Siemens sees golden opportunities in x-ray

While some competitors are restructuring or even selling their holdings in radiography and R&F, Siemens Medical Systems has been expanding its line of these products. The German company has quietly assembled a range of advanced products that address virtually every customer, from group practitioners and clinics to university hospitals.

The evolution of this strategy has depended less on 21st century technology than on ergonomics. Efficiency and productivity have been the keys.

"Our major strength in being a 100-year-old company working in radiography is that we've designed systems in which workflow is integrated so that the only things our customers have to do is position patients and press buttons," said Kurt Reif, Siemens product manager for digital and analog radiography.

Siemens has not shied away from developing or implementing flat-panel detectors. Trixell, a joint venture among Siemens, Philips, and Thomson Tubes Electroniques, provides the amorphous silicon detectors to fill market demand for flat detector (FD) systems. But Siemens has promoted these systems only when the technology addressed a practical need.

Thorax FD, a dedicated chest unit, and Multix FD, a table-based bucky system, were designed to address conventional radiographic needs with digital technologies. Flat-panel detectors from Trixell capture the data. Trixell detectors are also built into Vertix FD, a system capable of both upright and horizontal imaging, offering a potential sweet spot as far as sales are concerned.

"The number of dedicated chest systems that can be applied is limited," Reif said. "Flat detectors are so fast that if you have 80 to 100 chest exams a day, you would be done in two or three hours. What you can do with a combination system is use it for any number of procedures besides chest imaging-orthopedic and abdominal and trauma."

Siemens' strategy is not so much to develop such advanced technologies as digital radiography systems, but to integrate them into the practice of medicine. Intuitively, digital x-ray makes sense. Anecdotes abound. But the proof is in the numbers that define efficiency and effectiveness of workflow. Siemens is out to get those numbers, having begun ergonomic studies at several installed sites.

Meanwhile, the company is playing it safe in R&F. Flat-panel detectors will not have a role in fluoroscopy for at least several years, according to Siemens strategists. Spatial and temporal resolution cannot approach the performance level of image intensifiers and television cameras now in use. Inferior image quality is not an argument that will convince customers to pay a 30% premium for a flat detector system, Reif said.

There are myriad roadblocks to developing flat-panel detectors capable of state-of-the-art performance in fluoroscopy. One is the need to handle large quantities of data. Another is to rapidly "wipe" the detector after each exposure, so lingering data do not create artifacts. The toughest hurdle, however, will be to develop a system capable of high-resolution digital subtraction angiography.

Fluoroscopy is designed primarily as a means for following the progress of interventional tools in the body, explained Paul Slater, x-ray marketing manger for Siemens in North America. X-ray dose, therefore, is relatively low, especially when pulsed fluoro is used. Generating a diagnostic image requires substantially more dose, which is not a problem for conventional systems, because an iris can be used to control dose to the patient. Digital flat panels, however, cannot use an iris, and they lack the dynamic range to deliver a diagnostic image without exposing the patient to an unacceptably high x-ray dose or delivering unacceptably poor image quality, according to Slater.

Siemens executives recognize that digital imaging is a necessity in R&F, so they have chosen mature technologies to meet those demands-digital charge-coupled device cameras integrated with conventional image intensifiers. The digital imaging systems have been designed for integration into the PACS environment, Slater said.

"Integrating simply and effectively into the information technology world is where you are going to get the benefits of digital technology," he said.

Fluorospot T.O.P. and Fluorospot Compact represent the Siemens offerings in digital fluoroscopy. T.O.P. is a 10-bit system, featuring matrix sizes of 10242 or 20482. Compact is a 10-bit Windows NT-based system capable of a 10242 matrix.

These are the imaging chains built into Siemens remote or conventional R&F devices, which are exemplified by two systems, Iconos R200 and Sireskop SX. Iconos R200 is a universal remote fluoro system; Sireskop SX is an undertable x-ray product designed for use in just about any setting from hospitals to private practice.

The hardware has been enhanced by technologies such as digital density optimization (DDO), which enhances the differences in density found in an image.

"It virtually eliminates any need for a retake," Slater said.

Angiography provides an even better example of how x-ray strategy at Siemens is changing to accommodate digital technologies. Recognizing that MR and CT are providing ever better angiographic images, Siemens strategists are repositioning x-ray angiography in medical practice.

"MR and CT angio are getting very good at diagnosing vascular disease-but they can't cure it," Slater said. "So our systems are migrating from diagnosis to treatment, because they can cure it."

Its development of a high-powered workstation for rotational angiography, called InSpace 3D, addresses a key point in the Siemens approach-workflow. Volumetric and 2-D reconstructions, as well as fly-throughs, are generated from data captured during a rotational scan on the Siemens Angiostar O.R., a premium-end angiography system optimized for endovascular interventions in the operating room.

As these technologies become more intertwined, a clear vision of the future will be all the more important.

The difficulty in coming up with a viable strategy may be not in the discovery or development of advanced technologies, but in exercising the restraint to proceed at a moderate pace and stay the course.