A Diagnostics & Imaging Week

CHICAGO – Big companies and small, the firms offering products and services to the medical imaging sector have crowded the exhibit floor at the 91st annual meeting of the Radiological Society of North America (RSNA; Oak Brook, Illinois) in their efforts to catch the attention of attendees at the huge conference.

More than 26,000 persons are expected to attend this year’s gathering at the lakefront McCormick Place convention center by the time RSNA draws to a close on Friday.

One of the biggest players in the sector, Siemens Medical Solutions (Malvern, Pennsylvania), is featuring the syngo Suite, which it said is the foundation of an integrated workflow environment that forms the basis of a true electronic health record (EHR).

Siemens said that with the syngo Suite, image acquisition, radiology information system (RIS), picture archiving and communication system (PACS) and post-processing “come together with the clinical and administrative cycles addressed by Soarian, [our] new-generation health information solution.”

The company said Soarian features a longitudinal clinical repository “that gives clinicians browser-based, real-time access to the complete patient record, including patient histories, demographics, allergies, results and images.”

Tom Miller, president of Siemens Medical Solutions’ Healthcare IT Division, said, “Siemens understood the importance of integrating imaging and IT workflow early on, embarking upon a trendsetting strategy. With the syngo Suite and Soarian, we are ... helping to advance accurate, quick diagnoses and early disease detection.”

With syngo, all imaging workflow – from scheduling to viewing and reporting – is available at the referring physician and radiologist’s fingertips, Siemens said.

The syngo Suite includes syngo Imaging, Siemens’ radiology PACS, which the company said is scalable to meet the image volume needs of everything from large academic medical centers to smaller diagnostic imaging facilities. The company said the solution features “specialized workplaces; Smart Select, a patented navigational tool; dynamic loading and intelligent layout enhancements to speed image reading; tight integration of all components and advanced post-processing functions.”

Also featured is syngo Workflow, which Siemens said “drives the complete radiological workflow from order entry to image and report distribution.” It said that “more efficient radiological diagnoses and interpretation are supported via new integrated referring physician and radiologist portals that combine the traditional information located in a HIS, RIS and PACS into a single user interface and workspace.”

The product package also includes syngo Dynamics, a multi-modality, dynamic image review, diagnosis and archiving system, which Siemens said “[enables] evidence-based reporting to help improve the efficiency of clinical procedures for cardiology, general imaging and ob/gyn.”

The company said the solution is scalable for imaging clinics, hospitals and multi-facility health enterprises and features optional interfacing to clinical or hospital information systems.

Siemens also said that through its strategic partnership with NextGen Healthcare Information Systems (Horsham, Pennsylvania), a provider of ambulatory EHR and electronic practice management (EPM) software, it provides an end-to-end workflow solution for standalone diagnostic imaging centers.

The companies achieved the first “go live” of Siemens RIS/PACS integrated with the NextGen EPM system at Galen Medical Group (Chattanooga, Tennessee) in October.

“There is much being said about the need for greater IT adoption in healthcare and the integration of imaging and IT, but Siemens is the vendor that is making it happen and meeting our business model needs today,” said James Busch, MD, director of Specialty Networks, the application service provider for the Galen Medical Group. “From a standalone imaging center perspective, having RIS/PACS interoperating with an EPM system provides a complete solution for managing our imaging workflow. That is what we achieve through our Siemens partnership.”

In its collaboration with Siemens, Specialty Networks said it expects to bring at least nine other diagnostic imaging center customers live on the Siemens/NextGen solution in the coming year.

For its part, the Philips Medical Systems (Andover, Massachusetts) unit of Royal Philips Electronics is using patient case studies to emphasize the seamless operation and connectivity of its radiology portfolio, which includes both advanced imaging technology and information management systems.

Philips is highlighting “Ana” and her family, anonymous patients whose personal medical history is told through diagnostic images and medical data throughout the company’s booth. The company said the case study of Ana and her family highlights “the real patient benefits of medical environments that are fully integrated across the radiology spectrum.”

Brent Shafer, executive vice president and CEO, North America, for Philips Medical Systems, said, “Our technology portfolio clearly illustrates how the advanced new radiology solutions we are introducing this year, and have in past years, all integrate into the patient care cycle, allowing clinicians to focus on their patients.”

Among the new products being introduced this year is Philips Smart Exam, which the company calls “a breakthrough in magnetic resonance (MR) enabling improved workflow efficiencies and clinical scan quality.”

Other include Philips Brilliance Workspace Portal and Halo, computed tomography (CT) products that address patient throughput and comfort, and Philips PET/CT Viewer, available on the Extended Brilliance Workspace, an intuitive PET/CT viewing environment that the company said “can easily adapt to the productivity needs of individual users, substantially improving workflow and efficiency for routine clinical review.”

At the Philips booth, attendees are viewing Ana and her physician’s interaction around a CT scan of her hip after complaints of recurrent pain. It also showcases how other diagnostic tools – including Precedence SPECT/CT, Allura Xper FD20 and DigitalDiagnost – are used to help diagnose Ana’s brother, who suffers from liver disease, and her father, who has neurological issues. The scenario also includes data management issues for the administrator monitoring the family’s care.

Philips’ SmartExam represents what the company said is “a major innovation in MR workflow.” Typically, MR examinations require multiple scans that result in a series of images, each with its own characteristics, assisting the physician in making a diagnosis. With SmartExam, clinicians and technologists have automatic planning, scanning and processing available through a single mouse-click. The new tool offers consistency and reproducibility of scan results, creating optimized scan quality.

The customizable system enables shorter total examination times for patients, while radiologists capture consistent reproducible clinical results, without operator variability. SmartExam also has the flexibility to perform MR exams defined by the user, tailored to the user’s own conventions and practices.

Currently available on Philips Achieva 3.0T, Achieva 1.5T and Panorama 1.0T scanners, the SmartExam tool can also be applied to previously installed Philips MR systems.

Philips also has unveiled two technological innovations that it said portray a “stunning vision” about the future of CT. The first, already in clinical trial at Hadassah Medical Organization (Jerusalem), is a new Simultaneous Multi Energy detector. The new detector is made up of layers designed to simultaneously detect both low-energy (soft) and high-energy (hard) X-rays.

Philips said simultaneous imaging of both soft and hard radiation promises to “dramatically improve” tissue characterization. Simultaneous Multi Energy detectors do not require a second beam of radiation and thus avoid the potential pitfalls of time lag, registration artifacts and unnecessary radiation dose.

“Our goal is to differentiate soft and hard plaque,” said John Steidley, PhD, vice president of global CT marketing for Philips Medical Systems. “First images from the Simultaneous Multi Energy detector show better soft tissue contrast, simplify the process of removing bone and calcium plaque for CT angiography and reduce calcium blurring artifacts.”

The second major innovation cited by the company is a new full-coverage detector platform based on Nano-Panel technology that will image an entire organ, such as the heart or head, in a single rotation. Philips said this new detector is based on tiles that can be integrated into panels of any size, and thus, it noted, finally “breaking the slice barrier” of conventional CT scanner technology.

The new PET/CT Viewer available on the Extended Brilliance Workspace offers PET/CT users complete access to the full suite of positron emission tomography and computed tomography clinical applications. The company said this comprehensive package can adapt to the productivity needs of individual users, improving workflow and efficiency for routine clinical review.

The new workspace provides PET users with a truly integrated, powerful, yet simple image review and analysis environment for routine clinical evaluation of PET/CT examinations.

Being shown at RSNA for the first time and now available in North America, Practix Convenio is a fully motorized, mobile X-ray system combining advanced technology with a wide range of mobility. Philips said the battery-powered Practix Convenio offers “robust” electrical and technical concepts by combining “cutting-edge” technology with extensive mobility.

Also being shown for the first time at this week’s meeting is the DigitalDiagnost Compact, a step-in solution for direct digital radiography that features a 17” x 17” flat detector mounted on a fixed multi-purpose stand.

Another of the big imaging companies, Toshiba America Medical Systems (TAMS; Tustin, California) reported its newest innovations in ultrasound – expanded Differential Tissue Harmonic Imaging (DTHI) for its Aplio ultrasound system and 4-D imaging for the Xario ultrasound system.

Both techniques are being demonstrated for the first time at this year’s meeting.

“The continual advancement of enhanced imaging applications for ultrasound further reinforces Toshiba’s ongoing commitment to developing applications that improve diagnostic confidence and streamline clinical workflow,” said Gordon Parhar, director of TAMS’ Ultrasound Business Unit.

He cited the steady adoption rate of the company’s premium and high-end ultrasound systems. “In fact,” said Parhar, “we have shipped more than 1,500 Xario systems globally since its introduction to the market in October 2004, and our Aplio system remains extremely popular, with more than 4,000 units shipped globally since 2001.”

Expanded DTHI is Toshiba’s second-generation DTHI technology and the latest addition to the Aplio XV premium package. Featuring what the company termed “dramatic improvements in image resolution,” DTHI delivers quality images, TAMS said, and can accommodate larger patients who previously could not be imaged using ultrasound technology.

The company said that expanded DTHI has been proven to “significantly improve” efficiency when evaluated in clinical practice.

Showing for the first time at RSNA and now available on the Xario ultrasound system, 4-D technology is designed to improve departmental efficiency, while enhancing user and patient comfort. Toshiba America said 4-D “is ideal for multispecialty practices that require high-quality, 3-D images of the internal anatomy viewed in real time.”

It said that 4-D technology “allows clinicians to increase success rates using automated 4-D volume acquisition with the touch of a button and enables simultaneous display of 2-D and continuously updated 4-D volume images.”

TAMS also has introduced a new “large-bore” computed tomography (CT) scanner specifically designed for cancer patients. The Aquilion LB CT scanner has a larger-than-normal opening so that radiation oncologists can move their patients into crucial exam positions without being limited by the size of the scanner’s opening, as with other models. That will allow them to capture “the most accurate images possible and position the patient for optimal treatment,” the company said. “They then can use these images to better detect, localize and treat tumors during radiation therapy.”

With the new scanner, radiation oncologists can move patients, particularly those with breast and lung cancer, into the positions needed to get the best images possible to precisely locate and measure the size and position of a patient’s tumor. “The scanner then sends this information electronically to the radiation therapy machine, which mirrors the exact location and size of the tumor when delivering radiation beams,” TAMS said.

The company said that until now, one of the main challenges faced by radiation oncologists in scanning cancer patients has been the dimensions of the CT scanner. While a traditional scanner’s opening is 70 cm (27 inches), the size of the Aquilion LB’s opening is 90 cm (35 inches), making it possible to much more accurately scan cancer patients in a variety of positions. With the Aquilion LB, patients with breast cancer, for instance, can now easily and comfortably place their arms over their heads or at other necessary angles, positions usually not possible with a traditional CT scanner, which requires patients to keep their arms at their sides.

Because of its larger opening, the Aquilion LB, which is a full diagnostic CT scanner, also can be used for larger patients having bariatric surgery and trauma patients. The increased access to the patient is important when doing interventional procedures, such as needle biopsies, CT-guided drainage and tumor ablation.

Toshiba received FDA marketing clearance for the Aquilion LB CT scanner in March and has installed the first scanner at Beth Israel Deaconess Medical Center (Bos-ton). It said that the new scanner should be “widely available” at hospitals and medical imaging centers around the country within six months.