10 Technical Advantages Every Customer Should Know About Hologic Discovery

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10 Technical Advantages Every Customer Should
Know About Hologic Discovery
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1 One Pass Fanbeam Vs. Rectilinear
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One Pass Fanbeam Vs. Rectilinear
1st Generation Rectilinear Pencil Beam
2nd Generation Rectilinear Multiple Detector
3rd Generation One Pass Fan Beam CT-like design
16 detectors
54 - 216 detectors
Single detector
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One Pass Fanbeam Vs. Rectilinear
ONE-PASS FANBEAM

• Faster (10-seconds)
• More data per second
• No overlap of beam
• No under-sampling
• Optimal for imaging

HOLOGIC
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One Pass Fanbeam Vs. Rectilinear
Rectilinear

• Slower
• Beam overlap
• Over/under sampling
• Lower-resolution
• Subject to mechanical misalignment

Competition
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2 Radiographic Vs. Non-radiographic
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Radiographic Vs. Non-radiographic
?? lp/mm
1.8 lp/mm
IVA-HD
Competition
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GEDVA
HologicIVA-HD
3.18 minutes
10 seconds
Upper thorax, clearly sharper endplates
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Key IVA-HD Benefits

• Differential diagnosis of fracture Vs
  degeneration
• Fast, single breath-hold image
• Higher sensitivity in upper thorax
• Perform Lateral and AP images
• Lower dose

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3 24 Arm Clearance Vs 16
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24 Clearance Vs 16
Discovery
Prodigy/iDXA
225 lb. Male subject
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24 Clearance Vs 16
Discovery
Prodigy/iDXA
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Key Benefits of 24 Clearance

• Assess ALL patients
• Average shoulder width
• Male 19.4
• Female 17.0
• Improved Image quality
• Reduces claustrophobia
• Simplifies positioning

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4 Continuous CalibrationVs. Once Daily
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Continuous Calibration Vs. Once Daily

• Internal Reference Standard
• Pixel by pixel calibration, bone and tissue
  equivalents
• Ensures long-term precision (even after
  repairs/maintenance)
• Eliminates manual QA steps
• Enables patient data continuity multiple across
  systems

Continuous Calibration
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Continuous Calibration Vs. Once Daily

• Manual scanning of calibration standard
• Doesnt account for environmental factors between
  calibrations
• Temperature
• Wall power
• Humidity
• Intermittent component drift

Once-daily Calibration
Competitor
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5 Full-size X-ray sourceVs. Dental
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Full Size X-Ray Source vs. Dental
DISCOVERY Full Size Source 300 lbs, Oil-cooled,
140 kVp
Prodigy X-ray Source 40 lbs, Fan-cooled, 76 kVp
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GE Prodigy Dental design X-ray Tube
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Full Size X-Ray Source vs. Dental

• Continuous-capacity X-ray tube
• Oil cooled to eliminate heat damage
• No need for cool-down period
• Unmatched record of reliability
• Single and Dual Energy
• High Penetration 140 kVp

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Comparison of Short- and Long-Term Precision of
Lunar Prodigy and Hologic Delphi Scanners
BMIL
Thomas N. Hangartner, BioMedical Imaging
Laboratory, Wright State University and Miami
Valley Hospital, Dayton, OH 45409
Introduction Whereas short-term precision is
often quoted as the most important performance
parameter of a dual-energy absorptiometry (DXA)
instrument, long-term precision is particularly
relevant in the assessment of follow-up scans
done years later. The goal of this study was to
assess the long-term stability of DXA scanners
and define, if necessary, corrections for
longitudinally measured bone mineral density
(BMD). Materials and Methods As part of the daily
quality assurance, a phantom containing four
blocks of hydroxyapatite-based material (Fig. 1)
covering a density range from 0.45 to 3.0 g/cm2
(Hologic units) was measured over a three-year
period. The plane areas of the blocks were
evaluated by sub-region analysis on two Prodigy
(GE Lunar, Madison, WI) and two Delphi (Hologic,
Bedford, MA) scanners. This type of analysis
excludes the effects of the edge finding
algorithm and reflects the possible changes in
the source-detector system of the scanner. The
Tukey-Kramers means test was used to evaluate
possible differences in BMD between marked
periods.

Results Figures 2 5 show the BMD values of the
central plane areas of the four blocks over the
duration of the investigation. The arrows show
service incidents that caused possible changes in
the data. Analysis of the changes revealed that
they were mostly proportional to the BMD value.
Thus, the relative changes were averaged over the
four blocks for each scanner (Figures 6 9). The
short-term precision was similar for all
scanners 0.6 0.8 for the three larger blocks
and 1.1 1.3 for the smallest
block. Discussion Three of the four scanners had
been subjected to a move and associated
recalibration during the observation period. The
changes seen in BMD between the beginning and end
were about 10 times larger for the better of the
two Prodigy scanners (A) and about 30 times
larger for the other Prodigy scanner (B) than the
worse of the Delphi scanners (D). It appears
that the manufacturer-defined calibration
tolerances are wider for the Prodigy scanners
than for the Delphi scanners. In addition, it is
necessary to implement corrections for patients
undergoing repeat measurements on the Prodigy
scanner B.
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Comparison of Short- and Long-Term Precision of
Lunar Prodigy and Hologic Delphi Scanners
BMIL
Thomas N. Hangartner, BioMedical Imaging
Laboratory, Wright State University and Miami
Valley Hospital, Dayton, OH 45409
Introduction Whereas short-term precision is
often quoted as the most important performance
parameter of a dual-energy absorptiometry (DXA)
instrument, long-term precision is particularly
relevant in the assessment of follow-up scans
done years later. The goal of this study was to
assess the long-term stability of DXA scanners
and define, if necessary, corrections for
longitudinally measured bone mineral density
(BMD). Materials and Methods As part of the daily
quality assurance, a phantom containing four
blocks of hydroxyapatite-based material (Fig. 1)
covering a density range from 0.45 to 3.0 g/cm2
(Hologic units) was measured over a three-year
period. The plane areas of the blocks were
evaluated by sub-region analysis on two Prodigy
(GE Lunar, Madison, WI) and two Delphi (Hologic,
Bedford, MA) scanners. This type of analysis
excludes the effects of the edge finding
algorithm and reflects the possible changes in
the source-detector system of the scanner. The
Tukey-Kramers means test was used to evaluate
possible differences in BMD between marked
periods.
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Comparison of Short- and Long-Term Precision of
Lunar Prodigy and Hologic Delphi Scanners
BMIL
Thomas N. Hangartner, BioMedical Imaging
Laboratory, Wright State University and Miami
Valley Hospital, Dayton, OH 45409

PRODIGY 1 1.5 Drift !
DELPHI 1 0.01 Drift !
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• 6
• Supine Lateral
• Hologic Exclusive
• 
  

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Two Approaches to Lateral Imaging/BMD
Supine
Decubitus

• Highest comfort
• Most Reproducible
• Easiest to position

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Supine Lateral Benefits

• Maximum Patient Comfort
• Optimum Imaging
• Highest Sensitivity for monitoring
• Easier positioning for technologist
• And now TOMO-3D

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Optimized Imaging

• AP and Lateral view without repositioning
• Straight Spine critical for end-plate
  visualization
• Two views are the radiographic standard of care
• Directly correlate AP and lateral results
• Lateral IVA does not show all fractures
  (Scoliosis)

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Why Measure Lateral Spine BMD

• AP Spine Influenced by Artifacts
• Osteophytes
• Degenerative changes in facet joints / end plates
• Schmorls / Jonghanns nodes

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Supine Lateral BMDHighest Response to Therapy

• Lateral projection isolates highly trabecular
  bone in vertebral bodies
• Trabecular Bone is 8X more metabolically active!
• gt2x higher response to therapy than the AP view
• 2x more precise than decubitus lateral

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Supine Lateral Highest Response to Therapy
Faster Response to Therapy
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• 7
• Innovation
• Not
• Plagiarism
• 
  

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Hologic A History of Innovation

• 1986 - Company Founded
• 1987 - Introduced Worlds First DXA System
• 1988 - Introduced Worlds First Total Body Scanner
• 1991- Introduced Worlds First Fan Beam Scanner
• 1995 - Introduced Worlds First Clinical Fan Beam
  Scanner
• 1999 - Introduced Worlds First Imaging
  Densitometer
• 2002 Combined Imaging with Rapid BMD
  Acquisition
• 2006 Fist AAC Approval
• 2007 First 3D Densitometer

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Abdominal Aortic Calcification and Discovery IVA
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AAC Detected by IVA
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AAC Why is it Important?
Demonstrated to predict MI and Stroke in two
independent prospective studies
Framingham Heart 2,500 subjects, followed for
22 years Rotterdam Study 6,500 subjects,
followed for 7 years
100,000 patient years of follow-up
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AAC multivariate risk for Coronary Heart Disease
(CHD)
Framingham Heart Study, 22 year follow-up
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AAC and Coronary Artery Calcification Scores
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AAC and Coronary Artery Calcification Scores
Men
Women
The 10-fold increase in calcium score in men and
the 20-fold increase in calcium score in women
implies that aortic calcification can be seen as
a continuous measure of generalized
atherosclerosis.
The Rotterdam Study
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Visualizing AAC Radiographic DXA Comparison
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Visualizing AACImage Quality Comparison
Superior Resolution and Contrast
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Visualizing AAC Image Quality Comparison
Resolution and Contrast More is better
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Visualizing AAC High Sensitivity and Specificity
IVA-HD Yields High Sensitivity
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The Future of Osteoporosis and Fracture Risk
Assessment
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The Future of Fracture Assessment Assessing Hip
Geometry
Beyond Bone Density. To Better Predict
Fracture
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Whats New in Bone ?Strength Density
Structure
Johns Hopkins University
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Phase 1Hip Axis Length

• Automatic analysis for optimized precision
• Correlated with Pencil Beam HAL
• Configurable on reports

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Phase IIBecks Hip Structure Analysis

• Over 30 Published Studies
• Most Recognized 2D Method of Structural Analysis
• Integrated into Hologic Software

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2D Error 10 - 40
As two-dimensional projection techniques such as
bone densitometry do not measure depth,
assumptions are made regarding bone shape
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QCT had a dosage 200 times larger than DXA, but
not so large as to threaten the health of
examinees.
On the other hand, DXA has the disadvantage in
that it only provides two dimensional evaluation
of bone density.
The 3D Model predicted bone strength more
accurately than bone densitometry and diagnostic
imaging.
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Phase IIItDXA

• vBMD (Volumetric BMD) gm/cm3 the gold standard
• New Strength Measurements
• Cross section moment of inertia
• Section Modulus
• FNAL (femur neck axis length)
• NSA (neck shaft angle)
• DICOM Compatible Dataset

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Introducing tDXA FY06 Strategy

• 3D - potential breakthrough in fracture risk
  assessment
• Position Hologic as Innovation Leader to all
  accounts
• Target presentation to all major Academic Centers
  (Early adopters)
• Discovery SL/A only 3D solution - short of a full
  CT
• Collaboration list is forming

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Introducing tDXA The New Leading Edge

• Developed in collaboration with Johns
  Hopkins University
• Upgrade to Discovery SL/A
• Availability Mid 2007
• Same status as Tomosynthesis
• Not 510k Approved
• Research Only
• Why invest today in technology that is NOT 3D
  capable tomorrow?

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• 8
• Hologic
• Not
• General Electric
• 
  

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Sell Who We Are

• Dedicated Womens Health Company
• Market Leader in DXA
• Market Leader in Analog Mammography
• Market Leader in Digital Mammography
• Market Leader In Breast Biopsy
• Market Leader in CAD

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Hologic Who we are
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Hologic Who we are not
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Customer satisfaction Ratings
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Hologic Manufacturing Sites
Bedford, MABone Densitometry, CAD Systems,
Fluoroscan Mini C-arms
Danbury, CTMammography Biopsy Systems
Shanghai, China photoconductor materials
Indianapolis, IN Biopsy Systems
Newark, DE Warstein, DEUDetectors
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Hologic Exclusive Studies

• Merck F.I.T. Study (100 Fan Beam)
• Pfizer Pearl
• Aventis Activate
• Womens Health Initiative (NIH)
• Mr. O.S. (NIH)
• Health, Aging, and Body Composition Study (NIH)
• NHANES BMD Reference Data (NIH)
• SWAN--Study of Women's Health Across the Nation
  (NIIH)
• Bone Mineral Density Database for Children (NIH)

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• 9
• Superior Connectivity
• 
  

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IRIS Integrated Radiology Information System

• Modality Worklist
• DICOM 3 Image Storage
• Remote Softcopy Interpretation
• Electronic Report Generation
• HL7 Output

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Advanced Reporting Solutions

• DICOM based image transfer maintains full image
  fidelity
• Remote interpretation with Physicians Viewer
• Electronic reporting with Physicians Report
  Writer

Report Writer with Speech Recognition
Compatibility
Remote Softcopy Interpretation
Scanner
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IRIS Enterprise
Acquire
Analyze
Report
Archive to PACs
Archive Raw Data locally
Now includes Raw data !
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IRIS Enterprise
Acquire
Analyze
Report
Archive to PACs
Archive Raw Data locally
Now includes Raw data !
Eliminates Local Archiving !
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Physicians Viewer with CADfx

• DICOM Viewer
• Remote soft-copy interpretation
• Report generation
• Integrated IVA/BMD interpretation
• Full image fidelity
• Zoom, brightness and contrast control

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CADx

• Computer aided fracture assessment
• Simplified IVA interpretation
• Quantitative confirmation of vertebral
  deformities
• Displays degree of vertebral compression
• Improves confidence in interpretation

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Remote Interpretation and e-Reporting Tools

• MS-WORD format
• IVA and BMD images
• BMD and T-score results
• Reference data plots
• WHO Classification
• IVA interpretation summary

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• 10
• Energy Switching
• Vs.
• K-edge Filtration
• 
  

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Energy Switching Technique

• Energy Switching uses higher energies 140/100
• Higher Energy means better penetration
• Better Penetration give the ability to measure
  larger patients
• Separate Energy readings means no pile-up or
  crossover

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K-Edge Limitations

• K-edge filtration uses lower energy x-ray beams
  (70/36)
• Requires simultaneous interpretation of high and
  low energy photons
• Inherent data overload (pulse pile-up)
• Number of x-rays exceeds detector processing
  capability
• Skips and interpolates data to speed up scan
  acquisition... a sub-optimal design solution