Applied Radiology

Toshiba America Medical Systems, Inc. (Tustin, CA) designs, develops, manufactures, and distributes a wide range of imaging products, including complete systems for computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, X-ray, angiography, and nuclear medicine. Recently, the company's Senior Vice President and General Manager, Edwin A. Lodgek, sat down with Applied Radiology to discuss current trends in technology development and their effect on the practice of radiology.

Applied Radiology: What do you see as the major trends in radiology technology development today?

Edwin Lodgek: Toshiba develops patient-focused technology, with the goal of faster acquisition of greater detail of the anatomy, in a trend toward capturing moving organs. We see these trends developing in particular in multislice CT and parallel imaging in MRI.

There is another trend toward a tighter link between diagnosis and treatment. This has led to the development of a family of applications that allow the radiologist to communicate more effectively with referring physicians, surgeons, and interventionalists. For example, there has been an explosion in three-dimensional (3D) workstation applications that translate diagnostic imaging information into anatomically correct 3D images that are useful to surgeons and for planning treatment.

An additional trend is toward the presentation of cardiac information for the cardiologist in which the radiologist is again responsible for the collection and interpretation of the data, and sharing that information with the treating cardiologist.

AR: Is this trend designed to make the radiologist a more integral part of the diagnostic team?

EL: I think yes. The radiologist is certainly becoming more a part of that team and is increasingly integrated into that stream of events.

AR: How does changing technology impact the patient experience?

EL: In terms of the patient experience, we have addressed some of the concerns with new technology such as Pianissimo, which reduces the very loud and intrusive gradient noise in MRI by as much as 90%. That creates a more comfortable environment for the patient undergoing high-field MRI.

AR: Where do you see these trends leading in the future?

EL: The trend shows that the technology available today is capable of producing more raw data than the radiologist can really manage. The good news is that the radiologist can drill down into a finer level of detail than was ever possible before. The bad news is that today's radiologist can be overwhelmed by the volume of data.

Multislice CT is an example of this. How many images do they need to review? How many need to be archived? How many should be kept for legal concerns? There are a rapidly growing number of applications that we believe will alleviate some of these challenges. These applications will allow the radiologists to preprogram exact views of interest based on the anatomy being scanned or the disease state being diagnosed. As to the presentation of information to the physicians, there is a continuing discussion regarding what exactly you have to keep from a clinical perspective, but protocols will develop around those discussion outcomes. We believe that, as a result, radiology services will be in higher demand in the future. The quality of diagnostic information that will become available is really going to be unbelievable. However, it will require the expertise of the radiologist to pro-vide the needed interpretation for the treating physician.

There is a tremendous amount of information available in technology today and, again, we have to look at the applications that are going to produce the best information, provide for the best outcomes, and allow for a management stream that is within everyone's interest and capabilities. I think that's really what it comes down to.

AR: Recently there has been an explosion in the field of multislice CT. Where do you see that race heading--toward even higher numbers of slices or toward more sophisticated applications?

EL: Both, I think. More slices and greater speed is really going to produce better information, and I think that the companies that have the capabilities to develop those technologies are the companies that are going to excel. They are the companies, obviously, with sophisticated detector technology.

We know that there is still a race toward more and thinner slices, and certainly the ability to move that technology is the fuel that drives the industry to take advantage of more sophisticated applications. With our Research & Development efforts, we are working with leading-edge clinicians and partners to develop new ways to use this high-quality information. Not unlike our competitors in this industry, we are getting aligned with key clinicians and partners and developing that information from those sources.

From a technology standpoint, Toshiba has believed, and continues to believe, that the organic development of technology is critical to understanding these products, their design and engineering. So Toshiba has developed this technology and continues to develop it; that is, we do not acquire it from another manufacturer who understands it.

AR: Which area of medical imaging do you believe will be the next to undergo significant advances?

EL: There are several areas that are going to continue to undergo significant change, including the emergence of new applications that address cardiology, molecular imaging, multimodality fusion imaging, and screening applications. An example in this arena is lung screening and lung nodule detection. We believe that the trend is toward more sophisticated applications; however, in order for these applications to produce the optimum result, we believe there is a parallel race to develop better image acquisition technologies.

AR: What should we be looking for from Toshiba in the future?

EL: In the short term, certainly in the CT arena, we are going to see increases in speed and in coverage by way of detector and computer design. There's also an additional focus on clinical applications in cardiovascular interventional areas. Finally, in CT, you are going to see Toshiba continue to improve in dose reduction.

In MR, the focus is going to be on system performance with the launch of our new ultra-short bore 1.5-Tesla system, which we call the Vantage. Beyond that, there is a focus on clinical application development with luminary customers in the United States, particularly with our parallel imaging technology known as Speeder. Speeder is available today on our existing 1.5T platform known as Excelart. With the Vantage, we are going to go deeper into the core, or the "sweet spot," of the MR business here in the United States with a short-bore magnet. We are going to take some of the advanced applications that are already part of our 1.5T line and adapt and integrate them into the Vantage.

AR: When do you expect to launch the Vantage system?

EL: Actually we have initiated production and have received Food and Drug Administration approval. Our first clinical sites will be coming on line early this fall.

In ultrasound, we have focused product development on applications with the new vintage of component architecture. That technology is still relatively new, so further development of that will occur, particularly in terms of clinical applications--specifically in microvascular imaging.

In vascular X-ray, Toshiba continues to make advances in flat-panel development and is focusing on product development that meets specific application needs. We have several large field-of-view flat-panel clinical tests being conducting in Japan. We are also testing in Canada. The results of both radiofrequency (RF) and digital subtraction angiography thus far are outstanding. We continue to stress development of flat-panel technology to meet the specific needs of cardiac applications as well. In fact, cardiac flat-panel clinical testing is ongoing.

These are near-term development areas that Toshiba is concentrating in. We are going to continue to expand our growth in CT in the near term. We will regenerate our ultrasound business. We are going to expand on our significant installed base of vascular imaging systems and we are going to do that by, we believe, introducing a quality flat-panel detector system that will be a very competitive operating model once it's available.

AR: What are Toshiba's long-term goals?

EL: In the longer term, in addition to advancing the clinical technologies that are part of our core, we're looking seriously at wireless technologies and the benefits those can afford the radiologist. We'll be showing some of that at RSNA in partnership with one of our sister companies, Toshiba America Information Systems. They will partner with us and demonstrate some of the capabilities for wireless technology. We will start seeing some of that relative to some interesting areas that could benefit radiology.

AR: How would you sum up the outlook at Toshiba?

EL: Toshiba is a committed player in imaging technology. We are committed to a global presence, meaning being a top player in the global environment. From this discussion, and with the evidence of some of our technologies under development, it should be clear that that is our commitment. We are committed to being a top player in the United States, as well as around the world.