Applied Radiology

The theme for the 88 ^th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA 2002)--"Leading Medicine's Digital Transformation"--was echoed throughout the proceedings; from the infrared beaming stations located throughout the McCormick Place Convention Center to the Scientific Program and the Technical Exhibits.

RSNA President Nick Bryan, MD, PhD, expounded upon this theme in his Presidential Address, saying that the ongoing digital evolution will bring revolutionary changes to radiology. He predicted that "the practice of radiology will fundamentally change from relatively inefficient, small, local operations that still keep the radiologist relatively remote from the patients, to very competitively managed, large, automated medical enterprises that will better incorporate the patient into the process."

He called on radiologists to embrace the digital nature of their profession. "Essentially, all contemporary imaging studies consist of data which is intrinsically digital," he said, "allowing a much more efficient and flexible use of this data and making it more readily available to patients, referring physicians, and other partners in healthcare."

The full scope of the digital environment, however, is more than just images, workstations, and software, he noted. "The wealth of information in these front-end components of the digital environment must be integrated into the rest of the enterprise. The radiologist, after adjusting to the changes," he proposed, "will be very happy having immediate access to all images and ancillary data, taking advantage of computer-assisted diagnosis (CAD), and generating rapid reports that can be distributed anywhere, at anytime." As a result, he concluded, "our referring physicians will be ecstatic to have prompt access to our images and reports and the health system will be happy because its patients are happy, its physicians are happy, and it costs less."

16-Slice PET/CT Systems

Among the highlights of this year's nearly 600 Technical Exhibits was the introduction of the first positron emission tomography/computed tomography (PET/CT) imaging systems to feature a 16-slice CT component.

CTI Molecular Imaging (Knoxville, TN) unveiled its new REVEAL XVI PET/CT, and Siemens Medical Systems (Malvern, PA) introduced the biograph 16.

The REVEAL XVI by CTI (Figure 1) combines lutetium oxyorthosilicate (LSO) "fast PET" crystal technology with 16-slice CT, and, according to the company, can perform high-speed cardiac procedures as well as tests for cancer detection and monitoring in 13 minutes for most patients.

"Our expectations are that the LSO PET scan, merged with a 16-slice CT image, will foster more accurate tumor detection and precise localization, improved biopsy sampling, and better assessment of patient response to therapy," said David Townsend, PhD, professor of radiology, University of Pittsburgh Medical Center and co-inventor of the PET/CT concept. "Further, the addition of the 16-slice CT capability is a major breakthrough because it allows the PET/CT scanner to perform high-speed cardiac tests, such as CT angiographies and real-time interventional studies."

"Combining faster scan times with better resolution allows visualization of coronary activity within one cardiac cycle for evaluation of coronary artery problems, wall-motion abnormalities, and heart tissue viability," agreed Todd Blodgett, MD, of the University of Pittsburgh Medical Center.

For cancer monitoring, Townsend said this system "gives the physician an improved assessment of recurrence or remission, and of the impact of chemotherapy or radiation at the tumor site."

"The ability to complete a PET/CT scan in 13 minutes is very convenient for patients and a major advantage for clinicians in high-throughput clinics or very large radiology practices," said Thomas Hook, senior vice president at CTI. "REVEAL offers radiologists the ability to conduct PET/CT studies for numerous oncology and cardiology applications on one system."

The company expects to begin full production on the $2.5 million system in the second quarter of 2003.

The other system introduced at RSNA 2002, the biograph 16 from Siemens, combines the company's SOMATOM Sensation 16 CT with its ECAT ACCEL PET system and includes the company's ultrafast ceramic (UFC) CT detectors and LSO PET crystals.

The company reports that the biograph 16 can perform whole-body oncology scans with submillimeter isotropic CT resolution in 7 to 15 minutes. The system also provides a larger field of view and co-scanning range than those of the company's previous hybrid scanners.

According to the manufacturer, this new technology is opening the possibilities for unprecedented PET/CT applications across the imaging spectrum. In oncology, protocols have been established for the whole body, lung, and colon scanning procedures. In cardiology, advanced applications include cardiac viability and imaging perfusion, calcium scoring, and CT angiography; with a single cardiac image acquired in <20 seconds. In neurology, the system can be used for brain perfusion studies designed to assess chronic conditions such as epilepsy and Alzheimer's disease.

Siemen's proprietary syngo and Soarian software solutions allow the biograph images and patient data to be distributed, accessed, and viewed across the enterprise.

The company expects to begin customer installations in spring 2003, with a price set at approximately 20% higher than the previous most expensive biograph units.

R2 Technologies previews CAD for CT

In other CT news, R2 Technologies (Sunnyvale, CA) showcased its CAD software with OmniCAD technology as a work in progress. The OmniCAD is designed for the detection of lung nodules in multislice CT images.

The ImageChecker CT CAD software uses proprietary algorithms to detect and highlight potential areas of interest. In addition, it provides measurement and characterization information about the detected nodules. The company points out that the technology allows the detection of nodules in CT images of the chest obtained for any clinical indication, not just for lung cancer screening studies.

"We are extremely excited about the use of CAD in CT and the potential to significantly improve chest imaging," said Gordon Gamsu, MD, professor and vice chairman, Department of Radiology, Weil Cornell Medical Center, New York, NY, who is also a member of the company's Chest CT advisory board. "Early-stage lung cancer is very difficult to detect, but with the opportunity to use R2's CAD software for the detection of lung nodules in multislice CT exams, we may be able to identify lung cancer early and potentially save lives."

In addition, the company announced that it has received 510(k) clearance for its ImageChecker CT display workstation. The workstation is a combination of dedicated software and hardware designed to allow the radiologist to review CT exams with the addition of CAD. The workstation receives CT exams and DICOM structured reports of CAD-identified areas using DICOM protocols. After reviewing each study, the user can view screens that summarize his or her findings and save the information to a local database.

Clinical studies for the ImageChecker CT CAD software are currently under way in the United States and Europe.

Toshiba unveils new open MRI and previews flat-panel detector

Toshiba America Medical Systems (Tustin, CA) introduced its Ultra open magnetic resonance imaging (MRI) system (Figure 2) and demonstrated its Dynamic Direct Conversion Flat Panel Detector as a work in progress.

The Ultra features a unique MRI gradient field technology with an amplitude of 25 mT/m (milli-Tesla per meter) and a slew rate of 100 T/m/sec (Tesla per meter per second). According to the company, this allows the system's gradient speed to be almost five times faster than the current open systems and 250% greater than high-field systems.

The company notes that the Ultra was designed to handle a full range of diagnostic procedures including routine neurology, body and musculoskeletal imaging, as well as more advanced neurofunctional and cardiovascular imaging. "The Ultra utilizes a very powerful gradient system to accomplish advanced clinical applications, high-resolution imaging, and faster scanning," said Dane Peshe, director, MRI and Nuclear Medicine Business Units at Toshiba. "This approach to increasing MR performance levels allows the Ultra to retain the spacious environment that patients have come to expect in an open system."

The company notes that the Ultra can perform many of the most sophisticated high-field imaging techniques including single-shot echoplanar imaging diffusion, TrueSSFP, SuperFASE, and Black-Blood MR angiography.

In addition, Toshiba previewed its Dynamic Direct Conversion Flat Panel Detector (FPD), the DynaDirect, as a work in progress on its Ultimax multi-purpose X-ray system. With the DynaDirect, the X-rays are converted directly to digital signals without first being converted to light. The detector delivers a 150-micron pixel size with a 14 * 14 inch coverage area.

"With DynaDirect, clinicians have already begun seeing more anatomical detail with greater clarity than ever before," said Don Volz, director, Vascular X-ray Business Unit. "In addition to the clinical benefits, eliminating film with a fully digital system holds numerous productivity and efficiency benefits."

Once approved, the technology will be made available in a field-upgrade package.

Hologic showcases new bone densitometer

Hologic, Inc. (Bedford, MA) unveiled its new line of bone densitometers, the Discovery series (Figure 3), at RSNA 2002. The new line combines 10-second bone density measurements with 10-second vertebral fracture assessment.

The system utilizes the company's proprietary OnePass Technology, which permits low-dose single-sweep scanning of the spine (L4­T4) with a 10-second acquisition time. The rapid acquisition time is paired with Hologic's Express BMD, which provides spine and hip bone mineral density (BMD) results in 10 seconds, and with the company's Instant Vertebral Assessment (IVA) for rapid assessment of spinal fractures.

The Discovery Series also includes a suite of productivity tools: The Express Exam feature groups routine scan protocols with automated patient positioning, scanning, and analysis workflow. Tech Tips aids the user in setting the proper patient alignment, scan start position, and correct scan position.

Once the images are acquired, the CADfx feature quantifies the degree of vertebral compression and simplifies IVA interpretation. The electronic reporting package integrates high-speed paperless data transfer, remote soft-copy image review, and automated report generation and distribution. The IRIS Connectivity Suite is IHE Year-3 compliant and can incorporate DICOM Modality Worklist, HL7 format output, and Microsoft Word-based electronic reporting software.

"Discovery is the result of more than 15 years of innovation in osteoporosis assessment," said Eric von Stetten, PhD, vice president and general manager of the Osteoporosis Assessment Division at Hologic. "By pairing 10-second bone density measurements with 10-second high resolution vertebral imaging, we believe Discovery provides physicians with the highest quality diagnostic information in the shortest amount of time. Discovery's unique combination of workflow enhancements, electronic reporting capabilities, and cutting edge technology sets the new standard for patient care and productivity."

All-digital handheld ultrasound units from SonoSite

SonoSite, Inc. (Bothell, WA) showcased its new handheld, all-digital ultrasound series, the iLook (Figure 4) at RSNA 2002. Weighing just 3 pounds, the iLook was designed to be used throughout the hospital to deliver a "quick look" in clinical diagnostics and vascular access guidance.

Initially, the company is offering two versions: The iLook 15 is intended for initial diagnosis of gallstones, abdominal aortic aneurysms, and pericardial or pleural perfusion across a wide variety of departments throughout the hospital.

The second version, the iLook 25--named for its 25-mm probe--was designed to be used during routine vascular access procedures, such as catheter insertions or placement of central or peripheral lines.

Both systems measure 6.4 * 10.85 * 1.5 inches with an integrated 5-inch thin-film transistor color Liquid Crystal Display with brightness and contrast control. Both offer 2-dimensional and color power Doppler. Harmonics are available on the iLook 15. Video can be output to a videocassette recorder, video printer, or external monitor. The iLook stand or a mobile docking station can be used to download bitmap images, and direct connectivity to a PC can be achieved using the SiteLink image manager.

"Our technology is driving a movement toward visual medicine that directly supports the top priorities in healthcare today--to reduce costs, increase access, increase safety, and improve quality of care," noted Kevin M. Goodwin, president and CEO of SonoSite. "iLook represents the newest member of the SonoSite family of systems and represents our unique ability to place the power to see inside the body directly in the hands of trained physicians, enabling them to make more informed decisions in any healthcare delivery setting."

The handheld device "frees up our larger machines for more complex studies and procedures, while giving physicians who depend on clear ultrasound imagery the information they need," reported Peter L. Cooperberg, MD, FRCP(C), professor of radiology, University of British Columbia and chief of radiology, St. Paul's Hospital, Vancouver, BC. "I have used SonoSite's hand-carried ultrasound devices for several years as an effective and cost-efficient way to improve how we care for our patients. Using visual technology in a clinical setting improves our ability to find and treat medical conditions early. We can make the diagnostic and treatment processes more convenient and more comfortable for our patients."

Both versions feature a single, fixed transducer and can be powered by battery or AC with battery back-up. They are controlled with a touch screen similar to that found on PDAs and cost from $12,500 to $15,500.

Kodak highlights latest dry laser Printer

Eastman Kodak Company (Rochester, NY) featured its new Kodak DryView 8900 laser imaging system (Figure 5) at RSNA this year.

This newest member of the DryView family contains three film drawers that are all capable of handling any of five film sizes: 14 * 17, 14 * 14, 11 * 14, 10 * 12, and 8 * 10 inches. The imager is capable of producing >180 films per hour at a laser resolution of 650 dpi for all film sizes. The manufacturer notes that the ability to hold such a variety of film sizes makes this unit suitable for producing output from modalities that generate mixed film sizes, such as computed radiography.

"The DryView 8900 system doubles the image resolution offered by most existing dry laser systems for general radiography and offers much greater speed," said Gregory Cefalo, worldwide marketing manager for laser imaging systems at Kodak.

This fifth-generation printer has a top-mounted, multi-bin film sorter that helps to decrease the unit's footprint and allow for greater flexibility in placement. The DryView 8900 also features a touch screen, multilingual color control panel, bagless DryView film cartridges, and Kodak's proprietary Automatic Image Quality Control (AIQC) process that verifies that all images have passed pre-set quality assurance parameters.

The DryView 8900 laser imaging system is expected to be available in the second half of 2003.

Amersham presents new corporate identity program

Amersham Health (Princeton, NJ) unveiled its new corporate identity campaign at RSNA 2002. Called "Every Single Second..." The campaign is based on the idea that every second, a patient somewhere in the world undergoes a procedure using an Amersham Health product.

"At Amersham Health, we are proud that every single second one of our products is used around the world to make a difference in a person's life," said Daniel L. Peters, president of Amersham Health's Medical Diagnostics business worldwide. "Physicians and technologists rely on our products to assist them in early, accurate diagnosis and to provide the information they need to determine the most effective treatment."

RSNA meeting attendance

The RSNA reports that the total attendance at the 2002 meeting was up 11% over last year, with 59,200 attendees, compared with 53,569 in 2001 and 60,443 in 2000. There were 24,471 radiology professionals at RSNA 2002 compared with 21,406 last year, and 24,600 in 2000. AR