BB&T Contributing Writer

CHICAGO – The annual Radiological Society of North America (RSNA; Oak Brook, Illinois) exhibition filled the McCormick Place halls after Thanksgiving, providing imaging equipment and information system firms direct access to their clinical customers, and both sellers and buyers seemed to welcome this unique opportunity. Perhaps once a year is enough to assemble the often large, complex booths with massive scanners and proliferations of computing equipment at a single venue. Every year the exhibits seem fancier, the crowds larger and the floor discussions more animated than the year before. The 2005 show was no exception.

As is now typical, the exhibition was anchored by the leading imaging scanner vendors, each with a large, sophisticated presence on the floor. On this occasion the most apparent square footage, and the most attention, was afforded to GE Healthcare (Chalfont St. Giles, UK), Siemens Medical Solutions (Malvern, Pennsylvania) and Philips Medical Systems (Andover, Massachusetts). Their mammoth booths were consistently crowded. But a very large number of medium-sized, small and tiny companies take up residence as well, and the overall ambiance is what makes this exhibition a success year after year. It appeared there were more of these smaller firms exhibiting in 2005, many targeting their support-product messages to the leading scanner providers.

It is impossible to capture all the highlights of this huge presentation. Rather, we briefly summarize below the exhibits that especially caught our attention and piqued our interest.

Breast imaging

Sixteen scientific presentations focused upon, or included, discussion of digital breast tomosynthesis (DBT), a relatively new breast imaging modality. In DBT, cross-sectional tomographic images of the breast are obtained. Preliminary work suggests that this approach might be particularly useful in imaging dense breasts by eliminating images of overlying tissue that might obscure cancers. Data to justify the additional expense of this equipment and to assist in the selection of appropriate patients for DBT will need to be generated. However, just as sectional imaging of other body parts has improved the detection and diagnosis of disease, there is little doubt that the same will be true in the breast. Hologic (Bedford, Massachusetts) highlighted its work in progress on DBT at the show, the company having hired one of the original developers of DBT, Dr. Loren Niklason, while at Massachusetts General Hospital (Boston). Shimadzu Medical Systems (Torrance, California) unveiled its work on DBT as well.

U-Systems (San Jose, California) exhibited an interesting automated breast ultrasound system, claiming a more systematic breast examination and potentially greater sensitivity in cancer detection in comparison to the usual hand-held ultrasound study. The system consists of the SomoVu Scan Station, which automatically acquires multi-slice ultrasound data, and the SomoVu View Station, which offers volumetric ultrasound review options including individual slices, tomographic images, and alternate views such as radial and anti-radial.

Inrad (Kentwood, Michigan) demonstrated a new one-handed breast localization device for use in ultrasound-guided localization procedures. The company claims that its UltraWire product facilitates the precise marking of breast lesions and allows for continuous imaging and accurate wire placement.

Aurora Imaging Technology (North Andover, MA) promoted its 1.5-tesla dedicated breast MRI system to large audiences. This new scanner creates an elliptical, homogeneous field of view including both breasts, chest wall and axillae in a single scan. The system is claimed to be the only fully integrated MRI system designed specifically for bilateral breast imaging.

i3Archive (Berwyn, Pennsylvania) formed the National Digital Medical Archive (NDMA) in 1999 in collaboration with the University of Pennsylvania (Philadelphia) and IBM (Armonk, New York) to change how hospitals and physicians store and access digital mammography images. The company now has developed MyNDMA, a personal health management portal that allows women around the U.S. to have access to and control their own electronic health records. One month following the launch of the portal, nearly 1,200 women had registered profiles and were managing their mammography records through MyNDMA.

Computer-aided detection

Computer-aided detection (CAD) software now is ubiquitous on the RSNA exhibit floor, sometimes offered in standalone format and often integrated into an existing image management system. But CAD capabilities are not yet widely accepted or notably commercially successful. So the positioning of a CAD product from Riverain Medical (Miamisburg, Ohio) is interesting for two reasons. First, it claims to address a huge unmet need – early detection of lung cancer. Second, as reported in last month’s issue, the American Medical Association (Chicago) has issued a CPT code covering chest X-ray CAD, and in October a reimbursement fee schedule was published for the code, a first for a radiological Category III code. One could reasonably expect this reimbursement determination to stimulate sales of the Riverain product line – the RapidScreen RS-2000 and RS-2000 D – and to stimulate radiologist and clinician acceptance of CAD generally.

The RapidScreen 2000 works with film-based chest X-rays; it was the first and still the only FDA-approved CAD for lung cancer. The newer RapidScreen 2000 D works with chest X-ray images either created or stored digitally. In clinical trials reviewed by the FDA, radiologists using RapidScreen technology demonstrated a 21% increase in detection efficiency of solitary pulmonary nodules ranging in size from 9 mm to 14 mm.

In a related development, I-MED Medical Imaging Lab (Torino, Italy) revealed the first commercially available CAD solution for colon cancer, CAD Colon. The company claims the software, which has not been cleared by FDA, can identify 85% of polyps 5 mm in size and greater. The effects of these developments on CAD adoption certainly bear watching.

Computed tomography imaging

The leading modality suppliers all emphasized 64-slice computed tomography (CT) machines (and hinted at more slices to come) with an emphasis on cardiac imaging in what is arguably the most pervasive theme on the exhibit floor. Of course these vendors are happy to sell these systems to cardiologists or radiologists, but their main targets at RSNA are the latter.

Siemens unveiled its new dual-source CT system, named Somatom Definition, on the RSNA exhibit floor. The method utilizes two X-ray sources at different wavelengths and two detectors simultaneously. According to the company, at 0.33 second per rotation, ECG-synchronized imaging can be performed with 83-millisecond temporal resolution, independent of heart rate, resulting in motion-free cardiac images. Clearly, this innovation, four years in the making, is targeted primarily at heart imaging. The system should be capable of imaging patients even with high or irregular heart rates, even arrhythmias, without the beta blocker drugs previously required to slow a patient’s heart and with less radiation exposure than current CT angiography studies. Siemens contemplates applications in acute care for assessment of patients with acute chest pain, abdominal pain and stroke symptoms. The new system is FDA-approved, and initial U.S. installations are scheduled for mid-2006.

An interesting mobile CT scanner was exhibited by NeuroLogica (Danvers, Massachusetts), a machine initially targeted at scanning the head and neck. It has a 25-centimeter field of view and generates up to 8 slices per revolution. The so-called CereTom also features wireless image transfer for enhanced flexibility in site of use, ostensibly including ERs, ORs, and various intensive care units. The scanner is less than one yard in length, slightly more than 5 feet tall and about 4 feet wide, weighing in at about 700 pounds. FDA clearance was obtained in July 2005. One of the company’s co-founders, Bernard Gordon, is best known for his founding and stewardship of imaging-technology leader Analogic (Peabody, Massachusetts) for several decades.

An equally interesting dental CT scanner was shown by TeraRecon (San Mateo, California) as a work in progress. Dental CT is a 3D cone-beam CT system featuring reconstructed CT slice inspection, high-resolution volumetric imaging, cut plane, and see-through functions for accurate dental implant planning and placement, orthodontic investigation and improved general dental imaging for diagnosing complications.

Magnetic resonance imaging

MRI developments exhibited on the RSNA floor focused on improvements to existing scanners, introduction of 3-tesla machines, and extremity scanning. GE Healthcare displayed three new scanners in its Signa HD line: two 1.5-tesla models and a 3-tesla machine. Siemens unveiled enhancements to its 3-tesla Magnetom Trio products and its ultrawide-bore, 1.5-tesla Magnetom Espree MRI. The latter offering generated especially high interest throughout the show.

Hologic signaled its broadening interests beyond mammography and bone densitometry with the introduction of an MRI scanner for extremity imaging manufactured by Esaote (Geneva, Italy), a leader in dedicated MRI systems. Hologic had earlier reported its first sale of the system in the U.S. Increasingly popular extremity MRI systems are designed to provide a more comfortable, less imposing patient experience compared to full-body systems.

Bruker Biospin MRI (Billerica, Massachusetts) unveiled its new ClinScan 7-tesla scanner for research, drug discovery and pre-clinical small-animal imaging applications.

Digital radiography

Digital radiography (DR) marches ahead as more and more radiology practices and clinical departments “go digital” to exploit its compelling benefits, notably easy PACS compatibility and image archiving. But new developments reflect modest, evolutionary change, not dramatic departures. Hologic featured InSight, a new small C-arm X-ray system, reinforcing that firm’s growing product-line diversity.

Likewise, Shimadzu unveiled its new Mobile DaRt digital portable X-ray scanner. And Eastman Kodak (Rochester, New York) demonstrated a new multi-purpose DR platform, the DirectView DR 3000, as a work in progress.

Flat-panel sensors are the heart of DR technology, and new sensor panels were featured by Canon Medical Systems (Irvine, California) and Swissray International (Elizabeth, New Jersey).

Ultrasound imaging

Along with a continuing trend toward more 3-D and 4-D penetration at the market’s high end, ultrasound modality suppliers are paying attention to decreasing procedural reimbursements by targeting lower price points, portability and point-of-care scanning. A good example of this trend is a new compact ultrasound system demonstrated for the first time, Voyager by Ardent Sound (Mesa, Arizona). This system treats an ultrasound scanner more like a laptop computer peripheral than a typical ultrasound machine. The company calls its approach “Plug and Know”: connect the probe by means of a USB interface cable, install the software, and generate real-time ultrasound images. And, the vendor compares its image quality to scanners costing ten times as much or more.

Visualization and image management

Newcomer True Life Anatomy (Adelaide, Australia) aims to bring 3-D images to the clinician’s desktop, freeing them from workstations in the radiology department. Using this technology, images can be exported from the radiology service for 3D interactive viewing on most standard PCs. The TLA software suite includes the 3D generator (from CT or MRI scan slice data), the viewer and an animator to create motion files simulating a virtual camera in 3-D space. Along similar lines, Medweb (San Francisco) unveiled its 3-D Web PACS at the exhibit. This product allows users of standard PCs to take advantage of 3-D templating and auto-segmenting of image data from spiral CT scanners. According to the vendor, this new product can be easily integrated into a conventional PACS infrastructure for a fraction of the price of a dedicated workstation.

Another Oceanic company, WinScribe (Auckland, New Zealand) capably displayed its dictation workflow management system. According to this supplier, users of WinScribe software can dictate anywhere, anytime and have their dictation automatically routed to the relevant transcription staff, wherever they are located. Increasingly, however, users are adopting an alternative feature of the system to utilize high-performance speech recognition in lieu of transcription. Current performance levels have improved dramatically, yielding speech recognition as a viable option. The company can host the application as a service, or the software system can be hosted at any user site.

Vital Images (Minnetonka, Minnesota), a provider of enterprise-wide advanced visualization and analysis software for screening, diagnosis and therapy planning, announced its comprehensive ViTAL Solutions portfolio at RSNA. The company highlighted its rendering performance, workflow capabilities and web-based analysis and distribution features. The firm’s baseline Vitrea software creates 2-D, 3-D and 4-D images of human anatomy from CT, MRI and PET image data.

Amicas (Boston) showcased its comprehensive suite of imaging IT solutions. The company is a pioneer of web-based PACS, and this methodology for delivering and storing images remains the touchstone of its approach. Among other offerings at RSNA, it unveiled its new Vision Reach software system, a module of its Vision Series PACS. Vision Reach is a tool designed for referring physicians, including a portal that supports physician group practices and “on call” schedules for referring physicians. The portal provides a complete visual record of the patient’s history, reports and images available on any Blackberry-type device.

Finally, EMC (Hopkinton, Massachusetts) demonstrated some new radiological archive products on the exhibit floor. These included a four-node version of its Centera content-addressable storage system, the next generation of its Documentum enterprise content management platform, new versions of its Clarion networked storage systems, and its next-generation Clarion disk library.

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