The 89th Scientific Assembly and Annual Meeting of the
Radiological Society of North America (RSNA 2003) was held November
30 through December 5, 2003 in Chicago, IL. The theme of this
year's gathering was Communication for Better Patient Care.
RSNA President Peggy J. Fritzche, MD, highlighted this theme in
her Presidential Address as she called on radiologists to "push
buttons less and talk more." She addressed four areas of essential
communication: with the patient, with colleagues (including
referring physicians), with medical students, and with the general
public. By maintaining good communication with these four groups,
she noted, radiologists will continue to ensure that theirs is a
thriving medical specialty.
"Sometimes the allure of technology is so powerful that it's
easy to be misled into thinking that it's the cure-all for
everything in healthcare," she concluded. "We need technology plus
communication. This is the equation that I believe will lead our
profession forward to prosperity."
The scientific portion of the meeting included >2145 research
presentations and posters covering 15 subspecialties of radiology.
There were 283 refresher courses and 1140 educational exhibits. A
total of 687 technical exhibitors covered 446,350 square feet of
exhibit hall space. The RSNA estimates that attendees at this
year's meeting contributed nearly $111 million to Chicago's
The following highlights some of the new technologies introduced
at RSNA 2003.
GE Medical Systems (Waukesha, WI) showcased two additions to
their line of mammography products: a three-dimensional (3D)
digital mammography system and a multimodality workstation for
The company featured their new patented TACT (tuned-aperture
computed tomography) technology, currently available on their
Diamond mammography unit. This technology allows the radiologist to
create and manipulate a 3D image of a region of the breast (Figure
1), similar to that which is achieved using computed tomography
When performing an examination, the system immobilizes the
breast with minimal compression, allowing the region of interest to
remain in a more neutral position. A scout film is taken, and the
region of interest is placed in the center of the field of view.
Seven images are then acquired from different angles, and
proprietary algorithms are used to reconstruct the image so the
physician can rotate and "slice" through the final volumetric
According to the company, this technology can be helpful in
ruling out some suspicious masses, particularly areas of dense
breast that may be superimposed upon each other with traditional
mammography. This, in turn, may reduce the number of breast
"The TACT images are serving a particularly important role in
helping us determine if a suspicious region is dense, but normal,
structures that are superimposed in the image or a mass that must
be further evaluated," said Michael T. Nelson, MD, Director of
Breast Imaging Research and Associate Professor of Radiology at the
University of Minnesota. "Before using TACT, we would review a
variety of two-dimensional images and use 'mental fusion' to
correlate the relationship of the different structures.
Fortunately, the TACT technology now provides us with a more
accurate way to evaluate these cases and have the diagnostic
confidence to avoid breast biopsies in some cases."
The company also showcased, as a works-in-progress, a new
multi-modality workstation designed specifically for breast
imaging. The Seno Advantage workstation, with more than 30
applications and tools, provides the user with a single point of
access for a variety of breast cancer detection tools, including
digital mammography, magnetic resonance (MR), ultrasound,
computer-aided detection (CAD), and more.
Based on the company's Advantage Workstation 4.2 platform, the
Seno Advantage includes two high-resolution grayscale monitors for
full-field digital mammography (FFDM) viewing and a color monitor
to view multimodality images and to run applications. The system
can be used to burn CDs with a free DICOM viewer inside or to
create an electronic film that can be archived or sent to another
"With the new Seno Advantage multimodality workstation in our
facility, we will now be able to access patient cases all from one
workstation and conduct a comparative view," said Debra S.
Mitchell, MD, Managing Partner at Breast Imaging of Oklahoma in
Edmond, OK. "It will allow us to view multiple modalities
simultaneously. If the patient had an ultrasound exam and an MR
scan, we are able to view each of these exams together, which
The Seno Advantage is currently available in Europe and is
pending FDA approval in the United States.
iCAD adds lower-cost CAD options
iCAD, Inc. (Nashua, NH) unveiled its new, lower-cost CAD system,
the iCAD iQ (Figure 2). Designed specifically for healthcare
facilities that perform <20 mammograms per day, the company
reports that new system is priced approximately 30% lower than
other currently available computer-aided detection (CAD)
"Mammography centers that perform >20 mammogram readings per
day have been priced out of the market until now," said W. Scott
Parr, iCAD President and Chief Executive Officer. "Most of these
smaller clinics do not require the networking and integrated
connectivity, high-speed mammography film handling, and case
management database capabilities of our higher-priced MammoReader
CAD systems. But they are under increasing marketing and legal
pressure to offer the early cancer detection benefits of CAD to
their patients. With the iQ system, we envision a significant
expansion in market opportunity for our company within the emerging
medical market for CAD. Most importantly, iQ will make the benefits
of earlier CAD of breast cancer affordable and accessible to an
increasing number of women at risk."
Designed to fit within the limited space of smaller mammography
clinics, the system is available through iCAD's recently expanded
network of resellers, with a purchase price <$70,000.
In addition, iCAD featured ClickCAD, a new fee-per-procedure
program, for health centers that perform <15 mammograms a
Under the terms of this program, iCAD will install an iQ system
without any capital cost to the customer. The heath center then
pays iCAD a fee of approximately $6.50 for each CAD procedure
The company states that third-party payer and federal
reimbursement for CAD procedures could allow ClickCAD to be a
revenue enhancer for women's health centers. "Assuming an average
daily case load of 12 patients," explained Parr, "a mammography
clinic could increase its revenues by more than $34,000 per year,
after its ClickCAD payments to iCAD, Inc. This program allows the
mammography clinic to improve the healthcare it delivers to women
at risk, improve its marketing position in attracting and keeping
patients concerned about breast cancer, reduce legal risks
associated with overlooking early-stage cancers, and add to
revenues and increase its net revenues--without a capital
CPS debuts high-resolution
CPS Innovations, a unit of CTI Molecular Imaging, Inc.
(Knoxville, TN), unveiled its latest-generation positron-emission
tomography/computed tomography (PET/CT) system in conjunction with
RSNA 2003. According to CPS, the new system, LSO Hi-Rez, provides
three times higher spatial resolution compared with existing
The system was formally released at the Chicago Field Museum on
December 1, 2003 with former New York City Mayor Rudolph Giuliani
providing the keynote address. David Townsend, PhD, Professor and
Director of the Cancer Imaging and Tracer Development Program at
the University of Tennessee Medical Center (Knoxville, TN) and
co-inventor of the PET/CT, provided an introduction to the new
technology. "The images from the Hi-Rez PET/CT are of exceptional
quality," he said. "The system offers the potential to visualize
disease that is smaller in size or earlier in development that
might well have been overlooked in some patients using existing PET
technology. We're anxious to begin larger scale trials to
demonstrate the potential benefits in lesion detection and
improvements in quantitative accuracy."
The new Hi-Rez LSO detector technology is integrated with
multidetector CT, including the latest generation of 6-slice and
16-slice scanners. The software is based on the syngo platform from
Siemens Medical Solutions USA, Inc. (Hoffman Estates, IL). CPS
Innovations markets the products through Siemens under the trade
name Biograph, and through CTI Molecular Imaging, Inc. as the
Toshiba showcases CT and
Toshiba America Medical Systems (Tustin, CA) used RSNA 2003 as a
backdrop to launch their new 32-slice CT system. The Aquilion 32
features a 64-row detector design, isotropic scanning, and patented
The system's hybrid 64-row Quantum Detector can produce 32
simultaneous 0.5-mm or 1-mm slices with each gantry revolution for
a total Z-axis coverage of 32 mm, allowing for the acquisition of
isotropic data sets for any region of the body within a single
breath-hold. Using 1-mm thick slices, the system can perform a CT
angiogram in 15 seconds. The system's 72-cm aperture accommodates
larger patients and the 1800-mm scan range accommodates taller
The company's patented helical cone-beam reconstruction
technique, based on the Feldkamp method for axial image
reconstruction from helical scans, incorporates data only from
views that are close to the image reconstruction plane, resulting
in reduced cone-angle effects and artifacts.
Toshiba also featured a new suite of applications for the
Aquilion 4-, 8-, and 16-slice CT systems at RSNA. The "SURE" suite
includes the following applications.
* SUREWorkflow was designed to allow users to obtain maximum
efficiency and image quality at the lowest possible dose.
* SUREScan provides real-time helical scan display of 12 images
per second to permit current scan monitoring.
* SUREStart allows for real-time contrast detection at 12
samples per second, automation of contrast bolus detection and
workflow, and elimination of test bolus.
* SUREFluoro provides real-time CT fluoroscopy at 12 images per
second and display of 3 simultaneous images to aid
* SUREExposure provides X-ray dose modulation matched to the
patient's body type and desired image quality, resulting in up to a
40% reduction in total dose.
* SUREColon permits CT colonoscopy with combined prone and
supine examination evaluation and automated fly-through.
* SUREPulmo is a lung nodule detection application with nodule
analysis and temporal comparison.
* SUREPerfusion enables CT cerebral perfusion analysis with
tilted perfusion dynamic scan for rapid stroke evaluation.
* SUREDiffusionEQ provides CT diffusion equivalent analysis with
early stroke detection and rapid noncontrast analysis.
* SURECardio provides automated cardiac scan planning, cardiac
functional analysis, Polar Maps, and cardiac or peripheral vessel
* SURESubtraction allows image subtraction before and after
contrast administration to facilitate CT digital subtracted
* SUREPlaque is a method for soft-plaque identification and
measurement and cardiac and peripheral vessel analysis with
multiplanar reconstruction of cross-sectional imaging.
* SURESupport includes Toshiba Applications Academy, the InTouch
assist program, and InnerVision remote diagnostics.
In the field of ultrasound, Toshiba showcased the latest
enhancements to its all-digital ultrasound system, Aplio, including
the iASSIST wireless remote (Figure 3), new transducers, and
next-generation contrast imaging technology.
The iASSIST feature, which utilizes Bluetooth wireless network
technology, enables the remote operation of the entire ultrasound
system, including the ability to switch modes from several feet
away. The new technology also permits the customization and sharing
of clinical protocols between other Aplio systems, which may be
useful in multicenter studies.
The new transducers include convex, linear, and sector
transducers featuring the extended field-of-view mode known as
trapezoid imaging. The transducers feature the company's
high-performance piezoelectric ceramics engineered specifically for
ultrasound applications to increase bandwidth and improve spatial
resolution. The advanced impedance matching and improved acoustic
lens material were designed to minimize reverberations and
artifacts for greater sensitivity and image quality.
In addition, the system has been designed to utilize
next-generation contrast imaging technology to visualize
microvasculature detail. Aplio's Intelligent Component Architecture
(ICA) technology enables the system's various components to operate
autonomously and communicate directly with one another. This
permits the system to perform highly complex data operations, such
as real-time contrast imaging. In the United States, contrast use
with ultrasonography is limited to left ventricular opacification
studies, with studies of general imaging agents currently under
review by the FDA.
Barco introduces 2MP color LCD display with 3D support
Barco (Kortrijk, Belgium) introduced a new 2-megapixel (MP)
color medical display system at this year's RSNA. The Color Coronis
2MP display was designed for viewing both color and grayscale
medical images and is compatible with advanced modality
workstations, including 3D applications.
The DICOM-compatible, 20.1-inch display features 1600 * 1200
resolution and comes bundled as either one or two 2MP LCD displays.
Designed for PACS, ultrasound, and orthopedic imaging, the system
includes the company's proprietary Color I-Guard sensor, the
Barcomed display controller with 3D support, Medical Pro softcopy
quality assurance (QA) software, display driver, and digital
The Color I-Guard feature was developed to provide improved
color consistency. A compact, front-mounted sensor located in the
corner continuously adjusts luminance output and color consistency
of the diagnostic viewing area at the front of the display. In
addition, the Medical Pro QA software tracks, maintains, and logs
display viewing performance, automates QA tasks, and initiates
system calibrations without requiring user intervention. The entire
system is driven by the company's new
Barcomed 2MP2CF-3D display controller, which was designed to
support 3D PACS.
The Color Coronis 2M is also compatible with Barco's PIN
(Product INtelligence) technology. The company's PIN-compatible
PACS products form a distributed network of Web-enabled,
intelligent devices that keep system administrators informed about
the display system's quality. If the imaging chain fails,
administrators can intervene from any location without disturbing
Sony introduces new color printer
Sony Medical Systems (Park Ridge, NJ) unveiled its new A6 color
video medical-grade printer with a USB 2.0 high-speed
The compact UP-D23MD (Figure 4) printer provides 400 dpi
printing with 16 million color tones. Data flow to the printer is
approximately 10 seconds. The printer includes the company's
proprietary Picture Quality Control technology and a color
adjustment function that allows users to fine-tune results to meet
their specific needs.
The printer, which can be connected directly to modalities, can
also print images from a PC or network server. Measuring 83Ž8 *
inches, the UP-D23MD printer was designed to be able to be
integrated into a medical cart or to be rack-mounted. It features
front-loading functionality and accepts both L-size media for A6
images and S-size paper for smaller prints.
"More and more, ultrasound is migrating to digital output,"
commented George Santanello, Director of Marketing for Medical
Systems in Sony Electronics' Business Solutions Division. "Medical
facilities of all sizes are looking for fast, efficient, and
convenient digital connectivity. Sony aims to bring the most
advanced technology to market to help today's busy medical
The printer is currently available at a manufacturer's suggested
price of $2379.