FerriScan is the world's first regulated, non-invasive liver iron concentration test for people suffering from iron overload conditions. The test offers these people a safe, fast and most importantly accurate determination of their liver iron levels. FerriScan enables patients and clinicians to plan and monitor their treatment more effectively.

Iron overload is the accumulation of excess iron in body tissues. Hemochromatosis is a disease resulting in iron overload. Hemochromatosis can have genetic and non-genetic causes. As such, the disease is referred to as hereditary hemochromatosis (HHC). Most cases are a result of a genetic predisposition resulting in excessive absorption of iron from the food we eat on a daily basis. The surplus iron is retained in organs and tissues throughout the body, particularly the liver (which is the primary site for iron storage in the human body). Other conditions resulting in iron overload include Thalassemia and Sickle Cell Anemia (secondary iron overload).

FerriScan is a new technology for the non-invasive measurement of liver iron concentration (LIC). Advanced computer software, the result of extensive research and trials, is used to analyse data obtained through magnetic resonance imaging (MRI) of a patient's liver to determine an accurate measurement of liver iron concentration. FerriScan measures LIC in three easy steps: 1. An MRI scanner will produce a set of internal images of the abdominal cavity containg the liver. 2. The image data collected from the MRI scans is then sent electronically to the FerriScan Service Centre where it is analysed using the FerriScan technology. 3. Once the analysis is completed, the LIC result is sent to the MRI centre within 2 business days of receipt of data.

An MRI scanner is a specialised piece of medical imaging equipment that takes images of the internal structure of the human body. The MRI scanner will make cross-sectional images or 'slices' of the body and allow detailed pictures of the liver to be taken for the FerriScan Analysis.

Detection and Monitoring FerriScan is useful for both the detection and monitoring of iron overload, a measurement of LIC is considered necessary in most instances for the detection of iron overload and to assist with a clinical diagnosis. Following detection of iron overload, the duration of de-ironing therapy may be predicted on the basis of the liver iron concentration. Safety FerriScan utilises MRI, which is readily available and internationally recognised as a safe imaging modality. The non-invasive nature of the test means that FerriScan is painless, can be used on patients who cannot, or do not wish to, undergo liver biopsy. For these reasons, the introduction of FerriScan will improve patient assessment, particularly as current management algorithms call for repeated measures of body iron status in conditions such as HHC and thalassemia. Accuracy FerriScan is a clinically proven, highly sensitive method for measuring LIC. The technology focuses on a specific measure known as the proton transverse relaxtion rate (R2) which is particularly sensitive to the presence of iron. A calibration curve developed following extensive clinical trials is used to transform the R2 measurements to liver iron concentrations. Measurement of R2 via FerriScan ensures high degrees of sensitivity and specificity are attained over the entire range of liver iron concentrations encountered in clinical practice. The calibration curve in conjunction with the R2 technology used by FerriScan is the most accurate means of determing levels of iron loading in vivo currently available.

FerriScan has regulatory clearances in Australia, Euope and the USA and is now available as a commercial service.

Measurement of LIC using FerriScan is indicated for individuals who would benefit from the following: - A definitive diagnosis of iron overload. - An effective means to monitor the liver iron burden as part of treatment (e.g. phlebotomy or chelation)

The MRI scan will take approximately 20 minutes. Results are then analysed and returned to the MRI centre within 2 business days. The MRI centre will then return the results to the referring clinician.

Patients should not eat any food 3 to 4 hours before the FerriScan MRI scan. Other than that patients may drink normally and continue to take any medications prescribed by their clinician. Patients should also remember to bring their referral form with them to the MRI centre.

Yes, FerriScan is clinically proven as an accurate method for measuring liver iron concentration. FerriScan has been clinically validated against the current industry 'Gold Standard', liver biopsy. To view the scientific journal publications supporting the research please navigate to the publication section of the website.

FerriScan is available at a growing number of MRI centres worldwide. To view a list of current FerriScan enabled MRI centres please navigate to the FerriScan locations page.

Clinicians can refer a patient to any FerriScan enabled MRI centre. For a clinician to refer a patient, they will need to either (a) tick or write FerriScan; or (b) indicate a request for MRI liver iron concentration measurement on the radiology referral form.

As a world wide service, the cost of FerriScan varies between different locations. If you would like to know the cost in your area, please contact us at info@ferriscan.com. In some states in Australia, FerriScan is available at no cost to the patient at certain public hospitals. To find out more information about this and which centres are offering FerriScan at no charge, please contact us at info@ferriscan.com.

Resonance Health (RHT) is an Australian Healthcare company specialising in the development and commercialisation of magnetic resonance imaging (MRI) related technology for the quantitative measurement of iron levels in the human body. Our mission is to develop and market our technologies to assist in the diagnosis and management of patients suffering from iron related conditions, whilst delivering significant added value for our MRI customers who deliver our service through their networks. In 2005, RHT began the global commercial launch of FerriScan, its world leading non-invasive tool for measuring liver iron levels. FerriScan is the only non-invasive test for liver iron concentration to have achieved regulatory clearances in the US, Europe and Australia. FerriScan provides a significant improvement over current blood markers and invasive surgical procedures. This improvement leads to increased clinical efficiency and accuracy in diagnosis, in addition to allowing optimisation of treatment programs for iron-related disorders. FerriScan is now positioned to become a routine part of the clinical diagnosis and managment of iron loading disorders as well as playing a major role in the testing and monitoring of drugs used to treat these conditions.

More information on FerriScan or Resonance Health is available by downloading brochures from our website or by emailing any further questions to info@ferriscan.com.

FerriScan is a post-image processing service that returns a liver iron concentration measurement. As inputs it requires 5 single spin echo series of axial images with TR = 2500ms and TEs of 6ms, 9ms, 12ms, 15ms and 18ms respectively. The report returned contains a liver iron concentration expressed in two different units (mg of iron / g of liver tissue dry weight and mmol of iron / kg of liver tissue dry weight).

Common times for acquiring a single series is 3 ½ to 4 minutes, resulting in a total scan time of 17 ½ to 20 minutes ignoring scout/localiser scans and setup time.

FerriScan results are lodged and returned using the FerriScan Analysis Service Tracking (FAST) system (follow the "FAST login" link at www.ferriscan.com). Recent jobs will be listed upon login, and selecting the job will bring up the job details screen. A link to the result is listed under the "Images" subheading. Adobe Acrobat Reader or a similar product is required to view the result which is downloaded as a "PDF" file (Adobe's Acrobat Reader is free to download and use from http://www.adobe.com). Less recent jobs may be accessed by using the "Job List" function to search between the appropriate dates.

Currently the scanner MUST have a 1.5T magnet. The FerriScan technology has not yet been extended to scanners with other field strengths.

FerriScan should work with any phased-array receiver coil for torso imaging. Previous experience has shown torso/abdominal coils and 8 channel cardiac array coils are compatible with FerriScan. Currently the main housing coil does not provide sufficient signal to noise for use as the receiver for FerriScan data acquisition.

To obtain optimal sensitivity and specificity over a large range of liver iron concentrations the fundamental 1/T2 value needs to be measured rather than 1/T1 or 1/T2*. This necessitates a long TR to minimise T1 effects and prevents the use of a breath-hold scan. As a result, modest breathing artefacts are expected and are compensated for during the FerriScan Analysis.

The FerriScan Analysis process has multiple steps to determine the fundamental 1/T2 values of tissue. Critical to the analysis are: the use of an external reference (saline infusion bag); the sampling of structured and unstructured noise from spaces all around the patient; and the measurement of the RF signal attenuation profile through the entire cross section of the patient.

A minimum of one third of the saline bag must be visible in most of the images displaying the liver, with the images displaying the largest cross-section of the liver being the most important. The saline bag needs to be as stationary as possible. Breathing artefact through the bag should be minimised by placing it off to the side of the patient where possible. We recommend that the bag is not placed on top of a patient's arm where possible. There is no difference if the bag is placed to the left or to the right of the patient.

The only acceptable movements are: postural relaxation as the patient relaxes during the scan and the movement caused by breathing. Unacceptable patient movements include: gross movements of the torso of more than a couple of millimetres left or right across the FOV (a few pixels at 256 x N); rotation causing a similar shift in liver tissue at any point; or any perceivable shift along the bore of the MRI scanner. Shifts in the saline bag of greater than approximately 1.25 cm (half an inch) are also unacceptable. Unacceptable patient movement, including movement causing significant shift of the saline bag, will require the patient to be rescanned. It is possible to identify unacceptable patient movement at the time of scanning. You may choose to view the images directly after the scan, while the patient is still in the scanner. If this is performed and unacceptable movement is detected, a rescan can be performed immediately, rather than having to call the patient back. Detection of unacceptable movement can be performed by sequentially comparing the 5 echo times for a given image cross-section in the same window (i.e. rather than a side by side comparison). Where the patient has moved unacceptably, the earlier echo time series should be re-acquired to obtain a complete set of echo time series (6, 9, 12, 15 and 18ms) without movement.

Long scan times commonly result from additional Fourier sampling. We recommend the use of partial averaging (Half Fourier or fractional NEX) to reduce scan times as well as the use of rectangular field of view (typically 75% RFOV is useful). Please note that FerriScan cannot currently tolerate cutting off or aliasing of skin surfaces; or the use of rectangular pixels (i.e. the percentage scan must remain at 100%). Some scanners will adjust the Fourier percentage sampling such that the half-fourier option actually results in a 70-80% Fourier, resulting in an increase in scan time. There is currently no solution for a shorter scan time in such cases. An oversized FOV to allow a smaller RFOV is acceptable; the decreased resolution will not adversely impact the measurement.

Scanners commonly in use with FerriScan include: Siemens Avanto, Siemens Symphony, Siemens Sonata and Philips Intera. GE scanners must be currently operating ScanTools 14 or later in order to be FerriScan compliant. Currently Picker and Shimadzu-Marconi scanners are not supported for use with FerriScan.

Previous experience has shown that some scanners require a larger bandwidth to achieve 6ms echo times. An increased bandwidth of approximately 400 Hz/Pixel has been a common solution. GE scanners running old software (prior to ScanTools 14) will probably not be able to achieve a 6ms echo time without the use of fractional echoes (currently not suitable for use with FerriScan).

The FerriScan protocol requires a single spin echo. Many of the sequences adapted for use with FerriScan were modified from a fast spin echo (FSE) sequence, and this may be reflected in sequence names.

For those parameters that are not explicitly stated for FerriScan it is advised that where there is an option to fix a value across all the series, that this is performed.

No, although these changes result in difficulties for low signal to noise ratio (SNR) situations, a correctly setup scanner can still perform Ferriscan and return valid measurements. It is recommended that for scanners that that cannot fix receiver gain, that 3 saline bags are included for data acquisition of the FerriScan Phantom Pack.

All date fields must be in the format of DD MMM YYYY (e.g. 01 Jan 2001).

The "Patient ID" field and the "Reference" field are for the patient code maintained by your organisation. As a secondary confirmation of the patient's identity we check these fields against the "Patient ID" tag in the DICOM header. If there is a mismatch we will contact you to confirm the correct details and to inform you of the fields we are trying to match. The Patient ID will appear on the upper left portion of the FerriScan Liver Iron Measurement Report.

A typical dataset is 2.5 - 3 Mb uncompressed (a single image is typically around 130 Kb in size). As a zip file (set of zip files) you may expect sizes of 1 - 1.5 Mb.

Transfer times of a few minutes are common. Upon completion of the transfer a message should appear on the screen informing you of the successful data transfer. Additionally, the job should be displayed within the "Queued Jobs" section of FAST and you can verify that the transfer has completed successfully by viewing the job details and ensuring that the attachments are displayed under the "Images" subheading. If there is a problem with the transfer, a message should appear on your screen informing you of the unsuccessful transfer and the Job Request will be moved to a "Pending Jobs" queue, indicating that another upload attempt is required. To re-perform the upload the existing Job Request is to be opened and the upload process repeated. Should the data fail to arrive more than one business day after you have lodged your Job Request you will be contacted by the FerriScan Support Team to rectify any problems in transferring the data.

If the data doesn't display when browsing for data for the web upload, the data may need to be compressed into a ".zip" type file. Files not of the "zip" type cannot be uploaded. Most zip compression tools will create zip files (winzip, jzip etc). If the problem persists please contact the FerriScan Support Team (support@ferriscan.com) for assistance.

Ferriscan can accept data that is de-identified, provided that the anonymised fields match between the DICOM header and the online Job Request system. The name field and DOB fields should be de-identified rather than omitted from images (age in years is required to calculate the hepatic iron index). Scanner specific information must be retained to confirm the scanners validity with Ferriscan (i.e. device serial number and organisation name must be retained).

For couriers our street address is: Resonance Health Analysis Services 1st Floor, 216 Stirling Hwy CLAREMONT WA 6010 AUSTRALIA Our postal address is: Resonance Health Analysis Services PO Box 1135 NEDLANDS WA 6909 AUSTRALIA