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Excitement around CAD focused on applications in breast imaging via mammography and MRI, as well as chest CT and x-ray applications for assisting in the diagnosis of early-stage lung cancer. (Currently, only 15 percent of lung cancers are caught in the early stage, according to the American Cancer Society; the five-year survival rate for treatable forms of lung cancer detected early is 70 percent.) CAD for chest CT brought increasing interest. On both fronts, CAD continues to advance accuracy and efficiency in image interpretation. Consolidation was also in the air, as iCAD, Inc. and CADx Systems Inc. used RSNA to announce their merger.

On the exhibit floor, R2 Technology - the only company with a commercially available CAD system to aid in the detection of lung nodules with chest multislice CT - showed its ImageChecker CT CAD system with OmniCAD technology, the ImageChecker CT LN-500 and LN-1000 systems. R2 also showed its ImageChecker LX, DX and DM products for mammography CAD and the first CAD on PACS.

The ImageChecker CT LN-1000, which is pending FDA approval in the U.S., has already been commercially installed in Europe and R2's CR/DR Chest CAD product is currently under development. The system is a combination of dedicated computer software and hardware, providing tools for radiologists to aid in the review of CT exams. The workstation receives CT exams and DICOM structured reports of CAD-identified areas using DICOM protocols. After review of each exam, radiologists can view screens that summarize his or her findings, and save to a local database in the workstation for later review. The system offers high sensitivity and low false marker rates per exam in lung nodule detection, R2 said.

For mammography CAD, R2 showcased its three systems based on OmniCAD technology, the ImageChecker LX, DX and DM. R2 announced the FDA clearance of the LX and DX systems at the show. The new systems complement R2's ImageChecker family of products by offering a cost-effective CAD solution to mammography sites, which conduct a lower or more moderate volume of mammograms.

The R2 ImageChecker LX and DX CAD systems are approved by the FDA for use in mammography to assist in reducing observational oversights. Clinical trials have demonstrated that use of the ImageChecker system as an adjunct to review by the radiologist could result in early detection of up to 23.4 percent of the cancers currently detected with screening mammography in those women who had a prior screening mammogram nine to 24 months earlier.

Designed for lower volume sites of up to 6,000 mammogram cases per year, the ImageChecker LX processes a case of four mammogram films in just a few minutes and multiple cases can be loaded into the processor at one time. The results of the analysis for the ImageChecker LX system can be viewed on either a CheckMate Ultra flat panel monitor or a printer. Other options include connection to a mammography reporting system, and certain features such as PeerView software, Automatic Film Marker Identification (AFMI) and SuperCheck markers, which provide enhanced CAD workflow and display features.

The LX system also has the new R2004 algorithm, which enables film-based users to either maximize CAD sensitivity or minimize false positive marks through the choice of multiple operating points, R2 said. R2 claims the lowest false positive rate in the industry at 1.44 marks per case, while R2's new algorithm offers specificity in mammography CAD of up to 37 percent specificity on normal cases. Available on all ImageChecker CAD systems, this is the first algorithm featuring multiple operating points approved by the FDA.

In addition to all the features of the LX, the DX also can accept full field digital mammography images from the GE Senographe 2000D system.  With the AFMI as a standard feature and an additional display option of a motorized viewer, the DX provides an economical CAD solution for those sites with up to 10,000 mammogram cases per year.

For higher volume sites, R2 offers the high-end ImageChecker DM (Dual Mode) system for digital and film-based mammograms in a single unit with an open architecture and a vendor-neutral platform. The system is designed to transmit CAD results to multiple display units and to archive systems.

To date, more than 1,200 ImageChecker CAD systems have been shipped worldwide.

Among the 10 PACS companies displaying R2's ImageChecker CAD system results at RSNA were Agfa, Philips Medical Systems,