Oncology Imaging Zeros in on Lesions
Image courtesy of Median 
Median LMS-Liver 

Oncology imaging and treatment planning systems continue to offer more tailored and precise radiation treatment planning and delivery. Vendors at RSNA 2007 are showcasing how advances are allowing healthcare facilities of all sizes to leverage software for quality assurance, improved workflow efficiency and management of multiple machines.

Collimator advancements allow for finer beam shaping, letting physicians craft the best treatment for cancerous lesions while better preserving healthy tissue. These more precise surgical systems require more dynamic image visualization.  The ability to more precisely measure lesion growth helps physicians better tailor treatment, so systems designed to track growth play a vital role in oncology imaging. Also look for offerings that allow for better PACS integration and systems communication.


Carestream Health (Booth 2513) is demonstrating the Kodak 2000RT CR Plus System and Kodak Radiation Oncology Beam Dosimetry Package, which provide flexibility and precision when conducting portal and simulation imaging, as well as essential dosimetric and physics quality assurance testing. The 2000RT CR Plus is a computed radiography system designed specifically for radiation oncology professionals. It supports multiple treatment rooms and multiple linear accelerators and simulation devices, regardless of manufacturer or age. It can be networked to any DICOM-compatible QC image analysis software and oncology information systems, as well as linked to the PACS to enable images to be reviewed on workstations outside the oncology department. A work list function can be integrated to the hospital HIS/RIS to enable improved workflow and increased productivity. For standalone cancer centers, Kodak Radiation Oncology Software provides features optimized specifically for radiation oncology workflow, such as importing digital reconstructed radiographs for side-by-side viewing, DICOM RT or DICOM 3.0 output, and the ability to view and approve images on any networked PC.

The addition of the Kodak Radiation Oncology Beam Dosimetry Package allows physicists to perform a wide range of machine, beam and IMRT QA imaging―along with the CR platform’s existing ability to capture portal localization, verification and simulation images required for radiation therapy patients. Physicists also can use the CR system for stereotactic QA, IGRT verification, HDR QA, and laser alignment imaging.

Cedara Software (Booth 1316) is highlighting its Cedara I-Response application, designed to help evaluate, assess and monitor the effect of cancer therapy over time using data from multiple modalities. In addition to providing tools for the standard anatomical measurements used for tumor assessment in cancer management and research, the Cedara I-Response can analyze both PET/CT and MR-based diffusion-weighted imaging (DWI). By providing the ability to visualize changes in tumors resulting from cellular and metabolic mechanisms during the course of treatment, Cedara I-Response provides clinically relevant information that potentially could be used to make mid-treatment therapy adjustments in an attempt to improve clinical outcome.

Cedara I-Response also features patented functional Diffusion Map (fDM) technology based on landmark work done at the University of Michigan. This functionality enables physicians to analyze DWI studies to visualize and quantify changes over time in the microscopic motion of water in healthy and diseased tissues. University of Michigan investigators have demonstrated that fDM can identify brain tumor patients who are responding to radiation (plus adjuvant chemotherapy in some cases) after only three weeks of treatment, more than two months earlier than conventional methods. The results of each analysis are included in automatically-generated reports, as well as exporting the results to file for import into a site’s existing data repositories. I-Response is available to OEMs as a standalone workstation, it also can be tightly integrated into existing PACS solutions using Cedara’s unique C4 integration platform—a configuration that is a works in progress.

Median Technologies (Booth 8548) is highlighting its LMS-Lung/Track and LMS-Liver software applications, which are designed to efficiently assist radiologists managing oncology patients in all steps from lesion measurement and follow-up to report generation for referring physicians. The applications segment user-identified lesions and measure their key characteristics such as volume and longest axial diameters. They also pair the lesions in follow-up exams, compute their growth and doubling time and finally generate reports according to the RECIST criteria used in oncology to assess the response to treatment of solid tumors. By automatically performing these tasks that radiologists normally do manually, LMS-Lung/Track and LMS-Liver improve workflow.

LMS-Lung/Track and LMS-Liver support images acquired on any multidetector CT scanner, and can be integrated with modality or RIS/PACS workstations. Median Technologies is currently deploying its LMS applications in 15 countries across Europe and expects to do the same in the United States in the coming months, with the recent extension of its American sales force.

Merge Healthcare (Booth 1122) is showcasing Merge PET/CT workstation, which is designed to overcome the clinical challenges of fusion imaging to easily accommodate the standard methods that radiologists use to read CT datasets. Following the norm found in PACS, the workstation shows the images by providing layouts split across dual monitors in panoramic mode. For efficient study comparison, this method of review allows simultaneous comparison of CT images, PET corrected, PET uncorrected, PET/CT images and maximum intensity projection (MIP) images. Rigid registration between images allows simultaneous navigation through all data sets.

Varian Medical Systems (Booth 1358) and BrainLab (Booth 3592) are showcasing Novalis Tx, which integrates the most successful radiosurgery technologies from both companies for imaging, treatment planning, and treatment delivery.

Novalis Tx integrates Varian’s Trilogy Tx linear accelerator and new HD120 multi-leaf collimator offering 2.5 mm leaves for finer beam shaping. The ultra-precise Novalis Tx radiosurgical instrument will use a variety of standard and configurable options, including Varian’s On-board Imager device, the BrainLab ExacTrac X-Ray 6D room mounted x-ray imaging system, BrainLab iPLAN treatment planning software as well as Varian’s Eclipse treatment planning and ARIA information management software.

The Novalis Tx offers the widest range of treatment options for the largest number of indications, including malignant and benign lesions, brain metastases, arteriovascular malformations, and functional lesions. It features the highest dose delivery rates in the industry, dynamic beam shaping, and frameless patient positioning for more rapid, effective, and comfortable treatments. Unlike other radiosurgical devices which are limited to a 6 million electron volt (MEV) energy level, the Novalis Tx allows multiple beam energies from 6 to 20 MEV for treating deep-seated tumors and sparing surrounding healthy tissue more effectively.  Clinics should be able to treat twice the number of patients per day than with any other radiosurgery system on the market.

The Novalis Tx offers the most comprehensive image guidance system available, including Varian’s machine-mounted 3D CT scanner with 2D radiographic and fluoroscopic imaging capability as well as BrainLab’s room-mounted x-ray imaging system for real-time imaging and motion management. Coupled with BrainLAB’s 6D robotic couch, this system offers an extremely fast and accurate solution for setting up and verifying proper patient position during treatment.