Applied Radiology

Every time a doctor sees a patient, there is an opportunity to transform patient care. And although radiologists play an active role in impacting care, rarely does the patient see how radiologists participate in the care cycle.

‘Patients First’ — the theme of the RSNA 2012 annual conference — was a call to action for radiologists to play a ‘visible’ role in the continuum of care. At the Opening Session at the annual conference, the 2012 RSNA President George S. Bissett III, MD, urged radiologists to become more visible to patients by developing stronger partnerships with primary care physicians, and by simply going out into the waiting room to meet patients and discuss their conditions.

To lead the charge, RSNA launched the Radiology Cares campaign, an initiative to challenge radiologists to put patients first. The program is designed to rally radiologists to interact with patients through improved communication, such as including in reports a practical explanation that patients can understand. Perhaps one of the most significant direct-to-patient encounters will take place through patient healthcare records (PHR). Already in its second year, RSNA’s PHR pilot project involves 5 leading academic sites that currently enable their patients to transfer images to a PHR. From there, patients have direct access to their own reports and can view their imaging exams in a Web viewer.

Applied Radiology also took the opportunity to shine the spotlight on the radiologists from the trade show floor, capturing a series of video interviews, in which radiologists describe their role in transforming patient care. These exclusive interviews are available on MyAR TV.

The evolving technologies that support the powerful connection between radiologists and patients were on display on the exhibit hall floors of RSNA and many are featured here in this review.

Advanced visualization

Philips Healthcare (Andover, MA) featured IntelliSpace Portal, its advanced visualization solution for the analysis and interpretation of medical images from CT, MRI, PET, and SPECT, and designed to support radiologists managing vast amounts of imaging data sets.

TeraRecon, Inc. (Foster City, CA) showcased its suite of iNtuition Vendor-Neutral Applications, including iNtuition Review for evaluating multi-modality imaging, such as cardiac (Cath, Echo, CT, qualitative MR) and breast (mammography, breast MRI, ultrasound). The company featured its zero-footprint viewer, iNtuition Enterprise Medical Viewer – iEMV, a scalable, VMWare Ready, and virtualizable technology. Also on view was iNtuitionSHARE, designed for CD-free transport and distribution of images between medical facilities and peers, or patients. Finally, the IT company presented iNtuitionCLOUD, a solution which allows the full capability of iNtuition to be deployed via a web browser, either as an externally hosted managed service, or as an in-house private cloud.

Vital Images (Minnetonka, MN) announced it received 510(k) clearance from the U.S. Food and Drug Administration for 3-dimensional viewing through its universal viewer, VitreaView, designed to provide a consistent image viewing experience across the patient continuum of care. VitreaView is used as a communication tool for DICOM and non-DICOM medical images through a standardized viewer, giving clinicians access to images through EHRs and providing a single, standardized imaging layer for referring clinicians.

Breast imaging

Hologic Inc. (Bedford, MA) featured Selenia Dimensions, their 3-dimensional (3D) mammography (breast tomosynthesis) system. In hands-on demonstrations, Hologic showed how radiologists read 3D breast tomosynthesis images in combination with conventional and synthesized 2D images.

Also on display were the Selenia and Selenia Dimensions 2D mammography systems. Plus, Hologic highlighted the Selenia Dimensions 2D Contrast Imaging Option, an effective means of adding physiological information to a diagnostic exam (CE marked and pending FDA clearance).

Image analytics innovations included Quantra^® breast density assessment software, providing a BI-RADS-like value for the consistent reporting of breast composition, and Hologic’s BACS (Breast Arterial Calcification Scoring) software package.

In the biopsy area Hologic showed a new introducer for use with the ATEC^® biopsy system under ultrasound guidance. One insertion allows for both biopsy needle placement and marker deployment.

A new iteration in breast MRI was the 16-channel Sentinelle Breast Coil array designed to provide high quality signal-to-noise ratio as well as optimal access for breast biopsies. The 16-channel array is available on some Siemens MRI platforms.

GE Healthcare (Chalfont, St Giles, UK) rolled out its newly acquired somo•v Automated Breast Ultrasound (ABUS), the only ultrasound system approved in the U.S. for breast cancer screening as an adjunct to mammography for asymptomatic women with greater than 50% dense breast tissue and no prior breast interventions. .

Another breast-dedicated tool on display was Discovery NM750b, indicated for molecular breast imaging (MBI). MBI helps detect breast cancer in high-risk patients, especially those with dense breast tissue. MBI uses a small injection of a radioactive tracer that locates metabolically active tumors (showing blood flow.) Patients can choose to sit or stand while the scanning takes place and each image view takes up to 10 minutes.

Philips Healthcare featured MicroDose with Single-Shot Spectral Imaging (SI) (pending 510(k) clearance) together with Spectral Breast Density Measurement (pending 510(k) clearance). The new Philips MicroDose SI, a full-field digital mammography system, brings the potential of noninvasive spectral imaging to clinical practice without exposing women to additional examinations or radiation.

Sectra (Linkoping, Sweden) displayed Sectra Breast Imaging PACS, a multi-modality PACS that now supports display and review of breast tomosynthesis images. Regardless of modality or vendor, all breast images are automatically aligned and displayed side-by-side in the same size and dimension. Tools for breast density assessment are integrated into the clinical workflow along with CAD.

An additional option for mammography workflow is osteoporosis screening. Sectra OneScreen combines with mammography workflow by taking a hand x-ray in < 30 sec at the same time breast images are taken using the same radiology equipment.

Matakina International Ltd. (Wellington, New Zealand) introduced Volpara Breast Density Assessment software, which offers objective breast density measurements for mammograms acquired from any commercially available digital mammography system. Volpara generates objective, automatic measurement of volumetric breast density values along with a BI-RADS Breast Density Classification. Volpara is FDA cleared for all digital mammography units, and integration with other digital mammography systems, CAD systems and mammography reporting systems are also under way.

Siemens Healthcare (Malvern, PA) unveiled the MAMMOMAT Inspiration Prime Edition, a digital X-ray breast imaging system designed to lower patient dose up to 30% without compromising image quality. The unit aims to lower dose by replacing the standard scatter radiation grid with a new algorithm for progressive image reconstruction. This new algorithm is intended to identify scatter-causing structures and calculate a corrected image, enabling complete use of primary radiation so physicians can achieve high-quality images using less dose.

VuComp Inc. (Plano, TX) rolled out M-Vu CAD, a computer-aided detection (CAD) system that automatically identifies areas of a mammogram that are consistent with breast cancer. M-Vu CAD analyzes a mammogram using advanced mathematical algorithms to search for suspicious areas and mark them with outlines that indicate the type of potential abnormality. Solid lines indicate a possible mass while dotted lines indicate a possible cluster of microcalcifications. M-Vu CAD communicates over a clinic’s network using DICOM communication standards to receive digital mammograms and to send results to a PACS system, review workstations, or a printer. M-Vu CAD employs VuCOMP’s SmartMarks technology, which provides a new level of instant clarity to CAD results. This allows a radiologist to spend more time considering a marked area and less time wondering about what CAD is indicating.

Computed Tomography

GE Healthcare presented the Optima CT660 FREEdom Edition, which features Motion FREEdom technologies (fast registered energies and ECG) designed to freeze coronary motion in higher heart rate coronary CTA exams by using intelligent motion correction via SnapShot Freeze. By precisely detecting vessel motion and velocity, SnapShot Freeze can determine actual vessel position and intelligently correct the effects of motion during cardiac CT exams. The extended coverage of 80 mm with VolumeShuttle provides twice the brain coverage for a single bolus of contrast at lower dose than continuous acquisition techniques.

GE also introduced the Optima CT540 with ASiR CT iterative reconstruction technology, and Xtream workflow management tools, such as Default Patient Positioning (DPP), gantry LCD touch screen, Dynamic Transition with SmartPrep on the Xtream Injector, and the emergency patient mode as a dedicated user interface (UIF) to start emergency exams quickly.

Hitachi Medical Systems America (Twinsburg, OH) announced a recent upgrade for the Scenaria 64-detector-row scanner to Advanced 128, which offers 128-slice reconstruction, and a 40-mm detector area with 64 channels, open design, with a 70-cm gantry and 88-cm gantry thickness. The scanner’s table supports patients weighing > 500 lbs, and it features a laterally shifting design called IntelliCenter that enables users to shift the table left or right by up to 80 mm. This allows the field-of-view to be focused on the area of interest, enabling the use of smaller bow-tie filters and lower radiation dose. Also available on the Scenaria system is the second-generation iterative reconstruction algorithm, called Intelli IP (Advanced) — a new version of its conventional Intelli IP. Intelli IP (Advanced) features an updated reconstruction engine that doubles the speed of reconstruction from 18 images per second to 35. The Advanced 128 is pending 510(k) FDA clearance.

Philips Healthcare showcased its latest update to its iterative reconstruction solution, the iDose4 Premium Package, available on Philips’ CT platforms. The package offers two image quality enhancement technologies: iDose4, which reduces artifacts and increases spatial resolution at low dose, and provides metal artifact reduction for orthopedic implants (O-MAR).

Philips’ also showcased its CT IMR solution, a knowledge-based iterative reconstruction technique that transforms CT imaging from data approximation to data restoration. IMR is designed to provide virtually noise-free image quality with improvements in low-contrast detectability. This process is a significant step towards discovering new clinical potentials for CT imaging.

Finally, Philips featured iPatient, a solution for its CT and PET/CT scanners to simplify the use of iterative reconstruction techniques, as well as its SyncRight feature, which allows for easy and efficient communication between the CT system and the injector in order to deliver appropriate contrast dose and consistent image quality.

Siemens Healthcare featured its SOMATOM Perspective, a high-end CT scanner to facilitate CT business without compromising clinical results. The scanner can help manage financial performance while focusing on patient needs and easing your daily routine using eMode, a feature that supports more efficient scanner use.

Contrast media

Bayer Healthcare (Tarrytown, NY) highlighted its Certegra SR Outbound Interface with Nuance’s PowerScribe 360 | Reporting platform which auto populates injection and study information directly into the radiologist’s report. Data is captured from the MEDRAD Stellant D, Modality Worklist/RIS, and CT scanner, and documented via the Certegra Workstation directly into PowerScribe. Bayer HealthCare and Nuance Healthcare aim to enhance operational and clinical workflow and improving the accuracy of the data reported.

Bayer also announced the acquisition of Radimetrics Inc., the developer of software that measures a patient’s radiation exposure over the course of multiple imaging procedures.

Bracco Imaging S.p.A. (Milan, Italy) highlighted pre-programmed protocols integrated into its CT contrast injectors, including the Empower line of integrated contrast injectors. The EmpowerCTA and EmpowerMR are designed to help streamline workflow by linking to the facility’s existing database to manage patient data and automate the imaging procedure. The EmpowerCTA Contrast Injection System offers a protocol option that delivers venous-side iodinated x-ray contrast with saline chase capabilities for use in state-of-the-art CT imaging. Features include the EDA™ Extravasation Detection Accessory, a preprogrammed MDCT reference protocol for major brands and models of scanners, IRiSCT Data Networking application to generate reports for budgeting, for cost control and to improve efficiencies. Finally, EPP™ Empower Phasing Protocol helps you achieve optimal image quality for cardiac CT studies. EmpowerSync^® synchronizes timing between the EmpowerCTA Contrast Injection System and the CT scanner.

Bracco also featured its ACIST Contrast Delivery System, an all-in-one, variable-flow technology that gives physicians control over the full range of injection volumes, from small vessels in the coronaries to large vessels in the ventricles and peripheral vasculature. The system has demonstrated benefits in reducing costs and complexity and in enhancing patient care.

Also on display was its CT Expres 3D, which has received FDA 510(k) approval, is available for sale in Europe and is pending launch in the US. This automated, 3-channel, syringe-less contrast media injector for CT represents significant advances in cost management, workflow and automation.

Covidien (St. Louis, MO) showed its Optivantage Dual-Head CT Contrast Delivery System with optional RFID upgrade. The touch-screen interface with built-in safety features supports injection protocols communicated between the contrast media syringe and the power injector. The RFID-enabled contrast delivery system is an upgrade and features Ultraject prefilled syringes combined with the Optivantage injector designed to reduce the risk of infection.

Diagnostic displays

Barco (Kortrijk, Belgium) featured its best-in-class diagnostic imaging technologies: the new Conference CloneView software tool for large-format image projection, Mammo Tomosynthesis 5MP displays, Coronis 5MP Mammo displays, and the new Conference CloneView allows users to project large-scale medical images from a Barco display through a projector and onto the main screen to share accurate information.

The Barco Mammo Tomosynthesis 5MP display provides increased brightness, image-enhancing capabilities and improved visibility of differences in tissue density. The Coronis 5MP Mammo displays grayscale images with higher resolution, contrast the Per Pixel Uniformity technology, and eliminates screen-noise, which can hide subtle details.

NEC Display Solutions of America (Itasca, IL) debuted the MultiSync MD211C2 and MD211C3 medical-grade displays. The 2MP and 3MP displays are factory calibrated to the DICOM grayscale function for luminance and include a new, smaller front sensor to maintain a calibrated brightness based on existing lighting conditions. The all-digital connectors, including DisplayPort and a new two-port USB hub, support workstation connectivity.

Sony Electronics’ Medical Systems Division (Park Ridge, NJ) highlighted the Sony LMD-DM series of high-luminance, high-contrast medical displays offering well-defined images for critical diagnoses through Independent Sub-Pixel Drive (ISD*) technology. The technology’s use of 3 independent sub-pixels in a single pixel enables a 5MP display to achieve resolutions up to 15MP; the feature used with the 3MP display allows for a maximum of 9MP.

The new line of radiology monitors includes the following: 5MP Diagnostic Display for Full-Field Digital Mammography; 3MP Color Display; 3MP Grayscale Display; 2MP Color Display; and 2MP Grayscale Display.

Digital radiography

Agfa Healthcare (Greenville, SC) showcased its high-productivity DX-D 600 platform, which comes in 3 different configurations, and introduced the DX-D 400 system into the U.S. market. With the versatile manual system, you have the possibility of a mixed CR/DR configuration, with several options for 1 or 2 fixed or switchable detectors in the wall stand and table. The semi-automatic configuration includes vertical tracking on table and wall stand, and fixed or portable DR detectors in both the wall stand and the table.

Agfa announced the U.S. availability of its DX-D 400, a floor-mounted x-ray suite and the newest member of the company’s extensive imaging portfolio. The DX-D 400 is both compact and versatile; it can be configured to meet specific workflow needs or budget constraints. Combined with either the latest computed radiography (CR) technology or with a cassette-sized DX-D detector and the renowned NX workstation, the DX-D 400 offers state-of-the-art imaging technology at an affordable cost – without compromising functionality, performance or image quality.

Canon Medical Systems (Lake Success, NY) highlighted its first compact wireless DR detector, the CXDI-80C Wireless DR Detector. The system features a lightweight body design with an imaging area of approximately 11 in × 14 in, compatible with standard-size Bucky trays, enabling radiology room upgrades from analog to cutting-edge digital imaging. Providing high-quality images with low x-ray exposure to the patient, the CXDI-80C weighs 5.1 lbs and incorporates a 6.1 MP image sensor with a pixel pitch of 125 microns, a cesium iodide (CsI) scintillator, and can produce up to 140 images on a fully charged battery.

Carestream Health (Rochester, NY) introduced CARESTREAM DRX-Revolution Mobile X-Ray System, a new mobile DR system featuring a unique, collapsible column that allows unobstructed views for enhanced visibility and safety while moving the system. It is a dual-drive system with 2 monitors that can make 360-degree turns in tight spaces to improve productivity in bedside imaging.

Del Medical (Roselle, IL) introduced a new approach to patient imaging with DelWorks PatientSide, a multifunctional technologist console fully integrated to the tube stand. DelWorks PatientSide provides point-of-care capability by allowing the technologist to preview a digital image within seconds after exposure while being next to the patient. The technologist can also review images from the current digital study and set generator techniques, thus reducing the exam time. A touchscreen console allows for simple and fast technique selection and adjustment by the technologist.

Fujifilm Medical Systems U.S.A. (Stamford, CT) showed its latest extensions to its portable digital radiography (DR) arsenal with the FDR D-EVO Portable Upgrade System and the FDR Go flex. Now the FDR D-EVO system can be fitted with any of Fujifilm’s wireless FDR D-EVO models and includes the FDX Console workstation. The workstation includes a swiveling and tilting display to simplify image previewing for the technologist. The lightweight, compact FDR Go flex consists of a wireless FDR D-EVO flat panel detector, a full-featured laptop workstation and supporting mini components box.

Fujifilm also presented its flagship DR system, the FDR AcSelerate, which will include enhanced features necessary to perform dual energy subtraction (DES) with multi-stage registration and tomosynthesis exams. The recent tomosynthesis upgrade on FDR AcSelerate will capture up to 60 images in one fluid sweep, and then display the images on the PACS workstation. Tomosynthesis in the DR application is designed for head and neck trauma, shoulder, extremities and chest exams, or for prescreening to rule out the need for CT exams.

Konica Minolta Medical Imaging (Wayne, NJ) lets physicians take hold of Aero DR, one of the lightest, wireless DR flat panel detectors. The cesium iodide (CsI) scintillator panel is available as a 10-in × 12-in plate. The small size, high detective quantum efficiency (DQE), and dose efficiency are applicable to pediatric patients.

Also new to the Aero DR flat panel technology is an auto-stitching system, in which a moveable slit detects the upper and lower edge of the field, determines the number of exposures, and then moves the detector to capture the images. The exposure is ready in only 5 seconds.

Imaging informatics

The American College of Radiology (ACR) rolled out ACR Select, a decision support system for appropriate image ordering. This web service version of the ACR Appropriateness Criteria (AC) provides integration ready, evidence-based guidance for the appropriate use of medical imaging. By integrating the ACR AC with EHR technology through ACR Select, physicians can order image exams with decision support that can help reduce unnecessary scans, lower imaging costs, and add value to outpatient, inpatient and ED settings.

Agfa Healthcare (Greenville, SC) launched the IMPAX Data Center (IDC) 3.0. This new version of Agfa HealthCare’s proven enterprise medical imaging repository, also called a Vendor Neutral Archive (VNA), is PACS and storage vendor agnostic. New to IDC 3.0 is support for VMware™ virtualization to deploy the IMPAX Data Center on any VMware™ compliant platform. IDC 3.0 makes it possible for hospitals to distribute clinical data from different departments through EHRs, using the facility’s existing solutions.

AT&T (Dallas, TX) teamed up with Calgary Scientific Inc. (Calgary, Canada) to offer ResolutionMD, an FDA-cleared mobile diagnostic viewer. The viewer allows physicians to access, view, and interact with patient images and reports stored within any healthcare facility, utilizing the AT&T Medical Imaging and Information Management solution, to render a clinical diagnosis from virtually anywhere. The mobile diagnostic viewer, designed to be secure, is a cloud-based application from which physicians can access, view, and interact with patient images and reports stored within the healthcare facility.

AT&T Medical Imaging and Information Management is a vendor-neutral, cloud-based medical imaging repository, providing large storage capacity, back up the data, and is delivered on the AT&T network. The archive brings together images from multiple PACS into one centralized location, where multiple providers can access, view, and share the data.

BRIT Inc. (Dallas, TX) rolled out Roentgen Works Version 1.5, featuring HTML-5 support for mobile devices, patient portals, and enhanced image manipulation capabilities. Roentgen Works runs BRIT’s Roentgen Cloud DICOM sharing platform that includes 5 GB of free storage. With Version 1.5, users can access new and comparison studies regardless of where the study originated. Version 1.5 includes a Patient Discovery tool for finding the same patient with different patient IDs. The new morphing router is used to pre-fetch studies from multiple servers and/or facilities based on select criteria and does not require the patient ID. This facilitates the creation of a single patient record and enables clinicians to view all studies on a single timeline and access cross-facility patient records.

Carestream Healthcare highlighted its MyVue patient portal designed to securely access, manage, and share their medical images and radiology reports with specialists and healthcare providers. It also positions U.S. healthcare providers to meet Stage 2 meaningful use requirements. Available for Vue PACS, Vue Archive, and as a Vue Cloud Service, the MyVue portal provides access to patient images, information and reports through the secure log-in from a variety of Web-browser enabled devices, allowing patients to view their study or portfolio and share them with desired physicians. MyVue can be embedded within an existing HIS or EMR patient portal.

Claron Technology (Toronto, Canada) debuted a range of enhancements to its family of Nil zero-footprint, web-based image viewers. NilRead now provides viewing of federated historical patient exams across multiple PACS archives, VNAs, and Health Information Exchanges (HIEs), supports rules-based hanging protocols displayed according to a physician’s preferences, plus the viewer enables multi-monitor viewing (patent pending). Both NilRead and NilShare referral viewers will support integration with Skype for voice, data, and instant messaging collaboration. NilRead is awaiting FDA approval.

CoActiv Medical (Ridgefield, CT) demonstrated its enhanced zero-footprint, web-based EXAM-BROWSER with real-time, multi-user collaboration and 3D reconstruction on-the-fly. Also on display was EXAM-PACS, which supports viewing and archiving of Hologic C-View 3D/2D tomosynthesis images. CoActiv also debuted variable pricing for its new EXAM-CLOUD/EXAM-VAULT extended time archiving with options from back-up and disaster recovery to complete medical image sharing and management.

Del Medical introduced EvoView Ultima, its new web-based PACS with advanced streaming technology designed to retrieve images extremely fast. EvoView Ultima PACS Systems feature customizable reading protocols, MPR/3D visualization, reporting, and more. EvoView Ultima PACS Systems also employ a Smart Fetch technology, allowing it to load images of interest while other images download in the background.

ETIAM (Cambridge, MA) debuted ETIAM Viewer, a universal zero-footprint, web-based DICOM viewer using HTML 5 that runs on PC and MAC desktops, as well as on Android and iOS. Designed to enhance the accessibility of medical images for physician and patient, ETIAM Viewer is included in ETIAM’s new distribution service to share patient studies through the web.

EMC2 (Hopkinton, MA) launched EMC Atmos Cloud Delivery Platform, an add-on software product used to deliver and manage storage-as-a-service to an Atmos storage cloud. Enterprises can deliver and manage storage-as-a-service, offer users self-service access and storage management, and integrate chargeback and billing.

Fujifilm Medical Systems U.S.A. featured Synapse RIS 6.2, its next-generation RIS for outpatient facilities with EHR certification and integrated financial management. New features include drag-and-drop scheduling; Pulse patient tracking using social media methods; dose tracking and management; revenue management with Synapse Financials; ACR-compliant peer review capability; urgent finding notifications and management reporting; and voice and video chat. Synapse Mobility is a mobile-device app that displays interactive 3-dimensional diagnostic images, and provides advanced viewing capabilities including zoom, window and level, and uses MIP/MPR.

GE Healthcare demonstrated how Centricity PACS-IW integrated with its Universal Viewer connects advanced visualization solutions, provides breast-imaging tools, and image-enables EMR systems to provide a unified, web-based reading desktop. The Universal Viewer offers intelligent productivity tools, including smart hanging protocols and 3D applications, and supports breast imaging workflow with screening and diagnostic capabilities.

iCAD Inc. (Nashua, NH) highlighted its Prostate MR-TRUS Fusion Integration, a work-in-progress integration of prostate MRI/TRUS-Fusion to enable radiologists and urologists to provide a more accurate assessment of the prostate gland. Additionally, iCAD featured its next-generation CAD solution for mammography, SecondLook Premier, as well as its SecondLook digital multi-vendor solution.

iCAD launched VersaVue Enterprise 3.2.1, the latest release of the company’s MR software solution that provides improvements in workflow efficiency, providing dynamic contrast enhanced (DCE) MR image analysis and flexible review and reporting tools that facilitate standardization of kinetic analysis and interpretation and reporting of morphology.

Intelerad Medical Systems (Quebec, Canada) introduced Nuage Disaster Recovery Services, providing hosted disaster recovery solutions for hospitals and ambulatory imaging providers. Built on the Nuage Cloud Imaging Platform™ by Intelerad, Nuage services are scalable and supported by Intelerad infrastructure for PACS data security and reliable business continuity.

Also new is Flow for streamlined workflows, accelerating team collaboration and growing business in complex distributed environments. It showcased InteleConnect Clinical Hub, an online portal for referring physicians, providing easy access to patient images and exams, anywhere and anytime.

KJAYA Medical (Stamford, CT) showed its cloud-based iShareScan.com technology designed to enable on-the-fly retrieval and viewing of images, reports, dose reports, and other imaging-related data from any XDS-compliant archive using a web-enabled computer. From the KJAYA cloud archive users can view and share it over the web as desired with any authorized user. Utilizing the company’s universal remote viewer, physicians can manipulate images instantaneously in 2D, 3D, 4D or fusion.

McKesson (San Francisco, CA) announced the acquisition of MedVentive’s solutions to complement their Enterprise Intelligence suite of solutions, enabling providers to proactively manage the clinical health of at-risk patient populations by identifying gaps in patient care and delivering actionable information to the physician and care team. These capabilities are integral to the accountable care and patient centered medical home offerings from McKesson Health Solutions, McKesson and RelayHealth.

Medweb (San Francisco, CA) introduced Medweb Exchange, allowing communities to share, link, index, and audit clinical information with live links to legacy information systems. The exchange indexes clinical documents and maintains a reference to where the data is stored, so unrelated/different healthcare IT systems can share specific clinical data between enterprises in a HIPAA-compliant manner.

The medical IT company also demonstrated Medweb Collage, designed to enable users to rapidly initiate a One Click LIVE Internet consult or multiple-video stream consult. It fully integrates live desktop video conferencing with ultrasound, fluoroscopy, or other streaming image data to allow radiologists to assist with remote procedures without physically traveling to those sites. The tool integrates the live data with the full suite of web review tools to provide simultaneous access to priors from Medweb systems, DICOM devices or PACS.

Also on display was the Medweb Zero Footprint Viewer, which uses existing DICOM or IHE gateways to interface to existing DICOM devices or archives. This way clinicians can access and view patient images across myriad desktops and mobile devices in response to the increasing demand of BYOD (bring your own device) architectures.

Nuance Communications (Burlington, MA) introduced Assure, a clinical language understanding (CLU) offering for Powerscribe 360 | Reporting that will identify quality errors and omissions in radiology reports prior to final signature. CLU documentation technologies and enterprise-wide coding provide feedback and CDI recommendations for better reports and downstream benefits to facilities and providers.

peerVue (Sarasota, FL) showed off its intelligence solutions with QICS (Qualitative Intelligence and Communication System), a single-platform system that helps automate workflow for closed-loop communications, integrated patient care, and strategic healthcare business management. Peer review, ED discrepancies, teaching files, PQRS alerting, and coding discrepancies are among the dozens of solutions that QICS has can automate directly into PACS.

Philips Healthcare showcased IntelliSpace Portal, a thin-client collaboration tool, which provides 3D tools, multimodality analysis packages, advanced image review and analysis, and collaboration features that support access, creation and distribution of images and data in real-time.

Sectra updated Sectra RIS/PACS to include instant messaging, teaching files, support for multi-disciplinary team (MDT) meetings and central handling of non-DICOM images. The company also demonstrated its Sectra Business Analytic Suite used to streamline workflow with tools for monitoring PACS and RIS production and performance including analyses of key performance indicators. With Sectra’s solution, users can easily visualize statistics and perform actions, thus better meeting referring physicians demand for swift and accurate reports.

Also on view was Sectra DoseTrack, a solution for radiation dose monitoring. The solution tracks cumulative doses, sets up dose alerts with a threshold, and can be integrated into national registries to reduce the risk of patients being exposed to unnecessarily high radiation doses in conjunction with radiology examinations.

Siemens Healthcare emphasized workflow efficiency its line of IT solutions, including syngo Workflow, the radiology information system (RIS) component of the syngo portfolio, which drives the radiological workflow from order entry to image and report distribution. The syngo Workflow Cloud Solution provides online access to the syngo Workflow RIS application via a network connection without the cost associated with in-house operations.

With syngo.plaza, 2D, 3D and 4D reading comes together in one place. Syngo.plaza has a wide range of applications and tools to support fast and efficient reading workflow. Token View provides a quick guide across studies and helps identify what is already displayed on the screen and what is loaded in the background.

Viztek (Garner, NC) introduced their Meaningful Use-certified RIS that brings a full range of electronic health record (EHR) functionality to freestanding radiology clinics, while serving as a sophisticated RIS in hospital installations. Viztek also debuted its Dynamic system, a multi-purpose digital radiography and fluoroscopy solution that produces high-quality static mode DR images in as little as five seconds and offers a 17-in × 17-in panel that eliminates the need for rotation.

Interventional imaging

GE Healthcare unveiled the Discovery IGS 730 system for hybrid operating rooms (OR) and imaging departments. The system uses a laser-guided, mobile gantry for interventional imaging. Neither floor nor ceiling mounted, it has the mobility of a C-arm with the power and image quality of a fixed system, allowing multiple parking possibilities, while helping maintain sterility for a flexible and secure OR environment. The gantry comes with a new wide bore design, allowing for steep angles and 3D acquisition, especially for large patients.

Hologic Inc. debuted the Fluoroscan InSight-FD Mini C-arm with flat panel detector technology. The system is designed specifically for orthopedic and extremity surgeons and offers a thin profile and improved workspace access with enhanced ease of positioning.

Philips Healthcare rolled out its upgraded Ingenia MR-OR solution for intraoperative neurosurgery, expanding its MR offering in the interventional MRI area. An MR-OR suite for intraoperative MRI adds value to neurosurgical facilities, supporting resection procedures that can save precious time for both surgeon and patient.

Siemens Healthcare debuted a new X-ray tube and detector technology for its Artis Q and Artis Q.zen angiography systems, designed for minimally invasive therapy of diseases such as coronary artery disease, stroke, and cancer. The new X-ray tube in both the Artis Q and Artis Q.zen series is intended to help physicians identify small vessels up to 70% better than conventional X-ray tube technology. The Artis Q.zen combines this X-ray source with a new detector technology designed to support interventional imaging in ultra-low-dose ranges to patients, doctors and medical staff – particularly during longer interventions.

Also on display were the Artis zeego systems with the MAQUET Magnus OR table system, in addition to the tried-and-proven Artis OR table and the TRUMPF TruSystem 7500 for Artis systems. These different integrated tables can accommodate a variety of procedures and patient positions. This enables the use of the hybrid OR across multiple surgical disciplines, leading to optimized room usage and a quicker return on investment.

Imaging in the interventional suite also includes syngo DynaCT 360, which allows physicians to create soft tissue images with a larger field of view (35 cm × 25 cm, 13.8 in × 9.9 in) in only 6 sec, and it utilizes robotic technology.

Another new imaging application, providing functional imaging during interventional procedures, is syngoDynaPBV Body, which introduces 3D functional information for body imaging directly in the interventional lab and compensates for motion in the region of interest. syngoDynaPBV Body provides color-coded, cross-sectional blood volume maps for tumors, and helps physicians select patient-specific treatment options, such as chemoembolization or radioembolization. Physicians can monitor treatment and determine the end point of therapy during an interventional procedure.

Magnetic Resonance Imaging

GE Healthcare biggest splash at RSNA 2012 was intentionally its quietest — Silent Scan (510(k) pending) is a new technology to lower the acoustic noise generated during an MR scan, which typically reaches levels in excess of 110 dBA (decibels). Designed to improve the patient’s MR exam experience, the solution eliminates acoustic noise essentially by employing an advanced 3D acquisition and reconstruction technique called Silenz, in combination with GE Healthcare’s high-fidelity MR gradient and RF system electronics.

The company also debuted the Optima MR360 Advance and Brivo MR355 Inspire 1.5T systems. The Optima MR360 Advance is a premium system engineered to balance workflow and a broad array of clinical applications. Its Needle Free Suite of clinical applications can help reduce the need for biopsy, contrast, and sedation for patients, and it offers 16 channels and newly designed RF coils that further improve image quality and productivity.

The Brivo MR355 Inspire features the new Caring Design to improve patient comfort. Both systems come with GE’s Express coil technology; a new low-height table for easy patient access, even for larger patients; and both systems are designed to feature the OpTix Optical RF technology for a higher signal-to-noise ratio (SNR).

Hitachi Medical Systems America featured the Echelon Oval, designed around the shape of the human body to provide a better patient experience with added comfort, space, and efficiency in imaging. The 74-cm, oval-bore, 1.5T MR system is combined with Hitachi’s Workflow Integrated Technology (WIT), advanced imaging capabilities, and UltraPlus Customer Support. The oval bore is designed to create a feeling of openness and greater comfort for patients and has a thin-type wide table.

Also on display was OASIS, a 1.2 tesla, super-conducting MRI system, which features an open bore to reduce patient stress, and suits large-framed, elderly, and pediatric patients.

Philips Healthcare launched its digital broadband MRI, a dStream broadband technology, integrated into its Ingenia MR systems, providing enhanced image quality, improved workflow, easier coil handling and better patient comfort. The technology will now become available for the majority of the installed base of Philips Achieva and Intera MR systems.

Siemens Healthcare featured several upgrades to its portfolio of MRI systems. These included the MAGNETOM Aera 1.5T MRI system with an ultrashort open bore and integrating Siemens’ Dot (Day optimizing throughput) engine and its Tim (Total imaging matrix) 4G technology to provide the power needed for excellent image quality while helping to remove the time-draining complexity inherent in MR scanning.

Siemens showed the MAGNETOM Avanto, a 1.5T, short-bore MRI system, its ultra-short MAGNETOM Essenza 1.5 T, and the MAGNETOM Verio, an ultrashort, open-bore 3T MR system — all with Tim technology.

On the other end of the spectrum, there are several advantages to a wide-bore system, particularly when imaging oncologic or bariatric patients. The MAGNETOM Skyra 3T MRI system has a large, 70-cm open bore and a short length (173 cm) for comfortable, patient-centric examinations. The MAGNETOM Spectra 3T MRI system offers premium imaging at a reduced cost of ownership compared to other scanners in this product range, employing Siemens’ Tim 4G-coil generation technology. The MAGNETOM Trio is a high-end research 3T MRI system with Tim technology.

Finally, the MAGNETOM Prisma from Siemens Healthcare is a 3 Tesla MRI system designed with a significantly higher signal-to-noise ratio to tackle demanding clinical and research challenges. This product is currently under development and is not for sale in the U.S. Its future availability cannot be guaranteed.

Molecular Imaging

GE Healthcare showcased the Discovery NM/CT 670, as a single photon emission tomography (SPECT/CT) system designed to improve workflow, dose management, and overall image quality. The hybrid system combines a newly designed SPECT gantry with the BrightSpeed Elite 16-slice CT, engineered to shorten acquisition times. It has a wide bore and the table is capable of handling patients up to 500 lbs.

Also featured in the GE booth was the Brivo NM615, an advanced gamma camera developed through GE’s Evolution technology. This single-head system has the ability to achieve shortened scan times, rivaling a dual-head system. Brivo NM 615 SPECT allows doctors to lower injected patient dose by as much as 50 percent of those of standard nuclear medicine scanning protocols, or the potential for patients to spend significantly less time on the table during exams without compromising image quality.

Philips Healthcare featured an all-new Ingenuity TF PET/CT with Astonish TF time-of-flight (TOF) performance with up to 30% greater contrast, designed to improve lesion detection beyond the capabilities of other non-TOF systems. Additionally, Ingenuity TF offers Point Spread Function technology for enhanced spatial resolution to measure lesions at <2 mm. Plus, Ingenuity TF has iDose4 for maintaining image quality while managing dose.

Siemens Healthcare put the spotlight on its Symbia family of SPECT and SPECT/CT scanners with the IQ•SPECT, a technology that supports routine scans using half dose and double speed to provide comprehensive cardio workup, while easing the burden of the global molybdenum shortage via a reduction in technetium dose. Diagnostic SPECT/CT, including calcium scoring, uses half of the typical technetium dose and cuts acquisition time from approximately 20 minutes to less than 5 minutes with the addition of IQ•SPECT.

Siemens also touted the many clinical imaging applications offered in its Biograph mMR, a hybrid PET/MR system. The Biograph mMR is used as a tool for evaluating coronary artery disease and heart failure, gynecologic and brain tumors, neurologic disorders, such as Alzheimer’s disease, and for the development of new radiopharmaceuticals. Siemens featured the FDA-cleared diagnostic agent used to evaluate beta-amyloid neuritic plaques in the brain when imaged on the Biograph mMR. The Eli Lilly and Company and Avid Radiopharmaceuticals developed the commercially available florbetapir (Amyvid), a radioactive PET tracer that has been shown to evaluate Alzheimer’s disease and other causes of cognitive decline.

Ultrasound

GE Healthcare introduced the new LOGIQ E9 with XDclear, a new general imaging ultrasound system. Built from the acclaimed LOGIQ E9 platform, new features on the company’s premium product allow for increased penetration on large patients with improved clarity and diagnostic confidence.

Philips Healthcare debuted the ClearVue 550 (pending 510(k) clearance), which is designed to be a user-friendly, lightweight and energy-efficient ultrasound system that produces high-quality imaging at an affordable price. The product uses proprietary Active Array technology, which results in enhanced image quality in both 2D and color images, lighter-weight cabling, increased system reliability, and easier serviceability. The versatile platform aims to meet a broad range of clinical application needs, including abdominal, OB/Gyn, small parts, vascular, musculoskeletal, cardiac, pediatrics, urology, and transcranial Doppler (TCD) imaging.

Samsung Electronics America (Ridgefield Park, NJ) introduced Accuvix A30, which features the proprietary EZ Exam and ElastoScan. Its 21.5-inch LED monitor combined with 3D performance is designed to deliver high image quality. The Hybrid Beamforming Engine is for detailed scanning and improved color performance. Hybrid Beamforming, also known as spatial filtering, offers greater flexibility than standard omnidirectional reception and transmission.

Siemens Healthcare introduced a wireless transducer as part of the ACUSON Freestyle ultrasound system. The wireless transducer eliminates the impediment of cables in ultrasound imaging and the cable-less solution addresses infection control risk in sterile interventional settings. The ACUSON Freestyle system employs a synthetic aperture imaging technology, an integration of proprietary hardware and software that was specifically developed for the wireless signal transmission of full-resolution digital image data at very high data rates. This design reduces the transducer’s power requirements, increasing battery life. Wireless real-time ultrasound data transmission is further enabled through a novel ultra-wideband radio technology, which, operating at a high frequency of 7.8 GH, is not susceptible to interference with other electronic equipment. The user can operate the transducers up to 3 meters away from the system. The ACUSON Freestyle system has a 38-cm, high-resolution LED display. Three wireless transducers are available for the ACUSON Freestyle system, covering a range of general imaging, vascular, and high-frequency applications such as musculoskeletal and nerve imaging.

Supersonic Imagine (Aix-en Provence, France) touted its Aixplorer ultrasound system providing ShearWave™ elastography (SWE) and UltraFast™ Doppler (UFD). SWE is a proven technology that displays local tissue elasticity on a color-coded map in real-time. UFD unites color flow imaging with pulsed wave DopplerUltraFast Doppler, which unites color flow imaging with pulsed wave Doppler, is said to have frame rates up to 10 times faster than conventional color Doppler. The system also acquires fully quantifiable Doppler data throughout the color box, enabling the generation of post-processed pulsed wave Doppler spectra from multiple locations in the same image.

Toshiba America Medical Systems, Inc. (Tustin, CA) showed innovations to the Aplio 500 ultrasound system. The system comes optional with Fly Thru and Smart Fusion features. Fly Thru uses 3-dimensional volume rendering to “fly through” interiors of ducts and vessels for better exploration of lesions and masses, and to assist in planning interventional procedures. The other feature, Smart Fusion, shows both CT and ultrasound images side-by-side on a single screen. Smart Fusion syncs the 2 images, helping to locate hard-to-find lesions and aiding in ultrasound-guided biopsy without additional CT scans.

Another upgrade is Luminance (a work-in-progress), a 4D rendering and lighting technique producing fetal images. Luminance can be used to examine the fetal face and other anatomical structures by applying color and illumination to enhance features.

ZONARE Medical Systems, Inc. (Mountain View, CA) highlighted its ultrasound image quality with the Zone Sonography Technology (ZST) for its z.one system. The company has added real-time 3D ultrasound imaging capabilities (4D), the new C8-33D Curved Array transducer for the z.one ultrasound system with primary applications for obstetrical imaging during the second and third trimesters; the C8-33D transducer for 3D/4D fetal surface rendering and 3D/4D Multi-Planar rendering. These capabilities are available for abdominal ultrasound imaging that includes MPR and tomographic viewing. Also new is the E9-33D transducer designed for high-quality 2D, 3D, and 4D imaging for endovaginal applications with imaging frequency choices form 9-3MHz.

ZONARE also presented a contrast-enhanced imaging feature using the P4-1c Phased Array echocardiography transducer, and showed contrast-enhanced imaging for the left ventricular opacification (LVO).