Promoting a theme of "Science to Practice," the Radiological Society of North America (RSNA) held its 84th Scientific Assembly and Annual Meeting in Chicago from November 29 through December 4, 1998. This installment of the Technology & Industry Section previews the best of the year to come in 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
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
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
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
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.
PowerScribe® speech recognition aims to capture25% of radiology
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
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
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
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
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
"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
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
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."
1. Lund PJ, Fritz TA, Unger EC, et al:
2. Harisinghani MG, Saini S, Schima W, et al: