MEDICAL PHYSICS RESEARCH INSTITUTE

The Medical Physics Research Institute (Instytut Badań Fizykomedycznych - IBF) was founded in may 1993. The Chairman is dr phys. Jerzy Janicki.

The main aim of the MPRI activities is the design and application of new technologies in medical diagnostics and therapy.

In the first stage of our activity, in cooperation with outstanding spacialists from the University of Medical Sciences in Poznań, basic procedures to introduce cryodestructive methods were developed. An optimization of spatial spectra of constant non-uniform magnetic fields and the assessment of their influence on living organisms was also achieved.

Many solutions developed in the MPRI in this field have made it possible to design apparatus with previously unencountered medical applications, which were subject to clinical trials by scientists from various centres, as the Dept. of Physiology, Dept. of Biophysics and Dept. of Rheumatology of the Poznań University School of Medicine, and the Dorbin European Institute and the Scientific Team of the Ukrainian Health Ministry from Odessa.

The results of these studies were published and presented at numerous conferences by scientists from the University School of Medicine in Poznań ( Prof. dr hab. Feliks Jaroszyk , Prof. dr hab. Janusz Paluszak, dr n. med. Włodzimierz Samborski) in Medical News and twice in Sports Medicine (Medycyna Sportowa).

The results of other trials by the MPRI were published in internationally recognized periodicals ( Physica A23, 365 1996 , Physical Review A54, 3369 1996, Quantum Semiclass. Opt. 8, 775-803 1996, Physical Review A 55, 3874 1997 ) to be found on the Philadelphia list.

MPRI Scientific Board members are: dr phys. Jerzy Janicki, dr phys. Janusz Grabowski and dr med. Dariusz Kwolek

Many years of work in the field of electrocardiological signal analysis and research on myocardial physiology have made it possible to the MPRI to create a model describing the heart’s electrical activity and the origin and distribution of its depolarisation. In cooperation with outstanding specialists in this field (Prof. dr hab. med. Andrzej Dąbrowski, Prof. dr hab. med. Józef Jagielski) the SATRO software was subject to reference studies. Very good corelation with SPECT (single photon emission computed tomography) was achieved in the assessment of early-stage ischemia. Further studies on SATRO are being coordinated by Prof. dr hab. med. Ryszard Piotrowicz, as part of cooperation with the Institute of Cardiology in Warsaw, led by Prof. dr hab. med. Zbigniew Religa.

The clinical studies on SATRO were supported by European Union funds, in the framework of the Countrywide Development Programme MSP.

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COMPUTER AIDED HEART EXAMINATION USING THE SATRO SYSTEM

TheSATRO diagnostic system contains a PC, circuitry for electrocardiographic signal measurement and specialized software.

SATRO is the trademark of a noninvasive diagnostic procedure, using the standard 12-lead ECG signal, and enhancing its resolution by digital processing, as well as performing interpolation by a unique procedure developed in our Institute.

Contrary to the standard EKG the main subject of analysis is the QRS complex, which carries the most information about potential perfusion abnormalities, being at the same time very difficult to examine with standard methods, due to its high amplitude and very short duration. The outcome presentation follows the traditional morphological approach (anterior, posterior, lateral wall etc.), reproducing the electrical activities of the heart’s regions on one simple graph, and in comparison to normal values.

SATRO employs advanced mathematical algorithms to analyze the QRS complex, obtained from resting ECG. The result is a multiphase QRS complex, and its components are ordered according to the corresponding fragments of the myocardium, time coherent with the depolarisation wave distribution.

Thus, it is possible to determine the electrical activity of the single fragments of the myocardium, and compare it to normal values, obtained from healthy subjects.

The fast and complex myocardial depolarisation process, from which we obtain the multiphase QRS, gives better possibilities to assess the subtle conductive system abnormalities than the repolarisation, which is most probably a continuous occurrence and is provided by the heart muscle cells.

Currently, further clinical trials are running, in order to widen the field of applications to this method.

The SATRO software we have developedgreatly enhances the possibilities to assess the electrical activity of the myocardium and will be the basic equipment for diagnostic centres our company is setting up in Poland. Our Institute has had years of achievements in implementing new, unconventional medical diagnostic and therapeutic solutions. The heart is another challenge for the IBF scientific team, led by Chairman Dr Jerzy Janicki. Within three years a complete and coherent theory emerged, which allows for explaining the basic phenomena occurring during the electrical activity of the heart.

This theory is about to be published in the world’s leading physical and medical periodicals, its framework had been presented at the 6th International Cardiology Forum in Zakopane and is being intensely discussed, gaining a rising number of supporters. It is commonly known that existing theories, such as the dipole theory, for instance, have provided an approximate and incomplete description of those phenomena. In contrast to its predecessors, this theory explains the heart’s function starting from the molecular level, and ending at the full heart function cycle. It connects all earlier approaches to the problem: it explains the heart’s function from the biological viewpoint – as contractions of heart muscle cells, electrically – as ion flows and consequently electric currents, as well as magnetically. In this theory, those formerly independent approaches have been combined to a coherent whole, and earlier attempts of the rules governing the heart’s function have been incorporated in it as generalizations and approximations.

Not only scientists of IBF Primax Medicaare involved in developing this project. The trials proving its applicability have been conducted in cooperation with renowned and valued scientific institutions. The main phase, requiring hundreds of patients to be examined, was performed at the Institute of Cardiology in Warsaw, led by Prof. Zbigniew Religa. The coordinators thereof were Prof. Ryszard Piotrowicz and Doc. Rafał Baranowski. The independent research centre was the Central Clinical Hospital in Warsaw.

Since the very beginning, as early as in its creation phase, this theory had gained favourable opinions of such luminaries of cardiology as prof. Andrzej Dąbrowski. Currently, IBF is starting to cooperate with the Institute of Mathematics and Information Science of the Adam Mickiewicz University in Poznań, which will further enhance possibilities of developing the theory as well as its practical consequences and gains.

Current methods in the heart function diagnostics can be divided into two groups:

The first group consists of cheap procedures which are easy to perform, but the outcome may be unreliable, often in conflict with the patient’s real status. The second group are methods that are far more effective and sensitive, but usually complicated, often invasive and incomparably more expensive.

ECG is probably the most popular representative of the first group. Its application simplicity and cost effectiveness coincides with less effectiveness. You cannot trust a clean ECG. On the other hand, if you see signs of ischemia they might already be a result of an infarction. The ECG stress test is a more complicated modality, which may alas prove just as fallible and risky for some patients.

The second group is represented by computerized scintigraphy and coronarography. These are effective and exact (though sometimes the outcome depends on subjective human factors). Coronarography is complex, invasive and very expensive – it can be performed only in specialized medical facilities.

SATRO combines the advantages of both groups – with high sensitivity, comparable to that of scintigraphy, it allows for quick, simple and cheap testing, wherever the patient requires.

What is so special about this method?

As mentioned above, the theory created at IBF Primax Medica combines the diverging approaches to the problem of the heart’s function. Especially, it precisely relates the EKG signal shape to the processes running in the heart, with emphasis on ischemia and post-infarction lesions. It describes the currents generated by the single heart regions and their pendants on surface of the examined patient’s chest. Only the analysis of the ECG’s QRS complex delivers invaluable information about each of the five regions of the left heart chamber. With precision comparable with that of scintigraphy, ischemic or post-infarction fragments may be pointed out.

Another advantage is the fact that nothing is obtained by way of subjective interpretation or activity of the examiner. Everything is done automatically, according to the mentioned theory, and the final results are generated by the software itself. The effectivity of such an examination may lead to the decrease of “silent” infarctions, which some estimate at 45%. The patient with a normal result in SATRO may be certain of the good condition of his/her heart.

CORONARY HEART DISEASE

Coronary heart disease (CHD) may be defined as an insufficiency of the coronary arteries – a disproportion occurs between the heart muscle demand for oxygen and the amount that the coronary arteries can deliver.

This disease is one of the main causes of premature death, despite all progress in cardiology, since its complications include myocardial infarction, circulatory insufficiency and severe arrhythmia. 700 of 1000 persons with multiple risk factors will have symptomatic coronary heart disease after 8 years.

17% of the population are at moderate risk, 40% at high risk, which is statistically proven – about 50% of premature deaths (with regional fluctuations) are the consequence of coronary heart disease.

According to the American Heart Association and the World Health Organization (WHO), the worldwide direct and indirect economic impact of this amounts to hundreds of billions of US dollars (see http://www.americanheart.org).

With industrialization, the number of CHD-related deaths is disturbingly rising. As stated by the Journal of the American College of Cardiology, 25 of 40% of elderly male infarction patients are asymptomatic, and their death risk is higher than that of the symptomatic ones (no treatment).

After years of studies, cardiologists from Washington are wondering if the predisposition to subclinical myocardial infarction lies in the „traditional” risk factors, or do these patients have some unique conditions that make them different from those with symptomatic infarctions.

Another troublesome fact is that many (esp. young) patients have no signs predecessing the first infarction (the risk factors themselves are not felt by the patient), and so remain untreated.

The very high sensitivity of SATRO, combined with its accessibility and ease of use, makes it possible to ensure a new quality of CHD prevention – in registering subtle abnormalities, often long before they would become visible in a standard ECG. This is also confirmed by Prof. dr hab. Józef Jagielski, who has been Board member of the International Electrocardiology Association for many years.

Some known methods (e.g. SPECT) have that potentioal too, however they could not be appliable to everyone – as screening, for technical as well as economical reasons. The motivating function also shouldn’t be underestimated – asymptomatic patients are reluctant to change their lifestyle, unless there is visible improvement of „results” – here SATRO may be a method of monitoring the outcome of, say, a diet change.

In subjects with normal ECG, among asymptomatic patients (I) 35% have had significant abnormalities in the electrical activity of some heart region(s), whereas such abnormalities were found in 95% (II) of patients with symptoms. All persons with an abnormal ECG have also had significant abnormalities in SATRO.

Most of the patients of group (I) and (II) were able to avoid any further deterioration of their condition by early preventive and curative measures, the symptoms that were present subsided. Some however did not take the warning too seriously and would not change their lifestyle or take medicines, which in some cases had led to complications, including heart attacks with lethal outcome. Patients with particularly high risk were referred directly to the supervision of cardiology specialists and were able to avoid an infarction by early coronarography/PTCA (Percutaneous Transluminal Coronary Angioplasty).

Applications of SATRO are:

• screening and early prevention of coronary heart disease by early detection of abnormalities in the electrical activity of the single myocardial regions
• objective, and not just statistical risk stratification
• therapy monitoring
• early (before the first infarction occurs, if possible) qualification for reference procedures (SPECT/EBT) and invasve diagnostics (coronarography), to perform coronary angioplasty (PTCA), which allows to avoid an imminent infarction.