Impax ee r20

Manufactured by AGFA HealthCare

Sourced in Belgium

The IMPAX EE R20 is a digital radiography system developed by AGFA HealthCare. It is designed for use in healthcare settings to capture and manage digital X-ray images. The system includes a digital detector and imaging software to enable the acquisition, processing, and storage of digital radiographic images.

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Lab products found in correlation

Somatom definition, by Siemens (1 mentions) Magnetom skyra, by Siemens (1 mentions)

9 protocols using impax ee r20

Evaluation of MOCART 2.0 Knee Score

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Image analysis was performed on a picture archiving and communication system
(PACS) workstation (IMPAX EE R20, Agfa Healthcare N.V., Mortsel, Belgium) by
four independent readers: one expert reader with more than 25 years of
experience in musculoskeletal imaging and extensive familiarity with the
original MOCART scoring (reader 1); one expert reader with more than 30 years of
experience in musculoskeletal imaging, but no familiarity with the original
MOCART scoring (reader 2); and two radiology residents with 1 year of experience
in musculoskeletal MR imaging (readers 3 and 4) and no familiarity with the
original MOCART score. Imaging studies were assessed under supervision of the
study coordinator in random order, and all readers were blinded to all patient
details. The expert reader 1 and both inexperienced readers 3 and 4 performed
the evaluation twice, separated by a four-week interval to avoid recall bias.
The MOCART 2.0 knee score was assessed according to the newly introduced scoring
system, which now contains seven variables that add up to a total score between
0 and 100 points (Table 2). The first reading was based on the MOCART 2.0 knee score evaluation
sheet only. For the second reading, readers 3 and 4 had access to the newly
introduced atlas to support decision making.

Schreiner M.M., Raudner M., Marlovits S., Bohndorf K., Weber M., Zalaudek M., Röhrich S., Szomolanyi P., Filardo G., Windhager R, & Trattnig S. (2019). The MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 Knee Score and Atlas. Cartilage, 13(1 Suppl), 571S-587S.

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Measuring Maximum Diameter of Stones

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Size measurements were independently performed by 2 licensed radiologists using a clinical DICOM-Viewer (Impax EE R20; Agfa Healthcare). The maximum diameter was measured on clinically established 2 mm and 5 mm axial image reformatations and on multiplanar reformatations (MPR) of thin slices (0.67 mm) using a soft-tissue window setting (width = 360 HU, level = 60 HU) and a bone window setting (width = 1720 HU, level = 530 HU), respectively. For measurements using MPR, the readers were asked to choose the image plane alongside the largest diameter of the stones taking the irregular 3-dimensional structure into account.

Reimer R.P., Klein K., Rinneburger M., Zopfs D., Lennartz S., Salem J., Heidenreich A., Maintz D., Haneder S, & Große Hokamp N. (2021). Manual kidney stone size measurements in computed tomography are most accurate using multiplanar image reformatations and bone window settings. Scientific Reports, 11, 16437.

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Knee Joint MRI Signal and Noise Ratios

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Measurements of signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were performed by a radiologist with 5 years of experience (R3). The picture archiving and communication system (PACS) installed at our institution (Impax EE R20, Agfa Healthcare) was used for manual positioning of regions of interest (ROI) in the following anatomical structures of the knee joint: meniscus (the anterior horn of the lateral meniscus), muscle (gastrocnemius muscle), bone (distal femur), and synovial fluid. Pathologies in the respective areas were excluded prior to measurement. Average ROI areas were 91.90 ± 1.64 mm² for bone, 91.60 ± 1.39 mm² for muscle, 5.11 ± 0.23 mm² for meniscus, and 5.10 ± 0.31 mm² for synovial fluid.
Similar to Lee et al.,^{10 (link)} SNRs for bone, muscle, meniscus, and synovial fluid were derived from the ROIs by dividing the average signal intensity (SI) value by the standard deviation (SD) of the tissue.
Additionally, CNRs for meniscus-synovial fluid, bone-synovial fluid, and bone-meniscus were calculated with the following equation, as described in previous studies^{4,10,19 (link)} : |

(S I a - S I b) / \sqrt{({S D a}^{2} + {S D b}^{2})}

Iuga A.I., Rauen P.S., Siedek F., Große-Hokamp N., Sonnabend K., Maintz D., Lennartz S, & Bratke G. (2023). A deep learning-based reconstruction approach for accelerated magnetic resonance image of the knee with compressed sense: evaluation in healthy volunteers. The British Journal of Radiology, 96(1146), 20220074.

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Quantitative and Qualitative CMR Protocol Analysis

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Image analysis was performed by an experienced board-certified radiologist with 9 years of CMR experience (J.A.L., reader 1) and a radiologist with 3 year of CMR experience (N.M., reader 2), both blinded to the clinical information. For image analysis, a commercially available software (IMPAX EE R20, Agfa Healthcare, Mortsel, Belgium) was used. Image quality, blood-to-tissue contrast, the quality of fat suppression of the mDixon steady-state CMRA as well as quantitative measurements of thoracic vasculature were evaluated. For the qualitative and quantitative image analysis all dynamic phases of the first-pass CMRA and the water-only images of mDixon were used.

Mesropyan N., Isaak A., Dabir D., Hart C., Faron A., Endler C., Kravchenko D., Katemann C., Pieper C.C., Kuetting D., Attenberger U.I, & Luetkens J.A. (2021). Free-breathing high resolution modified Dixon steady-state angiography with compressed sensing for the assessment of the thoracic vasculature in pediatric patients with congenital heart disease. Journal of Cardiovascular Magnetic Resonance, 23, 117.

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Vertebral Fracture Evaluation and Treatment

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All measurements were taken on CT scans to eliminate inaccurate measurements due to projection errors. CT scans were performed using 64-slice dual source scanner (Siemens Somatom Definition, Siemens, Forchheim, Germany). Multiplanar reconstructions were calculated and pictures were transferred into the clinical PACS server. Measurements were performed using IMPAX EE R20, AGFA Healthcare, Mortsel, Belgium. Vertebral heights were measured at the anterior and posterior walls as well as in the centre of the vertebral bodies in the midsagittal plane of the vertebral body according to the six-point method. Measurements were performed by an experienced surgeon and coauthor Ludwig Oberkircher according to clinical practice. Vertebral heights were measured before and after fracture as well as after treatment and cyclic loading. The bisegmental Cobb angle (angle between upper endplate T12 and lower endplate L2) was measured according to clinical studies.
The spinal canal compromise in the midsagittal plane was measured as a percentage of the minimum diameter before fracture (= 100%), after fracture, after surgical procedure, and after cyclic loading.

Krüger A., Schmuck M., Noriega D.C., Ruchholtz S., Baroud G, & Oberkircher L. (2015). Percutaneous Dorsal Instrumentation of Vertebral Burst Fractures: Value of Additional Percutaneous Intravertebral Reposition—Cadaver Study. BioMed Research International, 2015, 434873.

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Bone Age Assessment using X-ray and MRI

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A conventional X-ray image of the left hand was used to determine the bone age of patients during diagnosis/follow-up. An MRI examination was also performed on the same day (▶ Fig. 1,2).
The X-ray images of the left hand were acquired on one plane in anterior-posterior projection (a. p.) on a digital X-ray device (Samsung Electronics GC 70, Samsung Healthcare, Seoul, South Korea) (tube voltage 50 kV, tube current 1 mAs). MRI examinations were performed on a 3-Tesla scanner (Magnetom Skyra, Siemens Healthcare, Erlangen, Germany). The examination was performed in a prone position with the arm extended. The left hand was positioned in a 16-channel hand coil (hand/wrist 16, Siemens Healthcare, Erlangen, Germany). One T1-weighted turbospin echo sequence (TSE) and one T1-weighted volumetric interpolated breathhold examination sequence (VIBE) were acquired. The sequence parameters are shown in ▶ Table 1.
A coronal T1 VIBE sequence was acquired in all 50 children and adolescents and a coronal T1 TSE sequence was additionally acquired in 34 participants The image material was archived in a picture-archiving and communication system (PACS) (IMPAX EE R20, Agfa Healthcare, Mortsel, Belgium) for evaluation.

Diete V., Wabitsch M., Denzer C., Jäger H., Hauth E., Beer M, & Vogele D. (2021). Applicability of Magnetic Resonance Imaging for Bone Age Estimation in the Context of Medical Issues. RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin, 193(6).

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Quantitative CT Analysis of Aortic Intramural Hematoma

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Imaging analysis was performed on a radiology workstation using a 3D imaging tool (IMPAX EE R20, Agfa HealthCare N.V., Mortsel, Belgium) by a radiologist with 4 years of experience in CT angiographies. The affected aortic segments, as defined by the Society for Vascular Surgery/Society of Thoracic Surgeons,^{17 (link)} were determined in all 260 CTs (Figure 1) and the maximum thickness of the IMH was measured (Figure 2). Time course of hematoma thickness was evaluated for all patients. The number of ULPs was documented and, if present, location and size (width/depth) of the biggest ULP was measured (Figure 2). If pericardial or pleural effusion (right/left/both) was present, maximum thickness and density were documented.Figure 1.

Aortic segments affected by IMHs.

Figure 2.

Measurement of maximum thickness of IMH in the aortic arch (coronal CT angiography image; left) and of ulcer-like projection in the descending aorta (axial CT angiography image; right).

Nebelung H., Hoffmann R.T., Plodeck V., Kapalla M., Bohmann B., Busch A., Weiss N., Reeps C, & Wolk S. (2023). Outcome After Conservative and Endovascular Treatment of Stanford Type B Aortic Intramural Hematomas – A Single-Center Retrospective Study. Vascular and Endovascular Surgery, 58(5), 477-485.

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Evaluating Sagittal Spinal Alignment

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Four raters evaluated each alignment parameter: one spine surgeon with more than 30 years of experience (rater A), one senior physician with more than ten years of experience (rater B), one resident (rater C) and one postgraduate student who was instructed in the measurement (rater D). The measurements were done manually on digitized X-rays within IMPAX EE R20 (Agfa HealthCare©) and every rater was blinded to the results of the other ones. For the determination of the inter-rater reliability the ICC was computed for all possible rater pairs (“A/B”, “A/C”, “A/D”, “B/C”, “B/D”, “C/D”) and for all four raters together (“ALL”), resulting in seven ICC values for each spinal parameter (see Fig. 2).
Fig. 2

Overview of the different ICC calculations that were done for each sagittal alignment parameter

As second step, we divided our measurement results associated to the treatment of all patients into pre- and postoperative values, respectively. The differences induced by the operation were compared for every parameter in each rater separately.

Hohenhaus M., Volz F., Merz Y., Watzlawick R., Scholz C., Hubbe U, & Klingler J.H. (2022). The challenge of measuring spinopelvic parameters: inter-rater reliability before and after minimally invasive lumbar spondylodesis. BMC Musculoskeletal Disorders, 23, 104.

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Liver Volume Assessment Before and After PVE or TARE

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Volumetry of the FLR before and after PVE or the contralateral liver lobe before and after TARE was performed using the contour segmentation tool with semi-automated edge detection of IMPAX (IMPAX EE R 20, Agfa HealthCare) by two independent raters. Both were trained prior to the evaluation by a radiologist with more than 15 years of experience in liver imaging (Figs. 2, 3).Fig. 2

CT scans before (left) and about two months after PVE (right) with volumetry of the FLR (blue)

Fig. 3

CT scans before (left) and about two months after TARE (right) with volumetry of the contralateral liver lobe (blue)

Nebelung H., Wolf T., Bund S., Radosa C.G., Plodeck V., Grosche-Schlee S., Riediger C., Hoffmann R.T, & Kühn J.P. (2021). Radioembolization versus portal vein embolization for contralateral liver lobe hypertrophy: effect of cirrhosis. Abdominal Radiology (New York), 46(8), 4046-4055.

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