BB&T

VIENNA, Austria — Florence Gazeau is everything you would expect in a French researcher studying structural mobility for the National Center of Scientific Research (CNRS) at the Laboratoire Matière et Systèmes Complexe with the Université Paris-Diderot.

An unassuming and serious person, nothing about her suggests revolution.

In fact just reading the topic of her abstract, delivered at the European Congress of Radiology here in March, "Labeling and manipulating the cell with ultra-small super paramagnetic particles of iron oxide," might lull you to sleep.

Yet fellow researchers leaned forward in their seats during a parade of slides displaying images from a microscope showing cells loaded with magnetically sensitive particles that were first arranged in rows inside of cells using magnetic force, and then pulled from healthy tissue to a tumor in a mouse.

At this point, Gazeau suggested the first hint of a revolution shaping up in molecular biology that would shake fundamental ideas of medical devices and surgery.

"These cells can be considered as living robots, not only to image but to be manipulated and deliver therapies such as heat and the reconstruction of tissue," she said.

Think differently.

Today we understand the medical discipline to see-and-treat has shifted from the traumatically invasive cutting of open surgery to minimally invasive closed surgeries using sheaths and tubes, lighting and cameras and miniaturized knives or graspers.

What if at some point in your lifetime even today's most advanced micro tools used for procedures described as "willful violence upon the body," were to be replaced by a simple syringe, a magnet smaller than one on your refrigerator door and a humming magnetic resonance imaging (MRI) machine?

One day earlier, during the opening keynote presentation, Hedvig Hricak, chair of the department of radiology at Memorial Sloan-Kettering Cancer Center (New York) and chair of the board for the Radiological Society of North America (Oak Brook, Illinois) called for "targeted imaging for targeted therapies."

Hricak noted that disease-specific imaging linked to direct intervention are converging at the molecular level in the field of oncology.

Using images from a study of progressive prostate cancer that is still enrolling patients at Memorial Sloan-Kettering, she showed a standard computed tomography (CT) scan of a patient's pelvis indicating a few lesions.

For the same patient using a radioactive coated sugar, 18F-fluoro-2-desoxy-glucose, and positron emission tomography (18FDG-PET), the image showed a greater number of lesions for the same patient at the same site.

Finally, using the tracer [18F] fluoro-dihydro-testosterone (18F FDHT), which attaches to androgen receptors, PET imaging revealed the full extent of the spread of the cancer.

"And the best is yet to come, imaging a cell," Hricak said, adding that it is an advance that radiologists would not have imagined five years ago.

"Imaging is just one element in an integrated diagnostic approach," she said. "We have no choice but to learn serum screening, proteomics and molecular pathways. We need to embrace physics, chemistry and biology."

Hricak also expressed a sentiment that was echoed in sessions throughout this year's congress when she said that with today's chemical contrast agents and tracers illuminating the detailed processes of disease, "it is sometimes frightening to see how little we have known."

She suggested the emerging concept of theranostics, where an immunoassay lab-on-a-chip is developed as a companion diagnostic for ongoing measurement of the effectiveness of a pharmaceutical therapy, could be applied to imaging diagnostics as well.

In the field of oncology, Hricak said it is increasingly important to use highly targeted imaging modalities in combination with a specific tracer to monitor treatment directed at a specific type of tumor

Lab-on-chip test for biomarkers can be an excellent tool in some therapeutic applications, she told Biomedical Business & Technology, but because these tests work with micro droplets drawn from the patient, "we don't know where the marker is coming from, so they do not tell us about a specific cancer.

"Metastatic disease is different from the primary cancer, so while immunoassays help, targeted imaging is essential for targeted therapies," she said. "The tracers being developed for medical imaging today are fantastic compared to five years ago," she told BB&T.

Working at a major research center, Hricak said she has special access to these new molecular agents for investigational purposes, but said it is frustrating that they are not yet available for widespread use.

In a scientific session the following day at ECR 2009, Gazeau showed exactly the potential for molecular imaging, and to the growing amazement of her colleagues, took them further than imaging to show non-interventional, yet mechanically induced therapies.

Particles measuring from 5 nanometers to 20 nanometers can be considered as a disease tracer actively seeking out specific cells, she said, and at the same time serve as a contrast agent to observe the disease process or monitor the forced migration of these cells with externally, or endoscopically, delivered magnetic force.

Their magnetic properties also mean electromagnetic force can be used to excite these nano particles in the cells and convert energy into heat causing the agents that targeted a tumor to serve as a thermally active therapy.

"I will not discuss this aspect today," she said, focusing her presentation at ECR on monitoring, targeting and delivering pharmo-biologic therapy.

"Iron oxide is a particle of a tunable size," she said showing a test tube with iron oxide particles in liquid state stuck against a magnet with the liquid suspended in a lump against the side of the tube like a refrigerator magnet.

They can be constructed to work with, or against, the body's natural processes, she said, to help determine where they will go.

Big particles, for example can be trapped within an organ such as the liver, or be small enough that the body allows them to circulate with blood.

Surface coatings for these nano particles are extremely important in this emerging field and determine the uptake by the patient's cells.

Tinkering with ligand coatings can result in low or medium or high uptake of anionic iron oxide particles by a tumoral cell.

High labeling efficiency, or coatings, can result in a predictable iron load in a cell and once taken into the cell, the particle is contained within the cell.

This leads to what Gazeau called "the best part."

Cell proliferation is not affected as it turns out anionic iron oxide particles are biocompatible and do not provoke exocytosis, or excretion of the particles by the cell as a waste product.

There is, however, a long-term degradation of the particles.

The benefit of these properties is that nano particles carrying payloads can be integrated into cells that continue to divide and proliferate naturally, and the particle can add or direct processes, such as muscle regeneration.

"Sorting cells in micro canals can be interesting, too," she hinted.

The question we asked, Gazeau said, is whether these properties can be used for tissue engineering.

A group in Japan has created an artificial vessel, she reports, asking then if this it be done in vivo.

Gazeau notes a research group in the United States recently conducted in vivo experiments to reconstruct tissue with a magnetic steel stent loading endothelial cells with magnetic nanoparticles.

In the brain, magnetic nanoparticles were accumulated at a point where they were held to affect microcirculation of blood, a proof of concept for micro targeting in vivo, she said.

There is a lot of work yet to do, Gazeau concluded, packing up to head back to the lab.

Radiology meets the ER physician

Emergency medicine is the guest of honor at ECR and a Special Focus session highlighted the current debate between advocates of ultrasound and computed tomography (CT) as the best modality for triage and diagnosis of trauma patients.

Michael Rieger, a radiologist, and Wolfgang Voelckel, a trauma physician, collaborate on enhancing workflow for the emergency room at University Hospital Innsbruck in Austria that features a dedicated dual-source CT scanner. They advocate the abandoning all other modalities in favor of whole body, high resolution, 64-slice evaluation of polytraumatized patients.

"The use of ultrasound is just a waste of time," during the golden first hour of trauma treatment, said Rieger. "CT phase acquisition and evaluation has brought a revolution in trauma care."

Describing the Innsbruck workflow, the physicians said that once and anesthesiologist validates stable hemodynamics, the patient is sent for the CT scan. They reported the average elapsed time from admission to creation of the first CT image is 31 minutes and the time to evaluation of the images is 19 minutes.

Voelckel said scans provide a head-to-toe evaluation with two meters of coverage showing "the whole head, the entire skeletal system, the thoracic cage, the pelvis and any organ injuries in the abdomen. "

"We include molecular diagnosis CT angiography of cervical arteries to detect carotid injury, of the thoracic aorta to detect traumatic aneurysm, and we can see arterial injuries of the extremities with high resolution that will show finger artery ruptures," said Rieger. A study of 500 injuries in Innsbruck showed that "we missed 10 injuries, of which three were considered serious.

Moderating the ardent Austrians, the chair of radiology at Antwerp University Hospital (Edegem, Belgium), Paul Parizel, said ultrasound may not be as sensitive as CT but that it is more readily available and will provide a certain amount of critical diagnostic information immediately.

"A number of papers from emergency or surgical departments claim that focused ultrasound is the way to go in triage of patients," he said, while papers coming out of radiology groups are more cautious, saying that is CT scan is not available or not practical, the ultrasound is the best choice.

Gerhard Mostbeck of the Wilhelminenspital and Otto Wagner Hospital and Medical Centers (Vienna) tightly explained the dilemma in this ongoing debate between CT and ultrasound by underlining the practical issue of whether an emergency department is able to afford afford a dedicated CT scanner.

"In my experience, the role for ultrasound is quite small in the case of polytrauma patients if you have a dedicated CT unit in the emergency department," Mostbeck said.

"But if it is going to take 20minutes to take the patient to the CT scanner in another building, then things look quite different," he said.

Toshiba, Hitachi face off in ultrasound

Toshiba and Hitachi went head to head at the ECR with the launch of high-end ultrasound products, with the CEO of Hitachi Europe intensifying the competition by promising that his company will overtake Toshiba in sales this year in Europe.

Toshiba Medical Systems Europe (Zoetermeer, the Netherlands) transferred features of its flagship Aplio XG to a laptop model called Viamo in order to enter the fast-expanding market for portable ultrasound with high-end quality that adds a novel image enhancement capability called Precision Imaging.

Meanwhile, Hitachi Medical Systems Europe (Zug, Switzerland) overhauled its leading Preirus line with features that include an ultrasound broadband engine, real time tissue elastography, a new generation single crystal transducer, ultra fast processing and reengineered the ergonomics with off-axis rotation.

Hitachi also introduced the Oasis MRI to Europe at ECR 2009, reporting it already has sold 40 units in the U.S. and has installed 30 since the open platform system was introduced last summer.

Both the products and the promise of a sumo match between the Japanese giants provoked discussion at ECR 2009 that provided insights into the European landscape for radiology.

The new Toshiba Viamo was introduced as a premium portable without limitations on image quality, which usually is a trade-off in portability for ultrasound products, nor a loss ergonomics and workflow.

The Viamo laptop shares the same processing engine as the top-of-the-line Aplio XG and connects to the same transducers, meaning the Viamo can share the same basic tools as well as expensive specialty transducers, including high-frequency probes.

Viamo presents a 15" LCD display screen with touch controls that can fully operate the system, as well as 15 hard keys that are programmable. The screen features the trademark Toshiba swivel that rotates 270 and can be turned into a tablet configuration. At the Toshiba booth, Viamo was displayed in five configurations – including a mobile hand carry, mounted on slim pole cart, packed in a rugged suitcase for remote transport and a wall-mount bracket.

The screen displays thumbnails of images from either a session in progress or to review past sessions and also offers a direct print-to-PDF feature for transfer of reports to a USB key.

Commercial delivery is set for April and Toshiba said it sees Viamo going everywhere from the operating room to sports stadiums to physicians offices.

"This is mobility without compromise, and I don't even want to compare this with lower-end systems" said Joerg Schlegel, marketing manager for the ultrasound business group of Toshiba, during a press conference.

"There are not many portable systems with even a decent quality, let alone high quality," he said. "Viamo creates a new opportunity, we believe there is a significant demand for such a high end portable, and that this demand will grow."

The clinical view of the new Viamo was offered by Adrian Lim, MD, and a fellow of the Royal College of Radiologists with Imperial College, practicing at the Hammersmith and Charing Cross Hospitals (London), who tested the unit on three occasions.

"I call it Toshiba's new 'baby' because that was my first impression of the Viamo, quite compact and clean," he said, adding that the pièce de resistance is the touch screen, which he called revolutionary.

"Standard B-mode is very good quality, with good gray scale," he said, adding that he also liked the sensitivity of the Doppler and the probe compatibility.

Asked if he had concerns for infection control with a tactile screen, Lim replied, "I would say the risks are similar to any portable device being brought into an infection-sensitive environment. In this sense, the touchscreen does not add greater concerns than, for example, a keyboard." He said he and his colleagues experimented using swab tips to operate the touch keys and reported no difficulties.

When it came to assessing the new Precision Imaging mode for Toshiba's Viamo, Lim became less than clinical, saying flat-out that "my colleagues and I loved turning it on. This new mode gives greater uniformity and a cleaner interface," than conventional ultrasound displays, he said.

In one of the three occasions he used Viamo, he said, "Precision Imaging gave clear indications of a patient's condition and thereby avoided the need for a transvaginal scan by depicting the endometrial cavity, which has a high potential for significant hemorrhage." He said the Precision Imaging mode can continue running when switching to a Doppler overlay.

Where ultrasound image processing is line-by-line, the Precision Imaging software module pulls information from adjacent lines to verify if the signal indicates structure or is clutter.

Where the software decides data is anatomy, it enhances the display of the structure while suppressing data it decides is noise.

The result of this complex calculation is a more coherent display with improved contrast where layers, boundaries and contours are more cleanly delineated and the clinician can more quickly identify a targeted structure, as did Dr Lim with the endometrial cavity. "What is important is that you do not lose the effect turning to other modes such as differential tissue harmonic imaging, color Doppler imaging, and in 3-D/4-D," Schlegel said.

New from Hitachi was the Preirus model that extends the company's Hi Vision line upward. "The is a new system inside and out," said Ellison Bibby, ultrasound product manager for Hitachi Medical Systems Europe, adding that Preirus is compatible with the Hi Vision line of 26 transducer probes, including endoscopic.

On the outside the accent is on ergonomics, with an off-axis rotation that allows the Preirus unit to swivel and arc for better positioning at bedside or exam tables. "Let the system do the twisting and turning, not the operator," said Bibby, who noted that 20% of ultrasound operators experience a career-ending fatigue to head and shoulders after five years.

Other ergonomic features include smart tab menus integrated onto the touch screen display and thumbnail galleries for imaging session or to recall stored images. There also is an option for operators to save and later recall specific combinations of parameters for a session with the touch of a button.

Inside Preirus, the emphasis is on speed, with ultrafast processing, she said, to support a platform loaded with software feature including Hi Rez+, a real-time tissue adaptive filtering technology, high-definition dynamic tissue harmonic imaging, speech-recognition and picture-in-picture display capabilities.

The 1.2 tesla Open Architecture Superconductive Imaging System will be ready for delivery no later than 4Q09 and Marco Dolci, CEO for Hitachi Europe, said installations already are planned for units in Germany, Italy, Austria, France and Spain.

Unlike traditional MRIs where patients are passed through a doughnut hole to be scanned, patients are sandwiched between two magnets in the OASIS configuration. That allows an open architecture with extra-wide dimensions for extra-large patients and normal eye contact that the elderly and children find more reassuring than being passed through a tube.

Surprisingly, the larger OASIS weighs just 15 tons compared to traditional MRIs that weigh 40 tons, thanks to the superconductive high-field magnets.

Elastography apps open new markets

Just as high-end ultrasound machines were reaching maturity with the menace of commodity market pricing a break-through opens new applications for tissue characterization with elastography. The immediate potential for this technology is rapid diagnosis of tumors for breasts, prostate and the liver that may dramatically reduce the need for interventional biopsies.

Yet tissue characterization with elastography is a vast field in medical research stretching further than anyone can see at this moment. Already seen as the "must-have" feature among ultrasound manufacturers the lines are being drawn in a classic fight for distinguishing product quality among competitors and a renewed exploring for setting value against the clinical benefits.

For example, what is it worth for the U.S. to eliminate, according to a conservative estimate, over one-third of the two million breast biopsies performed annually?

Elastography begins with old-fashioned finger-poking by a general physician to see how stiff a patient's liver may be, or a woman feeling a lump in her breast. Stiff tissue is neither normal nor healthy.

Hitachi introduced elastography for ultrasound in a symposium at the European Congress of Radiology in 2004, using a simple physical manipulation and some powerful algorithms in its software. The radiologist pushes down on a breast, for example, and the software analyzes how the sound waves bounce against underlying tissue, rendering an image of troublesome stiffness. This compression method, relying only on a software upgrade, was matched by competitors to the point that elastography was a significant theme at ECR 2009, with scientific papers and product demonstrations.

Hitachi continues to lead in the compression technique available on its Hi-Vision line with the HI-RTE (Real-time Tissue Elastography) and has been followed by Toshiba (Tokyo) with its Differential Tissue Harmonics (DTH) on the high-end Aplio line, which has now been migrated as well to the portable Viamo.

Ellison Ribby, Hitachi Europe's manager for ultrasound, told BB&T that speed for processing is a good question to be ask about the quality of other systems, adding "Our algorithm has stood the test of time since 2004. Multicenter studies have shown the accuracy and reproducibility of results with HI RTE," and it has emerged as a key capability for biopsy in guiding fine needle aspiration.

Hitachi sponsored a special session for a standing room only crowd to hear abstracts presented from studies using HI RTE capabilities in procedures for non-invasive, quantitative evaluation of diffuse liver disease, results from a multi-center study of prostate exams and elastography in musculoskeletal applications.

GE Healthcare has not yet entered the elastography competition and the elastography picture at Philips was somewhat confused at ECR. But Radjen Ganpat, sales development manager for ultrasound with Philips Healthcare EMEA, told BB&T, "we will have elastography on the IU22 by the end of 2009."

Oddly, product literature promoting Philips Compact Extreme 50 (CX-50) for cardiologists claims capabilities for "tissue motion quantification including functions like annular excursion, velocity, and regional shear," and also for strain quantification, both principles that speak specifically to elastography.

Riding the shear wave

Two manufacturers stand out from the crowd with a different approach to elastography that does not depend on operator-induced compression but uses a shear wave pulse from the transducer to compress tissue. Both Siemens (Erlangen, Germany) and Supersonic Imagine (Aix-en-Provence, France) quickly dismiss the operator compression technique because results are highly dependent on the skill level and experience of a given operator.

Results from compression examinations are not reproducible, even by the same operator with a second exam, they agree. Jacques Souquet, the founder of SuperSonic, said operator compression ultrasound provides "only a global assessment of deformation where shear wave pulse provides a local assessment of specific lesion stiffness."

SuperSonic began deliveries in Europe of the Aixplorer with elastography capabilities on board and Souquet told BB&T, "Our sales funnel has exceeded our expectations for the first three months of this year and we are building up the capacity to meet this kind of demand.

"We won two contracts in France beating them out because of elastography," he added. "It is true we have a home court advantage there. But we also won in Germany and will be delivering the Aixplorer there next month."

Siemens offers operator compression elastography and also began shipping its shear wave technology, called ARFI (Acoustical Radiation Force Impulse), in Europe in May 2008. ARFI is not approved by the FDA, though Siemens said it is in the filing process.

Roee Lazebnik, director for ultrasound product development at Siemens Medical USA, said elastography is "the most exciting change in ultrasound in a long time. It is rare in any imaging modality to get a truly new source of information," he said, explaining that "usually we get better at looking at existing information."

He explained that a shear wave created with an ultrasound pulsation is the same as ripples in a pond with waves passing faster through stiff tissue and more slowly through soft tissue, just as sound waves will vibrate more quickly through a brick than a sponge. ARFI renders a 2-D image displayed side-by-side in gray scale for the operator with a standard ultrasound B-mode image.

Siemens offers two versions of shear wave elastography under the brand Virtual Touch with ARFI running in one mode to quantify the shear wave and in a second mode to quantify the effect on the tissue, resulting in tissue characterization, which is "very new," according to Lazebnik.

TomTec, Bracco join forces on liver tumors

The giant of contrast enhancement agents for ultrasound imaging and the "silent partner" of medical imaging software are collaborating on a novel approach to diagnosing liver tumors, and potentially to monitor the effects of therapy.

Bracco (Milan, Italy) and TomTec (Munich, Germany) introduced SonoLiver, a PC-based software for radiologists to review of-line dynamic images of blood perfusion in the liver. Using Bracco's contrast agent SonoVue and reviewing the images within TomTec's Image-Arena simplifies workflow for radiologists and increases diagnostic confidence in characterizing focal liver lesions.

"No one has any kind of application for quantifying perfusion in Contrast Enhanced Ultrasound (CEUS)," said Bernard Mumm, president/CTO of TomTec. "There are a lot of contrast agents out there and many more organs, such as prostate, kidneys or breasts," he told BB&T. "I see quite a future in this considering all the upcoming new treatments for cancer. Whenever there needs to be a careful monitoring of patients under cancer treatment, then there is a need for this technology," he said.

"A cancer patient can not be scanned by computed tomography (CT) or be X-rayed every three weeks, it is too much," Mumm said.

"There is a real and unmet need for using new tools like SonoVue and ultrasound, which brings the problem back to software, which is what TomTec does best," he added.

TomTec generates just 20% of its revenues from direct sales of branded products. The remaining 80% is generated through licensing of its medical imaging software and algorithms to original equipment manufacturers (OEMs) such as Philips, Toshiba, GE Healthcare or in ophthalmology, Carl Zeiss (Jena, Germany). "Bracco knows everything about micro bubbles and they have acquired a tremendous expertise working with ultrasound OEMs to adapt their contrast enhancement products to specific procedures," Mumm said.

"Where they do not have an expertise is in software for CEUS visualization, especially where there is a need to quantify an actvitiy through the data that is collected during a scan," he said. Mumm said TomTec worked for almost three years with the Bracco research and development group in Geneva to develop SonoLiver. The new software was being displayed simultaneously at Bracco and TomTec during ECR 2009 and Ralf Ludwig, TomTec's product manager for SonoLiver said Bracco reported a high interest among radiologists.

More from the exhibit floor

Medicsight (London), a developer of CAD and image analysis software that assists in the early detection and diagnosis of disease, launched ColonCAD API 4.0, the latest version of its computer-aided detection software. The software is designed to assist radiologists in the detection of colorectal polyps in CT colonography image data. Version 4.0 includes what the company termed "a significant increase in the performance of the polyp detection algorithm, reducing the number of false positive CAD marks displayed for each patient case."

David Burling, MD, consultant gastrointestinal radiologist and VC program director at St. Mark's Hospital (London), said, "We welcome this latest improvement to Medicsight's ColonCAD product. CAD is now an integral part of our reading strategy in routine clinical practice. It improves interpretation accuracy and is complimentary to workflow."

Internal testing on a dataset of 91 patient cases showed that the ColonCAD API 4.0 maintains the same high levels of sensitivity to the previous version but displays a 50% reduction in false positives, with the CAD now returning a mean of 6.5 false positive marks per patient case. Medicsight said the patient data used in this testing "remained independent from the development of the CAD and have been endoscopically validated and reviewed by a panel of radiologists to determine the ground truth against which the CAD performance was assessed."

CEO Allan Rowley said, "Previous research has shown Medicsight's ColonCAD significantly im-proves the performance of radiologists in the detection of polyps in CT colonography image data. The reduction in the numbers of false positives returned by our latest version of CAD is expected to further improve the performance of radiologists, by reducing the number of CAD marks which must be assessed when reviewing a patient dataset."

ColonCAD API 4.0 has been CE-marked and will be available for sale in Europe through Medicsight's network of partners. Medicsight is a subsidiary of MGT Capital Investments (New York).

Also at ECR:

• Agfa HealthCare (Mortsel, Belgium), a provider of diagnostic imaging and healthcare IT solutions, said it has been selected by ENEL-MED, a private healthcare provider in Poland, to install its IMPAX 6 Picture Archiving and Communications System (PACS) to serve the needs of its seven facilities and more than 360 medical provider customers across Poland.

The agreement also foresees the installation of eight of the company's Computed Radiography (CR) systems and seven Drystar 5302 imagers.

Agfa also said it has signed an agreement with the Bulgarian Ministry of Health to implement IMPAX 6 at four of its sites in that country. To support the hospitals' transformation into digital imaging, Agfa also will install two CR 85-X and four CR 35-X solutions. at the Clinical Center Alexandrowska in Sofia, and the hospitals at Sveta Anna, Blagoevgrad and Stara Zagora.

Lastly, the company reported that it has delivered the first phase of solutions at several of the Basque Healthcare Service's 28-site Osakidetza facilities in Spain, including a go-live of its centralized Radiology Information System (RIS) across the facility's network.

In late 2007, Agfa was selected to install its IMPAX 6 system, a centralized RIS, 59 Computed Radiography solutions, and 52 diagnostic imaging printers across five hospitals and 23 primary care centers in the Basque Country of northern Spain.

• Confirma (Belleview, Washington), pioneer of CADstream, a dedicated CAD [computer-aided detection] operating system for MRI, and Medrad (Indianola, Pennsylvania), a global provider of medical devices and services for diagnostic imaging, reported that they have partnered to advance patient care in the European Union.

The companies announced at the European Congress of Radiology in Vienna, Austria, that they have signed an agreement that enables Medrad to sell the next-generation CADstream, version 5.0, for breast and prostate treatments in the UK, Germany and Italy.

"Our partnership with Medrad will make CADstream available to more physicians and patients, ultimately helping improve patient care in the EU," said Confirma President/CEO Wayne Wager. "With their customer relationships, dedication to the radiology market and reputation as a leader in medical imaging devices, Medrad will be a strong partner."

Joe Havrilla, senior vice president, in Medrad's MR business unit, said, "We are delighted to be able to offer CADstream to our customers who are starting or growing their breast or prostate MRI programs. CADstream is an excellent complement to our MRI products and will allow us to offer application based breast and prostate MRI solutions."

The two companies are exhibiting at the ECR 2009 meeting, which runs through today at the Austria Center in Vienna. Confirma is exhibiting with Medrad in the latter company's booth.

CADstream is a dedicated CAD operating system designed for radiology networks and workflow-specific MRI applications. The system automates the analysis, reporting, and interventional planning of studies and promotes standardization of MRI studies with the incorporation of recognized standards. Specific applications are available for breast and prostate treatments.

• Philips Healthcare rolled out a new 3 Tesla MRI machine to enter a market it says is rapidly expanding and currently dominated by GE Healthcare and Siemens. Boosting the power of an MRI provides higher resolution but also poses a higher risk to patients and the Philips engineered the new Achieva 3.0T X-Series to deliver distinguishing features on both counts.

Robert Körbler, managing director for healthcare in Austria with Philips, said the company's analysis shows installations of 3 Tesla machines have grown from less than 10% of the MRI market to almost a third of units sold today. In Europe, Siemens leads the market, he said, with GE strong in the UK and France, but that GE "disappears in Germany, Austria and Switzerland."

Philips' installed base in Europe is stronger than North America and it would be ranked third on the Old Continent, he said. Sales of 3 Tesla machines started off strong but then stalled in 2004-2006 due to reports of risk of injury to patients caused by overheating.

Philips is taking a different approach with the Achieva 3.0T, offering a novel dual-source transmission of the radio frequency (RF) that is safer for patients while also rendering the higher resolution images. With the 3.0T X-Series Philips engineered the transmission from dual coils with different phasings at the same frequency.

Philips also launched in Europe the Panorama vertical high-field MRI open platform, offering a 360-degree open platform with 160 cm wide (63-inch) patient aperture.

• Siemens Healthcare showed the latest expansion of its imaging portfolio with the addition of the Biograph TruePoint 16-slice PET•CT imager. The company said the Biograph TruePoint PET•CT imaging family is the first portfolio of imaging systems to include high-definition PET•CT and now expands its offering with 16- slice CT capabilities.

"The introduction of this particular system is critical as we continue to search for the balance between innovation and access. The likelihood that universal adoption of PET•CT technology will increase with accessibility is a shared industry vision. As an industry leader, it is our responsibility to make that vision more readily attainable,"said Michael Reitermann, CEO of molecular imaging for Siemens Healthcare. "The Biograph TruePoint 16-slice PET•CT is a means to achieve that end, with high-performance technology housed in an economical package."

Siemens said Biograph TruePoint 16-slice PET•CT represents a "viable solution" for healthcare providers at an affordable price and offers features such as high-definition PET and routine 10-minute, whole-body imaging.

• Varian Medical Systems' X-ray Products Group (Salt Lake City), a supplier of X-ray tubes and flat panel digital X-ray image detectors for filmless imaging, is exhibiting its line of PaxScan flat panel X-ray image detectors for digital radiography (DR) at the ECR event.

Varian also is showcasing its full line of X-ray tubes for fluoroscopy, angiography, cardiology and cone-beam CT imaging.

The Varian booth is spotlighting several advanced filmless imaging and X-ray tube products, including:

– The PaxScan 4336R, a 43cm x 36cm detector designed to replace standard film cassettes used in existing radiographic applications and intended for use in mobile and multi-bucky imaging systems.

– The PaxScan 4343R, Varian's largest panel, a 43cm x 43cm detector designed for permanent mounting in radiographic tables or wall stands. The company said the large size of the 4343R makes it an "excellent receptor" for real-time, large field of view image acquisition.

– The new G-296 rotating anode X-ray tube developed for use with flat-panel digital detectors. The insert is specifically designed for general radiology, cineradiographic and fluoroscopic procedures.

– The MCS-6074 rotating anode X-ray tube for CT scanning along with a line-up of replacement X-ray tubes that are available through Varian's Interay subsidiary, which offers medical X-ray tubes "on demand" for service and small OEM markets.

"We are committed to providing our growing European customer base quality products and 'on demand' service," said Steve Kimmel, vice president of marketing for the X-ray Products Group. "From stocking locations around the world we are able to offer regional product and support services, which in turn help increase our customer's competitiveness in the marketplace."

• Ziehm Imaging (Nuremberg, Germany) said that Stryker (Kalamazoo, Michigan) has joined the list of companies with surgical navigational systems who are integrating 2-D and 3-D image data from the Ziehm mobile C-arms for intraoperative guidance during minimally invasive orthopedic, trauma and spinal surgery.

Ziehm has previously integrated its X-ray platforms with BrainLAB ((Feldkirchen, Germany/ Westchester, Illinois), Praxim (Grenoble, France) and CAS Innovation (Erlangen, Germany), which was acquired by Siemens in February 2008.

Stryker will add the capability for real-time imaging of surgery to its active infrared navigation system for surgical planning and guidance. The first Stryker system using the integrated Ziehm platform was installed at the Neurocenter of the University Medical Center in Freiburg, Germany, and has been used for spinal surgeries