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This first-of-a-kind report combining hydrodynamic testing, multimodality imaging, and histological assessment on explanted failed TAV found that functional stenosis can occur to a similar extent in the absence of leaflet calcification. #JACCINT #TAVR

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JACC Journals

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Called to a report of a timber sleeper on fire. Line blocked on arrival , sleeper found and fire extinguished from water containers I carry in my van. Operational assessment made that normal working can resume. My P-Way colleagues will replace the long timber later.
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Called to a report of a timber sleeper on fire. Line blocked on arrival , sleeper found and fire extinguished from water containers I carry in my van. Operational assessment made that normal working can resume. My P-Way colleagues will replace the long timber later.

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PHOTON COUNTING CT is NOT a better CT It is a NEW imaging modality Photon Counting CT (PCCT) represents a transformative leap in medical imaging, not only as a molecular imaging modality but also as a technology offering ultra-high resolution and functional imaging capabilities. It is fundamentally more than just an enhanced version of traditional CT—PCCT introduces new ways of seeing and understanding the human body, providing critical insights at the molecular, structural, and functional levels. This positions PCCT as a unique imaging modality that requires a fresh approach to technical implementation, operational workflows, and financial planning. Despite the larger upfront investment, PCCT’s ability to drastically reduce downstream healthcare costs makes it a highly valuable investment in the long run. 1. Technical Innovations • Molecular Imaging and Energy Discrimination: Unlike traditional CT, which simply measures the total absorbed energy, PCCT counts individual X-ray photons and differentiates their energy levels. This allows for precise molecular imaging, revealing the composition of tissues and materials at a biochemical level. By distinguishing between different tissue types and contrast agents, PCCT opens up new diagnostic possibilities, such as identifying molecular biomarkers in tumors or distinguishing between stable and unstable plaque in coronary arteries. This capability shifts the focus of imaging from purely anatomical to both anatomical and molecular, offering more comprehensive diagnostic information. • Ultra-High Spatial Resolution: PCCT features significantly smaller detector elements compared to conventional CT scanners, allowing for ultra-high resolution imaging. This means clinicians can visualize fine structures such as microcalcifications in arteries, small lesions in soft tissues, or the intricate architecture of bones. This level of detail was previously unattainable with traditional CT. When combined with molecular imaging, this ultra-high resolution allows for the precise localization and characterization of disease at very early stages, which is essential for early diagnosis and intervention. • Functional Imaging Capabilities: PCCT also excels as a functional imaging modality. By capturing energy-resolved information, PCCT can provide insights into tissue functionality and dynamic physiological processes. For instance, it can detect changes in blood flow, tissue perfusion, and oxygenation without the need for additional contrast agents or scans. This functionality allows for real-time assessment of physiological processes, making it particularly valuable in cardiology, oncology, and neurology for evaluating organ function and monitoring disease progression. • Reduced Noise and Artifact Reduction: Photon-counting technology dramatically reduces electronic noise and imaging artifacts, such as beam hardening, resulting in clearer and more accurate images. The ability to deliver ultra-high resolution images with minimal artifacts improves diagnostic accuracy, reducing the need for repeat scans and ensuring that even subtle abnormalities are detected. 2. Operational Considerations • New Workflow for Molecular, High-Resolution, and Functional Imaging: The integration of molecular, ultra-high resolution, and functional imaging into routine clinical workflows introduces complexity that requires adaptation. Radiologists and technicians need specialized training to interpret and analyze multi-energy datasets that include molecular and functional information. PCCT produces a vast amount of detailed data, requiring clinicians to adopt new imaging protocols and refine their diagnostic approaches to fully leverage its capabilities. • Post-Processing and Data Management: PCCT generates richer, more complex datasets, which necessitates advanced post-processing tools and data management systems. Existing PACS and imaging software may not be equipped to handle such large volumes of data or to process functional and molecular information effectively. This means healthcare institutions must invest in robust IT infrastructure, including upgraded software and storage solutions, as well as provide additional training for staff on new imaging analysis techniques. • Revised Clinical Protocols: The molecular, functional, and ultra-high resolution imaging capabilities of PCCT will likely prompt changes in clinical protocols. For instance, the need for contrast agents may be reduced, simplifying patient preparation and decreasing the risk of adverse reactions. Additionally, the ability to monitor physiological functions in real-time through functional imaging could lead to more dynamic diagnostic procedures, such as assessing the effectiveness of interventions or treatments in real-time. 3. Financial Impact • Higher Initial Investment: PCCT systems are more expensive than traditional CT scanners due to their advanced technology, which includes photon-counting detectors and the computational power required for high-resolution, molecular, and functional imaging. While this upfront cost is significant, it is crucial to view it in the broader context of the downstream benefits and cost reductions that PCCT offers. • Downstream Cost Reductions: Although the initial capital investment is higher, PCCT’s ability to combine molecular, functional, and ultra-high resolution imaging leads to substantial reductions in downstream healthcare costs. Its superior diagnostic accuracy minimizes the need for follow-up tests, repeat scans, or invasive diagnostic procedures, such as diagnostic coronary angiographies. For example, in cardiology, PCCT can precisely differentiate between types of coronary plaque, reducing the need for invasive procedures to assess risk. • Lower Overall Healthcare Expenditures: By enabling earlier, more accurate diagnoses, PCCT can reduce the overall cost of patient care. Early detection of disease, particularly through its molecular and functional imaging capabilities, allows for more targeted treatments, potentially preventing the need for more aggressive and expensive interventions down the line. For instance, early-stage tumor detection via molecular imaging could lead to less invasive treatments, reducing hospital stays and improving patient outcomes, ultimately driving down healthcare costs. • Increased ROI Through Enhanced Patient Outcomes: Over time, the combination of molecular, functional, and ultra-high resolution imaging enhances diagnostic precision, which translates into better patient outcomes. Improved diagnostic accuracy reduces the incidence of unnecessary procedures, minimizes treatment delays, and results in more personalized and effective care. This leads to increased patient satisfaction, better healthcare outcomes, and greater patient throughput—all factors that improve the institution’s return on investment (ROI). • Competitive Advantage and New Revenue Streams: By adopting PCCT, healthcare institutions position themselves at the forefront of advanced imaging technologies. The ability to offer molecular, functional, and ultra-high resolution imaging creates a competitive advantage, attracting more complex and high-value cases. This can boost the institution’s reputation for excellence in diagnostics, leading to increased referrals, new patient populations, and expanded revenue opportunities. Summary Photon Counting CT (PCCT) is not just an evolution of existing CT technology—it is a molecular, ultra-high resolution, and functional imaging modality that fundamentally transforms the diagnostic landscape. Its ability to capture detailed molecular data, visualize minute anatomical structures with ultra-high resolution, and provide real-time functional imaging opens new possibilities for earlier and more precise diagnoses. While the financial investment in PCCT is larger, the reduction in downstream healthcare costs through improved diagnostic accuracy, fewer unnecessary interventions, and earlier disease detection far outweighs the initial expense. For institutions committed to advancing patient care and improving long-term financial outcomes, PCCT is an essential investment in the future of medical imaging. The video attached shows a patient accessing the Hospital for ACS. PCCT can provide ALL the imaging information of the concurrent imaging modalities (CXR, CAG, Echo, CMR) that you see around it... that's a lot! #PhotonCountingCT #MolecularImaging #UltraHighResolution #FunctionalImaging #FutureOfImaging #AdvancedMedicalImaging #EarlyDiseaseDetection #InnovativeCT #CuttingEdgeHealthcare #PrecisionDiagnostics #HealthcareInnovation #MedicalTechnology #CostEffectiveImaging #NextGenCT #PatientCareRevolution
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PHOTON COUNTING CT is NOT a better CT It is a NEW imaging modality Photon Counting CT (PCCT) represents a transformative leap in medical imaging, not only as a molecular imaging modality but also as a technology offering ultra-high resolution and functional imaging capabilities. It is fundamentally more than just an enhanced version of traditional CT—PCCT introduces new ways of seeing and understanding the human body, providing critical insights at the molecular, structural, and functional levels. This positions PCCT as a unique imaging modality that requires a fresh approach to technical implementation, operational workflows, and financial planning. Despite the larger upfront investment, PCCT’s ability to drastically reduce downstream healthcare costs makes it a highly valuable investment in the long run. 1. Technical Innovations • Molecular Imaging and Energy Discrimination: Unlike traditional CT, which simply measures the total absorbed energy, PCCT counts individual X-ray photons and differentiates their energy levels. This allows for precise molecular imaging, revealing the composition of tissues and materials at a biochemical level. By distinguishing between different tissue types and contrast agents, PCCT opens up new diagnostic possibilities, such as identifying molecular biomarkers in tumors or distinguishing between stable and unstable plaque in coronary arteries. This capability shifts the focus of imaging from purely anatomical to both anatomical and molecular, offering more comprehensive diagnostic information. • Ultra-High Spatial Resolution: PCCT features significantly smaller detector elements compared to conventional CT scanners, allowing for ultra-high resolution imaging. This means clinicians can visualize fine structures such as microcalcifications in arteries, small lesions in soft tissues, or the intricate architecture of bones. This level of detail was previously unattainable with traditional CT. When combined with molecular imaging, this ultra-high resolution allows for the precise localization and characterization of disease at very early stages, which is essential for early diagnosis and intervention. • Functional Imaging Capabilities: PCCT also excels as a functional imaging modality. By capturing energy-resolved information, PCCT can provide insights into tissue functionality and dynamic physiological processes. For instance, it can detect changes in blood flow, tissue perfusion, and oxygenation without the need for additional contrast agents or scans. This functionality allows for real-time assessment of physiological processes, making it particularly valuable in cardiology, oncology, and neurology for evaluating organ function and monitoring disease progression. • Reduced Noise and Artifact Reduction: Photon-counting technology dramatically reduces electronic noise and imaging artifacts, such as beam hardening, resulting in clearer and more accurate images. The ability to deliver ultra-high resolution images with minimal artifacts improves diagnostic accuracy, reducing the need for repeat scans and ensuring that even subtle abnormalities are detected. 2. Operational Considerations • New Workflow for Molecular, High-Resolution, and Functional Imaging: The integration of molecular, ultra-high resolution, and functional imaging into routine clinical workflows introduces complexity that requires adaptation. Radiologists and technicians need specialized training to interpret and analyze multi-energy datasets that include molecular and functional information. PCCT produces a vast amount of detailed data, requiring clinicians to adopt new imaging protocols and refine their diagnostic approaches to fully leverage its capabilities. • Post-Processing and Data Management: PCCT generates richer, more complex datasets, which necessitates advanced post-processing tools and data management systems. Existing PACS and imaging software may not be equipped to handle such large volumes of data or to process functional and molecular information effectively. This means healthcare institutions must invest in robust IT infrastructure, including upgraded software and storage solutions, as well as provide additional training for staff on new imaging analysis techniques. • Revised Clinical Protocols: The molecular, functional, and ultra-high resolution imaging capabilities of PCCT will likely prompt changes in clinical protocols. For instance, the need for contrast agents may be reduced, simplifying patient preparation and decreasing the risk of adverse reactions. Additionally, the ability to monitor physiological functions in real-time through functional imaging could lead to more dynamic diagnostic procedures, such as assessing the effectiveness of interventions or treatments in real-time. 3. Financial Impact • Higher Initial Investment: PCCT systems are more expensive than traditional CT scanners due to their advanced technology, which includes photon-counting detectors and the computational power required for high-resolution, molecular, and functional imaging. While this upfront cost is significant, it is crucial to view it in the broader context of the downstream benefits and cost reductions that PCCT offers. • Downstream Cost Reductions: Although the initial capital investment is higher, PCCT’s ability to combine molecular, functional, and ultra-high resolution imaging leads to substantial reductions in downstream healthcare costs. Its superior diagnostic accuracy minimizes the need for follow-up tests, repeat scans, or invasive diagnostic procedures, such as diagnostic coronary angiographies. For example, in cardiology, PCCT can precisely differentiate between types of coronary plaque, reducing the need for invasive procedures to assess risk. • Lower Overall Healthcare Expenditures: By enabling earlier, more accurate diagnoses, PCCT can reduce the overall cost of patient care. Early detection of disease, particularly through its molecular and functional imaging capabilities, allows for more targeted treatments, potentially preventing the need for more aggressive and expensive interventions down the line. For instance, early-stage tumor detection via molecular imaging could lead to less invasive treatments, reducing hospital stays and improving patient outcomes, ultimately driving down healthcare costs. • Increased ROI Through Enhanced Patient Outcomes: Over time, the combination of molecular, functional, and ultra-high resolution imaging enhances diagnostic precision, which translates into better patient outcomes. Improved diagnostic accuracy reduces the incidence of unnecessary procedures, minimizes treatment delays, and results in more personalized and effective care. This leads to increased patient satisfaction, better healthcare outcomes, and greater patient throughput—all factors that improve the institution’s return on investment (ROI). • Competitive Advantage and New Revenue Streams: By adopting PCCT, healthcare institutions position themselves at the forefront of advanced imaging technologies. The ability to offer molecular, functional, and ultra-high resolution imaging creates a competitive advantage, attracting more complex and high-value cases. This can boost the institution’s reputation for excellence in diagnostics, leading to increased referrals, new patient populations, and expanded revenue opportunities. Summary Photon Counting CT (PCCT) is not just an evolution of existing CT technology—it is a molecular, ultra-high resolution, and functional imaging modality that fundamentally transforms the diagnostic landscape. Its ability to capture detailed molecular data, visualize minute anatomical structures with ultra-high resolution, and provide real-time functional imaging opens new possibilities for earlier and more precise diagnoses. While the financial investment in PCCT is larger, the reduction in downstream healthcare costs through improved diagnostic accuracy, fewer unnecessary interventions, and earlier disease detection far outweighs the initial expense. For institutions committed to advancing patient care and improving long-term financial outcomes, PCCT is an essential investment in the future of medical imaging. The video attached shows a patient accessing the Hospital for ACS. PCCT can provide ALL the imaging information of the concurrent imaging modalities (CXR, CAG, Echo, CMR) that you see around it... that's a lot! #PhotonCountingCT #MolecularImaging #UltraHighResolution #FunctionalImaging #FutureOfImaging #AdvancedMedicalImaging #EarlyDiseaseDetection #InnovativeCT #CuttingEdgeHealthcare #PrecisionDiagnostics #HealthcareInnovation #MedicalTechnology #CostEffectiveImaging #NextGenCT #PatientCareRevolution

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"a lot of the members of svt said to vernon that you seem kind of similar to mark, and a lot of members in nct told me that you have a lot of similarities with vernon and they told us together on that day and it kind of made it more awkward" IJBOLLL 😭😭

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And this is why leftists have got to stop purity testing James Talarico and his language on policy. He is the kind of Progressive that can win Texas!

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Jordan Mailata responds to LunchableLord Gunn's report that Jalen Hurts' play has been "frustrating in a lot of ways to the coaching staff and to the players" "It's kind of unfair to say he's the main problem... it's kind of crazy. Kind of crazy that somebody in the organization would [say] that."

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JOE ROGAN: “Hey folks, do you think it’s a coincidence that the biggest f*cking ICE protests were all going on in the same place where they found all that fraud?” “Do you think...” “Did it ever occur to you?” “Did it ever occur to you that these organized MASSIVE protests were all occurring in the same place where that Nick Shirley cat found f*cking BILLIONS of dollars in fraud?!” “SHOCKER!” “Kind of crazy!!”

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This individual suggests that Nigerians 🇳🇬, even when facing similar challenges, tend to engage in a competition regarding the extent of their suffering. He further posits that the majority of Nigerians perceive success primarily through the lens of comparison. That is a very interesting perspective 🤔
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This individual suggests that Nigerians 🇳🇬, even when facing similar challenges, tend to engage in a competition regarding the extent of their suffering. He further posits that the majority of Nigerians perceive success primarily through the lens of comparison. That is a very interesting perspective 🤔

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Baby Formula is poison‼️ Breast is best 💯 What do heavy metals and glyphosate have in common? BOTH can be found in baby formula 👇 “It is really a disaster and really awful that the FDA has allowed it to go on this long, to have this kind of contamination when this is the only thing that our babies drink for the first six months of life.”

𝕊𝕔𝕒𝕣𝕪 𝔼𝕝𝕖𝕔𝕥𝕚𝕠𝕟 𝔻𝕖𝕟𝕚𝕖𝕣 🇺🇸

35,220 görüntüleme • 8 ay önce

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"We are already deeper in than I think he thought we would be, to the extent he thought about it at all. And the pain...it's not the kind of thing you can just get in and out of—and it is the kind of thing that voters notice." Sarah Longwell weighs in on Trump's war with Iran.

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One of the biggest hoaxes in American History was the report from the feds on 9/11 that stated that they “found the passports of the hijackers” that just somehow miraculously flew out of the plane and survived the crash. This report led America into a 20-year war with thousands of dead American soldiers. Bravo to Cenk for having the spine to call this out.

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Nine beaches have been closed in Australia after small, mysterious balls of debris washed up on their shores. Last October, similar balls also closed a number of beaches and testing found that they were lumps of fat from human-made waste.

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Have disagreements between radiologists on the degree of cervical canal stenosis become a pain in the neck? This month’s AJNR SCANtastic has the latest about Cspine MRI! In the Cspine, we need to think about canal stenosis & the cord. No matter the degree of stenosis, if the cord isn’t happy, the patient won’t be either Here’s how to grade canal stenosis & cord flattening: CANAL STENOSIS Cord swims in CSF, like a fish in water. Like a fish, it needs room to swim. How much room is in the fish bowl determines stenosis 🔸Mild stenosis = fish bowl decorations take up 1 side of the bowl. Not great, but fish can still swim. Either ventral or dorsal CSF is effaced, but the other side of the fish bowl is still empty 🔸Moderate = decorations take up both sides—swimming is very affected. Both ventral and dorsal CSF have been effaced. 🔸Severe = all out w/decorations & there’s no more room for the fish. No room for the cord & it is compressed. CORD FLATTENING It’s like a fight. Cord deformity w/o signal is like someone pushing you to start a fight---you can still walk away. Cord deformity w/signal is a punch to the face—it’s on! 🔸Grade 1: no flattening (just words exchanged, no punches) 🔸Grade 2: flattening but no cord signal (you have been pushed but not bruised, can walk away) 🔸Grade 3: flattening w/cord signal (you have been punched & have a bruise, so you must fight) In this month’s AJNR, Koo et al. found that using a deep learning algorithm produced images in half the time—and the images were non-inferior for evaluation of degenerative chages & canal stenosis Now you know the grading of canal stenosis & cord flattening, for both normal & fast AI imaging! Hopefully, you’ll take to these rating systems like a fish to water!!
1:20

Have disagreements between radiologists on the degree of cervical canal stenosis become a pain in the neck? This month’s AJNR SCANtastic has the latest about Cspine MRI! In the Cspine, we need to think about canal stenosis & the cord. No matter the degree of stenosis, if the cord isn’t happy, the patient won’t be either Here’s how to grade canal stenosis & cord flattening: CANAL STENOSIS Cord swims in CSF, like a fish in water. Like a fish, it needs room to swim. How much room is in the fish bowl determines stenosis 🔸Mild stenosis = fish bowl decorations take up 1 side of the bowl. Not great, but fish can still swim. Either ventral or dorsal CSF is effaced, but the other side of the fish bowl is still empty 🔸Moderate = decorations take up both sides—swimming is very affected. Both ventral and dorsal CSF have been effaced. 🔸Severe = all out w/decorations & there’s no more room for the fish. No room for the cord & it is compressed. CORD FLATTENING It’s like a fight. Cord deformity w/o signal is like someone pushing you to start a fight---you can still walk away. Cord deformity w/signal is a punch to the face—it’s on! 🔸Grade 1: no flattening (just words exchanged, no punches) 🔸Grade 2: flattening but no cord signal (you have been pushed but not bruised, can walk away) 🔸Grade 3: flattening w/cord signal (you have been punched & have a bruise, so you must fight) In this month’s AJNR, Koo et al. found that using a deep learning algorithm produced images in half the time—and the images were non-inferior for evaluation of degenerative chages & canal stenosis Now you know the grading of canal stenosis & cord flattening, for both normal & fast AI imaging! Hopefully, you’ll take to these rating systems like a fish to water!!

Lea Alhilali, MD

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