Applied Radiology

At the RSNA, Eastman Kodak Company (Rochester, NY) announced the completionof its acquisition of Imation's medical imaging businesses in North America,Latin America, and Asia. Over the next six months, Kodak will acquire Imation'smedical imaging businesses in Europe. In addition, Kodak has acquired Imationmedical imaging facilities in Minnesota, Oregon, and California.

"We believe that there are tremendous opportunities in health imagingwhich expand beyond traditional diagnostic markets where we have competed forover a century," said Martin M. Coyne II, president of Kodak's HealthImaging Division. ACCESS Radiology Corporation (Lexington, MA) concluded itsacquisition of EMED (San Antonio, TX), which the company said makes ACCESS thelargest independent provider of teleradiology and image distribution systems.According to the company, about "one out of every four hospitals, clinics,outpatient imaging centers, and radiologists are ACCESS or EMEDcustomers."

"The combined business represents an excellent technology platform forthose institutions planning to migrate from teleradiology to hospital-basedimage distribution applications while preserving the investment they havealready made in this technology," said Scott S. Sheldon, chief executiveofficer (CEO) and president of AccEss. The combined company said it will retainthe EMED teleradiology product lines and key components of EMED imagedistribution and viewing systems, integrating these products into the ACCESSline of FRAMEWAVE™ DICOM and web products.

GE Medical Systems (Milwaukee) announced the completion of its acquisitionof the nuclear medicine and magnetic resonance (MR) businesses of Elscint Ltd.(Haifa, Israel). The business deal includes sales and service for bothmodalities and some design and manufacturing of Elscint's MR business. GE andElscint will continued their joint venture, ELGEMS, formed in 1997 for designand manufacturing of nuclear medicine equipment.

Internet and Java™ create new networks for imagedistribution

Advances in how radiology uses the Internet and Java technology are creatingnew networks for image distribution. For example, Kodak has proclaimed a newera in medical imaging based on global acceptance of the Internet, widespreaduse of network servers, and the availability of low-cost medical printers.

"Distributed medical imaging means that physical location no longerlimits access to medical images and reports," said Marcelo Lima, generalmanager of medical printing and vice president of Kodak's Health ImagingDivision. "The impact of this shift in medical image distribution will beenormous," added Mr. Lima.

The company introduced the Kodak Digital Science™ 1000 DistributedMedical Imaging Server and Distributed Medical Image Web Viewer designed forhospitals and imaging centers to share images and diagnostic reports overintranets and the Internet. These new products make it "possible forclinicians and referring physicians to view patient images and reports in theiroffices," said Lori Martin of Kodak. "With this server and software,retrieving a radiology exam can be as easy as checking e-mail," she added.

"Web browser technology is an extremely effective technology fordistribution of images and diagnostic reports," said Vishal Wanchoo,general manager of GE's Integrated Imaging Solutions, which introducedPathSpeed™ WebLink 2.0. PathSpeed is a new picture archiving andcommunications system (PACS), also introduced at the 1998 RSNA. According toGE, WebLink 2.0 enables referring physicians and radiologists to have completeaccess to patient history, reports, and images using a standard web browser.Image processing tools include window levels, magnifying glass, flip, invert,mirror, and bitmap saves.

Sun Microsystems Inc. (Palo Alto, CA) announced its Java Advanced Imaging(JAI) Application Programming Interface (API), "a network-centric imagingframework that is secure, platform-independent, and scalable across the entirehealthcare enterprise." An early access version of JAI is available athttp://www.sun.com/java/products/java-media/jai.

Sony entered the telemedicine market with three video-conferencing systems:the TriniCom® 5100Plus, TriniCom 3000Plus, and TriniCom DigitalMeeting™ System. The systems are designed for face-to-face, interactivemedical care and education. List prices range from $5,000 to $25,000, dependingon configuration, according to Sony. DeJarnette Research Systems (Towson, MD),a leading provider of teleradiology, PACS, and medical imaging and informaticsinterface technology, announced a strategic alliance with Swearingen Software(Houston, TX), a company that develops PC-based radiology information systems(RIS). As a result, both companies will now offer complete RIS/PACS to theirclients. In addition, DeJarnette and Swearingen are working together to developa "tightly integrated RIS/PACS solution," according to DeJarnette.

Integrated healthcare enterprise

The infoRad exhibit at RSNA this year was dedicated to the goal of anintegrated healthcare enterprise (IHE). Leaders in electronic communicationsenvision that future hospitals will have comprehensive integration of medicalinformation systems, including radiology information and imaging systems.

Radiologists can take advantage of the explosion of computer networks andpatient databases that are widely used in other specialties, according to C.Carl Jaffe, MD, professor of Medicine and Diagnostic Radiology at YaleUniversity. Databases that combine all medical records of a single patient, forexample, could help improve service from radiology practices.

Direct radiography brings x-ray into digital age

The promise of digital x-rays seemed closer to reality as several companiesexhibited direct radiography (DR) systems. Unlike computed radiography (CR)systems, which rely on phosphor imaging plates that replace film cassettes, DRsystems send data directly from the detector to the workstation.

Siemens Medical Systems (Iselin, NJ) introduced the Pixium 4600, a digitalflat-panel x-ray detector still under review by the FDA. Based on amorphoussilicon (a-SI/Cs-iodide) technology, the detector replaces traditional x-raybucky and film cassettes. The detector features an active matrix of 17 ¥17" and contains 3000 ¥ 3000 pixels. According to Siemens, the systemgenerates 18 megabytes of data with a 12-bit data depth, "several timesgreater than that of a CT or MR image."

Incoming x-rays first strike a cesium iodide layer that converts the x-raysinto light, which then passes through a photodiode matrix of amorphous siliconand is converted into electrical signals, which are amplified and digitized.The digital data are then processed into images that are displayed, printed,and/or stored on the network. According to Siemens, future refinements inflat-panel detector technology could reduce x-ray doses by up to 75%.

Fuji Synapse™ available 1999

The next general PACS from Fuji Medical Systems U.S.A., Inc. (Stamford,CT), called Synapse, will be available in early 1999, according to the company."More and more facilities are adopting a PACS strategy which leverages useof Fuji CR to bring their predominant volume of x-ray images online quickly andefficiently," said Clay Larsen, vice president of marketing and networkdevelopment at Fuji.

Pilot sites for SYNAPSE include Children's Hospital Los Angeles andResurrection Health Care in Chicago. "A year ago, we outlined what weconsidered to be our ideal PACS architecture," said Marvin Nelson, MD,acting chairman of Radiology at Children's Hospital. SYNAPSE fit that idealarchitecture by "incorporating web-based technology and commonoff-the-shelf hardware and software," said Dr. Nelson.

PowerScribe® speech recognition aims to capture25% of radiology transcription market

Providers of the PowerScribe Radiology dictation/transcription systempredicted that this speech recognition system would capture 25% of theradiology transcription market. Formerly marketed by the MRC Group (Cleveland,OH), PowerScribe is now marketed by fonix corporation (Draper, UT), whichspecializes in human-computer interaction technology.

Within the eight months after PowerScribe Radiology became available lastyear, more than 20 healthcare institutions have chosen the system, according tofonix. As part of these installations, fonix reported that it has developedinterfaces to several RIS products, including those from Shared Medical Systems(SMS), Cerner Corporation, ADAC Laboratories, and IDX Corporation.

New multislice CT technology

Siemens introduced its multislice Volume Zoom upgrade for its SOMATOMM® Plus 4 CT scanner, which provides "speeds 8 to 24 times faster thanone-second CT examinations," according to the company. "Sub-secondmultislice scanning is the future of CT, especially in applications such as 3-Dangiography and virtual endoscopic procedures," said Richard Hausmann,vice president of marketing and sales at Siemens Medical Engineering's CTDivision.

According to Siemens, the Volume Zoom upgrade, with "an extremely fastquarter-second scan time," can image the heart and lungs "virtuallymotion-free." The company said that a complete lung study can be acquired"with more than doubled resolution in a fraction of a breath-hold,"and that the system can provide calcium scoring to help assess the risk ofcoronary artery disease.

Toshiba America Medical Systems, Inc. (Tustin, CA) introduced theAquilion™, "the industry's first one-half second helical whole-bodyCT scanner," according to the company. Aquilion is the cornerstone ofToshiba's multislice imaging technology, a works in progress.

With a four-slice multidetector with one-half second rotation, the systemwill deliver eight slices per second, according to Toshiba. Using ContinuousImaging™ in conjunction with multislice technology, interventional CTfluoroscopy may become more effective, predicted the company.

Real-time MR, or "MR fluoroscopy"

GE announced real-time interactive MR imaging, also called "MRfluoroscopy," which may lead to rapid MR screening techniques. The companyexpects the new technology to be useful in cardiac and vascular imaging,kinematic MR (imaging joints in motion), functional brain studies, bowelimaging, and MR-guided surgical/interventional imaging.

Addressing the year 2000 computer problem

Trevor D. Cradduck, PhD, president of The Keston Group (London, Ontario,Canada), gave a presentation at infoRad on the year 2000 (Y2K) problem forcomputers in radiology. As has become common knowledge, many computers willassume that the year 2000 is actually 1900 because software programs generallyrecognize a year by its last two digits. This problem could affect patientscheduling, billing, and many other functions of radiology information andimage management systems. "Radiology equipment users need to ensure thatmanufacturers can update imaging and computer equipment to become 'Y2K'compliant," said Dr. Cradduck. The Keston Group provides consultingservices on medical physics and the application of computers to diagnosticimaging. More information on Y2K is available at the http://www.keston.com website.

Additional news from the RSNA 1998 will be covered in future Technology andIndustry columns. The March issue, for example, will focus on advances inultrasound, including real-time 3-D scanning, tissue harmonic imaging, andultrasound PACS.

Bracco introduces SonoRx® ultrasound contrastagent

A new oral contrast agent that reduces gas shadowing in abdominalultrasound studies is now available. Bracco Diagnostics Inc. (Princeton, NJ)received marketing clearance last October from the U.S. Food and DrugAdministration (FDA) for SonoRx®, a simethicone-coated cellulose suspensionadministered as an orange-flavored drink.

"Ultrasound imaging of the upper abdomen can be a challenging exambecause gas in the stomach and adjacent bowel typically produces shadowingartifacts that may obscure the radiologist's view of the anatomy of thestomach, gastric wall, pylorus, duodenum, and pancreas," said NormanLaFrance, MD, vice president of Medical and Regulatory Affairs at Bracco.

SonoRx is indicated to enhance delineation of upper abdominal anatomy inconjunction with ultrasound imaging. In many patients referred for ultrasoundfor nonspecific abdominal pain, gas shadowing diminishes diagnostic accuracy.1These artifacts may result in significant disease remaining undetected, or inpatients being referred for more expensive studies, such as x-ray computedtomography (CT).1 Simethicone-coated cellulose may be effective as anultrasound contrast agent even in patients who undergo emergency abdominalultrasound without prior fasting.2 Reducing gas shadowing with this contrastagent also can improve reader confidence in interpreting abdominal ultrasoundimages.1,2

Removes "acoustic mirror," providing"uniform sonic window"

Clinical studies of SonoRx demonstrate that it adsorbs and disperses gas,creating a "uniform sonic window" that significantly improves upperabdominal ultrasound images. "A gas bubble almost fully reflects the soundbeam back to the transducer. Because there is an acoustic mismatch between gasand the adjacent tissue, the sound beam is reflected, just like light off amirror, and the sonogram does not visualize the tissue behind the gasbubble," explained Joe Balogh, director of marketing for MRI/Ultrasound atBracco.

If the patient drinks SonoRx within 10 minutes before the ultrasound exam,gas is displaced or adsorbed by the cellulose fibers, removing the"acoustic mirrors" that degrade images with gas shadowing. The mostsophisticated ultrasound system cannot scan through gas, noted Mr. Balogh.According to Bracco, one dose of SonoRx will cost about $25 to $30, and thepatient must drink the entire dose in 15 minutes.

Radiologists and sonographers may use the new contrast agent in a"selective problem-solving mode," said Mr. Balogh, in which theystart scanning, discover the patient has gas, have the patient drink SonoRx,and then complete the exam. Or, drinking SonoRx could become a routine part ofpatient preparation for abdominal ultrasound. "The market will tell us howthe product is being used in clinical practice," noted Mr. Balogh. Theingredients of SonoRx-which include water, simethicone, cellulose fibers,flavorings, and preservatives-are classified as "generally recognized assafe, or GRAS," explained Mr. Balogh, "and the adverse event profileis very good."

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