VIENNA, Austria – With a heavy footprint in Austria for manufacturing and operations, Siemens (Erlangen, Germany) is working its home-court advantage at the European Congress of Radiology (ECR) here by launching more products than any other major manufacturer and setting up a massive showroom that dominated the exhibition hall, forcing the 18,000 radiologists and competing exhibitors through the space on their way to anywhere else.

Siemens broke ground recently for a monumental office complex along the Danube River, just a short walk from the Austria Center Vienna where ECR is held each year, assuring a domination of the event for years to come. The portfolio of new products from Siemens at ECR 2008 proved worthy of the expense, and judging from the crowds, worth the time for radiologists.

The new Ysio radiology suite (pronounced Easy-O) is the fullest articulation to date of “wiD,” a wireless flat-panel detector for digital radiography developed in a joint venture with Philips (Eindhoven, the Netherlands) and Thales (Paris).

Siemens also rolled out the Acuson S2000, the big brother in a family of ultrasound products for which the hand-held P10 introduced at Medica in November was the avant-garde for this platform of new imaging capabilities.

And for computed tomography (CT), Siemens introduced four new applications of the dual energy Somaton Definition that was introduced last year and is capable of rendering unexpectedly vivid imaging of the heart, for example, in “woxels,” the term for pixels in three dimensions.

Bernd Weber, director for marketing with Siemens’ radiography and fluoroscopy group based in Forchheim, Germany, said the goal of the new Ysio suite is nothing short of making the computed radiography (CR) cassette obsolete. No easy feat, considering that CR cassettes and readers are a relatively recent innovation that according Frost & Sullivan (F&S; London) has disrupted a traditional radiography market that it estimates in Europe alone was worth $224 million in 2007.

“With CR cassettes you have an exposure and the cassette is removed from the table or the wall stand to be taken to a reader,” Weber explained. “Then you wait, and the patient waits in whatever uncomfortable position you left him, until the cassette is read.”

With wiD, it takes five seconds for the data to be transferred wirelessly from the table, and then another five seconds to be fully processed to a diagnosis-ready image,” he said. The wi-fi connection is between 12 and 40 megabytes per second, transferring 9 million pixels.

Like a cassette, the wiD tablet, which is the size of a thin briefcase at 14” by 17”, is removable and can be inserted as a detector in a table slot, a wall-mounted unit or a mobile stand. But unlike a flat-panel detector, the Ysio panel also can be placed directly against a patient, for example someone confined to a wheelchair, or someone unable to be transferred from a gurney to a radiology table.

The wiD flat panel can be specified for dual detectors.

Ysio, which is CE-marked with FDA approval pending, is a fully expressed line of components that can be specified to create a radiology suite, including a table that lowers to a 20-inch height and can support more than 600 pounds, a wall unit for chest X-rays, and an articulated arm unit.

The ceiling-mounted track for guiding the gantry extends far beyond the traditional radiology table to cover wall-mounted and even wheelchair positions in the room.

The Ysio MaxTouch controls also are maxed-out with servo-motors that guide the gantry to pre-programmed positions that can be adjusted with one-finger controls in fractions of degrees of rotation. There also is a tube-detector synchronization to assure correct alignment.

By selecting modules, a radiology clinic can be customized to meet workflows, patient volume and profiles, local standards and regulations, and, of course, budget.

A low-end Ysio will run $200,000 and tops out at $400,000.

The high initial cost of converting to digital radiography was cited as the key barrier to the market in the F&S report, and by creating a tailor-made offering with pay-as-you-go options, Siemens has embraced the recommended strategy for overcoming the sticker shock.

Weber said Siemens is targeting “easily over 500 units per year, but not 1,000 units.”

Siemens’ Acuson S2000 ultrasound unit was introduced at the meeting of the Radiology Society of North America (Oak Brook, Illiniois) in Chicago in December, but in Vienna at ECR 2008, “this is the first time anyone has seen it running live, scanning and w(orking real-time,” said the first time “see the system live, scanning and working,” said Alexander Stanke, director for marketing for Europe, the Middle East and Africa with Siemens’ ultrasound division.

“It may sound boring to say that Acuson takes ultrasound to the next level, but we are pulling MRI-like images here with contrast and resolution radiologists do not associate with ultrasound,” he said.

Acuson features a compacted transducer with double the elements in half the space to condense the slice and boost both image uniformity and contrast resolution, he explained.

The platform pulls together the best of Siemens, with SieClear spatial compounding that enhances anatomic border definition, and enables acoustic radiation forced impulse (ARFI) imaging, which is the only feature holding back FDA approval.

The platform is loaded with software applications, such as for breast imaging, but significantly with thousands of case images “to make system less user-dependent,” said Stanke, and thereby speed workflow.

He said technology introduced last year, eSie Touch elasticity imaging that calculates and displays relative tissue stiffness through gentle compression, is great for handling breasts but with ARFI, Acuson is now going deeper to organs such as the liver.

The approach to market is very aggressive, he said, and Siemens is targeting internal medicine radiology imaging including vascular diagnosis and echocardiography as well as gynecology and obstetrics.

In the two years since introducing CT dual energy with Somaton Definition, Siemens has installed 300 scanners, according to Peter Seitz, global product manager for the Somaton Definition division.

“These have been the early adopters, the reference hospitals,” he said. To win the larger market of regional and mid-range hospitals, “we absolutely need clinical studies to move this market, studies for each workflow, for each application.”

Seitz said Siemens began releasing studies six months ago at the rate of one per month.

With six established applications and the four introduced for diagnosis of diseases of the heart, brain, lungs and extremity joints at ECR 2008, customers can look forward to another year of study-of-the-month from the company.

The significance of dual-energy CT is that it not only can locate, but characterize a targeted disease state. And this greatly improves workflow.

Using the application for kidney stones as an example, Seitz said CT is famous for its ability to localize the stones, but with dual energy the physician can determine which stones are uric acid and which are non-uric acid.

The significance is that uric acid stones can be dissolved without an intervention, where all other require an uncomfortable, and time-consuming procedure.

Characterization is the hot button for sales.

There is software that can remove bone structures from an image to see vessels, he said, but these algorithms also remove vessels adjacent to the bone which can very much be the target of the diagnosis.

“With dual energy we can acquire woxels, 3-D pixels that will render precisely those vessels while extracting the bone,” Seitz said. “The advantage is to characterize tissue, not just to display density, which CT is famous for doing, but to show what kind of density.

Seitz said that for the moment Siemens has this market to itself, although Philips and GE Healthcare (Waukesha, Wisconsin) simulate dual energy with software. “The good question is where can we go with dual energy, and the answer is color,” he said. “The difference is going to be exactly the same as when the world went from black-and-white television to color.”