Huge. Epic. Awe-inspiring. No, that’s not the buzz about Peter Jackson’s remake of King Kong; it’s the buzz surrounding the 91st Annual Meeting of the Radiological Society of North America (RSNA of Oak Brook, Ill), held this past November at McCormick Place in Chicago. Booths that could fill entire city blocks and feature space-age briefs on the latest and greatest CT scanners, sonography systems, or MRI machines? That’s the stuff radiologists go ape for.
Per usual, the post-Thanksgiving convention drew crowds from here, there, and everywhere?trying to count the number of different flags and accents always proves a quick reminder of the global radiology and imaging market’s vastness. McCormick Place was practically bulging from the amount of vendors and attendees that filled the enormous North and South halls, as John Jaworski, manager of technical exhibit services for RSNA, can testify: “We are very pleased with the medical industry’s support of the RSNA Annual Meeting. With 718 commercial companies occupying 489,359 square feet of exhibit space, we have exceeded last year’s totals by 4 percent in the number of exhibitors and 7 percent in total square footage. Both figures are all-time highs for RSNA.”
Although the show itself was a gigantic bash, the general trends of the season indicate that the industry is looking at a smaller focus?or smaller machines, at least. In the world of ultrasound, machines are becoming more portable. Additionally, everyone?vendors, administrators, and physicians alike?are working to improve workflow and reduce repetitive-stress injuries. The general consensus seems to be that radiologists are simply too precious a cargo to be abused by outdated devices. “We’re looking at multiple ways to reduce repetitive-stress injuries with ultrasound,” said Barbara Del Prince of Siemens Medical Solutions (Malvern, Pa).
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| RSNA attendees who crossed over into Lakeside Center of McCormick Place for educational sessions know this view of Chicago. |
The buzzwords that came up over and over again were “soothing,” “integrated,” and “stronger.” Machines to accommodate the increased weight of Americans also were prominently featured, the biggest of which, by Philips Medical Systems (Andover, Mass), is the CT Portal, which accommodates a person that weighs up to 650 pounds. (That’s big enough to accommodate a gorilla!)
To sum it up: Equipment and systems are getting faster, stronger, and, well, better. Here, we take a look at some of the exhibitors who made a splash at this year’s convention. Clearly, not every vendor can be included, so look for breakthroughs unveiled at RSNA to be covered in Medical Imaging throughout 2006. And, of course, feel free to review the products we highlighted in our RSNA Preview in the November 2005 issue.
What’s New?
Aurora Imaging Technology Inc (North Andover, Mass). The 1.5T Dedicated Breast MRI System by Aurora Imaging was showcased at RSNA, featuring the new UltraRodeo Plus fat and normal ductal tissue suppression technique; AuroraCAD integrated diagnostic software; Aurora SuperShim shimming technology for breast imaging, which reduces hot spots; and the fully integrated, MRI-guided AuroraBiopsy functionality. The system, the only FDA-cleared dedicated breast MRI system on the market, uses a specialized breast-coil design that provides an elliptical “sweet spot” that images both breasts, the chest wall, and the axillae in a single bilateral scan without compromising image contrast or resolution. “As research continues to improve our understanding of breast cancer, the need for more sensitive and refined technologies for both screening and disease evaluation is clear,” said Olivia Ho Cheng, president and CEO of Aurora. “MRI is proving to be one of the most promising modalities for this, with a strong body of research underscoring its effectiveness. As an innovator in breast MRI, Aurora is proud to be making a significant contribution to the fight against this deadly disease.”
Candelis Inc (Irvine, Calif). A division of Procom Technology Inc, Candelis debuted the ImageGrid 700 and 1000 for healthcare professionals. The systems are fully integrated DICOM server appliances that accelerate digital-image access and routing; simplify image management; and provide highly reliable, cost-efficient storage. “The ImageGrid 700 and 1000 are ideal solutions for medical-imaging centers, clinics, and medium-sized hospitals, [all of] which are demonstrating a growing need to archive the large image files being generated by high-resolution imaging modalities, such as multidetector CT and MRI systems,” said Candelis CEO Alex Razmjoo. “With the ImageGrid, physicians and medical-imaging professionals can focus on their operations instead of system management, while reducing overall ownership cost.”
DeJarnette Research Systems Inc (Towson, Md). At RSNA, DeJarnette focused on its PACS migration gateway technology: dyseCT, PACSware intelligent router, and VistAware. “Currently, we have more than 25 migrations in progress, and the business is growing at a very fast rate. We see it more than doubling in 2006,” said Wayne DeJarnette, president and CEO of DeJarnette. “In the field, we are running into the need for even more sophisticated data-cleansing algorithms during PACS migration. The data-cleansing requirement of a migration is a function of both the type/vendor of the source and destination PACS, the customer’s modalities, and the configuration of the interface between the modalities and the source PACS. Data-cleansing technology is the single most daunting technology in PACS migration.”
DMS Health Group (Fargo, ND). At this year’s RSNA, DMS pulled out all the stops in showing its mobile-imaging vans. The company currently owns more than 190 mobile units in addition to several fixed-site and interim systems. The goal for the upcoming year, according to DMS Marketing Director Lynn Speral, is to grow the company’s reach. “We’re looking to expand east and west, since we are very solid in the central corridor, where we are a fixed territory,” she said. “We’ll continue to service there, but we are looking to branch outward. We’ll also continue to stay very strong in MRI and PET/CT as well as the other modalities.”
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| The Wrigley Building. |
Dynamic Imaging (Allendale, NJ). Dynamic Imaging debuted and demonstrated its latest product, IntegradWeb RIS/PACS, alongside the latest version of the company’s IntegradWeb PACS. The RIS/PACS builds on the Dynamic Imaging’s standard PACS to fulfill the complete radiology informatics needs of ambulatory settings, such as RIS, PACS, billing, document management, and digital dictation. “With IntegradWeb RIS/PACS, Dynamic Imaging offers [a] filmless and paperless experience for all ambulatory facilities,” said Dynamic Imaging CEO Alex Jurovitsky. “No matter the complexity of the business model, or challenging clinical and business requirements, our Web-based desktop has it covered.”
FUJIFILM Medical Systems USA (FMSU of Stamford, Conn). FMSU added a playful touch to its introduction of three new CR readers in the FCR Carbon model line by strapping the latest model of the machine to a dummy dressed as an astronaut. The systems made their debut at RSNA and combine outstanding image quality and high throughput in a unique design. FCR Carbon is the smallest full-featured CR system?with two models: Carbon XL and Carbon X?that offer the same capabilities, differentiated by throughput. The Carbon XL is ideal for small to medium-sized facilities, while the Carbon X is optimal for remote or low-volume areas with less-demanding workflow. “With more than 15,000 SmartCRs sold worldwide, we’ve taken feedback from our users and developed a system that is smaller and more efficient with two models that better meet the needs of lower-volume users,” said Penny Maier, FMSU’s national marketing manager of digital X-ray. “Our goal with the Carbon line is?like its namesake, the basic element of life?to make quality X-ray universal.”
Guardian Healthcare Systems (Herndon, Va). Next time you go through an airport-security checkpoint, think about the X-ray machinery used to look inside your carry-on luggage. It isn’t that different from a medical X-ray, is it? Guardian Technologies realized this and started a healthcare branch, which led to the development of its Flow Point system, featured at RSNA. The product uses the same basic technology that discovers organic terrorist bombs to detect terrorists of a different kind, such as cancer. Guardian’s Flow Point system, built on an expandable set of configurable Web services, provides intrinsic, seamless RIS, image management, radiology workflow, and archive-management solutions. “Because the bombs we were looking for were organic and human tissue is organic, the transition made sense to us,” said Tom Ramsey of Guardian. Adds Richard Borelli, VP of business development, “Additionally, the workflow is slightly different. It’s required to add information about billing. We’ve added a PACS viewer. It’s very easy.”
Intelerad Medical Systems Inc (Montreal). En pointe for Intelerad was the company’s new Inteleviewer Web?made for hospitals looking to supplement PACS or begin a digital transition with an affordable, easy-to-use, high-performance Web server. Inteleviewer Web features unlimited user licenses, lossless storage compression, configurable JPEG 2000 streaming by modality, Web-based tools for handling user and user-group management, user-auditing reports, thumbnail display, measurement tools, linked stacking, and optional HL7 report integration. Additionally, Intelerad introduced DICOM cache ability in the Inteleviewer Enterprise; grouped procedure-handling ability and reporting workflow manager in the IntelePACS Reporting Worklist; and PACS Dashboard and PACS Statistics for PACS administrators.
McKesson Corp (Alpharetta, Ga). Making its debut at RSNA was the Horizon Optical Imaging solution, designed to enable digital automation of diagnostic specialties across the healthcare enterprise. The new solution enables clinicians to turn an analog optical device into a DICOM-enabled digital modality that enables digital capture of still and cine images. “Our goal is to create an ergonomic environment for the radiologist to perform the task in the best, most efficient way,” said George Kovacs, senior product marketing manager of McKesson’s Medical Imaging Group. “It’s combined into one environment.”
Medical Standard International Inc (MSI of Minneapolis). MSI showcased a wealth of products?from its Mini-PACS to its PACSPartner line of total image-management solutions. The system, developed to meet the needs of imaging centers and small to medium-sized hospitals, provides plug-and-play setup, efficient image management, and configurable short- and long-term archiving at an entry-level price. “Our Mini-PACS is [a good] choice for a radiology clinic or department that wants to enter the digital world but feels its image volume will support only select modalities. It also is an excellent choice for facilities that want to go filmless in stages for budgetary or administrative reasons,” said Brian Hong, VP of sales and marketing for MSI. “Our PACSPartner Mini-PACS is an advanced DICOM image-management system that offers many of the features of more costly, full-scale PACS and also provides a great way to convert to filmless, Web-based communications for referring physicians.”
Medicsight USA Inc (Nashville, Tenn). The two big guns Medicsight brought out for this year’s RSNA were the LungCAD API and ColonCAD API programs, which help radiologists evaluate lesions or nodules found on CT scans (with the former) and identify potential colorectal polyps (with the latter). Each version of the software uses an advanced CAD algorithm to review CT scan data to automatically highlight specific regions of interest for future investigation. The APIs offer clinical validation; concurrent-read capability; user-adjustable CAD filter settings; and seamless integration, which allows the software to be used within a variety of PACS and advanced 3-D workstations, eliminating the need for multiple applications. “We want to take the CAD technology and embed it into those kinds of systems so they can take advantage of CAD,” said Jonah Aburrow-Jones, commercial development director of Medicsight. “By doing this, it reduces the period of time on a study?meaning you can analyze the data very quickly and find pathology very quickly.”
Plasmon Inc (Englewood, Colo). A big announcement at RSNA was the agreement between Plasmon and Agfa’s HealthCare Business Group (Ridgefield Park, NJ) for the latter to begin selling and supporting Plasmon UDO drives, libraries, and media for its PACS solutions. The UDO products will be available as part of Agfa’s Impax Archive Management System. Plasmon’s mission for RSNA: “Continue getting the archive appliance with the PACS and HIS makers,” said Andrew E. Richards, VP of business development at Plasmon. “We’re engaged with the PACS vendors and adding five new PACS vendors over the next six months. In addition, we’re constantly upgrading the product and are adding new features. Over the next year, we plan to work with partners to implement our new 60 GB media.”
R2 Technology Inc (Sunnyvale, Calif). A CAD leader, R2 unveiled its Citra Mammography Applications Suite at RSNA. Citra is the first system to “CAD-enable” digital mammography reading workflow, offering radiologists decision-support tools and superior productivity while reviewing mammography cases. Among the features is RightSize Optimized Temporal Comparison, a package that equalizes the size of all displayed images to facilitate efficient comparison of prior and current images. “R2’s CAD systems already offer physicians a ‘second set of eyes’ to help improve the earlier detection of cancer,” said John Pavlidis, R2’s president and CEO. “With Citra, we now offer physicians a universal and ‘CAD-intelligent’ system for reviewing digital mammography images and comparing them with digitized prior film images. Citra optimizes R2 CAD information presentation to assist the radiologist in review and decision-making, while streamlining workflow.”
Sectra North America Inc (Shelton, Conn). The buzz at Sectra’s booth during RSNA was all about the PACS. After all, the company recently launched its new PACS-Guard service for new and existing users. PACS-Guard provides real-time around-the-clock monitoring of critical system performance and extends Sectra’s ability to provide remote service and support. “PACS-Guard is an important element in providing timely and cost-effective service and support for our customers,” said John Goble, MD, president of Sectra North America. “The break-fix model traditionally applied to the imaging modalities is not appropriate for mission-critical IT components. We are uniquely positioned to provide service and support to products designed and built by Sectra, whether sold by us or by others.”
Siemens Medical Solutions (Malvern, Pa). Siemens had a lot on its plate this year. First was the Somatom Definition, the industry’s first dual-source CT?faster than a beating heart and capable of imaging full cardiac detail with as much as 50% less radiation exposure in comparison to traditional CT scans. Also in the company’s CT area were new CT clinical engines that addressed four key clinical fields in medical imaging: acute care, cardiology, neurology, and oncology. In ultrasound, Siemens Medical introduced the Encompass II release for the Acuson Sequoia ultrasound platform as well as the Cadence contrast pulse sequencing, which offers new levels of contrast detection and specificity for molecular imaging with ultrasound. The company also presented its prototype digital breast tomosynthesis system, based on the Mammomat Novation DR full-field digital mammography system. Mammomat was developed in close collaboration with Duke University Medical Center (Durham, NC) and is currently being investigated in preliminary clinical trials for the detection of subtle mass lesions that are often not detected by conventional mammography. Finally, the company showcased its optical navigation platform, NaviVision. The new system combines a surgical C-arm and an optical 2-D/3-D navigation unit into a common platform and allows for more room in the operating room.
Sony Electronics Inc (Park Ridge, NJ). Celebrating 20 years in the medical market, Sony exhibited multimedia productions and application displays that showcased products in a range of modalities, including ultrasound printers, a photo-realistic color printer for PET/CT and 3-D CT imaging, and the FilmStation dry film imager. “A lot of people don’t realize we’ve been around for 20 years,” said Brian Zimmer, marketing manager for Sony. “We really wanted to show our impact on the market. We offer a full range of product solutions for major radiation applications, and we want to make sure people are aware of that.”
Toshiba America Medical Systems (TAMS of Tustin, Calif). MRI and DR were two big elements of TAMS’ presentation at this RSNA. Up first: the Vantage ZGV MRI, a high-end 1.5T system featuring new product sequences, enhanced image quality, and the Mac 8 processor?a faster CPU allowing 1,230 images per second reconstruction for more powerful clinical applications. Still a work in progress, the Vantage ZGV is currently installed at the Steinberg Diagnostic Medical Imaging Center (Las Vegas) and is undergoing evaluation. Additionally, TAMS launched two new coils: one designed for long bones; and another, a new 32-channel head/spin coil designed specifically for brain, cervical, thoracic, and lumbar imaging in trauma or immobile patients. Also, TAMS showcased its integrated DR panel for Kalare R&F System, enabling true, all-digital examinations and postprocessing for a reduced procedure time. The 14- x 17-inch DR panel now can be used in the table buckey or vertical wall stand, or it can be removed to accommodate routine tabletop exams. Additionally, the company unveiled a new room configuration for its T.RAD Plus product line?offering traditional radiographic systems a removable DR panel and adjustable PIVOT table.
US Electronics Inc (USEI of Minneapolis). In conjunction with Totoku (Japan), USEI introduced a range of high-resolution color and monochrome LCD displays. Among those that debuted were the CCL250i color and ME251i monochrome 21.3-inch, 2-megapixel flat panels with Sentinel II front-sensor technology and advanced DICOM calibration. Additionally, USEI and Totoku debuted 20.8-inch and 3-megapixel QXGA medical-grade color and monochrome LCDs with front-luminance sensor technology. “Recent advances in engineering have enabled displays that have both high-bright color and grayscale with unprecedented dynamic range,” said Madhu Reddy, VP of sales and marketing for USEI. “Recently, the FDA has cleared these advanced new monitors for the interpretation of a full range of modalities, including X-ray, MRI, and CT.”
Vital Images Inc (Minneapolis). Vital Images introduced its comprehensive ViTAL Solutions portfolio at this year’s RSNA. The highlights included Vitrea-quality rendering performance and workflow restore in ViTALConnect, the company’s Web-based analysis and distribution solution, as well as enhancements to clinical applications within its flagship Vitrea and ViTALCardia solutions. Combined, these solution components deliver a scalable and customizable enterprise-wide advanced visualization and analysis solution and enable customary inclusion into expanded clinical review. “Vital Images clearly understands the need for these tools throughout the complete enterprise workflow, from the radiology technologist to the PACS to the referring clinicians,” said Paul J. Change, MD, director of radiology informatics at the University of Pittsburgh Medical Center. “With Vital Images’ increased integration capabilities and Web-based deployment of ViTALConnect, advanced analysis can be distributed anywhere it is required.”
Virtual Radiologic Consultants (VRC of Minneapolis). The teleradiology powerhouse’s crown jewel, the VRC Workflow, was its main selling point. “The thing that we’ve seen is consistent acceptance to augment and assist the local radiologists for the benefit of the hospital and the community,” said Brent Backhaus, CTO and security/privacy officer of VRC. “There’s still a focus on the enterprise-level healthcare environment. What we have to do is take that one step further in an integration fashion. The challenge we’ve overcome over the past three years was to bring the data to the hospital with the least amount of intrusiveness. We want to keep things as easy as possible for the hospital. As we say, evolution is good; revolution is bad. If we can evolve and make it a little bit better, that will make everything better.”
Study Break
Vendors weren’t the only ones who got their messages out at RSNA 2005. Several studies saw their time in the sun (so to speak-we’re talking Chicago in November, after all), potentially leading to groundbreaking developments in the field. In the spirit of keeping up to date, here are a few of the findings revealed this year. (For more details, visit www.rsna.org/Media/rsna/newsroom2005.cfm.)
? Carotid Artery Stenting Could Improve Thought Process. Stenting of the carotid artery significantly improves cognitive speed and could improve memory function in some patients, in addition to preventing strokes. The decreased blood flow to the brain is credited with the improvement in memory function. Presenter: Iris Q. Grunwald, MD
? Cell-Transplantation Technique Restores Insulin Production in Diabetics. A new minimally invasive technique, where researchers use a new cell-transplantation technique with ultrasound guidance, restores cells that produce insulin in patients with type 1 diabetes, typically children and young adults. Thus far, the method boasts a high survival rate and few complications. Presenter: Siobhan Flanagan, BS
? Coffee Jump-Starts Short-Term Memory. Caffeine exerts a positive effect on short-term memory and reaction times, according to a new study-the first of its kind to prove a link. Using fMRI, researchers noted that 100 mg of caffeine (roughly two cups of coffee) increased activity in regions of the brain associated with working memory and attention. The increased activation patterns in the brain had a direct effect on performance in a memory task within the study. Lead author: Florian Koppelst?tter, MD, PhD
? CT Colonography Enhanced by CAD. According to a large-scale, multicenter study by the National Institutes of Health (NIH), CT colonography (aka virtual colonoscopy) with CAD is highly effective for finding colon polyps. Presenter/senior investigator: Ronald M. Summers, MD, PhD
? CT-Guided Injection Treats “Sweaty Hands” Condition. A minimally invasive, 20-minute procedure-CT-fluoroscopy guidance-can permanently cure those who suffer from palmar hyperhidrosis (sweaty hands). Percutaneous sympathectomy with CT fluoroscopy is less costly than surgery and has fewer risks and complications. Presenter/lead author: Hugues Brat, MD
? Digital Tomosynthesis Could Help Radiologists Find More Breast Cancers. Tomosynthesis might be a more specific breast screening technique and a more accurate diagnostic technology, outperforming screening mammography at recognizing benign or normal breast tissue in addition to reducing the number of false-positive screening mammograms by half. Presenter/lead author: Steven Poplack, MD
? Go-Carts Cause Serious Injuries to Children. Researchers have used diagnostic images to conduct a study of go-cart injuries in children, leading to disturbing results. Fractures, brain injuries, and burns are all potential results from the use of go-carts by children, with 65% of the injuries attributed to children under the age of 15. The primary cause of go-cart injuries among children is loss of vehicle control, resulting in collision or ejection from the cart. Presenter/co-author: Annemarie Relyea-Chew, JD, MS
? HRCT Reveals Asthmatic Risk Lingers Long After Cat Allergen Exposure. Using high-resolution CT (HRCT), researchers have proven for the first time that cat allergens can impair lung function in people with asthma for up to 22 hours after exposure. Such prolonged exposure could lead to severe subsequent asthma attacks. Presenter: Jared W. Allen, PhD
? Imaging Shows Link Between Marijuana Smokers and Schizophrenics. According to research, heavy use of marijuana could put adolescents genetically predisposed to schizophrenia at a greater risk of developing the brain disorder. Using diffusion tensor imaging (DTI), the research proves there are similar abnormalities in the brains of adolescents who are daily marijuana users and adolescents with schizophrenia. The abnormalities were found in a part of the brain still developing during adolescence that is associated with the higher aspects of language and auditory functions. Presenter: Manzar Ashtari, PhD
? Internet Answer to Mammography Crisis? According to a new study, the answer could be yes. Due to the ease of digital mammography images accurately transmitted over broadband Internet without loss of data or image quality, regional interpretation centers could be established to reduce screening backlogs and aid underserved areas. This news comes at a time of great demand for breast-imaging specialists. Presenter/lead author: Alan R. Melton, MD
? MR-Guided Laser Effective in Treating Liver Tumors. A 12-year, large-scale study has found laser ablation guided by MR to be as effective as traditional surgery in the treatment of liver tumors in some patients. More good news is that laser ablation has lower rates of morbidity and mortality than surgery and can be used to treat multiple tumors simultaneously. Presenter/lead author: Martin Mack, MD
? Noninvasive Ultrasound Treatment Shrinks Fibroids. MR-guided focused ultrasound surgery (MRgFUS) has been proven to safely and effectively treat fibroids in women, according to the results of a multicenter clinical trial. MRgFUS significantly relieves uterine fibroid symptoms and reduces fibroid volume. This comes as great news for the 25% of US women in their reproductive years who are affected by fibroids and who account for one third of the hysterectomies performed annually in the United States. Presenter/lead author: Fiona M. Fennessy, MD, PhD
? Obesity Prevents Injections from Reaching Muscle-Especially in Women. Excess fat in the buttocks has been identified as the key reason that injections do not deliver the optimal level of drugs such as painkillers, vaccines, contraceptives, and anti-nausea drugs, according to a study by the Adelaide and Meath Hospital (Dublin). Researchers used CT exams of the abdomen or pelvis to determine these results. Presenter/lead author: Victoria O. Chan, MB
? Radiologists Tackle Strange Football Injuries. New discoveries in imaging may improve physicians’ ability to diagnose and treat ligament injuries in the knee and high ankle sprain. MRI helped the researchers discover injuries without uncomfortable physical examination of the ligaments, which, if undiagnosed, can impede athletic performance and lead to arthritis. Presenter/lead author: Jeffrey Towers, MD
? X-Rays Good Predictor of Survival in Avian Flu Patients. Ordinary chest X-rays show distinctive disease patterns of avian flu in humans that are good predictors of patient survival, according to University of Oxford investigators. Their findings have shown patterns, such as fluid in the space surrounding the lungs, cavities in the lung tissue, and enlarged lymph nodes. The severity of the patterns has proven to be a good predictor of patient mortality. The researchers believe identifying avian flu disease patterns will help physicians with more aggressive treatment planning to improve a patient’s chance of survival. Presenter/lead author: Nagmi Quresi, FRCR
is associate editor of Medical Imaging.
PARTY HEARTY!Medical Imaging hosted its Third Annual Soir?e at RSNA, a delectable cocktail party held Sunday, November 27. The MI team offered a variety of spirits, delicious appetizers, scintillating conversation, and a string quartet. |
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