RSNA preview: back to basics on exhibit floor

The bread and butter modalities of radiology, radiography and ultrasound, will be among the standouts of RSNA 2010. Underlying their popularity will be technical advances in detector technology and a palpable need for ways to cut patient exposure to radiation. This need will be seen also in CT vendors’ delivery of all things low-dose.

Protocols that get the most from every x-ray and high-tech algorithms that delete noise will drive modalities that rely on ionizing radiation at this year’s show. CT will be joined by other modalities as vendors anticipate the spread of dose concerns. Some will bring to bear unusual technological combinations to cut dose; for example, cardiac cath and ultrasound-and even MR-as an alternative to CT in hybrid scans.

The need for increased efficiency will continue to ripple across radiology as it has since the start of the great recession, leading the community to seek better and lower cost ways to mange patients. This year, as in years past, this need will be satisfied in large part by offerings in information technology.

WIRELESS DR STEPS UP

When the gatekeepers clear the way to the exhibit halls at McCormick Place, Canon USA will be front and center with its CXDI-70C Wireless Digital Radiography System. The product received FDA clearance for marketing in the U.S. this summer and was first shown at the Association for Medical Imaging Management (AHRA, formerly Ameri-can Healthcare Radiology Administrators) annual meeting in August. The portable detector weighs 7.5 pounds and offers a 14 x 17-inch imaging area. It incorporates a new Canon-developed glass substrate with a pixel pitch of 125 microns, realizing a higher resolution compared with the company’s current 160-micron pixel pitch DR systems. The CXDI-70C Wireless features a cesium iodide scintillator, which delivers high-quality images while reducing the x-ray exposure to the patient. Without the cable required by its predecessors, Canon CXDI-55G and CXDI-55C, the newly available wireless DR detector enables handling similar to that of film-cassette x-ray systems with the immediacy of digital imaging.

Carestream will showcase the latest model of its wireless DR detector, the DRX-1C. The cassette-sized DR detector delivers improved detective quantum efficiency thanks to its cesium iodide scintillator. Designed for general radiography exams including orthopedic, trauma, pediatric, and other specialty environments, it uses the same battery and electronics as Carestream’s initially released DRX-1 detector. It can be used with the other DRX-based imaging solutions: DRX-Evolution radiography suite, DRX-1 System for upgrading analog radiography rooms, and DRX-Mobile Retrofit kit for upgrading mobile x-ray units.

Fuji Medical USA will be talking up its FDR D-EVO flat-panel detector as the modern way to turn analog radiography systems digital. The 14 x 17-inch detector, which is not wireless, began shipping to U.S. sites in late August. Images are transmitted to the technologist’s workstation in as little as three seconds with nine-second cycle times between exposures.

Agfa will showcase its DX-D 100, a portable DR new to the U.S. market. The heavy-duty mobile system was shown earlier this year as a work-in-progress at the European Congress of Radiology. It features a 15-inch touchscreen; is compatible with Agfa’s portable DR detectors, including the DX-D 20G; and runs MUSICA2 image processing software.

Computed radiography will remain a viable alternative to DR-particularly for cost-constrained customers-say vendors, who will continue developing the technology. Carestream will show a new tabletop CR, the DirectView Vita CR System, primarily for use in independent imaging centers, clinics, and multiphysician offices, as well as chiropractic and veterinary facilities. In November, the Vita CR system will be available for bundling with optional Image Suite software to create a mini-PACS solution that includes digital image capture, viewing, printing, storage, and management. Image Suite allows users to interface with other digital imaging modalities. It runs on a broad range of PC-based workstations with either standard or high-resolution monitors for reading.

ITERATIVE RECONSTRUCTION

GE’s ASIR (adaptive statistical iterative reconstruction) technology will take center stage as a means to reduce patient x-ray dose by up to 50% on the company’s Discovery CT750 HD and LightSpeed VCT. ASIR is now running on more than 450 scanners worldwide, cutting dose for more than 10,000 patients per day, according to the company. GE competitors will make similar claims for their proprietary versions of iterative reconstruction: Siemens IRIS and Philips’ iDOSE.

Toshiba will bring to RSNA 2010 its adaptive iterative dose reduction (AIDR) for high-end CT dose reductions. The company showcased the product for cardiac CT exams done on its Aquilion One, Aquilion Premium, and all its 64-detector row CT scanners at the European Society of Cardiology Congress in Stockholm, Sweden, in late August. AIDR remains a work-in-progress in the U.S., pending FDA clearance. It will be accompanied by Target CTA, a cardiac protocol for reducing dose on the Aquilion One. The company will also spotlight its work-in-progress 160-detector row helical scanning technology on the Aquilion One and Aquilion Premium, allowing full chest, abdomen, and pelvis scanning in less than five seconds.

GE will port developments in iterative reconstruction for CT to nuclear medicine with the unveiling of its SharpIR, an iterative reconstruction enhancement compatible with the company’s Discovery PET/CT 600 scanners. The CT version, ASIR, will be ported also to PET/CT and SPECT/CT scanners in the GE portfolio to minimize CT dose.

Software is not the only way to cut x-ray dose. One alternative is to pair a modality that uses ionizing radiation with one that does not. Phillips will follow this path by integrating ultrasound and cardiac cath. The ultrasound will allow real-time imaging and measurements in the context of hold-frame cardiac cath images.

Following this idea of integration, Philips will also show progress in its fusion of MR and PET onboard a work-in-progress hybrid scanner.

After its launch last year in Europe, GE’s hybrid SPECT/CT will be shown at this RSNA meeting for sale in the U.S. The company announced in early October that the system, dubbed the Discovery NM/CT 670, had cleared the FDA. The system combines GE Healthcare’s BrightSpeed Elite 16-slice CT, a newly designed SPECT gantry that optimizes positioning flexibility, and recent advances in nuclear medicine detectors. GE will promote the product as having the potential to shorten acquisition times, improve dose management, and enable more convenient patient scheduling compared with separate conventional SPECT and CT exams.

Philips’ iU22 premium ultrasound system will get a boost from its newly minted xMatrix technology, which enhances 2D image quality while generating 3D images. The X6-1 PureWave xMatrix transducer drives this technology into the clinical arena, allowing users to view two planes simultaneously without moving or rotating the transducer, capturing volume images in less than a second and sending 3D multiplanar reconstructions to any PACS.

Toshiba will emphasize developments made in compact ultrasound technology, namely its laptop-sized Viamo. Upgrades will enhance image quality, as well as provide high-frequency acquisition. A tightly curved transducer will be added along with DICOM structured reporting.

Celebrating the installation of its 1000th MR system, Toshiba will showcase its Toshiba Vantage Atlas MR for general radiology imaging, including both cardiac and neuro imaging, while showing a 3T work-in-progress. Philips will showcase a work-in-progress that represents the “next generation” in MR imaging for the company, according to a Philips representative. The firm will also configure its Panorama HFO (high-field open) scanner for oncology, enabling MR scanning of patients in a treatment position, as well as for taking MR-guided biopsies and inserting radioactive seeds for brachytherapy.

WHAT CUSTOMERS WANT

Advances in information technology will bring images from PACS to consumer-driven handhelds. Carestream will show as a work-in-progress a zero-footprint, web-based portal that will allow remote users to view images and patient data on Windows- and Macintosh-based computers, as well as mobile devices, such as iPads. The portal is designed to link with hospital information and electronic health records systems. It will connect with Carestream’s vendor-neutral Clinical Data Archive and be able to integrate with Carestream SuperPACS Architecture to enable zero-footprint image access by clinicians and referring physicians.

GE’s Centricity PACS will arrive in Chicago with version 3.2, offering integration with Centricity Enterprise Archive 4.0 as well as a range of as yet undisclosed features the company says will reflect customer wants and needs. Optionally, Centricity PACS 3.2 will include support for GE Healthcare’s web-based diagnostic viewer, Centricity PACS Web Diagnostic (Web DX 2.0) with embedded MIP/MPR. The latest version will also allow configuration with AW Server, 3D advanced clinical applications for areas such as cardiology and oncology, and server virtualization using VMware.

Merge will emphasize its vendor-neutral archiving platform, Merge ECM, and its Clinician Access Portal for zero-client distribution of images and reports to any browser-enabled device, including the iPad and iPhone. Merge ECM is designed to integrate clinical specialty imaging. The company will also spotlight its Merge iConnect for sharing images among healthcare providers and integrating medical imaging into broader HIT applications.

Syngo.via, which is pending FDA clearance, and syngo.plaza PACS will take point for information technology offerings by Siemens. Siemens’ syngo.via software supports multimodality reading of clinical cases, using automated case preparation and structured case navigation to cut through inefficiencies across multiple specialties, including cardiology, oncology, and neurology, according to the company. The software, which is designed to integrate with existing PACS and RIS of all major vendors, allows access to state-of-the-art advanced visualization tools. Siemens PACS, syngo.plaza, offers a preconfigured intuitive interface and a customizable viewing mode that allows users to define and use layouts they choose.

With September’s unanimous finding by the FDA’s Radiological Devices Panel that Hologic’s digital mammography tomosynthesis system is effective and safe, Hologic will be in position to cautiously present Selenia Dimensions at the RSNA meeting as the digital mammography system of the future. The 3D mammography product is already sold outside the U.S. for volumetric use and in the U.S. for 2D applications. If FDA reviewers agree with their advisory panel and remaining issues are worked out with Hologic, Selenia Dimensions could be on the U.S. market as a breast tomo product early next year.

Sectra will be pushing its Sectra MicroDose Mammography systems at the upcoming meeting as part of a financial initiative to boost its profit margin to at least 15% and achieve 15% annual growth over a seven-year period. To meet those goals, market shares and sales volumes of the mammography product must increase, according to the company. Version 8.3, scheduled to be unveiled at the show, will grease the financial skids. This version will include a laser-based needle examination add-on to localize lesions for preoperative planning, detector enhancements that increase dose efficiency and image quality, and support for remote monitoring to improve proactive service.