Q & A on Superb Microvascular Imaging Technology for Interventional Oncology

In August, Toshiba's Superb Microvascular Imaging (SMI) ultrasound technology received clearance for use on the Aplio 500 system from the US Food and Drug Administration. SMI is an ultrasound Doppler technique that uses an algorithm allowing visualization of minute vessels with slow velocity without necessitating a contrast agent. Toshiba predicts that SMI could be used to assess the therapeutic effect of chemotherapy. Interventional Oncology 360 asked Adrian Lim, BMedSci, BMBS, MD, FRCR, adjunct professor, reader in radiology, and consultant radiologist at the Royal College Tutor and Head of Ultrasound, Imperial College London & Healthcare NHS Trust, Charing Cross Hospital in London, to answer questions about the tecnhology as it applies to interventional oncology. 

Q: What makes this system different from other visualization systems?

A: This is a very sensitive Doppler technique that allows visualization of small vessels that were previously not detectable with conventional power or color Doppler. The resolution of the microvasculature is significantly better than the current Doppler techniques but have some artifacts as it is very motion sensitive.

Q: What is the main challenge that this system helps healthcare providers to overcome?

A: To better visualise the vascularity of tissue and organs, some of which was not possible without the use of contrast agents or conventional Doppler techniques.

Q: What is your personal experience with SMI?

A: I have trialled this new technology since its inception and helped develop the user interface and also its potential clinical applications.

Q: What data is available on the efficacy of SMI?

A: A white paper from Toshiba only. We have some data that is to be disclosed at the coming RSNA meeting.

Q: How will this help with visualization of tumors for interventional oncology purposes? 

A: It will help with depiction of the vascularity of a tumour. It may therefore help determine whether it is benign or malignant and could have a role such as in RFA procedures which utilise CEUS.

Q: And how will this benefit IO patients?

A: Not sure this can be answered yet.

Q: How will it help with peripheral vascular procedures? 

It may obviate the need for the use of contrast agents and help provide a more confident diagnosis.

Q: What’s the most important takeaway point for an interventional oncology provider to know about SMI?

A: It is easy to use and is a significantly improved Doppler technique with better sensitivity and resolution compared with the conventional power and color Doppler.

Q: Anything else you’d like to include?

A: The visualisation of tumour vascularity may be helpful in assessing response to treatment rather than just basing response on changes in size.