Just as advances in genetics, cellular engineering, and pharmacokinetics are changing the practice of radiology, electronic advances are pushing the envelope even further. This installment of the Technology & Industry Section reviews the "critical pathways" of radiology, as covered during the 1997 RSNA meeting, held last December in Chicago.
The theme of the 83rd Scientific Assembly and Annual Meeting of
theRadiological Society of North America (RSNA), held at McCormick
Place inDecember 1997, was "critical pathways." The Eugene P.
Pendergrass NewHorizons Lecture gave an idea of where some of those
critical pathways may leadas radiology enters the next century. ln
"Medical lmaging in the NewMillennium," Bruce J. Hillman, MD, of
the University of Virginia HealthSciences Center (Charlottesville,
VA) predicted dramatic changes in the scopeof medical imaging.
Advances in genetics, cellular engineering, and pharmacogenetics
will opennew worlds to radiology. "Very soon, radiologists must
find ways to useinformation technology to integrate imaging data
with new information in theseareas and place the results in a
functional context," said Dr. Hillman."This will allow us to
participate in the new style of interdisciplinarymolecular
medicine. Our residents are ill-prepared to work in this
environment,so we must train them and retrain ourselves. We must be
more collaborative andfocus in on the biological and physical
foundations underlying the radiologicimages," he explained.
Just as biomedical advances are changing the practice of
radiology,electronic advances are moving ahead with lightning
speed. Computers aregetting smaller and more powerful, leading to
numerous innovations in medicalimaging. PC power.
The personal computer (PC) is becoming a more and more useful
tool forvarious radiology applications. The small upstart companies
at the RSNA canoffer more powerful radiology products every time
Microsoft, Intel, or Netscapeupgrade the "off-the-shelf"
technologies used in today's medicalimaging devices.
E-mailing image display capability
There's a new type of e-mail that enables the recipient to
download,display, manipulate, and transmit annotated radiology
studies-essentiallyturning any PC into a medical imaging
workstation. According to Medweb (SanFrancisco), the Medweb E-Mail
Plug-in is free to facilities that buy the Medwebserver. "Because
our plug-in is very small and costs nothing, physicianscan include
a copy of the software in their e-mail," said Berta Hyken ofMedweb.
They can send that e-mail to any consultant worldwide who has
aninternet browser (specifically Netscape Navigator, Microsoft
Explorer, or LotusNotes). The consultant can then annotate selected
studies, includevoice-dictated and/or written comments, and e-mail
the study back to thesender.
The E-Mail Plug-in (an investigational device pending FDA
clearance)includes more than 40 image viewing and manipulation
tools, such as pan, zoom,digital edge enhancement, window/level,
interactive window/level, magnify,flip, rotate, measure, arrow
annotation, and a freehand annotation pencil. TheMedweb server with
wavelet compression, "typically saves users $50,000
perworkstation," said Ms. Hyken.
Perception Ultrasound (Issaquah, WA) offers the 5000, a PC-based
ultrasoundscanner, recently cleared by the FDA for marketing.
It's the first general-use ultrasound system using the Windows®
NToperating system, explained Martin E. Doyle, chairman and CEO of
Perception, acompany established in 1993 by several ultrasound
engineers. The system usesIntel hardware and Microsoft software
that generates "'virtual knobs' thatcontrol the ultrasound image,
unlike traditional scanners that arehardware-based and sometimes
use dozens of knobs, levers, and switches,"explained Mr. Doyle.
Applications for the ultrasound system include
obstetrics/gynecology,vascular imaging, urology studies, and family
practice and emergency-roomimaging. According to Perception, the
average system cost is approximately$40,000. Combined with the PC,
the Perception ultrasound scanner becomes a"virtual console" that
can store up to 5,000 patient files. With astandard modem,
ultrasound images can be sent from the scanner via internet,e-mail,
or local area networks.
"We told one radiologist that, with our system, he could
networkultrasound scanners in various hospital departments for
about $72,000. Theclosest quote he got from other ultrasound
manufacturers for the same setup was$350,000," said Mr. Doyle.
DICOM: "Buyer beware"
At RSNA 1994, DICOM (Digital Imaging and COmmunications in
Medicine), thestandard for electronic image data transfer, made a
big splash; 39 exhibitorssaid they were linked on RSNAnet, a
network located at McCormick Place, with anarchive of 128 sets of
images that could be retrieved from a server. At RSNA1997, however,
some attendees were disillusioned with how DICOM has evolved.There
is too much room left for individual interpretation, and today
two"DICOM-conformant" devices may still need a little extra help
"We've actually built DICOM-to-DICOM gateways betweendevices,"
said Wayne DeJarnette, PhD, president of DeJarnette ResearchSystems
(Towson, MD). "When investing in PACS, it's 'buyer beware' whenyou
hear that components are DICOM-conformant," he added. The
electronicgateways and interfaces are the key components that
determine the success of aPACS, noted Dr. DeJarnette. His company
is now providing PACS components toPicker.
DeJarnette Research Systems also is expanding its role in PACS
with a newline of imaging display stations, now in joint
development with ColumbiaScientific, Inc., a company known for
reconstructive and dental implantsimulation and surgery-planning
"While other manufacturers are struggling to convert their
existingimaging systems over to DICOM, Hitachi chose to start with
a totally compliantplatform," said Gary Enos, general manager for
Hitachi's nuclear medicinedivision. The SPECTRADigital 300SS, a
nuclear data and image processing system,is configured with Hewlett
Packard's open-architecture UNIX RISC workstation.Hitachi is a
member of the Andover Working Group, a consortium of
medicalmanufacturers that reviews HL7-DICOM communication protocols
for radiologyinformation systems (RIS), hospital information
systems (HIS), and centralinformation systems (CIS).
Kodak offers DICOM interface for non-DICOM equipment
The Eastman Kodak Company (Rochester, NY) introduced the Kodak
DigitalScienceTM medical image manager 100, a hardware/software
package that enablesmedical images from non-DICOM-compliant
equipment to be routed toDICOM-compliant workstations and archives.
The package also provides aninterface to RIS and HIS, allowing
patient demographic data to be linked withradiology images before
those images are sent to archives and workstations.This package
provides a convenient, low-cost means of linking any medicalimaging
device to a DICOM-compliant network. It's ideal for devices that
cannotbe upgraded to DICOM compliancy, or for devices where such
upgrades arecost-prohibitive," said Mike Cullinan of Kodak.
"Enterprise-wide" image management
Fuji Medical Systems (Stamford, CT) is developing
an"enterprise-wide" image management and information system,
theSynapseTM, designed to "expand the definition and functionality
ofPACS," announced the company. "Enterprise-wide" is the term
usedtoday to describe a system that encompasses the whole hospital
or institution,beyond the radiology department. The first
components of the system will becomputed radiography (CR)
workstations, based on a Windows NT platform and openarchitecture
that uses "cost-effective, off-the-shelf" hardware. Theworkstations
will feature "native DICOM output," and some will bedesigned for
upgrades to "full multimodality functionality,"according to
RIS with web report browsers
Per-Sé Technologies (Atlanta) introduced a new radiology
informationsystem (RIS) that includes a "web-enabled report browser
that givesreferring physicians access to reports from anywhere, any
time, withoutinstalling or maintaining software," according to the
company. ProgRIS 98also allows for simultaneous viewing of images
and report text, as well astwo-way communication with PACS (picture
archiving and communication systems)to support tracking of complete
film histories, both digital and on hard copy.Other features of
ProgRIS 98 include electronic signature, automatic reportrouting,
and voice recognition integration.
Flat-panel technology from NEC
NEC Technologies, Inc. (Itasca, IL) introduced its 14.1"
MultiSync®LCD400VTM, an active-matrix, thin-film transistor
(AM-TFT) flat-panel monitor,with an estimated street price of
$1998. The total depth of the monitor is6.6", making the monitor
well suited for radiology environments with spaceand weight
limitations. Access patient records with fingerprint scan.
Inaddition, NEC demonstrated Positive IDentification, a technology
that usesfingerprints to speed patient registration. When a patient
places a thumb onthe fingerprint scanner, any file from a previous
visit is brought up on thescreen. The system is being used at La
Porte Hospital (Indiana).
New MRI liver contrast agent from Nycomed
Nycomed Amersham (Princeton, NJ) introduced a new contrast
agent,mangafodipir (Teslascan®), for liver imaging with magnetic
resonance (MR).Mangafodipir is a complex formed between a chelating
agent (fodipir) and aparamagnetic metal ion, manganese. It shortens
the spin lattice (longitudinal)relaxation time (T1) of targeted
tissues during MR, leading to an increase inthe signal intensity
(brightness) of the tissues. Mangafodipir is indicated
fordetection, localization, characterization, and evaluation of
In clinical trials involving 105 histopathologically confirmed
liverlesions, paired comparisons of unenhanced MR and
Teslascan-enhanced MRcorrectly characterized 49% of the lesions,
compared with 30% by unenhanced MRalone, and 21% by
contrast-enhanced x-ray computed tomography (CT). Accordingto
Nycomed, Teslascan is the first hepatocyte-specific contrast
New injection system from Bracco
Bracco Diagnostics Inc. (Princeton, NJ) announced an exclusive
agreementwith ACIST Medical Systems (Eden Prairie, MN) to
distribute the ACISTTMInjection System, a contrast-delivery system.
The system gives physiciansconstant interactive control of contrast
administration through the use of aremote handpiece and a
touch-screen monitor. In comparison, current injectiondevices can
be used only at predetermined injection rates, explained Bracco.The
agreement also includes the ACIST line of proprietary
After the RSNA, Bracco announced a sole-source agreement with
AmericanPhysician Partners, Inc. (APPM) to provide radiographic
contrast media. APPM, amerger of seven radiology groups in New
York, Maryland, Kansas, Texas, andCalifornia, was formed in 1996.
The group operates 65 diagnostic imagingcenters and maintains 45
Nonionic contrast medium from Cook
Cook Imaging (Bloomington, IN), a manufacturer of interventional
radiologydevices, recently introduced a new nonionic contrast
medium, ioxilan(Oxilan®), indicated for cerebral arteriography,
coronary arteriography,left ventriculography, visceral angiography,
aortography, peripheralarteriography, excretory urography, and CT
imaging of the head and body.Ioxilan is a low-osmolality,
low-viscosity agent. Clinical trials showed nosignificant clinical
difference between ioxilan and iohexol (Omnipaque®,Nycomed), the
News from the RSNA 1997 will be covered in future Technology
& Industrycolumns. Our next installment, for example, will
focus on advances inultrasound.