The full-body digital X-ray system, the Lodox Xmplar-dr, was launched last month, in Johannesburg, by South African X-ray manufacturer Lodox Systems. It can scan an entire body in only 13 seconds and an imaging study, in two planes, can be completed in three minutes.

The Xmplar-dr has two main fields of application – emergency trauma imaging and forensic pathology imaging.

“The Lodox full-body X-ray imaging system is the only system in the world that can take a full-body X-ray image. Lodox uses a patented, specialised method of linear slot scanning radiography to produce large-format images, with a single sweep of the X-ray source and detector, simultaneously. “These large-format images eliminate the need for stitching or retakes,” says Lodox Systems sales and marketing manager Christian Di Zio.

The speed and size of imag- ing are also accompanied by radiation safety. “The Lodox imaging technique concentrates on increasing the signal-to-noise ratio as much as possible,” he says, adding that this increase in signal results in best-quality images at a lower dose.

“This makes it much safer for patients and reduces staff exposure to scattered radiation. Lodox differs from other X-ray technologies, as it combines full-body, high-speed, low-radiation X-ray imaging,” he notes.

Di Zio adds that for trauma imaging, the machine is installed directly in the resuscitation area of an emergency room (ER).

“Critical patients are brought directly from the ambulance to the machine for full-body X-ray imaging, giving doctors access to the patient’s complete information quickly and safely,” he says.

In a trauma scenario, the ability to obtain virtually instant X-ray information for the entire body in multiple planes is invaluable, notes Di Zio. “The low scattered radiation means that the machine can be installed in the ER, which enables doctors to retain contact with their critical and potentially unstable patients, without having to send them to radiography to obtain X-ray imaging information.”

These benefits, he says, really come into play when evaluating potentially unresponsive trauma patients who have multiple injuries. “Lodox provides an image overview of the patient, which informs the clinical picture at the beginning of trauma treatment,” Di Zio explains, adding that this allows not only for improved clinical decision-making earlier in a patient’s treatment but also for more focused follow-up imaging.

He notes that this is beneficial for the patient and the hospital and that Lodox’s large-format images can precisely locate bullets and bullet shrapnel in gunshot victims.

“In cases of mass casualties, such as large traffic accidents, the high rate at which the machine can process patients allows for more accurate triaging that is impossible to achieve using conventional X-ray technology. “The ability to accurately assess which patients are most critical and adapt treatment pathways accordingly translates directly into saved lives,” says Di Zio.

“The reliability of the machine is also a feature that is especially valued in the trauma environment where there is no scope for problematic or poorly functioning equipment,” he explains. He states that, in forensic pathology imaging, the same features translate into benefits and the Xmplar-dr’s ease of use enables autopsy staff to obtain X-ray images without the assistance of radiographers.

“In contrast to the often- deployed C-arm X-ray systems, with limited fields of view, Lodox provides a full-body image in multiple planes. This enables a medical examiner to locate pathologies that cause of death could be attributed to, throughout the body.

Di Zio states that, in the field of forensic pathology, the machine can be installed in the autopsy room of a mortuary, noting that getting imaging information about the entire body is helpful in determining cause of death.

“This, together with a clearly laid-out user-friendly interface and simple machine interfaces, simplifies operation,” he notes.

He adds that it can also provide clues for identifying unidentified bodies, for instance, by revealing orthopedic implants of which the serial numbers can be traced.

Further, Di Zio notes that, the scanning overview provides a greater level of safety for pathologists, enabling them to obtain a complete image of the subject before starting an autopsy.

This is relevant in South Africa, particularly where the ability to screen for tuberculosis before opening the chest can allow for the necessary precautions to be taken to avoid potential infection of mortuary staff, he explains.

“The high speed of imaging reduces delays in the autopsy process and it is particularly useful in mass disasters, where multiple bodies must be identified and processed.

Di Zio says t

he machine is simple to use, since it has user-friendly preset technique factors, which automatically optimise the dose, depending on patient size.

The original research and devel- opment for the machine was done at De Beers Technologies at its Crown Mines campus, south of Johannesburg.

“Lodox Systems shares a close collaboration with the University of Cape Town through the Lodox programme, which involves sponsoring the students to work on various ideas pertaining to the Lodox technology,” Di Zio explains, adding that various outputs from this programme have been successful in solving key technical aspects and to help explain and lend credibility to the Lodox concept.

He highlights that this technology has been exported to 40 installations in eight countries and that the company is in discussions to open new markets for export.

State of the Industry

The industry is challenging and exciting, Di Zio states, explaining that although the medical imaging market faces challenges, such as imported low-cost and low-quality products, there is a definite move by the medical industry towards acquiring digital imaging and showing greater awareness of the importance of imaging in the provision of adequate healthcare.

“Therefore, opportunities are greater now than they ever have been, as the positioning of medical imaging increases. “Most organisations are deciding on how best to prepare for the imminent arrival of the National Health Insurance (NHI) and how best to provide solutions that dovetail with the requirements of the NHI,” he says.

Di Zio points out that one of the great challenges is to overcome the influx in the market of cheap, low-quality alternatives that are supplied with little or no after-sales support.

“These products are often supplied in large quantities and erode the availability of funding for future projects,” he says.

Another challenge is the effects of the global recession, which are still present in parts of the world which traditionally would have been areas of potential growth.

“These economic difficulties translate into reduced purchasing of medical equipment, but also a greater propensity for fly-by-night, low-quality options to proliferate,” Di Zio elaborates.

Meanwhile, he states that, in medical imaging, radiation exposure is a major topic of conversation.

“There is increasing concern about the amount of potentially avoidable radiation to which patients are being exposed,” says Di Zio, explaining that this concern has been particularly focused at Computed Tomo-graphy imaging, which has become a go-to tool for many medical practitioners, but which subjects the patient to extremely high levels of radiation.

Another approach is the development of strict radiation logging and monitoring procedures to limit a patient’s radiation exposure,” he states.

“Di Zio also points out that in trauma imaging, the development of highly portable ultrasound scanners is leading to an increase in the use of Focused Assessment with Sonography for Trauma to assess trauma patients.

“This trend is also aimed at obtaining imaging information quickly within the ER environment and is particularly beneficial, since no radiation exposure is involved.

“In forensic pathology imaging, the concept of virtual autopsy is gaining popularity, which entails using imaging techniques to provide three-dimensional images of the subject without the need for dissection,” he concludes.