Clinical printers are everywhere these days, from big downtown hospitals to suburban private clinics. With picture archiving and communications systems still at only 20 percent market penetration, the domination of “filmless” facilities is still a long way off.

Printer vendors are in total agreement, if the recent RSNA meeting was any proof. A slew of next-generation dry printers was in evidence, giving both wet printers and filmless technologies a tough act to follow. Their latest bells and whistles include DICOM-ready connectivity, faster throughput, and remote support capabilities. Here’s a selection from among the new offerings shown in Chicago.

“We introduced a new model at RSNA, the DryStar 5500,” says Ray Russell, business and marketing director for healthcare imaging at Agfa HealthCare (Greenville, S.C.). “It’s a fully networked printer, DICOM-resident in the operating software. It’s plug-and-play. There’s no external box associated with it. If you’re attaching it to a non-DICOM legacy modality, then we have an analog-to-DICOM converter that we call Paxport. The 5500 can connect to just about anything.”

The entire DryStar line — the 2000, 3000 and 5500 — all come with resident DICOM. Besides making them easy to connect to modalities, says Russell, that also makes them versatile when the unexpected crash happens. “If you’ve got a standard Ethernet DICOM network in the department and multiple Agfa printers, we can use any of those printers as a print server. If one of them goes down or you’re having maintenance, you can use the down unit as a print server and send from the keypad to any other printer on the network.”

One of the hottest innovations shown by most of the dry printer vendors was remote service capability. Russel describes Agfa’s as “a tech link box that’s just a modem through which we can remotely service any of our DryStar printers. For those customers who use the service, upwards of 60 percent of all problems are actually solvable remotely by a phone line.”

Despite all the latest advances in dry printing, there are still plenty of darkrooms out there. Messes and chemicals aside, it’s hard to fault wet-printer image quality. Vendors that make dry printers, though, seem to have plenty of reasons why wet printing may not be around much longer.

“Dry offers the ability to do both centralized and decentralized printing,” says Russell. “Decentralized allows you to put a printer where the patient is, so you can have a dedicated printer per modality. If your department’s already set up around a centralized wet laser, you can just replace it with a 5500.”

Another threat to wet printing is the extent to which image quality has improved in dry printing. The DryStar 5500, for instance, can output at 508 DPI for all formats. It can hold two sizes of film at once, with time to first film under 90 seconds. “With the first film, you’re developing the DICOM template,” says Russell. “On a 20 MB image, most printers take minutes for that first film to come out. DryStar 5500 outputs 100-plus films per hour.”

“We introduced a new dry laser imager at RSNA, DryPix 7000, that has the performance of wet laser imagers,” says Robert Neary, national marketing manager of imaging systems for Fujifilm Medical Systems (Stamford, Conn.).

“When dry laser imaging first came out, there were obviously many advantages over the environmental problems with wet chemicals and the fact that you have to have a special water supply and drains. However, along with dry imaging technology came much slower throughput, and also some image quality limitations with regard to color, stability, and those kinds of things.

“With every generation of film technology we have introduced since then, the film has gradually become better. But until the introduction of the DryPix 7000 and the DI-HL film, which is specifically designed for it, we really haven’t had a product that you could say provided the same performance as a wet laser imager in terms of throughput, speed and image quality.”

DryPix 7000 is one of the flock of breakthrough high-throughput, high-res imagers with plug-and-play network capability. It can print 180 14×17 films per hour and 240 10×14 films per hour at 254/508 DPI.

“The DryPix 7000 has a print server built into it, so you don’t have to have an external print server to hook it up to a DICOM print network,” says Neary. “All of the imagers in the current Fujifilm product line are network capable and DICOM print compliant. The DryPix FM-DP L, which was our top-of-the-line model until we introduced the DryPix 7000, did require an external print server in order to make it compatible with a DICOM print network. The other products — DryPix 1000 and 3000, and the new 7000 product — all have built-in DICOM capability.”

Remote diagnostic capability also is part of the DryPix package. “All of our products have it,” says Neary. “Because they sit on a DICOM TCP/IP network, we can dial into the network and communicate with the printer over telephone lines, fast Internet or whatever, and we can do remote diagnostics. We can also get some management information from the imager using remote capability. We communicate with the DryPix FM-DP L through the print server, but for all of the others we communicate directly with the imager.”

All the dry printer vendors were also talking about centralization and decentralization, and Fujifilm was no exception.

“In a centralized application,” explains Neary, “you could have two or more printers serving the printing needs of the entire hospital department. Clearly, it becomes very important that you have redundancy. If your printers are not able to back each other up, you could have a whole hospital department with 20 modalities out of action just because your printer goes down. So what we designed into our DryPix FM-DP L print server is an automatic failover capability. If one printer fails, we could automatically failover from the print server to another printer that was connected to the print server. Or if one of the print servers was to fail, then we would automatically reroute through another print server to the printer that was being used.”

Fujifilm was a relative latecomer to the dry printer market, but has more than made up for lost time. In January, healthcare industry research firm MD Buyline (Dallas) named Fujifilm the No. 1 laser imager company in customer satisfaction.

The next-generation printer from Kodak Health Imaging (Rochester, N.Y.), the DryView 8900, won’t be available until the second half of this year — but the company provided a preview to eager crowds at RSNA.

“We had two 8900s in our booth,” says Gregory Cefalo, Kodak’s worldwide marketing manager for digital output. Like Fujifilm’s DryPix 7000 and Agfa’s DryStar 5500, Kodak’s DryView 8900 will be configured with an internal server, remote service capability, and DICOM connectivity.

“All of our printers are DICOM printers,” says Cefalo, “but the 8900 is DICOM connectible more so than any previous DryView. It will support up to 12 simultaneous DICOM associations. We’ve built this to have a really strong front end and really high throughput.” DryView 8900 prints 180 650-DPI films per hour.

“High resolution has typically slowed down printers in the past,” says Cefalo. “It doesn’t slow this one down. As modalities such as 16-slice CT and high-speed MRI are hitting the market, customers are looking for their films to come out faster.

“When we talk to our customers, we hear that they’re constantly looking for improved image quality. That’s why we offer 650 DPI on all film sizes with the 8900. We’ve increased the dynamic range by extending the dMax [density of black] to 3.5 on our standard film. Calibrating the system happens automatically. The 8900 provides five film sizes; any three can be online,” says Cefalo: 8×10, 10×12, and three 14-inch sizes, ideal for CR and DR. The 8900 also has remote diagnostic and troubleshooting features.

“Kodak products are ergonomically designed, easy to load, and require infrequent film loading,” says Cefalo. “Our cartridge holds 125 sheets of film; with three drawers loaded, that’s 375 sheets online. It also automatically knows which film is in which drawer, whether the film’s expired, and how many sheets remain in the cartridge.” How does that work? Very cleverly, explains Cefalo: “We use a technology similar to E-ZPass,” the automobile toll collection system.

Kodak shipped its 20,000th DryView imager last year.

At the 2001 RSNA meeting, Codonics Inc. (Middleburg Heights, Ohio) introduced Horizon, one of the first tabletop laser printers that could wrestle with multiple sizes of paper and film at once and output both color and grayscale. For 2003, the Horizon line has expanded to three models: the SF (color and grayscale in 8×10 format), the GS (grayscale in 14×7 and 8×10 formats), and the newest entry, Ci, which prints color and grayscale on film and paper in both small and large formats.

The Horizon line prints at 320 DPI, features 300-sheet capacity, and supports 12 DICOM associations. Time to first print is a speedy 90 seconds. The company’s literature says it’s “perfect for nuclear medicine/PET, ultrasound, DR, CR and CT/MRI perfusion 3D applications.” C-arm fluoro, endoscopy and oncology imaging are all well served by Horizon.

Konica Medical Imaging (Wayne, N.J.) has extended its DryPro laser printer line with the 751 and 752 models. They were introduced to the market last July. Like their competition, they receive data directly from DICOM modalities without the need for a connectivity device, and they boast a first-film time of 90 seconds. Both models will output 11×14, 14×14 or 14×17 film at a speed of 120 prints per hour. The 752 can accommodate two different sizes of film at once. The original DryPro, the 722 model, is still a popular clinical choice. It can juggle three different formats and output 150 films per hour.

Mitsubishi Digital Electronics America (Irvine, Calif.) has five high-speed medical printers on the market. All are quite compact in size and have 8 MB of frame memory.

The CP-900 color series consists of two sublimation thermal paper printers that output 4.1×4.3 images in 12 seconds, or 4.3×6.3 images in 22 seconds, all at 325 DPI. The CP-900DW prints images from various imaging modalities or servers, and the CP-900UM prints stills from video. Each weighs about 25 pounds and will hold 200 small or 130 large sheets of paper.

The P-91 monochrome line-up includes a thermal transfer printer, the P-91W, and two that print by the thermal method on thermal sensitive paper, the P-91DW and P-91DW(UB). All three are cassette-based, will print 260-DPI images, and weigh in at around 7 pounds.

The P-91W prints seven sizes of paper at a range of speeds, from 4.7 seconds for the smallest to 11 seconds for the largest. It’s optimized to be compatible with any ultrasound system. Print capacity is 260 prints per roll for standard images, and 310 prints per roll in side-by-side mode.

Its two siblings are capable of six printing sizes from 3.7×2.8 to 3.9×19.7, and they can be used in a wide variety of applications. The P-91DW has a parallel interface and can output two different types of paper: high-density thermal and multitones thermal. The P-91DW(UB) has a USB interface and goes one better on the media choices, printing also to high glossy thermal paper. Both P-91Ds have printing times ranging from 3.6 seconds for the smallest size to 25.5 seconds for the largest.

FilmStation from Sony Electronics Inc. (Park Ridge, N.J.) is a 14×17 dry film imager with output speed of less than a minute per print. That can be nearly doubled by connecting two FilmStations with a link cable for printing up to 130 films per hour. The units can be installed horizontally as well as vertically, so they take up less space in a CT or MRI installation. Each has a 125-film capacity tray and automatic film calibration.

Canon U.S.A. (Lake Success, N.Y.) recently climbed on this train, too. The company souped up its compact N1000 office inkjet printer with software designed by Reina Imaging (Crystal Lake, Ill.), and the result was introduced as an economy clinical solution at RSNA. Canon says running costs are less than two cents per page for monochrome printing.

Reina sells different manufacturers’ products with applications it customizes. In the case of Canon’s N1000, Reina’s software enables it to output grayscale medical images on paper at — wait for it — a whopping 1,200 DPI resolution. It won’t set any speed records at two minutes per print, but budget-minded customers likely won’t mind. Clarity and price make up for that big time, plus the N1000 holds up to 750 sheets of paper.

“We were looking for an inexpensive solution to print images by paper,” says Bob Salzman, V.P. of Reina’s digital imaging division. “We’re like the grocery store. We’ve got paper and plastic. We can sell someone a $40,000 laser printer, or we can put in the N1000 for $750 so they can look at diagnostic film-quality prints on paper. That was our goal.”

Lookin’ good.