Applied Radiology

The 89th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA 2003) was held November 30 through December 5, 2003 in Chicago, IL. The theme of this year's gathering was Communication for Better Patient Care.

RSNA President Peggy J. Fritzche, MD, highlighted this theme in her Presidential Address as she called on radiologists to "push buttons less and talk more." She addressed four areas of essential communication: with the patient, with colleagues (including referring physicians), with medical students, and with the general public. By maintaining good communication with these four groups, she noted, radiologists will continue to ensure that theirs is a thriving medical specialty.

"Sometimes the allure of technology is so powerful that it's easy to be misled into thinking that it's the cure-all for everything in healthcare," she concluded. "We need technology plus communication. This is the equation that I believe will lead our profession forward to prosperity."

The scientific portion of the meeting included >2145 research presentations and posters covering 15 subspecialties of radiology. There were 283 refresher courses and 1140 educational exhibits. A total of 687 technical exhibitors covered 446,350 square feet of exhibit hall space. The RSNA estimates that attendees at this year's meeting contributed nearly $111 million to Chicago's economy.

Technical exhibits

The following highlights some of the new technologies introduced at RSNA 2003.

GE mammography

GE Medical Systems (Waukesha, WI) showcased two additions to their line of mammography products: a three-dimensional (3D) digital mammography system and a multimodality workstation for breast imaging.

The company featured their new patented TACT (tuned-aperture computed tomography) technology, currently available on their Diamond mammography unit. This technology allows the radiologist to create and manipulate a 3D image of a region of the breast (Figure 1), similar to that which is achieved using computed tomography (CT).

When performing an examination, the system immobilizes the breast with minimal compression, allowing the region of interest to remain in a more neutral position. A scout film is taken, and the region of interest is placed in the center of the field of view. Seven images are then acquired from different angles, and proprietary algorithms are used to reconstruct the image so the physician can rotate and "slice" through the final volumetric image.

According to the company, this technology can be helpful in ruling out some suspicious masses, particularly areas of dense breast that may be superimposed upon each other with traditional mammography. This, in turn, may reduce the number of breast biopsies performed.

"The TACT images are serving a particularly important role in helping us determine if a suspicious region is dense, but normal, structures that are superimposed in the image or a mass that must be further evaluated," said Michael T. Nelson, MD, Director of Breast Imaging Research and Associate Professor of Radiology at the University of Minnesota. "Before using TACT, we would review a variety of two-dimensional images and use 'mental fusion' to correlate the relationship of the different structures. Fortunately, the TACT technology now provides us with a more accurate way to evaluate these cases and have the diagnostic confidence to avoid breast biopsies in some cases."

The company also showcased, as a works-in-progress, a new multi-modality workstation designed specifically for breast imaging. The Seno Advantage workstation, with more than 30 applications and tools, provides the user with a single point of access for a variety of breast cancer detection tools, including digital mammography, magnetic resonance (MR), ultrasound, computer-aided detection (CAD), and more.

Based on the company's Advantage Workstation 4.2 platform, the Seno Advantage includes two high-resolution grayscale monitors for full-field digital mammography (FFDM) viewing and a color monitor to view multimodality images and to run applications. The system can be used to burn CDs with a free DICOM viewer inside or to create an electronic film that can be archived or sent to another clinician.

"With the new Seno Advantage multimodality workstation in our facility, we will now be able to access patient cases all from one workstation and conduct a comparative view," said Debra S. Mitchell, MD, Managing Partner at Breast Imaging of Oklahoma in Edmond, OK. "It will allow us to view multiple modalities simultaneously. If the patient had an ultrasound exam and an MR scan, we are able to view each of these exams together, which streamlines interpretation."

The Seno Advantage is currently available in Europe and is pending FDA approval in the United States.

iCAD adds lower-cost CAD options

iCAD, Inc. (Nashua, NH) unveiled its new, lower-cost CAD system, the iCAD iQ (Figure 2). Designed specifically for healthcare facilities that perform <20 mammograms per day, the company reports that new system is priced approximately 30% lower than other currently available computer-aided detection (CAD) systems.

"Mammography centers that perform >20 mammogram readings per day have been priced out of the market until now," said W. Scott Parr, iCAD President and Chief Executive Officer. "Most of these smaller clinics do not require the networking and integrated connectivity, high-speed mammography film handling, and case management database capabilities of our higher-priced MammoReader CAD systems. But they are under increasing marketing and legal pressure to offer the early cancer detection benefits of CAD to their patients. With the iQ system, we envision a significant expansion in market opportunity for our company within the emerging medical market for CAD. Most importantly, iQ will make the benefits of earlier CAD of breast cancer affordable and accessible to an increasing number of women at risk."

Designed to fit within the limited space of smaller mammography clinics, the system is available through iCAD's recently expanded network of resellers, with a purchase price <$70,000.

In addition, iCAD featured ClickCAD, a new fee-per-procedure program, for health centers that perform <15 mammograms a day.

Under the terms of this program, iCAD will install an iQ system without any capital cost to the customer. The heath center then pays iCAD a fee of approximately $6.50 for each CAD procedure performed.

The company states that third-party payer and federal reimbursement for CAD procedures could allow ClickCAD to be a revenue enhancer for women's health centers. "Assuming an average daily case load of 12 patients," explained Parr, "a mammography clinic could increase its revenues by more than $34,000 per year, after its ClickCAD payments to iCAD, Inc. This program allows the mammography clinic to improve the healthcare it delivers to women at risk, improve its marketing position in attracting and keeping patients concerned about breast cancer, reduce legal risks associated with overlooking early-stage cancers, and add to revenues and increase its net revenues--without a capital investment."

CPS debuts high-resolution
PET/CT system

CPS Innovations, a unit of CTI Molecular Imaging, Inc. (Knoxville, TN), unveiled its latest-generation positron-emission tomography/computed tomography (PET/CT) system in conjunction with RSNA 2003. According to CPS, the new system, LSO Hi-Rez, provides three times higher spatial resolution compared with existing technology.

The system was formally released at the Chicago Field Museum on December 1, 2003 with former New York City Mayor Rudolph Giuliani providing the keynote address. David Townsend, PhD, Professor and Director of the Cancer Imaging and Tracer Development Program at the University of Tennessee Medical Center (Knoxville, TN) and co-inventor of the PET/CT, provided an introduction to the new technology. "The images from the Hi-Rez PET/CT are of exceptional quality," he said. "The system offers the potential to visualize disease that is smaller in size or earlier in development that might well have been overlooked in some patients using existing PET technology. We're anxious to begin larger scale trials to demonstrate the potential benefits in lesion detection and improvements in quantitative accuracy."

The new Hi-Rez LSO detector technology is integrated with multidetector CT, including the latest generation of 6-slice and 16-slice scanners. The software is based on the syngo platform from Siemens Medical Solutions USA, Inc. (Hoffman Estates, IL). CPS Innovations markets the products through Siemens under the trade name Biograph, and through CTI Molecular Imaging, Inc. as the Reveal Hi-Rez.

Toshiba showcases CT and
ultrasound technologies

Toshiba America Medical Systems (Tustin, CA) used RSNA 2003 as a backdrop to launch their new 32-slice CT system. The Aquilion 32 features a 64-row detector design, isotropic scanning, and patented image-reconstruction technology.

The system's hybrid 64-row Quantum Detector can produce 32 simultaneous 0.5-mm or 1-mm slices with each gantry revolution for a total Z-axis coverage of 32 mm, allowing for the acquisition of isotropic data sets for any region of the body within a single breath-hold. Using 1-mm thick slices, the system can perform a CT angiogram in 15 seconds. The system's 72-cm aperture accommodates larger patients and the 1800-mm scan range accommodates taller ones.

The company's patented helical cone-beam reconstruction technique, based on the Feldkamp method for axial image reconstruction from helical scans, incorporates data only from views that are close to the image reconstruction plane, resulting in reduced cone-angle effects and artifacts.

Toshiba also featured a new suite of applications for the Aquilion 4-, 8-, and 16-slice CT systems at RSNA. The "SURE" suite includes the following applications.

* SUREWorkflow was designed to allow users to obtain maximum efficiency and image quality at the lowest possible dose.

* SUREScan provides real-time helical scan display of 12 images per second to permit current scan monitoring.

* SUREStart allows for real-time contrast detection at 12 samples per second, automation of contrast bolus detection and workflow, and elimination of test bolus.

* SUREFluoro provides real-time CT fluoroscopy at 12 images per second and display of 3 simultaneous images to aid localization.

* SUREExposure provides X-ray dose modulation matched to the patient's body type and desired image quality, resulting in up to a 40% reduction in total dose.

* SUREColon permits CT colonoscopy with combined prone and supine examination evaluation and automated fly-through.

* SUREPulmo is a lung nodule detection application with nodule analysis and temporal comparison.

* SUREPerfusion enables CT cerebral perfusion analysis with tilted perfusion dynamic scan for rapid stroke evaluation.

* SUREDiffusionEQ provides CT diffusion equivalent analysis with early stroke detection and rapid noncontrast analysis.

* SURECardio provides automated cardiac scan planning, cardiac functional analysis, Polar Maps, and cardiac or peripheral vessel probe analysis.

* SURESubtraction allows image subtraction before and after contrast administration to facilitate CT digital subtracted angiography.

* SUREPlaque is a method for soft-plaque identification and measurement and cardiac and peripheral vessel analysis with multiplanar reconstruction of cross-sectional imaging.

* SURESupport includes Toshiba Applications Academy, the InTouch assist program, and InnerVision remote diagnostics.

In the field of ultrasound, Toshiba showcased the latest enhancements to its all-digital ultrasound system, Aplio, including the iASSIST wireless remote (Figure 3), new transducers, and next-generation contrast imaging technology.

The iASSIST feature, which utilizes Bluetooth wireless network technology, enables the remote operation of the entire ultrasound system, including the ability to switch modes from several feet away. The new technology also permits the customization and sharing of clinical protocols between other Aplio systems, which may be useful in multicenter studies.

The new transducers include convex, linear, and sector transducers featuring the extended field-of-view mode known as trapezoid imaging. The transducers feature the company's high-performance piezoelectric ceramics engineered specifically for ultrasound applications to increase bandwidth and improve spatial resolution. The advanced impedance matching and improved acoustic lens material were designed to minimize reverberations and artifacts for greater sensitivity and image quality.

In addition, the system has been designed to utilize next-generation contrast imaging technology to visualize microvasculature detail. Aplio's Intelligent Component Architecture (ICA) technology enables the system's various components to operate autonomously and communicate directly with one another. This permits the system to perform highly complex data operations, such as real-time contrast imaging. In the United States, contrast use with ultrasonography is limited to left ventricular opacification studies, with studies of general imaging agents currently under review by the FDA.

Barco introduces 2MP color LCD display with 3D support

Barco (Kortrijk, Belgium) introduced a new 2-megapixel (MP) color medical display system at this year's RSNA. The Color Coronis 2MP display was designed for viewing both color and grayscale medical images and is compatible with advanced modality workstations, including 3D applications.

The DICOM-compatible, 20.1-inch display features 1600 * 1200 resolution and comes bundled as either one or two 2MP LCD displays. Designed for PACS, ultrasound, and orthopedic imaging, the system includes the company's proprietary Color I-Guard sensor, the Barcomed display controller with 3D support, Medical Pro softcopy quality assurance (QA) software, display driver, and digital cabling.

The Color I-Guard feature was developed to provide improved color consistency. A compact, front-mounted sensor located in the corner continuously adjusts luminance output and color consistency of the diagnostic viewing area at the front of the display. In addition, the Medical Pro QA software tracks, maintains, and logs display viewing performance, automates QA tasks, and initiates system calibrations without requiring user intervention. The entire system is driven by the company's new
Barcomed 2MP2CF-3D display controller, which was designed to support 3D PACS.

The Color Coronis 2M is also compatible with Barco's PIN (Product INtelligence) technology. The company's PIN-compatible PACS products form a distributed network of Web-enabled, intelligent devices that keep system administrators informed about the display system's quality. If the imaging chain fails, administrators can intervene from any location without disturbing normal activities.

Sony introduces new color printer

Sony Medical Systems (Park Ridge, NJ) unveiled its new A6 color video medical-grade printer with a USB 2.0 high-speed interface.

The compact UP-D23MD (Figure 4) printer provides 400 dpi printing with 16 million color tones. Data flow to the printer is approximately 10 seconds. The printer includes the company's proprietary Picture Quality Control technology and a color adjustment function that allows users to fine-tune results to meet their specific needs.

The printer, which can be connected directly to modalities, can also print images from a PC or network server. Measuring 83Ž8 * 55Ž16 inches, the UP-D23MD printer was designed to be able to be integrated into a medical cart or to be rack-mounted. It features front-loading functionality and accepts both L-size media for A6 images and S-size paper for smaller prints.

"More and more, ultrasound is migrating to digital output," commented George Santanello, Director of Marketing for Medical Systems in Sony Electronics' Business Solutions Division. "Medical facilities of all sizes are looking for fast, efficient, and convenient digital connectivity. Sony aims to bring the most advanced technology to market to help today's busy medical professionals."

The printer is currently available at a manufacturer's suggested price of $2379.