A basic requirement in neurosurgery is the ability to place instruments accurately on a target deep within the brain, usually with the use of a fixed stereotactic frame. The PathFinder system, developed by Armstrong Healthcare (High Wycombe, England), in collaboration with the Queen's Medical Center at the University of Nottingham (Nottingham, England), is a method of registering images to patients using a technique which avoids the need for a fixed frame. PathFinder is an image-guided robot designed to optimize the benefits of a mechanical arm.

It is a frameless stereotaxy solution that is an alternative to using a camera system to triangulate the position of a device fitted to a surgical instrument, although both systems use kinematic equations to calculate the position of the instrument tip. The camera system offers a major benefit of not posing any obstruction to the operating site or to free movement of the surgeon and his instruments. However, it is necessary to maintain a clear line of sight between the camera and the tracking device, not always possible in deep brain procedures.

The PathFinder robotic arm can be driven under motor power to a predetermined position, rather than relying on human positioning. In addition, it can be then locked into place, providing a tool guide for subsequent surgery stages. In the pre-operative planning stage, the surgeon can specify a target and trajectory on a medical image — usually computed tomography or magnetic resonance scans. This information is converted into robotic movements so that an instrument guided by the robot can be positioned in precisely the desired location.

Suitable instrumented tool holders, which can detect subtle changes in forces and torques corresponding to tissue boundaries, and which will respond accordingly, are being developed with physicians at the Queen's Medical Center with the aim of measuring and matching instrument manipulating techniques of neurosurgeons.

A camera is permanently fitted to the wrist of the robot, and this is used to register the medical image to the actual patient. The same camera is used to register the length and offset of the surgical instrument to be used. This enables the surgeon to instruct the robot at the beginning of the operation to move the tool, correctly oriented to a point immediately above the chosen cranium entry point.

Current clinical investigation has enabled the practical performance of the system to be optimized, the company said. A range of tooling including delicate sensors to replicate the manipulative abilities of skilled surgeons are under development, but the PathFinder is already CE-marked for sale in Europe. FDA approval is pending.

Better anastomosis in difficult corners

Maroo (Barrow upon Soat, England) has developed a new surgical anastomosis device that extends the benefits of minimally invasive surgery (MIS) to hard-to-reach sites such as under the sternum or deep within the pelvis. John McGuire of Maroo said there long has been a need for an anastomosis device for significant intraluminal travel, but with shaft flexibility to accommodate the anatomy.

Although rigid circular staplers are effective in conventional alimentary tract anastomosis, they are of limited use in MIS because they operate within the lumen and force the highly curved alimentary tract to conform to their rigid form. Maroo is confident that its solution, which is patent pending, successfully overcomes this shortcoming. McGuire said the company is seeking a partner to develop the device further.

Agfa PACS replaces film

The 900-bed Hopital Europ en George Pompidou (HEGP) has become one of the first major European health care locations to provide completely filmless imaging and to have all imaging studies available on a computer network. Agfa Gevaert's (Mechelen, Belgium) Impax medical image and image management solutions, developed in cooperation with Mitra (Waterloo, Ontario), will provide a PACS network to store approximately 400,000 imaging studies produced each year in general radiology, cardiac imaging and nuclear medicine at the hospital. Agfa has signed a letter of intent to acquire for an undisclosed price all shares in Mitra, a private company that provides health care imaging and information management systems. Mitra has played an integral role in development of Agfa's Impax PACS solution over the past 10 years and the acquisition will solidify Agfa's health care information strategy.

"By having all the images on computer, we can better protect the security of the information and have an enormous gain in time for the medical staff, making them more available to patients," said Professor Guy Frija, head of radiology at HEGP and general secretary of the French Radiology Society. The PACS network interfaces with nearly 60 different types of imaging equipment, ranging from general X-ray units to complex functional imaging systems.

Although the image management solutions now in place at HEGP meet the current needs of the facility, they are designed to adapt to future needs as well. The hospital plans to integrate its imaging studies and radiology reports with lab tests and reports, according to Professor Patrice Degoulet, head of the information department. In the future, he plans that patients themselves will be able to use image management systems to access their own medical records over the Internet.

In addition to the Mitra acquisition, Agfa also has invested about $3.5 million in acquiring 25% of the share capital of MediVision Medical Imaging (Yokneam, Israel). Under the terms of the agreement, the companies will jointly develop and market an integrated digital PACS solution for opthalmology using Agfa's Impax viewing station. Medivision owns 73% of Ophthalmic Imaging Systems (Sacramento, California), which will also be involved in marketing the new ophthalmology PACS system in the U.S.

Last October, Agfa Gevaert changed the name of its medical imaging business to "Healthcare" in order to reflect its moves into new markets and wider business scope as part of an ongoing and aggressive growth strategy. The division now is known as Agfa Gevaert Healthcare.

Bone densitometry with less exposure

Diagnostic Medical Systems (DMS; Montpellier, France) now has on general release in Europe its Lexxos multisite bone densitometer which provides the possibility of a fast examination with reduced patient dose. The system uses bi-dimensional X-rays with a digital 2-D detector.

The advanced Digital Flash Beam (DFB) technology used has been developed in collaboration with the LETI laboratories of the Commisariat d'Energy Atomique (Saclay, France). The use of DFB reduces the multisite (e.g. spine, hip, forearm) exposure time to 1.5 seconds (less than three minutes for whole body exposure), which is 20 to 30 times faster than fan beam or pseudo fan beam technology.

Images generated are claimed to be of a quality comparable to routine radiological images and are capable of providing additional morphological information to facilitate diagnosis.

Schering plans investment program

Schering (Berlin, Germany) is planning to put into practice a major investment program beginning early this year, particularly targeting American biotechnology companies.

The project will be financed by the expected $1.3 billion payment by Bayer (Leverkusen, Germany) for Schering's part ownership of Aventis CropScience, according to Hubertus Erlen, Schering chairman.

In the first three quarters of the current fiscal year, Schering profits were up 23% to $288 million, with sales up 7% to $3.11 billion. Klaus Pohle, finance director, said that taking into account the continuing success of Schering's Campath and Yasmin new introductions, which are showing good results in the U.S., he expects full-year profits of at least $350 million, a record profit level for the company.

Fresenius continues growth

Gerd Krick, chairman of Fresenius (Bad Homburg, Germany), projected that profits for the full year would be about 8% more than the previous year, with sales revenues up 20% in the first three quarters to $4.65 billion. Excluding Fresenius Medical Care (FMC; Rockleigh, New Jersey), profits on other activities would have been rather higher in the double-digit area, Krick said.

Fresenius Medical Care increased the number of dialysis procedures in its clinics worldwide in the first nine months by 18% to 11.2 million, with an average income per procedure of $235 worldwide, but $282 in North America. FMC has opened 50 new dialysis clinics this fiscal year, as well as acquiring another 80 units.

Biological attack detection system

Proteus (Nimes, France) has started up a collaborative project with Thales Industrial Services (Nice, France) to develop a system intended to use genetic technologies to detect and monitor biological terrorism. The agreement is the result of a public tender issued by the Direction General des Arm es, an arm of France's Department of Defense.

"The new project will benefit from the unique competencies of Proteus in microbiology and molecular biology, as well as the rapid analysis of nucleic acids," said Daniel Dupret, president and CEO. "Combined with the proven expertise of Thales Industrial Services, it should enable us to develop novel tools for the rapid detection of biological warfare agents." Dupret added, "The specifics, including the budget, are confidential, but the fact that we were selected is a testimony to our expertise in this area."

Real-time 4-D ultrasound

Kretztechnik (Zipf, Austria) has launched in Europe its Voluson 730 ultrasound imaging system, which the company claims is the first real-time 4-D ultrasound scanner. A subsidiary of GE Medical Systems (Waukesha, Wisconsin), Kretztechnik uses 4-D transducers to automatically scan multiple adjacent slices while providing a real-time display of the region of interest. Called Volume Contrast Imaging (VCI), the resultant image arises from a special rendering made consisting of texture and transparency information. VCI is claimed to improve contrast resolution helping visualization of diffuse lesions in organs.