technology through ongoing clinical validation and expansion of our US operation, where Founder and CEO, Andreas Fouras, is now based.

We would like to thank all of our investors for their ongoing support and will continue to update you with news as we reach significant milestones.

To find out about future opportunities, please register your interest here.

25 Aug 2016 interview 4Dx on their advanced visualization tool being used for imaging lung disease

4Dx was interviewed by, an influential community site for radiologists and related professionals in the medical imaging industry.

In the article “Advanced visualization tool assesses lung disease”, Eric Barnes interviewed the 4Dx team on the new technique they have developed that combines fluoroscopy and advanced visualization to generate high-resolution images of the motion and airflow of lung tissue.


“The patients breathe under fluoro and we can record the motion of the tissues, and from that we can quantify a number of things, like ventilation,” said Andreas Fouras, CEO and Founder of 4Dx.

4Dx uses software to segment and track the bronchial tree and estimate airflow inside that part of the body. The team explained that, assuming air inside the lung and lung tissue is incompressible, the calculated lung expansion directly represents airflow into and out of the lung regions.

Asked how the technology will be used, Andreas explained that they foresee a number of clinical applications.

“Depending on the nature of the disease, it may be easier to see the disease through an image of the ventilation, or it may be easier to see it on the airways themselves where you can see the airflow going through,” he explained. “It primarily depends on whether the disease is restrictive [affecting the tissues] or obstructive [affecting the airways].”


4Dx has tested the technology in animal studies and has started performing human trials with leading Australian and US hospitals.

Andreas believes the images to be very powerful for diagnosis of common lung disease, and, more importantly, for the monitoring and follow-up of a patient as a disease progresses, or as a patient undergoes treatment.

To view the original article “Advanced visualization tool assesses lung disease”, by Eric Barnes is available to members at

24 Aug 2016

4Dx’s CEO talks to the Australian Financial Review about how our culture is stifling innovation

Light BulbThe AFR cover insights from last weeks meeting of 400 of the top people in the innovation sector, where Andreas Fouras, CEO of 4Dx, highlighted one of the biggest problems Australia faces as it seeks to become high tech nation.

Contrary to the risk taking the government would lead us to believe is encouraged as a nation, when researchers leave academia and attempt to commercialise their research, if it doesn’t work out, they are rarely taken back.

Taking a leap of faith to quit a career to go and build a startup is daunting enough, but as noted by Andreas, as an academic, you want to be sure.

Andreas is so convinced of the merit of his research he sold his house, quit his job and relocated his entire family to the US.
Click here to read the full article.

18 Aug 2016

4Dx’s Andreas Fouras speaks alongside Australia’s leading academics and experts at the AFR Innovation Summit 2016

Andreas Fouras, CEO of 4Dx, yesterday joined some of  Australias leading scientists and academics at The Australian Financial Reviews  Innovation Summit to discuss Australia’s need to change its attitude toward entrepreneurial failure to protect the economy from missing out on the benefits created by risk takers.

Dr Finkel, Australia’s chief scientist, who was also speaking, highlighted that Australia’s start-up ecosystem will find success with the right attitude, investments and policies. This, he says, could maximise Australia’s potential to punch well above its weight.Andreas Presenting

Andreas added during his round table ‘Deconstructing successful commercialization: Lessons from the coalface’ that a key success factor for innovation was that it is important to have more mobility between universities and business and with other research organisations such as the CSIRO.

The article was published in today’s AFR on Page 2 or click here to read the full article online.