MRI

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MRI vendors have continued to ring out more ways to make 1.5 Tesla MRI systems more powerful and precise while setting their sights (and sites, too) on the future inevitable dominance of 3T systems. As one company described it, "Tesla envy" is beginning to rule the day. Vendors and healthcare facilities watch each other tirelessly. If your neighbor has a 3T, then you're probably going to get one too -- if your budget allows, of course.
   
Certainly those investing in 1.5 T will not be disappointed, however, for there are a plethora of new developments that make them dynamic and fully functional, allowing for more flexibility and precision in imaging than ever before. At RSNA, technological advancements included tilting and upright systems and better coils that are propelling this system evolution forward.
   
Specifically, several companies unveiled the latest in cardiac and breast MR imaging, with the latter being an alternative to traditional mammography without the radiation concerns. A number of developments in motion correction also were shown for difficult-to-image patients or complex exams.
   
Another big topic: Workflow. Multiple products on display have been designed to simplify imaging and processing as well as to speed up overall scan times and make review and analysis tools available across the enterprise.

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 MRI vendors had on display - and at the bottom is an update on new products and features to be used alongside MRI. Vendors are listed in alphabetical order.



Esoate SpA showcased a number of its MR systems, including the company's G-Scan "Tilting MRI" which is still awaiting FDA approval for use in the U.S.

The G-Scan has been installed in Europe in a few countries including Italy, Germany, and Austria, Esaote said. The system is currently being clinically tested before its release here which takes a little longer given its uniqueness.

G-SCAN is an MRI platform for use in all musculoskeletal applications with the tilting design offering a unique way through which patients can be positioned during exams. It therefore provides an optimal way to image all joints including the spine. The system can perform true weight bearing MRI incorporated in a standard MRI system.

Esoate SpA also highlighted the other systems in its MR series including C-Scan (hand, knee, foot) and E-Scan (includes shoulder imaging).

The company also offered details regarding its MR system developed especially for veterinarians called Vet MR.



Fonar Corp. highlighted its research and development in new applications of its Upright MR imaging, with its True Flow imaging of the cardiovascular system. The company believes there is an urgent need to make the type of Upright MR and its benefits available to the cardiovascular patient as cardiovascular disease is the leading cause of death in the U.S., the company said.
   
Many congestive heart failure (CHF) patients cannot be scanned due to the fact that they cannot lie flat. However, patients with this limitation now can be scanned using the Upright MR. The technology could make it possible for a patient's right ventricle chamber size to be measured to determine if pulmonary hypertension exists and to assess its severity, according to Fonar.

The company's initial concentration was on the neuro-orthopedic applications of Upright imaging, consisting primarily of perfecting technologies for Upright imaging for visualizing the spine and other joints under a full weight load.



GE Healthcare (GEHC) demonstrated the features of its Signa HD MR line with a number of new features available for its 1.5T and 3T systems, as well as some advancements in MRI coil technology.
    
GE's Signa HDe 1.5T is an entry-level system which takes up 30 percent less space than traditional systems which makes it considerably more "site-able," GE said. Other benefits of the smaller design are a shorter (one week) install time, the inclusions of just one electronic cabinet, an acoustically quieter design, and an overall 25 percent lower cost of operations, without sacrificing items on the application menu, according to the company.
   
The HDx 1.5T model is a faster, higher-resolution premium MR unit and includes a full range of components including ultra-fast image reconstruction through the new XVRE recon engine, advancements in parallel imaging algorithms, and a new interlocking, high-density head-neck-spine coil system called the Signa HD Array.
   
Other HDx features include the new peripheral vascular lower leg array as part of its scanners which provides images of the lower leg and foot vessels with high definition. The lower leg array can be used with the new SWIFT-XV, which provides direct sagittal imaging of both legs in one acquisition. Additionally, the new TRICKS-XV accelerates the temporal resolution of 3D dynamic imaging by a factor of eight.
   
Highlighted features of each of the HD line systems were Propeller-HD which counters movement by patients during scanning to allow acquisition of clear, high-resolution brain images. Another application is called MR-Echo-HD which enables clinicians to acquire cardiac images regardless of movement due to breathing without cardiac-gating or patient breath-holding.
   
3T versions of each of the HD series systems are available which essentially provide a "more powerful engine underneath," GE said.
   
GE currently has a worldwide installed base of 200 3T systems which indicates that the desire for more powerful MR units is growing.



Hitachi Medical Systems America (HMSA) introduced itself as a "full modality" company at this year's RSNA in extending its offerings in open MRI with a new system as well as going even further beyond its core expertise by adding a new computed tomography system, among other new offerings.

But the company is still very focused on its MRI roots. At RSNA, Hitachi introduced a major new 1.5 Tesla MR imaging system called Echelon. The system is a full-feature compact MR unit with scalable 8-channel RF, 30/150 gradient, and full parallel imaging capability. Other standard features include higher-order active shim, RAPID parallel imaging, multiple coil ports, and an advanced reconstruction engine. Additionally, Echelon's high-performance magnet boasts high homogeneity and low cryogen boil-off, while the gradient system's high peak strength and 150 T/m/sec slew rate allow the user to select short echo times, small fields-of-view, high matrices and thin slices.

Another feature of Echelon is the VERTEX computer system, an integration of a multi-processor CPU and an advanced scan/reconstruction engine. The parallel processing is designed to promote improved workflow and patient throughput. The system also includes the ORIGIN MR Operating Software, created to improve patient registration, scan set-up and image archiving tasks, Hitachi said.
   
"Echelon represents a new value standard in 1.5T MR," according to the company. "There are no 'tiers' to climbing order to get the image quality and capabilities you demand."
   
Hitachi said it hopes these new offerings will put it on the forefront of outpatient imaging technology providers.



ONI Medical Systems Inc. (ONI) showcased the latest upgrade of its compact high-field OrthOne XT - II, a 1.0T extremity MRI system. Beyond the open, non-claustrophobic design, new features include a more powerful operating system that offers increased scan speed as well as a 160-mm knee coil which offers "significant improvement" in its signal-to-noise ratios compared to previous coils, and also includes the option of a CD burner, the company said. The latest system also emphasizes comfort with a cushioned ottoman to relieve stress on a patient's arms and legs.



Much of Philips Medical Systems MR-related focus at RSNA was process acceleration and major workflow improvements through a number of new and upgraded technologies.
   
One of Philips major highlights at the show was SmartExam, a tool for MR which enables simple planning, scanning and processing - which can be easily reproduced with its IQ capabilities that remembers user settings. SmartExams is able to automatically determine the position of a patient's anatomy in the scanner for planning purposes. The tool also is able to maintain spatial resolution despite variations in the field of view. Also, settings are stored in the ExamCard which saves operator time by automatically processing images once they are available. SmartExam is able to run on each of Philips' MR systems including the Achieva 3T and 1.5T, as well as the Panorama 1T, the company said.
   
Philips also had on display its k-t BLAST for cardiac MRI which the company said is five times faster than traditional cardiac MRI scans. The product captures cine cardiac MRI in the time of a breath hold, and signal to noise drop off is not an issue.
   
The company also highlighted its 4D-TRAK MR Angiography that is able to perform 60 times faster than traditional MRA. This product also allows users to visualize the feeding and draining of arteries and veins in arteriovenous malformations to define the blood flow in congenital heart disease.
   
Another new capability is 2K Imaging, which provides 2048 x 2048 matrix resolution and offers expanded detail over a large field of view.
   
In addition to these new products, the company gave attendees a look at MR Workspace which is a software application that is able to extend MR image review and analysis across multiple workspaces within a department or enterprise.



Siemens Medical Solutions highlighted MRI applications that make use of the company's Tim (Total imaging matrix) technology and syngo applications.

Siemens MRI systems featured at RSNA included the Magnetron Trio, a 3T whole-body MRI with Tim, which targets clinical applications such as abdominal, cardiac, spine, whole-body and orthopedics. Also on display was the MAGNETOM Espree, an Open Bore 1.5T system that offers additional room for patients to address issues related to obesity and claustrophobia as well as elderly and pediatric patients.

Tim technology is a whole body surface coil design that combines up to 102 seamlessly integrated coil elements with up to 32 RF Channels, and enables flexible coil combinations to encompass local high resolution imaging to large anatomical coverage up to 205 cm (6'9").
   
Siemens also showcased the capabilities of syngo Expert-i which gives physicians the ability to interact remotely during the MRI examination from virtually anywhere, making it possible to address difficult clinical questions via a networked personal computer while a patient is being scanned. The entire patient set-up, imaging data and all sequences can be viewed in real-time, requiring less training while improving efficiency, quality and throughput, the company said.

Other Siemens MRI applications highlighted include:
  • syngo SPACE provides accurate 3D imaging with contrast, and is ideal for complex spine, head, inner ear, abdomen and pelvis cases, replacing multiple 2D acquisitions;

  • syngo SWI (Susceptibility Weighted Imaging) is a technique that reveals blood products and venous structures with great clarity in a matter of minutes. This allows for better depiction of bleeding in stroke and brain trauma patients, visualization of contusions and shearing injuries, and identification of minute intracranial vascular malformation;

  • syngo REVEAL is a body diffusion technique that provides additional information for differentiation of lesions throughout the entire body, offering high sensitivity to potential malignant lesions; and

  • syngo GRAPPA is a parallel imaging technique for patients with severe back pain or small children. Providing high temporal resolution in cardiac imaging even in double oblique orientations.     


Toshiba America Medical Systems Inc. (TAMS) introduced a new high-end MR system, along with new coils and new techniques for image acquisition at RSNA.

The company's new work-in-progress Vantage ZGV MRI scalable high-end system features new product sequences, improved image quality, and the Mach 8 processor, a CPU capable of 1,230 images per second reconstruction. Additionally, the Vantage ZGV offers a gradient strength of 33 mT/m (milliTesla per meter) and a slew rate of 200 mT/m/sec (milliTesla per meter per second) and the magnet delivers high homogeneity over the full 50 cm diameter spherical volume (DSV).  Field upgrade kits to the new ZGV are available to current Vantage users.
   
The Vantage line of systems offers optional packages for cardiac imaging, advanced Echo Planar Imaging (EPI), Perfusion and Diffusion Imaging, Peripheral MRA, and SuperFASE (Fast Advanced Spin Echo) imaging.  In addition, Toshiba has pioneered research into contrast-free MRA with its Fresh Blood Imaging (FBI) protocol and Body Diffusion.
   
Toshiba showcased some new MR techniques including Body Vision for cancer detection. Through a body fusion technique clinicians are able to see inflammation of body parts which could indicate cancerous tissue. Body Vision performs much like PET, though with this application inflammation "lights up," said Bob Giegerich, director, MR Business Unit, TAMS.  
   
Another new tool on display was the company's Radiance Breast Package which is an alternative to standard mammography imaging which eliminates the radiation, said Giegerich. The package includes a specialized coil and workstation software.
   
Two other highlighted MRI techniques were showcased including JET, a motion correction software for reconstructing patient data while sharpening and refining images that may have been unusable due to patient movement and can eliminate the need to repeat MR scans. Another technique called Dual Uniform Overlay (DUO) allows clinicians to utilize two SPEEDER coils simultaneously and enabling clinicians to image the entire torso in one process.  
   
Toshiba also launched two new coils. The first coil is designed for long bones, such as the humerus and femur, and is especially beneficial when imaging the spine on hard-to-move patients or those suffering from spine disorders like kyphosis, a permanent curvature of the spine. A new 32-channel head/spine coil also was demonstrated and is designed specifically for brain, cervical, thoracic and lumbar imaging in trauma or immobile patients-delivering high-resolution images without the need to change coils or move the patient, the company said.



MRI PERIPHERALS


Avotec Inc. displayed its SV-5300 Viewing Projector an MRI audio/video system which provides "Movies at the MRI" for patient comfort during an MRI scan. The system is placed at the front of the magnet and mounted on a roll stand and the position can be modified by the patient or placed inside the bore for pediatric patients.

Components include: Silent Vision Projector, Silent Vision Viewing Projector, Silent Scan Audio System, Real Friend Visual System, and Real Friend Audio Headset. Silent Scan Audio System also is available separately as is the Real Friend, which offers hearing protection, music, and three-way communication between the patient, family member, and technologist.



Bracco showcased its MultiHance contrast agent which is designed to improve the quality of MR scans in existing and upcoming applications from 0.2 to 3 Telsa (T). The agent was FDA approved last year for use in MRI of the central nervous system in adults for visualization of lesions with abnormal blood brain barrier or vascularity of the brain, spine and related tissues.



Everbrite Lighting Technologies (ELT) showed the benefits of its MedLux XLS LED Down-Light lighting technology for use in MR suites. Some of the features of the lighting technology include: a rating to 100,000 hours, more than 10 years of use, no maintenance, fully MR-ready with non-ferrous construction; completely dimmable; equivalent color temperature to incandescent light sources; and light output that is equal to a 75 watt bulb.



InSightec showed its ExAblate 2000 technology which combines GE Healthcare MRI technology with high intensity focused ultrasound to non-invasively thermally destroy tumors in the body during an outpatient procedure. The procedure requires a patient to lie in the MRI scanner as 3D images of the target at produced which enable precise guidance for ultrasound waves which are targeted to destroy certain tissue. The thermal imaging capabilities of MR give clinicians real-time feedback about the progress of the procedure as it moves along, the company said.

This technology was featured in seven educational presentations at RSNA and was also display at GE's booth.



IRadimed Corporation unveiled new accessories for its state-of-the-art 3850 MRidium MRI Infusion Pump. This follows the company's release earlier this year of the world's first non-magnetic infusion pump designed "from the ground up" for the MR, which the company said is the only IV System approved for use in 3T MR systems. 

The new 3855 MRidium Remote Control option is designed to allow healthcare professionals to view and control the infusion pump without having to stay in the MR while the scan is proceeding.  This allows the clinician to remain in the control room but still monitor the patient's IV fluids. Thus, the new remote control feature is designed to change how MR infusion delivery is provided today, by providing clinicians a way to deliver their medications for sedation, cardiac stress testing, and critical-care patients while remaining in the MR control room. This accessory can be used in combination with IRadimed's Bypass Infusion Set, and allows for quick transition of patient medications without having to disconnect current IV lines, the company said.



Kopp Development showed its new FerrAlert ENTRY MOBILE system which is able to detect and warn of dangers associated with ferromagnetic material in MR. There is a risk of accidents associated with ferromagnetic projectiles, and the risk goes up with the use of Mobile MR trailers. To counter this threat, the system can warn operators of a risk and potential injury or death. This problem has grown with the rise of MR magnet field strength and steeper field gradients.



Midwest RF showcased its Radiation Oncology MRI Head Array Coil (ROH), an 8-element array coil designed for patients with thermoplastic immobilization masks. The coil recently received FDA marketing clearance. The product was on display at two partner booths, Newmatic Sound Systems and Supertech.



MR Instruments Inc. (MRII) made its RSNA debut by showing its coils for the 3T MRI clinical market under the brand name Cheetah Coils. MRII showcased its 15-element head coils, which are currently FDA cleared/CE marked and available for GE and Siemens 3T MRI systems, the company said.

Additionally, the company announced its multi-channel, transmit/receive and multi-nuclei products, which will be available in early 2006. MRII also demonstrated its line of 3T extremity coils available in large, medium, and small sizes. These extremity coils are FDA cleared/CE marked and available today, with first deliveries again expected in early 2006, MR Instruments said.

MR Instruments has built the coils specifically for the demands of the ultra high-field market, and the coils provide the image resolution required for advanced MR in fields such as neurology and psychiatry, and other studies that image metabolic processes.



MEDRAD showcased its comprehensive line of MR compatible products such as new technology for contrast injection, MR coils, patient monitoring, and MR infusion.

Highlighted was the company's 3.0T Endorectal Prostate Coil which enables urologists to get precise and accurate images for diagnosing and treating a wide variety of ailments and can assist in the diagnosis and staging of prostate cancer. The coil's small field-of-view (FOV) and high spatial resolution, sensitivity, and specificity result in clear pictures of the prostate. Its ability to nestle up to the prostate and get closer to the problem helps clinicians get closer to the solution. The coil also is available for 1.5T systems.

Also featured was the next generation of the company's Continuum MR-compatible infusion devices, which debuted in 2002. The devices provide a larger offering of measurements so clinicians have a larger selection of medications, sedatives, and anesthetic agents at their disposal. The design also has been constructed to reduce errors during operation. Additionally, the system now includes new software called Non-Weight Dose, which provides dose selection capabilities that aid in dose calculation independent of a patient's weight.



Resonance Health at RSNA provided details on its lead product and service FerriScan, a regulated non-invasive MRI technique for liver iron measurement. The system is available on fee-per-procedure basis, and uses a 1.5 Tesla MRI instrument to take images of the liver. The images -- which are sent to a central analysis center -- are then evaluated using proprietary software and a report is sent back to the referring clinician for use in clinical management.
   
Patients only have to spend approximately 20 minutes in the MRI instrument and no contract agent is required, the company said.



Resonance Technology Company Inc. introduced a range of features to its CinemaVision audio-video entertainment system as well as the new FuncLAB functional MRI system with fully automated image data processing.

CinemaVision showed a lightweight headset that integrates video display and audio systems into a single unit designed. The headset delivers a resolution of 240,000 pixels for each of the two displays. It provides quality digital stereo sound with a passive noise-attenuation technology and an intercom for ongoing communication between patient and technologist. The entire headset fits within the MRI coil.

The company also introduced to CinemaVision a range of features to benefit anxious patients. The new features include cameras that allowing patients to see the technologists and communicate with them while the scan is going on at the push of a button. Sound levels can now be adjusted by the patient. Also, technologists can make their own settings independent to the patient.

CinemaVision can work with diverse media such as DVD, TV, camera, AM-FM and is all digital. The system also is wireless.

Resonance also showcased its SereneSound product - an audio system that brings high-quality digital sound to a patient being scanned via a passive noise-attenuation headset and transducer.

Additionally, the new FuncLAB is a mini-PACS-like fMRI (functional MRI) software add-on which acts as a workflow optimizer. FuncLAB combines a web-based complete functional imaging task presentation component featuring 3D graphics and sound capabilities with a fully automated data processing component. The fMRI data processor server attaches to the department network. Functional and anatomical images are automatically sent in DICOM format from the MRI system to the processor. No manual intervention is needed. After identifying and associating the data to a specific study and sensory task, the system processes the information. The resulting brain maps of anatomy fused with functional results are available onsite and over the web through a browser-based interface.

FuncLab is designed for simplicity so that "clinicians with no experience with fMRI imaging can perform these procedures, representing an important new revenue stream," the company said. FuncLAB also is designed to speed up data processing for experienced functional labs and academic institutions.



Suros Surgical Systems Inc. showcased at RSNA its ATEC system which includes the Sapphire console unit, an all-in-one unit compatible with any of the three primary diagnostic imaging modalities: stereotactic, ultrasound and MRI. Suros pioneered vacuum assisted breast biopsy using MRI-guidance in 2002 and has multiple patents pending with breast biopsy in this imaging modality. MRI-guided breast biopsy is now commonly accepted as the preferred secondary screening tool for women at high risk for developing breast disease or cancer. More than 200 hospitals and breast centers across North America currently use the MRI ATEC system exclusively for their MRI-guided breast biopsy needs, the company said.