An interview with Ed Lodgek from Toshiba Medical Systems on current trends in 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
to discuss current trends in technology development and their
effect on the practice of radiology.
What do you see as the major trends in radiology technology
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.
Is this trend designed to make the radiologist a more integral part
of the diagnostic team?
I think yes. The radiologist is certainly becoming more a part of
that team and is increasingly integrated into that stream of
How does changing technology impact the patient experience?
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.
Where do you see these trends leading in the future?
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
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.
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?
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.
Which area of medical imaging do you believe will be the next to
undergo significant advances?
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
What should we be looking for from Toshiba in the future?
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.
When do you expect to launch the Vantage system?
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.
What are Toshiba's long-term goals?
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
How would you sum up the outlook at Toshiba?
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.