CAD products look at processes as well as structures

Now that computer-aided detection systems are increasingly accepted in radiology, software developers are creating new algorithms to focus on pathological processes while fine-tuning existing ones to better define disease targets. Companies that operate in the breast MR market are tailoring products to look for physiological parameters, including permeability and cellular density, angiogenesis, and contrast enhancement patterns. Mammography CAD developers are easing the transition from analog to digital scanning by overcoming glitches that complicate the comparison of prior and current images, such as size and resolution. Colon and lung CAD providers are offering automatic volumetric and size calculations.

CAD Sciences

Originally named after its 3TP (three time point) software program, which compares MR signal intensities at three different points in time, the company changed its name to CAD Sciences to reflect its broadening technological base. Two products shown at the RSNA meeting rely on proprietary fTP+ (full time point) analysis, which calculates physiological parameters associated with breast and prostate cancer.

• Breast Pharmacokinetic Analysis integrates with parallel imaging interventional breast coil systems and includes programming that eliminates cardiac artifact.

• ProStream can be used without an endorectal coil for the detection of cancer. The software also may be used with an endorectal coil for staging disease.

Cedara Software

A subsidiary of Merge Healthcare since mid-2005, Cedara concentrates on custom engineering applications and tools for medical imaging OEMs and international markets. In the CAD arena, Cedara announced the market release of B-CAD, a CAD system for breast ultrasound that was shown as a work-in-progress last year.

• B-CAD 1.0 offers tools for automatic image analysis, segmentation, and classification of sonographic findings. It is designed to function as a stand-alone product, part of an existing OEM application, or an integrated element in PACS environments.

Confirma

A pacesetter in developing CAD systems for the analysis and interpretation of breast MRI, Confirma showed an expanded version of SureLoc, its tool for MRI-guided breast interventions, as well as a new storage and retrieval option and a visualization method for evaluating contrast enhancement patterns. The company also displayed its flagship CADstream product, which optimizes registration by eliminating cardiac artifact, produces angiogenesis maps and curves, and creates volume characterizations, including 3D volume renderings, diameter measurements, location specifics, and the BI-RADS Atlas lexicon for classification of each lesion in an MRI study.

• SureLoc reports the needle target for both grid and pillar methods in real-time and displays images and needle position in the patient's orientation.

• CADalog saves CADstream studies with a CADalyst user interface, retrieves studies on demand, and allows users to view and compare previous and current studies.

• The z3D Contrast Acuity option uses 3D graphics to visualize dynamic series, subtractions, and morphology and provides animations that can help radiologists interpret contrast enhancement patterns within the breast.

DOBI Medical International

A development stage company, DOBI is focused on improving the diagnosis of high-risk and malignant breast disease by identifying abnormal vascularization associated with tumors. Its DOBI (dynamic optical breast imaging) system is highly sensitive to the differential light-transmission properties of abnormal vascularization after application of an external pressure stimulus. The company is selling the ComfortScan System outside the U.S. and has begun clinical trials in anticipation of submitting the product to the FDA for approval.

• ComfortScan uses high-intensity light-emitting diodes (LED) and gentle external pressure to highlight areas of abnormal vascularization in the breast. It consists of a CCD camera, soft breast holder, LED illuminators, operator display, and proprietary software designed to visualize angiogenesis and target abnormal vascular beds.

Eastman Kodak

Based on technology it acquired a year ago from MiraMedica, Eastman Kodak introduced a film-based mammography CAD product using a digitizer that takes 2.5 minutes to scan four films and allows imaging facilities to input about 25 cases per hour. Eastman Kodak also showed at the RSNA meeting a work-in-progress CAD solution for bone mineral density testing. The software issues a report on a patient's bone density based on an x-ray of the hand using the same film and x-ray unit as a mammogram.

iCAD

The company offers a range of products addressing light to heavy volumes in mammography. Standard-bearers include the SecondLook 700 for high-volume centers, a CAD system that scans films and analyzes and stores images in a single console. Conversely, the ClickCAD program allows mammography centers with a relatively light volume to use iCAD equipment without purchasing it, so long as they share the reimbursement.

• TotaLook was showcased at the RSNA meeting. It offers an advanced form of film-to-digital conversion, automatically adjusting digitized images to allow comparison of past and current studies on the same workstation. It automatically retrieves and receives patient information from HL7 or DICOM work lists, digitizes standard mammography films in 23 seconds, and captures the full fidelity of original film mammograms.

• PureLook is a film-to-digital acquisition module for the TotaLook and SecondLook product lines. It incorporates iCAD's patented CIS device technology, which reduces image aberrations and flows and improves spatial resolution by eliminating mirrors and traditional lenses. PureLook is true to original mammograms at 42.3-micron spot size and up to 12 line pair per millimeter resolution in 16-bit gray scale and can scan small films in 23 seconds.

iMED Medical Imaging Lab

A Torino, Italy-based developer of advanced CAD products, iMED Medical Imaging Lab showcased its first product, CADColon at the RSNA meeting. The system includes a high-end computer designed to process data quickly and efficiently, a high-resolution 24-inch monitor to display 2D and 3D reconstructions, measurements, and data, and a user-friendly graphical interface.

• CADColon tags polyps in both 2D and 3D, automatically calculates the dimension of each polyp, simultaneously navigates in both prone and supine CT scans, and automatically updates each view in 2D and 3D. It features a virtual camera to provide a more detailed view of selected points of interest and classifies suspicious areas.

Invivo

A subsidiary of Intermagnetics General, Invivo has entered into a strategic partnership with Siemens Medical Solutions that will incorporate its DynaCAD system for breast MRI into Siemens' Magnetom MR product line. DynaCAD has five functional modules. DynaMatch suppresses image motion artifacts and automatically performs subtraction on 2D and 3D images. DynaMap provides color parameter maps that visualize changes in MRI signal intensity. DynaMIP produces dynamic MIP for interactive functional 3D visualization. DynaFlow gives interactive access to time-intensity curve data. DynaLoc automatically calculates target coordinates for MRI interventions. New features include an automatic search option that seeks out the most suspicious regions of interest, has improved configurations for archiving, and exports options in multiple formats.

• DynaCAD neuro is a work-in-progress system for perfusion/diffusion that targets MRI angiogenesis. It offers 3D segmentation, conducts advanced volumetric analysis, and integrates with functional MRI.

Medicsight

A developer of CAD products that allow radiologists to review images and CAD findings at the same time, Medicsight displayed its application versions of the ColonCAD and LungCAD products. Both incorporate a "sphericity" threshold that can be set manually to discriminate between actual pathology and morphologic features that may interfere with interpretation, such as blood vessels in the lung and retained stool or haustral folds in the colon.

• ColonCAD makes use of a polyp-enhanced filter (PEF), which identifies defects that protrude into the lumen of the colon and highlights areas of the colon wall that have suspicious raised spherical regions so they may be further investigated.

• LungCAD has the nodule-enhanced filter (NEF), which marks defects and spherical regions in the lung.

R2 Technology

R2 Technology has teamed with Swedish workstation leader Sectra to produce a "CAD-intelligent" system that optimizes the presentation of CAD information on mammographic images. The companies jointly launched the Citra Mammography Applications Suite at the RSNA meeting.

• Citra software tools include RightSize Optimized Temporal Comparison, which automatically and optimally scales current mammograms to the display window and matches the previous mammogram size with the current image. It can scale images obtained from different full-field digital mammography systems that have different detector sizes and acquisition resolutions, compare prior digitized films using R2's DigitalNow software with current digital mammography images, and reconcile two sets of images that were acquired with different compression paddles.

• ImageChecker Version 8.1 Mammography CAD system, available across the company's mammography CAD product line and to its installed base as an upgrade, offers flexible operating points so radiologists can choose different sensitivity and false marker rates for masses and microcalcifications. The upgrade also offers two other major features. Malc Mark identifies regions of breast tissue that contain both a mass and calcifications. EmphaSize features variable-size CAD marks that correlate in size to the potential for malignancy: Small marks reflect a lower chance of malignancy, and large marks indicate more suspicious findings.

Riverain Medical

To its RapidScreen CAD system for chest radiography, Riverain Medical has added new functionalities to reduce the false-positive rates of detection of solitary lung nodules in regions of interest located in the hilar area and near the ribs. The company also is testing a dual-energy subtraction CAD system to find suspicious lesions in difficult-to-see areas on chest scans.

• Lateral CAD and rib-over-rib upgrades have been added to a new version of the RapidScreen early cancer detection CAD system, which is pending premarket approval by the FDA. Both lateral CAD and the rib-over-rib feature aim to reduce the rate of redundant regions of interest that are similar to and may be confused with solitary pulmonary nodules.

• A dual-energy subtraction option is a work-in-progress targeted at the 400 to 500 digital radiography chest systems currently on the market.

Siemens Medical Solutions

Although Siemens has partnered with a number of vendors to include CAD in its imaging equipment, the company also is developing its own CAD products.

• The syngo Colongraphy with PEV (polyp-enhanced viewing) is an automated second reader for visualization of lesions. It runs at the same time as the primary read and provides results as soon as the primary read has been completed. It automatically takes measurements of polyps and marks lesions with customizable tools.

• The syngo LungCare CT NEV (nodule-enhanced viewing) features 3D visualization with thin slabs using MPR, MIP, and VRT displays, automatic segmentation of lung nodules, automatic volume and diameter measurements, and visualization of segmented nodules with perspective VRT display or MPR techniques.