RSNA 06 Marks New Era for CAD

As history looks back on RSNA shows, 2006 should stand as a watershed year for CAD. Breast imaging and lung solutions remain relevant and are certainly maturing. Breast MRI CAD continues to streamline breast MRI interpretation. But the real news in CAD is the broadening of applications. “In three years, it will be hard imagine an image coming through a hospital without some type of CAD applied,” predicts Dave Faller, general manager of Kodak’s CAD business.

PACS vendors are integrating digital mammography CAD into PACS workstations, and the first enterprise lung CAD solutions that bring CAD to the PACS workstation is on the market. The need for PACS integration is clear. “The average hospital performs 150 to 200 chest x-rays a day,” states Tim Ketchmark, vice president for EDDA technology. “Radiologists don’t want to break workflow to use the application.” Most PACS options allow the radiologist to determine which marks to save, which also aids workflow because the reader does not need to review previously dismissed marks.   

Visitors to the show floor checked out new and upcoming liver, colon and bone densitometry systems. And that’s just the beginning. CAD Sciences Chief Technology Officer James Conklin, MD, indicated that the company is working on a prostate solution and is evaluating other organ systems with researching at multiple institutions. The company is partnering with Saphenia to apply CAD technology to lung, liver and renal nodules. Breast MRI CAD provider Confirma also is evaluating a prostate solutions and expects to launch a system at RSNA 2007. State-of-the-art systems transcend mere markers, said Conklin, who noted that CAD Sciences’ solution can provide a quantifiable measurement of a tumor’s response to therapy weeks and months before a change in tumor size.   

Another company heavily invested in CAD is Kodak. The company expects to submit its FFDM CAD system for FDA approval early in 2007. Other Kodak CAD works-in-progress include an osteoporosis detection system that relies on an x-ray image of the hand. A future ICU CAD system from Kodak will enhance chest images to provide consistent renderings and allow physicians to more easily evaluate line placements.


CAD Sciences debuted Server 2.4 of its Full-Time-Point MR image post-processing engine and WorkSpace 2.1, a streamlined MR image viewer that facilitates the analysis of fTP colorized images and quantitative output data.

The products are the next generation of CAD Sciences’ advanced pharmacokinetic analysis software tools that assist the radiologist with lesion identification, characterization and diagnosis reporting. This advanced set of radiology software offers one-click lesion diagnosis reporting in conjunction with the ability to monitor vascular permeability over time in lesions treated with radiation, hormonal or chemotherapy. These capabilities have been integrated into an advanced workflow roadmap regime that guides the radiologist through the series of sequential tasks that must be performed in order to arrive at a diagnosis.     

Workspace 2.1 offers one-click lesion diagnosis reporting, permitting the radiologist user to identify lesions and generate diagnosis reports with graphical and quantitative analysis of tissue biology. These reports include numerical measurements of vascular permeability and cellular density, considered key physiological indicators of cancer, as well as standard contrast wash-in and wash-out measurements. Users may select a lesion for analysis by simply pointing and clicking on a region of interest. Statistical analysis of the lesion may be performed in 2D or 3D based on user preference. For many current users, automated lesion selection has eliminated manual selection and circling of ROIs (Regions of Interest) to streamline diagnosis reporting.

This latest product release contains a new Therapy Response Monitoring Module (TRM) module that assists radiologists wishing to monitor over time a patient’s response to cancer therapy. TRM is used by radiologists to compare, on a quantitative basis, changes in vascular permeability that are obtained at various stages in a patient’s cancer therapy treatment and measured by the Server 2.4’s advanced fTP algorithm.     

WorkSpace 2.1 has been configured to permit image viewing in dual, triple or super-wide monitor settings. In addition, users may now create multiple customized reporting templates for referring physicians according to specific informational or presentational preferences. Individual reports can be prepared using WorkSpace’s drag and drop image panes that allow for placement and final optimization of image screenshots, graphs and histogram data. For the first time, image panning, zooming and cropping may be performed directly inside the report. The end result is a better presentation of a radiologist’s findings to his referral base. A new hanging protocol system allows users to create and save preferred viewing configuration in WorkSpace. MR images and supporting graphical or statistical analysis cards may be pre-programmed at system installation, thereby permitting the radiologist to call up images according to a preferred hanging protocol. This new capability has eliminated the need to reconfigure image presentation for each individual use.

Confirma showcased CADstream breast MRI CAD solution. The company also announced the results of a recent study at the University of California, San Francisco, led by Nola Hylton, PhD. The research indicated that automatic volume measurements from CADstream are predictive of length of recurrence-free survival and support the robustness of volumetric measurements of tumor response as a surrogate endpoint for survival outcomes.    

CADstream’s workflow-based, thin-client architecture provides access to studies anywhere on a network, which allows physicians to read from virtually any location. CADstream is a centralized system located on the customer’s network; physicians securely access CADstream from existing computers through a web-based user interface. In addition to increased convenience, CADstream’s unique architecture creates a central database that allows multiple readers to access and work from the same study list, regardless of their location.    

“CADstream has markedly reduced breast MRI study analysis and interpretation time and has improved our diagnostic confidence,” explained Andrew Osiason, MD, Hackensack Radiology Group, N.J. “The thin-client architecture has further increased efficiency, allowing us to read study images from anywhere in our network.”      

CADstream advances breast MRI by enhancing efficiency, standardization, access and compatibility of studies. The system automates analysis, reporting and interventional planning of studies and promotes standardization with the incorporation of the ACR BI-RADS Atlas. CADstream is designed for any workflow scenario, integrating with existing equipment and providing access to studies anywhere on the network. Automated features include image registration, multiplanar reformatting, subtractions, angiogenesis maps, curves, maximum intensity projections (MIPs), volume summaries, morphology characterization, portfolio for reporting, SureLoc for interventional guidance and multimodality capability.

Eastman Kodak Company demonstrated CAD software for its CR-based mammography platforms and for full-field digital mammography (FFDM) systems from GE and Siemens as works-in-progress. Kodak also debuted lung CAD software in development and a third-party bone mineral density testing software that analyzes a digital x-ray image. Finally, Kodak announced the release of the KODAK In-Vivo Multispectral system for advanced research applications.   

Kodak’s mammography CAD software for its KODAK DIRECTVIEW CR 850/950/975 computed radiography systems is a work-in-progress in the U.S. and Canada, but is scheduled to be available in Europe and other regions of the world in the first quarter of 2007. The system will be available as a software upgrade for Kodak’s current film-based CAD customers. When the CAD solution for Kodak’s CR-based platform is available, Kodak will provide an integrated digital mammography solution on a single-vendor platform.   

Kodak showed lung CAD software and third-party bone mineral density testing software with the KODAK DIRECTVIEW DR 3000 digital radiography system as works in progress.   

The KODAK In-Vivo Multispectral system is capable of identifying molecular abnormalities that are the origin of disease at a very early stage, which can lead to expedited development of effective therapeutics. In vivo molecular imaging allows non-invasive measurement of biological processes within a living organism. The new system incorporates workflow automation and advanced multispectral fluorescence, luminescence, digital x-ray and radioisotopic imaging capabilities for in vivo imaging of small animals for drug development and life science research.

EDDA Technology launched IQQA-Chest software V2.0 and showcased IQQA-Liver.   

IQQA-Chest provides an enterprise CAD solution for digital x-ray and offers real-time interactive diagnostic analysis of digital chest x-rays with tools to support radiologists in their identification, confirmation and quantification of lung nodules. IQQA-Chest has clinically demonstrated an ability to improve radiologists’ detection of small lung nodules (5 to 15mm) up to 85 percent.

IQQA-Chest Enterprise aims to redefine how advanced clinical applications can and should be accessed by radiologists.  Up to now, radiologists have had to accept that the use of advanced imaging software meant they would have to operate at dedicated workstations detached from their primary PACS review stations.  Although static image results could be sent from these stand-alone workstations back to a PACS for review, it was not possible to enjoy access to the full functionality of these advanced applications at the PACS viewing station. EDDA’s solution instantly deploys the full functionality of IQQA-Chest on existing PACS review consoles without additional requirement or setup effort on the workstations.     

With the recent advances in MDCT and dynamic imaging, early detection and treatment planning of liver diseases has been significantly enhanced. These advances bring the challenge of efficiently dealing with a tremendous increase in image data as a typical multiphase liver study generates several hundred CT images.     

IQQA-Liver uses data from a contrasted multiphase CT liver study to provide radiologists with comprehensive tools to review all acquired phases simultaneously with automatic anatomic phase registration. It also provides segmentation and measurement tools for visualizing and analyzing liver lesions and vascular structures to support liver disease diagnosis and preoperative assessment and planning. “The application is more like advanced 3D,” says Ketchmark. “It’s not meant to identify areas of suspicion but rather to facilitate surgical planning and help determine the most appropriate surgical intervention.”    

Liver disease is among the 10 major causes of death in the US, according to the American Liver Foundation. There are 25,000,000 Americans afflicted by liver disease. Primary liver cancer, an extreme type of malignancy that starts in the liver, is one of the most common malignancies in the world, with approximately 1,000,000 cases reported every year. Liver metastasis tumors also occur frequently, as any primary cancer location can deposit metastases in the liver.  As the liver is generally the first site of metastatic spread, aggressive surgical intervention at an early stage of metastasis results in a reported 25-40 percent five-year survival rate.    

EDDA announced IQQA-Liver software has received FDA clearance. Guardian Technologies International, Inc. demonstrated Signature Mapping, the application of its core digital imaging detection technology to medical images.

Guardian showed its clinical work with Signature Mapping, a technology initially developed for threat detection, and currently under technical and scientific evaluation by governmental testing agencies in the US and Russia. Signature Mapping methodology and algorithmic process creates distinctive signature maps for organic or inorganic targeted materials. Signature Mapping is an adaptive, reaction-based analytical process whereby each image responds to applied algorithms. The resulting image signature map is then evaluated against a known library of targeted signature maps for the purpose of identification and characterization. The algorithmic process, built on machine learning platforms, can analyze and identify thousands of signature maps in real time.

Signature Mapping clinical results were derived from five pilot studies conducted in a collaborative research and development effort with the Image Processing and Informatics Laboratory (IPI), University of Southern California (USC). The wide ranging clinical research includes detection and quantification of multiple sclerosis lesions; normal pressure hydrocephalus; acute intracranial hemorrhage; tuberculosis; and, the quantification, tracking, clarification and detection in dense breast tissue.

iCAD, Inc. unveiled SecondLook CAD 7.2 and showed its advanced CAD applications in-development for mammography and CT colonography.

iCAD’s CAD v7.2 is an algorithm that automatically identifies and marks areas typically associated with cancer. The CAD software marks the primary indications of breast cancer in a consistent, logical manner that is closely aligned with standard mammography training. The result is earlier detection of hard-to-find cancers, improved workflow for radiologists and higher quality patient care. The company highlighted its relationships with digital mammography market leaders – including GE Healthcare, FujiFilm Medical Systems, Siemens Medical Solutions and others – that enable it to offer iCAD products through their worldwide sales channels. iCAD also demonstrated improved network connectivity that allows easy image exchange between clinical systems.     

Additionally, iCAD showed CAD solutions that would improve CT imaging for the identification of colonic polyps through virtual colonoscopy, with software solutions that automatically identify colon polyps. The work-in-progress systems are designed to assist in improving the accuracy, consistency and workflow during the reading process.Invivo highlighted DynaCAD.  The breast MR visualization and analysis (CAD) detection workstation facilitates processing of large digital datasets, generates additional diagnostic information, adds advanced analysis tools, streamlines report workflow, speeds interventional planning and improves diagnostic confidence.

INFINITT of North America shared INFINITT Lung Solution.

INFINITT Lung Solution supports lung nodule detection as a second reader opinion by providing detection algorithms not only for solid nodules but also for GGO (ground-glass opacity) nodules on multi-detector row CT images. “Many studies have suggested that these smaller GGO nodules represent precursors to early adenocarcinoma,” says INFINITT of North America Executive Vice President Bob Blake. “Despite their potential clinical significances, nodules in this category can be missed by observers on screening CT, and most CAD schemes for detecting lung nodules are designed and optimized for the detection of solid nodules.”   

With a detection rate greater than 80 percent for solid nodules and ground-glass opacity GGO nodules, INFINITT Lung Solution exhibits a false-positive rate of less than four per case, greatly improving radiologist performance in detecting small lung nodules. INFINITT Lung Solution’s features include tools for detecting various lung nodules, state of art visualization, dedicated nodule segmentation for both solid and GGO nodules and structured reporting of results   

The system is set to be released in early 2007.

Medicsight, Inc. launched and introduced Medicsight ColonCAR 1.2.1. The company also announced an agreement with 3mensio Medical Imaging BV to incorporate Medicsight's ColonCAD and LungCAD image analysis software tools with 3mensio's medical imaging product offerings.

Medicsight ColonCAR 1.2.1 image analysis software tool is designed to be used with CT colonography (virtual colonoscopy) to assist radiologists in searching for and measuring potential colorectal polyps. Medicsight's ColonCAR (Computer Assisted Reader) uses a series of filters deployed against image data from CT colonography studies. The filters highlight spherical areas as small as 5mm, allowing radiologists to examine these areas in 3D to judge their potential as true polyps.   

Radiologists also are able to manually highlight any irregularities for closer inspection. Once suspected polyps are found, the software can determine the shape and features, precisely identifying the boundaries and showing the lesion in 3D with automatic diameter and volume measurements. This allows the radiologist to accurately review and monitor polyps over time.

The Medicsight ColonCAR software will be integrated within leading imaging 3D advanced visualization products from TeraRecon Inc., Viatronics Inc. and Vital Images Inc. Medicsight announced FDA 510(k) clearance for ColonCAR at RSNA.   

The agreement with 3mensio allows the incorporation and distribution of Medicsight's ColonCAD and LungCAD image analysis software within advanced clinical applications based on the 3viseon 3D imaging workstation.
Philips Medical Systems introduced its CAD Chest solution xLNA (Lung Nodule Assessment) and showed iSite with CT colonography CAD as a work-in-progress pending FDA 510(K) clearance.

xLNA supports physicians in the visualization, identification, evaluation and reporting of pulmonary nodules as small as 5 mm in digital radiographic chest images. Philips xLNA Enterprise 2.0 supports visualization, identification, evaluation and reporting of pulmonary lesions and lung nodules in DR images. Tools are real-time and interactive. xLNA Enterprise 2.0 will be available in the first quarter of 2007.

Riverain Medical showcased enhancements to RapidScreen.

The FDA-PMA approved RapidScreen Chest X-Ray CAD system assists radiologists in the detection of early-stage lung cancer by quickly identifying solitary pulmonary nodules between 9 and 30 mm and other suspicious nodules on the original standard AP/PA chest x-ray. RapidScreen is used with the radiologist’s existing workstation, eliminating the need for a separate workstation. Riverain Medical demonstrated further advancements in RapidScreen’s sensitivity and specificity and showing lateral CAD chest images, further improving the ability to detect early-stage lung cancer, especially in the difficult area partially hidden by the heart. Finally, Riverain Medical showed the ability for universal connectivity with PACS.

Siemens Medical Solutions announced FDA approval for its syngo Lung CAD device.   

syngo Lung CAD is designed to assist radiologists in the detection of solid lung nodules in CT examinations of the chest. syngo Lung CAD was validated on the use of CAD in thoracic CT examinations in a large multi-center, multi-reader study. Each of the nearly 200 cases was reviewed by 17 radiologists using data from four leading medical centers in the US. The use of syngo Lung CAD as a second reader helped all participating radiologists to significantly increase their detection accuracy for clinically significant lung nodules.    

“The results represent important confirmatory evidence for the use of CAD in thoracic CT examinations,” said David Naidich, MD, professor of radiology and medicine at New York University Medical Center, and principal investigator of the study.   

syngo Lung CAD adds significant new capabilities to the syngo LungCARE CT application by increasing the medical professional’s ability to catch more pulmonary nodules during the review of CT studies with hundreds of images. It is based on proprietary image processing and pattern recognition algorithms that have been extensively trained on a large database of thoracic CT studies. syngo Lung CAD is designed to detect a range of nodule sizes, starting at 3 mm in diameter. The automatically detected nodules cover the full range of locations and contours and the CAD software works equally well in the presence or absence of intravenous contrast.

In combination with the underlying software syngo Lung CARE CT growth rate and nodule size of detected nodules can easily be compared by automated alignment and volume calculation, thus supporting the physician’s treatment regimen.

Lung CAD represents the second generation nodule detection software from Siemens following syngo LungCARE NEV (Nodule Enhanced Viewing), which was introduced in December 2003. syngo Lung CAD seamless integration into the syngo LungCARE CT application, allows Siemens to provide a comprehensive solution for the detection, evaluation and follow-up of lung nodules. syngo Lung CAD will be available on the syngo MultiModality Workplace.