Recently, Applied Radiology had the opportunity to speak with Arnd Kaldowski, Vice President of Global Sales and Marketing, Ultrasound Division at Siemens Medical Solutions (Malvern, PA) about the future of ultrasound technology.
had the opportunity to speak with Arnd Kaldowski, Vice President of
Global Sales and Marketing, Ultrasound Division at Siemens Medical
Solutions (Malvern, PA) about the future of ultrasound
What is the current status of ultrasound technology in clinical
practice and where is its development heading?
We believe that ultrasound (US) has made quite some progress over
the last few years. But, if you look at its impact on clinical
workflow and on changing standard clinical practice, US has not had
the impact during the last 10 years that other modalities that are
in more innovative phases have had. When looking at opportunities,
it is important to focus on what can be changed in the clinical
workflow by applying the technology rather than by developing a
technology for the sake of technology.
Are you saying that development should be driven by
Absolutely, it should focus on which new clinical US applications
can be identified and which developments can improve workflow by
offering higher diagnostic confidence as well as improvements in
throughput and user independence.
What indications are you most focused on?
Breast cancer screening is one area of very high interest at the
moment; going from diagnosis to early detection. It is well-known
that US, especially in dense breasts, has the ability to be very
specific with regard to identifying potential tumors, but it has
not yet been fully developed. You need to be able to perform a fast
examination with a relatively high degree of standardization to be
able to do a screening process.
There are a lot of new opportunities for US with the use of
targeted agents and patient-specific molecular imaging. Molecular
imaging with US is based on today's contrast approach with bubbles,
whereby active agents, or biomarkers, are placed on a bubble to
hook to a specific ligand or enzyme to identify specific areas of
What are the potential applications for molecular US?
There is work being done to identify tumor angiogenesis very early
on, before you can see the tumor. That is one application that we
are pursuing. Another one, in a very different direction, is called
sonothrombolysis. In this process, you send the contrast bubble to
a thrombus and, through an active agent, attach the bubble to the
thrombus. Then you can destroy the bubble with a high-intensity US
beam that starts to dissolve the thrombus. You can use a targeted
agent or just use the collapse of the bubble. You could even fill
the bubble with a medication, deliver it with a targeted agent to a
specific area of interest, and make the bubble burst and deliver
the drug targeted to the specific area.
What is silicon US?
We acquired a company last year that has developed, to a prototype
level, transducers based not on piezoelectric material but on
silicon technology. It is possible to build nanotechnology
structure on silicon. With silicon, you can build a drumhead-a
cavity-and keep the silicon standing around it. You then can put
connectors on top of it and, by applying a certain amount of
electricity and voltage, you can make the drumhead send sound
What are the benefits of this technology?
With this technology, you can go to a very large number of elements
per square cm or mm, far more than you have on today's
piezoelectric transducers. With that, you can go to a real-time
3-dimensional transducer. Secondly, the signal bandwidth of the
transducer is a lot better, so you get better resolution and
sharper images. The third benefit is that you can integrate the
first step of the signal processing in the silicon and then build
the silicon drum. Unlike today's transducers, this new technology
will allow some of the signal processing within the transducer,
even though it is lighter than today's transducer. Also, it will
not need a radiofrequency (RF) cable from the transducer to the
system. So the cable can be lighter and it can have more channels
sending more information to the system. A big limitation for US is
the need to connect the RF cable to the piezoelectric material.
That limits you in the number of elements you can use, and it also
limits you with regard to weight and ergonomics. By pushing the
signal processing to the front in the silicon, you get rid of a lot
of the problems.
Where is silicon US in the developmental process?
Currently, we have prototypes working on today's products. We are
learning about the images and how to optimize them. I would assume
that we are approximately 1 to 2 years out from the first
commercial availability. The first implementation is really using
the advantages of the technology for today's transducers, but you
can think further. One dream, based on the ability to have large
silicon US plates, would be to develop a belt-type transducer that
can be placed around the neck, but that is much further in the
future. Step one is to apply this technology to today's
transducers; in step two, the benefits of this technology will
guide us to different forms of transducers.
What other issues are important to US today?
One that is important for us is the integration of US into a
broader modality perspective. If you talk about fusion of
modalities, one area that we see as very important is how you
utilize the capabilities of US in combination with computed
tomography (CT) or magnetic res
onance (MR) imaging. If you can combine some of the advantages
of CT, for example, with US during an operative procedure and fuse
the information, especially with regard to image-guided therapy,
there are a lot of opportunities for ultrasound to either cover
ground that is not currently covered or to replace some of the
X-ray-centric approaches. The whole element of intraoperative
imaging and image-guided therapy is a huge field in which we see a
lot of opportunities.
What are the goals of the Innovation Center that Siemens opened in
Mountain View, CA?
We opened the Innovation Center last July with 2 main goals. On one
hand, we wanted to invite our customers to participate in our
decision making regarding which new applications and new
technologies we should ultimately invest our money in. If you have
an idea like silicon US, it might be 3 years before you have a
product available. There are a lot of decisions you have to make.
The Innovation Center is clearly focused more on discussions on
what will happen in US in 3 to 5 years, on what needs to happen
from a clinical perspective, and on getting more guidance early on
as to whether or not we are addressing the right topics.
The second goal is to have exposure on a continuous basis as an
organization, especially as a product-development organization, and
to gather input from customers so that the solutions we develop
will be more targeted to the real needs of the customer. I think
that exposing all of our employees to customers on an almost daily
basis is really the best way of getting us to the best level of a
SOAR Awards for Excellence in Cardiac CT
In other news,
, Siemens Medical Solutions, and the Society of Cardiovascular
Computed Tomography (SCCT) have joined together to present the SOAR
Awards for Excellence in Cardiac CT.
Designed to identify future thought leaders in cardiac CT, 8
outstanding third-year residents (4 each in cardiology and
radiology) have been selected to enter research papers on cardiac
CT into the competition. Each author will research a specific
clinical topic and will write a detailed article, including
diagnostic and therapeutic objectives, imaging protocols, outcome
data, and cost-effectiveness of cardiac CT within the assigned
topic. The papers will be judged by a panel of experts, and the 2
top papers-1 from the cardiology fellows and 1 from the radiology
fellows- will be selected. The winners will each receive a 1-year
fellowship to continue their research in cardiac CT and a trip to
the SCCT Annual Scientific Meeting. All accepted papers will be
published in a supplement to
later this year.
The members of the review committee are: SCCT President Stephan
Achenbach, MD, Erlangen, Germany; Suhny Abbara, MD, Boston, MA;
Michael Poon, MD, New York, NY; Elliot K. Fishman, MD, Baltimore,
MD; and Allen J. Taylor, MD, FACC, Washington, DC.