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Diagnostic imaging

Calgarians surge to forefront of cardiac MR

CALGARY – Cardiac MR software developed by researchers at Calgary’s Foothills Hospital is making waves – and sales – around the world. The software brings to cardio imaging a quantitative rather than interpretive method of diagnosis.

The system was developed at the hospital’s Stephenson Cardiovascular Magnetic Resonance Centre, part of the Libin Cardiovascular Institute of Alberta. It’s said to be Canada’s leading cardiac magnetic resonance facility and it’s rated among the top five in the world.

The centre’s director, Dr. Matthias Friedrich (pictured sitting), originally started devising the software while in Berlin, and continued development in Calgary.

“Further development and commercialization was done by Circle Cardiovascular Imaging Inc., resulting in CMR42, a system that offers physicians answers to their imaging questions by providing immediate quantitative data of heart functions from a magnetic resonance cardio image,” said chief executive Greg Ogrodnick (pictured with Dr. Friedrich).

The name CMR42 is a reference to science-fiction author Douglas Adams’ Hitchhiker’s Guide to the Galaxy, in which the answer to life – as calculated by a supercomputer – is 42.

In effect, the system provides answers to cardio MR questions.

What the software does, put simply, is collect data from the different views of the heart scanned during an MRI, from volume of blood flowing through the chambers to the muscle thickness, or tissue characterization.

The program analyzes discrepancies and structural abnormalities in the muscle immediately, and has the potential to improve survival rates of cardiac patients by providing information immediately from the scan, rather than having to run additional tests.

“It is changing the way medical professionals collect data to make their diagnosis,” said Dr. Friedrich.

“It’s all about workflow optimization,” Friedrich said. “We’re talking about very precious time being saved by using this software.”

“The data collected by the software eliminates the need for multiple studies – within half an hour, physicians get the same information as collected by ultrasound and nuclear imaging,” Friedrich said. As well, the image can be shared electronically, so a doctor in Toronto can confer with another in Calgary within minutes.

Myocarditis is a condition that strikes young athletes, occurs often and can have a good prognosis if caught early. The key is “early.” The symptoms often are difficult to diagnose because they can be vague, such as fatigue and chest pain.

“With this technology using a combined set of criteria, we can diagnose myocarditis through images,” Friedrich said. “Using standard criteria, myocarditis can be a silent killer.”

While not offering a cure, the software can provide early detection and early treatment, preventing the disease from progressing, he said.

Dr. Friedrich was recruited in 2004 to establish and run the Libin Institute’s Stephenson CMR Centre, the first dedicated cardiac magnetic resonance centre in Canada – and North America’s largest. More than 2,000 patients a year come through the doors of the centre, or about 20 per day, making it one of the largest such centres in North America.

He had been looking at alternative computer technologies since the mid-1990s, along with grad student Philipp Varcow in Berlin, figuring there had to be a way to both process and evaluate a magnetic resonance image.

“If you move from purely physical analysis to quantitative, the diagnosis is made quicker, more accurate and robust,” he said.

Ogrodnick joined Circle Cardiovascular in 2007 after several years of involvement with another cardiac-related business, The key ingredient to a successful health-related product is to meld business and science, he said, as scientists are good at developing a product but not at implementing the marketing to commercialize it.

In developing the software, more than 25,000 patient studies in North America and Europe have been completed in 45 sites in a dozen countries. The company raised $1.4 million through 14 private investors in 2007 when it incorporated, and was piloted in North America and Europe before going commercial this year. “The biggest hurdle was securing regulatory approvals in the United States, Canada and Europe,” Ogrodnick said.

The software is ISO certified, has U.S. Food and Drug Administration approval, as well as having a Health Canada device licence. “I would have to say it is very user-friendly,” said researcher Dr. Ingo Itel from the centre. “Other software doesn’t have such developed tools.” The program is compatible with any model of scanner, and can be used with Macs or PCs.

CMR42 is relatively inexpensive: for a three-year lease, the client pays $40,000 up front and a $25,000 maintenance fee for the next two years.

The key component of the program is having an MRI, which Friedrich admits is more expensive than CAT scans and other tests used to diagnose patients. However, in the long run, using cardio magnetic resonance and the software is more cost-efficient by cutting the number of other tests used to diagnose a patient, as well as reducing the staff hours, he argued.

Dr. Freiderich gave the example of a patient who comes into an emergency room complaining of chest pains. Over several days the patient could be subjected to blood tests, ECGs and ultrasound testing, at minimum, before a conclusive course of therapy is decided on.

In contrast, if the patient has a cardiac MRI, the physician can read the data collected by the scanner and decide a treatment almost immediately, reducing both patient time in hospital and staff hours.

“Yes, it is more expensive than an ultrasound, but it is more accurate and efficient, time-wise,” he noted.

Circle Cardiovascular takes a virtual approach to staffing – the company’s corporate office has 14 staff in Calgary, but its vice-president of sales is in Montreal, a hub for health-care-related software, an application specialist works from Houston, and four developers work on the product from Berlin.

The company’s latest contract was Helios Hospital Group of Germany, a 56-hospital corporation that expects to boost its capacity for cardio magnetic resonance to 18 facilities from eight within the next year. And all will be using the Circle Cardiovascular Imaging technology.

“For us to have secured the contract was a big coup,” Ogrodnick said. “The competition was pretty stiff.”

Posted October 22, 2009