May 2004

As the first open 16-slice system, the Somatom Sensation Open (left) from Siemens Medical Solutions enables new levels of diagnostic support for CT-based radiation treatment planning, trauma applications, interventional procedures, and imaging of bariatric patients.

The Somatom Sensation 64 is designed to offer improvements in acquisition time and resolution, which are key for cardiac, vascular, neurologic, and emergency examinations. The increased speed also facilitates data acquisition for patients who have difficulty holding their breath, such as elderly or pediatric patients.

Sixty-four slices per rotation is made possible by the Straton X-ray tube’s double z-Sampling technology. Double z-Sampling allows two focal points in the anode by precise deflection of the electron beam within the X-ray tube that generate two overlapping beams to pass the scan field. The double readout of the detector produces 64-slice projections down to 0.3-mm slice distance, increasing spatial resolution. Developed with Speed4D technology, the Sensation 64 features WorkStream4D for workflow optimization and data handling, syngo InSpace4D for evaluation of the moving heart, and Care Dose4D for automated real-time dose adaptation.

The Somatom Sensation 64-slice CT (right) is the fastest FDA-cleared imaging system on the market.

The extended field of view of the Somatom Sensation Open 16-slice CT allows visualization of the anatomy outside the conventional 50-cm diagnostic field of view, which optimizes CT-based radiation therapy planning. Physicians can more accurately plan treatment to the targeted area of the body while minimizing the dose to surrounding healthy tissue.

When performing interventional CT procedures, the system’s easy patient access enables faster and safer positioning interventional equipment. During emergency room examinations, the large bore of the open system virtually eliminates the need to reposition and adjust life-support equipment. Additionally, positioning and imaging of obese patients is simplified with the large bore and extended visualization. Based on Siemens’ 16-slice technology with 0.5-second gantry rotation speed, the Sensation Open incorporates the company’s Straton X-ray tube, which cools in less than 20 seconds.

The handheld apparatus is battery operated, but what makes it unique to the imaging market is that it does not use X-rays to diagnosis an injury. Instead, the Osteosonic uses a patented sensor system that responds to external vibrations. Diagnostic results are communicated directly to the user via an LCD display.

“Potential applications for this device are limitless,” Liebschner said. “Imagine the advantage it would give EMT crews in determining treatment options at the scene of an accident.”

Other potential uses for the Osteosonic include sporting events, the military, and possible space missions where the technology can be used to monitor the bone properties of astronauts.

According to Liebschner, the Osteosonic would be useful for family physicians who do not have immediate access to imaging systems like X-rays or DEXA, enabling them to make an initial diagnosis without having to consult a specialist. Additionally, the system’s small size makes it suitable for any medical kit or office.

Liebschner expects to have completed a field test of the Osteosonic prototype by the end of first-quarter 2004. Since the apparatus does not emit radiation or physically penetrate the skin, it won’t be subject to FDA or FTC clearance processes. Therefore, Liebschner expects the technology to be available for commercial application by early 2005.

The impetus to go public with the idea was winning a nationwide engineering design contest, sponsored by Emhart Teknologies (New Haven, Conn), a Black & Decker Co. “Emhart Teknologies sponsors the ‘Create the Future’ design contest annually to foster innovative and creative thinking in the engineering community,” said Paul Gustafson, president and CEO of Emhart Teknologies. “Although we received a number of quality submissions, Dr Liebschner’s innovative device truly embodies the pioneering spirit of the contest.”

The contest has three categories—everyday products, transportation, and safety, the latter of which the Osteosonic was entered into—and the entries are judged on innovation, manufacturability, marketability, and cost-effectiveness. Liebschner was honored in February at an awards ceremony in Chicago and was awarded a new hybrid automobile.

• See 317 to 919 patients each year.
• Perform 15,853 to 52,404 procedures each year.
• Employ three to 10 full-time staff therapists and one to three full-time dosimetrists.
• Perform 4,554 to 6,545 procedures on each machine annually.

Sources for SROA stated that the results of the survey provide data for those trying to assess reimbursement values of procedures performed as well as to provide information to justify adding new therapists and equipment to meet increasing patient volume.

The estimated information comes from a report by the BlueCross BlueShield Association, using estimates from a consulting firm.

Jack Friedman, chief executive of Providence Health Plans (Portland, Ore), said the scans might relieve a patient’s anxieties, but they do not always justify their costs.

“There’s a lot of heart but no science behind the escalation of scans,” Friedman said. “MRI and CT scans performed on Providence’s employer-insurance enrollees younger than age 65 increased 388% from the first quarter of 1996 to the same period of this year.”

According to the study, the growth in diagnostic imaging stems from medical advances in imaging technology that enable doctors to better detect what is wrong with a patient while avoiding more invasive procedures, such as exploratory surgery.

To meet the demand, experts say that orthopedic surgeons, cardiologists, and neurologists have joined radiologists in ordering diagnostic machines. But, according to these same experts, many practitioners also have a financial incentive to do so: Insurers and consumers both pay high prices for diagnostic scans.

Research shows that specialists and primary care physicians are offering more imaging services. Doctor billings for radiological services increased 75% among family practice groups from 1998 to 2002, and they doubled for cardiology groups, according to the Medical Group Management Association (Englewood, Colo).

“But more machines could translate into too much imaging and financial waste,” said David Levin, national medical director of HealthHelp (Houston), a radiology use management company.

According to Levin, physicians who refer patients to receive imaging scans on their own equipment are the biggest culprits. Although federal regulations generally forbid doctors from sending patients to imaging centers in which they have a financial interest, physicians are permitted to own and operate imaging equipment in their offices.

Additionally, many companies across the country, such as Open Advanced MRI & CT (McLean, Va), have opened imaging centers to accommodate the increase in imaging demand. Charles Citron, founder, owner, and medical director of Open Advanced’s parent company, does not deny that scans are contributing to the increase in healthcare costs.

“There are healthcare costs, and it’s a hefty number,” Citron said. “On the other hand, if we scan more people, we’ll find more diseases.”

With the Columbus Board, children are positioned just once for imaging procedures, improving both image quality and patient comfort.

Unlike the conventional apparatus, in which a patient or child is restrained in an upright position throughout the duration of the examination, patients are positioned just once with the Columbus Board and remain in place during the exam; it’s the equipment that moves.

The design of the Columbus Board enables higher quality images and is more comfortable for the patient. The current apparatus used by radiology personnel—called the Pigg-o-stat—often appears threatening to children and can be cumbersome to radiologists.

In addition to pacifying aesthetic anxieties, the Columbus Board also causes less emotional stress, as it allows constant communication and interaction between parent and child throughout the exam. A parent is able to hold the child in a designated position while actively communicating to help relieve anxiety.

Protomed’s prototype of the SuDyn device

For now, it seems as if France is at the epicenter of this shift in technology. Fr?d?ric Mouret, creator and manager of Protomed (Marseille, France)—whose solutions are equally aimed at classic surgery—states that his company is focusing on minimally invasive surgery because new tools are needed to develop this form of treatment so that it can expand in all fields.

“The demand for this type of product is very strong because, for example, vascular anastomosis through celioscopy is technically difficult and hinders development of surgical techniques,” Mouret said. “But reconstructive operations of the abdominal aorta represent around 150,000 procedures throughout the world each year.”

Other French companies, such as Image Guided Therapy (Pessac, France) and Mauna Kea Technologies (Paris), are developing new systems and software for monitoring surgical procedures.

Currently, Protomed is at the forefront of the evolution with the development of SuDyn, a dynamometric suturing device that holds the ends of surgical sutures in place. This method replaces the need for knots because the device consists of a small clip that can be adapted to all types of sutures. Once the predetermined tension for correctly and firmly holding the suture threads has been reached in the procedure, the positioning aid releases SuDyn. Made of biocompatible polypropylene, SuDyn remains in place and is colonized by the tissues within a few weeks.

This process leads to the practice of thermotherapy, which involves using radio frequencies or lasers to enable a certain number of tumors to be treated without surgery, such as those of the liver or prostate. The treatment requires an applicator, much like a needle, that is directed into the center of the tumor. It produces a local rise in temperature, causing necrosis of the tumor tissue. Before the procedure, and from the images obtained by MRI scans, the physician will have defined a safety margin around the tumor to avoid harming sensitive neighboring organs.

As of now, a means of controlling and monitoring thermotherapy in real time has not been available. Image Guided Therapy, along with the Molecular and Functional Imaging Laboratory (Bordeaux, France), is now working to develop the software—called Thermoguide, available later this year—for this new niche.

The idea behind Thermoguide is to visualize and measure, in real time and on screen, the spread of temperature to any organ being treated using thermotherapy as well as the progress of ablation of the tumor produced at the lethal thermal dose. Future plans include a servo-system, which will enhance the program and use a guided device for treatment via focused ultrasound, requiring no body contact.

In the works at Mauna Kea Technologies are tools combining aspects of microscopy, endoscopy, and medical imaging in the form of easily transportable platforms. The instruments obtained are making it possible to achieve micron resolutions never before attained by in vivo medical imaging.

The company offers two families of systems based on the use of lasers and optical fibers; both systems are focused on biophotonic imaging. These two systems can be coupled with spectroscopic imaging using auto-fluorescence, which allows them to obtain information about the biomedical composition of the tissue targeted, the addition to images of its morphology.

“There is a clear need for in vivo cellular imaging because, for example, almost any cancer begins with abnormal cellular manifestations,” said Benjamin Abrat, general manager and cofounder of Mauna Kea Technologies. “Today, the most sophisticated medical imaging technologies cannot see at the cellular level. In other words, the smaller you see, the earlier you can diagnose cancer.”

The two firms that conducted the research, Radlinx Group and US Radiology Partners (USRP), found that most US-based radiologists admit to seeing an increase in workload, but are not prepared to see imaging work go overseas.

“We see minimal risk to US radiologists losing much work to off-shore physicians,” said Mark Bakken, cofounder and president of the Radlinx Group/USRP. “But we do view the malpractice and quality control issues raised by off-shore imaging troublesome.”

The survey underscores the fact that imaging services are in growing demand. In fact, 83% of radiologists surveyed indicated that imaging volumes in their practices had increased in the last fiscal year. Additionally, 57% of radiologists surveyed indicated that their groups are overburdened due to either increasing volume or to understaffing. Nearly 50% indicated that their groups are understaffed with radiologists. Of those surveyed, 29% indicated that staffing shortages were diminishing quality of care by limiting patient access to services or by delaying the turnaround of interpreters.

Radiologists surveyed indicated that they are coping with rising volumes and staffing shortages in a variety of ways. Working hours have increased for 47% of radiologists; 46% of facilities are actively recruiting more radiologists, and 16% are using locum tenens radiologists. In addition, 67% of radiologists indicated that they are reading 15,000 or more studies a year. Of those surveyed, 36% indicated that radiologists are reading an inappropriately high number of studies per year.

Results from the survey suggests that rising workloads; understaffing; and the need to provide continuous, 365-day coverage has led to the rise in off-site imaging. Nearly 32% of radiologists surveyed outsource studies to an off-site call/coverage group. However, the need for off-site resources is not limited to nights and weekends; 37% of surveyed radiologists said that due to rising volumes or understaffing, they need additional coverage during the day.

Physicians question the idea of sending studies off-site merely because of concerns involving malpractice liability. However, information gathered from the survey points to the fact that the more severe the radiologist shortage becomes, the more accepted that off-site and even off-shore reading will become.

For more information on this Radlinx Group/USRP survey, visit www.radlinxgroup.com.

With the completion of the transaction, Sir William Castell, formerly chief executive of Amersham, assumes the role of president and CEO of GE Healthcare. Joseph Hogan, senior VP of GEMS, will continue to lead GE’s medical imaging, services, and IT businesses, now named GE Healthcare Technologies. Peter Loescher, former COO of Amersham, will be named a GE officer and will manage the newly created $3 billion GE Healthcare Bio-Sciences business, which will consist of the former Amersham operating units.

“What’s exciting about the acquisition of Amersham is the opportunities we will have from bringing these different types of technologies together,” Hogan said. “These opportunities include being able to detect disease earlier, possibly before the onset of physical symptoms. We’ll also be able to provide tailored treatment to patients more specifically and less invasively than what was possible before.”

Essentially, GE plans to use the expertise of each formally specialized company to focus on the process of personalized medicine, which consists of advanced methods of predicting, diagnosing and treating diseases.

According to Hogan, prediction entails the understanding of molecular diseases, the process of genetic fingerprinting, and in vivo types of images (referred to as molecular imaging). “This allows the prediction of diseases before the onset of physical symptoms,” Hogan said.

In terms of diagnosing, Hogan stated that if physicians can detect a disease earlier, the chance of cure—or the chance of moderating that disease—is greatly increased.

“We’re going to take transformational medical imaging and medical diagnostics and move more and more upstream,” he added. “And in terms of treatment, our goal here is not to treat the disease. Our goal is to partner with pharmaceutical companies and other types of therapeutic companies to help treat diseases, and to provide information and feedback for that particular treatment.”

Hogan explained that the overall vision of GE Healthcare is to strive to see life more clearly and to help healthcare providers better understand, diagnose, and treat their patients. “Broadly, we’re trying to say that the quality of life is being improved dramatically by this process,” he said.

GE Healthcare will base its global headquarters in Chalfont St Giles, UK; GE Healthcare Technologies will be headquartered in Waukesha, Wis; and GE Healthcare Bio-Sciences will be headquartered in Little Chalfont, UK.

Consorta Consorta Inc (Rolling Meadows, Ill) has signed agreements with OP-Marks (Athens, Ga) and Colby Manufacturing Corp (Tullytown, Pa) for surgical site identification products. The 3-year agreements will offer two options for surgical site marking to Consorta’s member hospitals across the country.

The company also has signed a purchasing agreement with Hologic Inc (Bedford, Mass). The agreement covers Hologic’s bone densitometry, mammography, and technology products, including the Discovery for osteoporosis assessment and the Lorad Selenia full-field digital mammography system. The nonexclusive agreement runs from March 2004 through August 2005, with the option to extend the agreement for 2 years.

NovaRad NovaRad (American Fork, Utah) recently installed NovaPACS at Campbell County Memorial Hospital (CCMH of Gillette, Wyo) and Northeastern Nevada Regional Hospital (NNRH of Elko, Nev). CCMH integrated the NovaPACS with its existing RIS; the installation was completed in November 2003. CCMH is now operating in a 100% filmless environment. NNRH installed NovaPACS and a Konica Xpress CR scanner.

Orex Through SourceOne Healthcare Technologies (Mentor, Ohio), Orex (Auburndale, Mass) has sold its 200th Orex CR system to the US military. Previously, two units were sold to the Navy for installation at the US naval base at Guantanamo Bay, Cuba. Others are in use in Iraq, Afghanistan, and Saudi Arabia as well as in special operations and maneuvers throughout the world. The US Army, Special Forces, Navy, and Air Force each use advanced Orex CR technology.

Philips Medical Systems Philips Medical Systems (Bothell, Wash) and ImTek Inc (Bridgeport, NJ) have announced the new dual-modality single photon emission computed tomography (SPECT)/X-ray CT imaging system for preclinical research. ImTek has expanded its MicroCAT laboratory animal X-ray CT product line to include SPECT. The MicroCAT platform can now be configured for X-ray CT, SPECT, or dual-modality imaging.

Additionally, Philips and Lenox Hill Hospital (New York) will expand their cardiovascular partnership to advance cardiovascular interventional technology and provide better patient care. Philips has agreed to a 2-year research agreement with the hospital to codevelop interventional technologies that will deliver insight into the heart’s anatomy and enable cardiologists to provide more thorough exams, diagnoses, and treatment plans for patients.

Philips also has installed its first Brilliance CT 40-slice system at the University of Indiana (Bloomington, Ind), which provides increased coverage and fast acquisitions. Indiana University Hospital is using the speed and image quality of the system to evaluate patients and identify disease using a variety of clinical applications.

Pilgrim Software Pilgrim Software (Tampa, Fla) announced that Canadian Blood Services (Ottawa) has selected Pilgrim’s SmartSolve suite, a

100% Web-based application designed for Microsoft’s .Net platform. Canadian Blood Services, Canada’s largest blood services organization, will implement Pilgrim’s SmartSolve Integrated Compliance Management Platform, which provides document management, internal and external assessments, and corrective/preventive action capabilities.

Expedition Imagem do Javari is the first to bring advanced medical imaging equipment to the area’s indigenous tribes for diagnosing and treating infectious diseases, such as hepatitis A, B, and D; yellow fever; malaria; and tuberculosis.

Bia Boleman, director of production for Expedition Imagem do Javari, holds a child of the Korubo tribe. Boleman has participated in many expeditions throughout South America, and she founded Dunas e Ventos, an organization that has been coordinating expeditions in Latin American deserts for more than 20 years.

“Indians were dying from various diseases after being contacted by outsiders,” stated sources from the FUNAI (the Isolated Tribes Division of the Brazilian government’s Federal Indian Bureau). “We chose this area of the Amazon because no health organizations are currently in place there to treat these kinds of diseases.”

Because the Vale do Javari region lacks laboratory facilities capable of screening for infectious diseases, the team has brought its own imaging equipment into the isolated region. X-ray and digital imaging technology—such as the DirectView CR 500 system and the company’s DirectView PACS System 5, both from Eastman Kodak Co’s Health Imaging Group (Rochester, NY)—have been transported by boat into the Vale do Javari. Once in place, images taken by physicians are sent via satellite to Cl?nica Imagem, an advanced radiology clinic in Florian?polis, Brazil, for analysis and consultation.

Dr Sergio Brincas, creator and lead physician of Expedition Imagem do Javari, currently works at Cl?nica Imagem in Florian?polis, Brazil, where he is partner and technical director.

Over the course of 8 weeks, physicians will screen 800 to 1,000 members of the Matis, Marubo, Kanamari, and Korubo tribes. The team is spending 4 to 10 days in each village performing radiological exams, ultrasounds, and blood tests. Because of the isolated nature of the mission, the team’s time, resources, and capabilities are at a minimum, leaving no room for inefficiencies. According to sources from FUNAI, all 18 members of the team—consisting of epidemiologists, radiologists, nurses, translators, and biomedical technicians from both Kodak and Cl?nica Imagem—have a function and expertise.

Although the expedition has just started, plans for follow-up care already have begun. FUNAI has made a tentative plan to treat high-risk patients back to health. At that time, the organization will determine the future of further expeditions in the Vale do Javari region.

Jennifer Padberg has been named director of research for the American Society for Therapeutic Radiology and Oncology (ASTRO of Fairfax, Va). Padberg previously served as assistant director of clinical affairs for the American Society of Clinical Oncology. ASTRO also announced the addition of Steven Smith to the position of director of the membership department. Smith has spent the past 20 years in the association and nonprofit fields, working with membership, marketing, educational programming, and trade shows.

Paul Hermann

MarCap Corp (Chicago) has announced Paul Hermann as the company’s regional manager of Mountain and Central. Hermann will be responsible for working with imaging center developers in Colorado, Idaho, Montana, New Mexico, Oklahoma, Texas, Utah, and Wyoming. The company also announces the appointment of Justin Tabone as director of strategic accounts group. Tabone will develop national vendor programs and work closely with MarCap’s healthcare financing clients.

Justin Tabone

Kaiser Permanente (Oakland, Calif) has selected Dr David Sherer as physician director of risk management for the Mid-Atlantic Permanente Medical Group. Sherer will assist the risk management team in enhancing patient safety and designing programs that will reduce medical errors. He is the author of Dr. David Sherer’s Hospital Survivor Guide.

Hans Wiik, FACHE, has joined USCS Equipment Technology Solutions (Brookfield, Wis) as VP of the healthcare division for the organization. Wiik, the former president and CEO of Health Future, has more than 25 years’ experience as a healthcare company chief executive.

Diagnostic Imaging Technical
Education Center Inc (DITEC)
DITEC 2K4
May 26–28 • Cleveland
440-519-1555    www.ditecnet.com

JUNE 2004

American Medical Technologists (AMT)
Annual Convention
June 28–July 3 • Los Angeles
847-823-5169    www.amt1.com

JULY 2004

American Society for Healthcare Engineering (ASHE)
41st Annual Conference and Technical Exhibition, in conjunction with the 18th Congress of the International Federation of Hospital Engineers
July 26–28 • Orlando, Fla
312-422-3800    www.ashe.org