VIENNA, Austria — Toshiba and Hitachi went head to head at the European Congress of Radiology 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 year (Medical Device Daily, July 25, 2008).

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 (see sidebar, "Sumo match between Japanese heavyweights set for Europe").

High-end entry for portable ultrasound

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 in 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.

Reading ultrasound between the lines

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.

Robust and loaded HI Vision Preirus

New from Hitachi at ECR 2009 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.

Hi Vision Preirus incorporates two advanced imaging processes: HI RTE (real time tissue elastography) and HI RVS (Real-time virtual sonography).

Hitachi first introduced tissue elastography to the world at ECR 2004 and this capability has become a must-have feature to compete in the high end of ultrasound.

Using the physical compression of the transducers against the body, the signal is analyzed to distinguish the flexibility of underlying tissue with stiffness being an indicator of potential tumors in examinations of breasts, the liver and the thyroid, and endoscopically organs such as the prostate, pancreas or lymph nodes. HI-RTE also enables accurate localization and targeting of lesions for ultrasound guidance in biopsy needle aspiration.

HI RVS fuses real-time display of ultrasound images against a backdrop of multiplanar reconstructed (MPR) images from CT or MR volume set data to provide a comprehensive view of reference anatomy and morphology.

Hardware enhancements for Preirus from Hitachi's in-house development and manufacturing include a single crystal transducer with precision element slicing for higher quality B-mode images and increased Doppler sensitivity, as well as broadband beam forming technology.

Open architecture MRI for Europe

The wide open spaces of the Hitachi OASIS MRI that has been a top seller in the U.S. was introduced for Europe at ECR 2009.

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.

The 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.

Asked if the 40 units sold in the U.S. in a single year would be an aggressive sales target for Europe, Dolci said, "The problem is not to collect orders; instead we want to be careful in this first year with the installations."

The OASIS high-field system uses a dual helium cooling system for the super-conductive coils, a variation from the traditional configuration for vertical bore MRIs, requiring the European team to first tame the learning curve for such installations, he explained.

"For this reason for the first year the sales targets are relaxed," he said.

Asked if 40 units in the second year would be aggressive for the European markets, Dolci said, "Yes, with the longer process of tenders and bids in public and private markets here in Europe, that would be aggressive."

Hitachi is a world leader in MRI, with an installed base approaching 5,000 units.

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