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The statistics are clear. Lung cancer is the No. 1 cancer killer, taking more lives annually than breast, prostate, and colorectal cancer combined. According to the American Cancer Society, only 15 percent of lung cancers are detected in the earliest and most treatable stage. Colorectal cancer is the second leading cause of cancer deaths. Breast cancer is the second leading cause of cancer deaths in women today - and the most common cancer among women. According to the World Health Organization, more than 1.2 million people will be diagnosed with breast cancer this year worldwide. The ACS estimates that in 2005, approximately 211,240 women in the United States will be diagnosed with invasive breast cancer.
As more emphasis is placed on the early detection of cancer, vendors are touting computer aided detection (CAD) software as the "second pair of eyes" to assist physicians to identify, segment, measure and analyze suspicious pathology. At this year's Radiological Society of North America meeting, it was apparent that vendors are working hard at developing the CAD technology needed for a variety of imaging modalities, including mammography, breast ultrasound and MRI, CT colongraphy and lung CT. 
However, vendors made it clear that CAD is far from replacing the physician, but instead helping to improve the radiologic interpertation process. Enhancements to systems focused on making CAD more user-friendly and easy to integrate into day-to-day workflow. CAD is not only for the identification and evaluation of lesions of interest, but available with comprehensive editing and evaluation tools that bridge diagnostic desisions with treatment planning.      

If you didn't make it all the way around the floor or not on the show floor at all, here are some details of what CAD vendors had on display. Vendors are listed in alphabetical order.

3TP Imaging Sciences announced at RSNA it changed its name to CAD Sciences. The change more accurately reflects its current expanding base of products in computer aided diagnosis (CAD) for breast and prostate MRI, the company says.

CAD Sciences' CAD products use a proprietary Full-Time-Point analysis algorithm (fTP) that offers users an advanced processing algorithm in conjunction with robust reporting and streamlined workflow capability.

Cedara, a Merge Healthcare company, announced the market release of B-CAD 1.0 that is designed to assist radiologists in the analysis of breast lesions using ultrasound images.

Cedara B-CAD provides tools for automatic image analysis, segmentation and classification for breast ultrasound. It assists radiologists in the analysis of solid breast nodules by automatically analyzing, segmenting and classifying shape and orientation characteristics of user-selected regions of interest. Addressing the need for consistent reporting practices, B-CAD automatically generates a report using the ACR BI-RADS ultrasound lexicon classification form, Cedara says.
Cedara has inked an agreement with Eastman Kodak Company that allows Kodak's Health Group to distribute Cedara B-CAD to its customers as part of an integrated system with the Kodak Carestream mammography workstation. Kodak's workstation is designed for viewing and storing mammography images and data from full-field digital mammography (FFDM) modalities from multiple viewers. The FDA-cleared workstation also can display images and data from a full range of modalities including ultrasound, MR, CR, DR, nuclear medicine, PET and digitized images.

Confirma at RSNA highlighted new features, products and options to CADstream, its flagship CAD software designed for breast MRI studies.
Confirma announced that an expanded version of SureLoc, CADstream's interventional guidance tool, is now compatible with all interventional guidance methods and equipment. SureLoc reports needle target for both grid and pillar methods in real-time, displays images and needle position in a patient's orientation and can be made available on any networked PC for access in the MR suite.
CADalog is another new feature of CADstream. The tool provides storage and timely access to CADstream studies saved with a CADalyst user interface, as well as studies available for on-demand retreival, Confirma says. In addition, CADalog is able to view and compare previous and current studies.
As a new option with CADstream, Confirma introduced z3D contrast acuity, which enhances the visualization of time-intensity changes. The tool, which Confirma says is under clinical investigation, uses 3D graphics for visualization of dynamic series, subtractions, and morphology. Its animations can assist radiologist's interpretation of a study's enhancement patterns, Confirma says.

EDDA Technology at showcased version 1.0 of its IQQA-Chest software that is tailored for softcopy review of digital radiographic chest images, as well as demonstrated IQQA-Liver, a work-in-progress software to enhance workflow in dynamic liver imaging.

According to EDDA, IQQA-Chest, which is designed as an aid to the visualization, identification, evaluation and reporting of pulmonary lesions or nodules, now features advanced DICOM connectivity (including DICOM storage, query/retrieval, structured report and send) and a refined worklist designed to further enhance workflow efficiency. The company says the system detects lesions as small as 5mm and may be an alternative for cancer screening. 

IQQA-Liver, which is pending FDA approval, is designed to assist the review of serial multi-phase CT acquisitions of the liver using dynamic imaging techniques. It offers advanced visualization and quantitative evaluation tools empowered by image registration and segmentation techniques and can be used in the diagnosis and staging of primary liver disease and liver metastases as well as in pre-operative assessment. Clinical testing of the system has been conducted in two hospitals in China.

iMED, an Italian company, introduced its CAD Colon 1.0.

The software identified 85 percent of polyps of 5mm to 10mm and 95 precent of polyps above 10mm in an internal clinical study on 52 symptomatic patients identified. iMED says CAD Colon 1.0 is now being tested within IMPACT, a multicenter clinical study which targets to analyze more than 350 patients.

Invivo Corp. showcased DynaCAD version 1.1 with additional features for improved workflow and increased diagnostic confidence. DynaCAD is a CAD system for breast MRI exams. Enhancements include standardized structured reporting, improved image viewing and image analysis and new options for interventional planning. 

In addition, Invivo says DynaCAD has expanded and configurable archiving options for automatic creation of post-processing image series and storage to PACS archives, export options available in multiple file formats for incorporating DynaCAD data into other PC applications and integrated utility for creation of DynaCAD CDs and DVDs within a built-in image viewer.

Kodak's Health Group announced enhancements to its film-based mammography CAD system.
New options include a viewing application for CAD results in portrait or landscape mode that allows radiologists to configure the system to specific hanging preferences. Kodak added a functionality that enables the system to save scanned mammograms as DICOM files. As films are digitized for CAD, they also can be sent to an archive or any vendor's PACS. This facilitates digital access to the image files and is useful for facilities that anticipate transitioning to digital mammography since cases that are digitized for CAD will automatically be available as prior exams, Kodak says. Also new is a feature that allows users to save log files from the system and report the number of markers per film and per case. 

Kodak showed a works-in-progress that will enable its mammography CAD hardware to also run bone mineral density tests. Using the same film and x-ray unit as a mammogram, an x-ray of a woman's hand will be produced and scanned by the CAD digitizer. The software will automatically analyze the hand image to produce a report that will indicate the woman's bone density.

Median Technologies showcased its web-based software CAD-Lung and CAD-Colon. The works-in-progress software provides tools and accurate segmentation to aid clinicians in the process of detecting and characterizing lesions of interest.

Medicsight used RSNA to highlight its CAD software for lung CT and CT colonography studies that are soon-to-be-available as an option within various advanced visualization software packages.

Medicsight's ColonCAD is available for CT colonography to assist radiologists in identifying potential colorectal polyps. The software uses an advanced CAD algorithm to review CT scan data and automatically highlight specific regions of interest.
According to Medicsight, the software has a concurrent-read capability that allows the review of original images simultaneously with the Medicsight CAD findings. User-adjustable CAD filter settings, such as the polyp enhanced filter (PEF), can be manually altered to suit a user's preference, clinical situation and experience.
Medicsight's ColonCAD is an API (advanced programming interface) that can be integrated into other medical imaging software such as PACS and advanced 3D workstations. According to Medicsight, ColonCAD will  be integrated with Vital Images' Vitrea CT colonography imaging software and will be commercially available in Q1 2006; Viatronix's V3D-Colon will be integrated with ColonCAD in Q1 2006; and TeraRecon's stand-alone AquariusCAD server and Aquarius workstation will incorporate ColonCAD in Q2 2006.
Medicsight's LungCAD software, also an API, assists radiologists in evaluating lesions or nodules found on CT scans of the lung. Equipped with concurrent-read capability, the software features user-adjustable CAD filter settings such as the nodule enhanced filter (NEF). Medicsight LungCAD will be integrated with Viatronix's V3D-Explorer and available in Q1 2006, as well as integrated with TeraRecon's AquariusCAD server and Aquarius workstation and available in Q2 2006.

Neurognostics, Inc. showcased its functional magnetic resonance imaging (fMRI) products and services, namely the MindState fDAD that in October was issued a special 510(k) approval for market clearance by the FDA. Originally, MindState fDAD received 510(k) clearance in February 2005 as an fMRI data acquisition device. The Special 510(k) allows Neurognostics to enhance fDAD by providing a library of stimulation paradigms, data collection protocols and image processing services, collectively known as MindState fDPD, and marketing it for clinical use, according to the company. With this clearance, the company is able to provide off-site fMRI data processing services to its customers.

MindState fDPD includes a library of ready-to-use stimulation paradigms designed to work optimally with the Neurognostics' fDAD fMRI data collection system. Each paradigm is designed to stimulate a specific cognitive, executive, memory, motor, or other brain function. Healthcare professionals can use these paradigms for a variety of clinical applications, including pre-surgical mapping of the brain, and neurological assessment of their patients. Each paradigm includes specific imaging protocols for optimal MR data collection. Neurognostics provides proprietary off-site data processing for fMRI data collected using its paradigms and imaging protocols. Processed results are returned to the facility in the form of a customized report.

R2 Technology launched at RSNA a new system designed for digital mammography CAD display and introduced a new software upgrade for the company's mammography CAD software. The company also highlighted it lung CAD applications.

R2 unveiled its new Citra mammography applications suite, for use with Sectra's multi-modality, vendor-neutral, universal breast imaging workstation. Citra "CAD-enables" digital mammography reading workflow providing radiologists with decision-support tools during review of mammography cases.

Key features of Citra include: RightSize Optimized Temporal Comparison that equalizes the size of all displayed images to facilitate the comparison of prior and current images; EmphaSize Variable Size CAD Marks that provides variable size CAD marks that correlate to lesion significance; PeerView Digital CAD Display that enhances the suspicious region to help the radiologist understand the specific features detected by R2's algorithm; and LesionMetrics CAD-Enabled Decision Support that provides additional information, including lesion size, distance to chest wall and distance to the nipple.

Citra works in conjunction with the Sectra IDS5/ breast imaging workstation and R2's ImageChecker D Mammography CAD system, and is compatible with all FDA-approved full-field digital mammography (FFDM) systems, including those from GE Healthcare, Hologic, Siemens Medical Solutions and Fischer Imaging, R2 says.

R2 also introduced its new ImageChecker Version 8.1 Mammography CAD system that is available as an upgrade for existing systems. According to R2, Version 8.1 contains features such as the R2 Malc mark, which indicates a mass with microcalcifications; EmphaSize variable size CAD marks, which correlate to lesion significance; and the GreenLight user interface, which enables technologists to process mammography cases quickly and monitor film scanning from a distance.

R2 also showcases its ImageChecker CT Lung CAD system that is equipped with AutoPoint automatic temporal comparison to assist radiologists in the review of multi-slice CT chest exams. The technology aids the physician in detecting actionable lung nodules early and tracking their size changes over time.

Riverain Medical showcased its FDA-approved RapidScreen RS-2000D - a CAD device that digitizes and analyzes chest x-rays to identify regions of interest that may have features associated with early-stage lung cancer. 
Using existing PA/AP chest x-ray films, the system provides second opinion for Stage 1 lung cancer ranging from 9 to 30 mm size. Since RapidScreen is intended as a review tool, no additional dose is required. The system is compatible with all modalities that generate DICOM 3.0 conformant direct radiography, computed radiography and digitized images.

Siemens Medical Solutions used RSNA 2005 to preview its new suite of CAD products that are currently awaiting FDA approval, as well as highlighted a cardiac CAD product intended for use with echocardiography examinations. 

Siemens demonstrated syngo LungCARE CT with NEV (nodule enhanced viewing), a computer-assisted reader device that supports the detection of lung nodules in thoracic CT examinations. According to Siemens, the next-generation version syngo LungCARE CAD provides improved detection performance as well as workflow enhacements. syngo LungCARE CAD is available on the syngo MultiModality Workplace 2006A for sale in Europe. U.S. availability pending FDA approval.

Siemens' syngo Colonography CT with PEV (polyp enhanced viewing) is a computer-assisted reader device that supports the detection of colon polyps in CT colonography examinations. Together with the other workflow-enhancing tools available in the syngo Colonography CT application, PEV is intended to help improve reading accuracy as well as reading efficiency, Siemens says. PEV is available on the syngo MultiModality Workplace 2006A as well as syngo Suite.
Siemens announced its Mammography CAD product for use with full-field digital mammography systems will be available in Europe in early 2006. Availability in the U.S. is pending FDA approval. The computer-aided classification technology is undergoing clinical validation and is not yet available for clinical use.

In addition, Siemens showed its Axius Auto EF, a cardiac CAD product for use in echocardiography examinations. Axius Auto EF applies a learning-based approach for detecting and tracking the borders of the left ventricle to provide automated and robust measurements of the cardiac ejection fraction. Siemens says the product is available on the Acuson Sequoia ultrasound platform.