One of the most amazing and spectacular developments in modern radiology has been the rapid growth and expansion of so-called interventional radiology, which can also be described as minimally invasive therapy guided by radiological imaging. Many applications of this method are now widely in use in different organs, particularly in the vascular system. Everybody is well aware of the shortcomings and drawbacks of the radiological modalities currently used for guiding minimally invasive procedures. Ultrasound, although it has the advantage of being absolutely harmless to the patient and the operator, cannot be used for many procedures because it does not provide the precise anatomical information needed for a safe performance of these procedures. Rontgen rays provide superb anatomical insight to guide delicate manipulations inside the human body, but as operations tend to become longer and more complicated, the radia tion dose for patients, as well as for operators, is becoming an increasing source of concern. It is therefore logical that we should explore the possibilities for interventional radiological procedures provided by the latest imaging modality -magnetic resonan ce imaging -taking advantage of the specific physical properties of this method and the absence of ionizing radiation. It soon became evident that this new approach represents a tremendous challenge involving the development of new hardware and software, new catheters and other material that can be used in a magnetic environment, etc.
The imaging potential of the MR experiment continues to evolve. In recent years, an increasing number of fast and ultrafast imaging strategies has been described. In this evolu tion the definition of the terms fast and ultrafast has been blurred. Hence they are frequently used interchangeably. The evolution of these methods has been based on two related, yet separate developments: an increasingly thorough understand ing of the complexities inherent to pulse sequence design and the increasing availability of stronger and faster gradient sys tems. The combination of these two factors has laid the foun dation for vast reductions of MRI data acquisition times. Min utes have been replaced by seconds. Beyond shortening MR examination times and thereby increasing patient throughput, a most significant consequence has been the ability to acquire complex MR image sets within the time confines of a single breath-hold. The constraints placed by the presence of respi ratory motion have thus been effectively eliminated. Ultrafast breath-held data acquisition strategies already represent the backbone of many abdominal, thoracic and even pelvic imaging protocols. The enhanced image quality permits full exploitation of the unsurpassed soft tissue contrast inherent to the MR experiment. Beyond improving the quality of ex isting applications, the implementation of ultrafast imaging techniques has permitted the exploration of new imaging in dications, particularly in the area of perfusion and diffusion as well as ultrafast 3D imaging.
Non-invasive, high resolution contrast arteriography without arte rial catheterization or nephrotoxicity is now possible. It is accomplished by using paramagnetic contrast and an MR scanner. Paramagnetic contrast media is injected intravenously and image data are collected as the con trast circulates through the vascular territory of interest. Due to the strong enhancement effect of paramagnetic contrast media, a small dose injected as an intravenous bolus is sufficient to briefly enhance the entire arterial vascular tree. This allows imaging with a large field-of-view that encompasses an extensive region of vascular anatomy. By using a 3D gradient echo pulse sequence on magnets with high performance gra dient systems, high resolution 3D volumes of image data are acquired in a single breath-hold. This has vastly improved image quality of 3D con trast MRA exams, particularly in the chest and abdomen. Subsequent post-processing allows an angiographic display of image data in any desired obliquity. The success of this technique is reflected by its incorporation into clinical practice in centers throughout the world. It has been applied to multiple vascular territories, using various magnets, and slightly differ ing imaging strategies. As is the ca se for all MR imaging techniques, a thorough understanding of the underlying mechanisms and proper technique are essential to fully exploit the diagnostic potential of this new form of angiography. This book will familiarize the reader with the basic principles of 3D contrast MRA.
The "prescribable app" has become reality in Germany! Digital health applications (known by their German acronym, DiGA) now have access to 73 million beneficiaries of the statutory health care system in Germany. Pioneering public policy is creating compelling new opportunities for innovation driving digital transformation within the largest European health care market. A great opportunity for many stakeholders this is where this book comes in! Written by deep domain experts who helped shape the core DiGA policy framework and its implementation, the book is a streamlined guide to developing and disseminating digital health applications - from concept, to approval, to successful digital product. Designed for DiGA developers in both start-ups and established companies, the necessary steps from ideation to successful market launch are described. Edifying and clearly structured, the DiGA VADEMECUM also provides valuable insights for investors and financial partners from the venture capital and private equity sectors as well as for potential distribution partners from the pharmaceutical and medical technology communities. Finally, the DiGA VADEMECUM is also an invaluable resource for physicians and therapists who want to learn not only how to prescribe DiGA in a meaningful way, but also how to use digital feedback in the service of delivering better care to patients. DiGA VADEMECUM - A Must-Have for Digital Leaders in Health Care! from the expert team of the health innovation hub (hih) Germany step by step from development to approval to market launch best practice knowledge for developers, investors, manufacturers and users