CT: Return of the Slice Wars?
Image courtesy of Philips  
Philips Brilliance
CT is arguably the workhorse of high-end diagnostic imaging. A plethora of slice configurations and software application packages are available that ensure the ongoing clinical utility of this modality now and for years to come.

At RSNA, developers are focusing their attention on refinements to CT technology including: dose-reduction techniques; image-reconstruction algorithms; enhanced electronics for cardiac applications; and workflow solutions that distribute the functionality of a dedicated CT workstation across the enterprise. Expect a preview of next-generation systems, more slices, better resolution, shorter scan times—although word prior to showtime is mum. 

Here is a sample of some of the latest CT products and devices being showcased in the RSNA exhibit halls of Chicago’s McCormick Place in November.

AFP Imaging (Booth 6562) is highlighting two new versions of its cone-beam CT systems geared for in-office use. The NewTomVG (Vertical Generation) provides hard and soft tissue imaging, while delivering the lowest radiation emissions in the industry, the company said. The system, geared for 3D dental imaging, offers flexible seating options to allow patients to stand, sit or remain in a wheelchair for scanning. Safe Beam Technology ensures the lowest possible dose of radiation, automatically sensing the size of the patient and adjusting the dosage accordingly. Additionally, the vertical unit takes up 60 percent less space than a comparable horizontal system, according to AFP.

AFP’s NewTom 3G Cone Beam CT system produces 3D x-ray studies of the jaw, mandibular canal and sinuses. The variable field-of-view system is geared for use in ENT applications, orthodontics, endodontics, implantology, TMJ and oral surgery. It can be sited in a room as small as 3-by-5 feet.

Apollo Medical Imaging Technology (Booth 6228) is exhibiting one-click CT Perfusion workflow. It offers automated processing of dynamic CT images collected from MDCT scanners with the click of a mouse button, coupled with automatic motion correction, detection of baseline and input functions. It provides various quantitative maps to aid in the assessment of the extent and type of blood flow, blood volume, transit time and permeability changes related but not limited to stroke or tumor angiogenesis and be helpful in therapy monitoring.

GE Healthcare (Booth 1729) is demonstrating the capabilities of its LightSpeed VCT XT, a CT system the company says can maintain image quality while reducing a patient’s radiation exposure by up to 70 percent in diagnostic cardiac scans.

Building on the foundation of GE’s CT platforms, the LightSpeed VCT XT is capable of capturing images of the heart and coronary arteries in as few as five heartbeats. Using SnapShot Pulse, the LightSpeed VCT XT reduces a patient’s x-ray exposure time using a process called prospective-triggered gating. In standard cardiac CT exams, x-ray energy is delivered for the duration of the scan, even during periods when a patient’s heart is at an undesirable phase for diagnostic imaging. SnapShot Pulse introduces a timed, automated response to a patient’s heart rate, ensuring the x-ray is only on for portions of the scan, according to GE. Its functionality is further improved by the company’s step-and-shoot scanning feature, which allows the gantry to move from one location to the next to cover the entire volume of the patient’s heart.

LightSpeed VCT XT also features VolumeShuttle, which addresses the need for wide coverage for both dynamic angiography and perfusion in a single scan to enable whole organ anatomical and physiological assessment. VolumeShuttle doubles the coverage width of the anatomy without increasing dose, using a single contrast injection, GE says.

Medrad (Booth 8513) is introducing its Pressure-Rated Extension Set (PRES) for CT power injectors. An extension set, which is commonly used in conjunction with IV access, is a disposable tube set that attaches the patient catheter and the power injector tubing. According to the company, the FDA recommends using only venous access devices that are compatible with the high pressures achieved when power injecting.

Medrad says its PRES reduces the risk of disposable extension set rupture during powered injection of contrast agent or saline when using the company’s CT injection systems, including its Stellant CT injection system.

The developer also is introducing a set of custom adhesive tape strips designed to help clinicians use PRES quickly and easily. HandiStrips secure the catheter and pressure-rated extension set to the patient and can secure a bandage at the end of the procedure. The product helps achieve adherence to current Centers for Disease Control guidelines regarding improvement of sterility when placing catheters, according to Medrad.

NeuroLogica (Booth 4379) is featuring its CereTom mobile, 8-slice CT scanner for dedicated bedside imaging of the head, neck and extremities. The 700-pound unit that is five feet tall and four feet wide, can be wheeled to the bedside, and used in any hospital room or clinic bay. It performs normal CT, perfusion, Xenon perfusion and angiography exams, acquiring 1-¼  mm slices per revolution.
Designed for use in the ER, OR, ICU, MICU, SICU, NICU, interventional suite or medical clinic, the CereTom includes CT perfusion software, multiplanar reconstruction (MPR) capabilities, and 3D maximum intensity projection (MIP) software for the viewing of CT angiography via a 20-second head and neck scan.

Images can be sent from the point of care to NeuroLogica’s Clarus wireless workstation via wireless image transfer. The scanner also utilizes Voxar 3D imaging technology.

The company says that in the near future, the CereTom will be expanded for use by orthopedic surgeons and dental specialists.

Philips Medical Systems (Booth 4129) is unveiling innovations in three key areas of CT technology—tube, detector and reconstruction on its Brilliance CT 64-slice scanner, which may dramatically improve the speed and power of the system, the company says.

Philips says it is sensitive to the impact that legislation and reimbursement issues are having on the industry in the United States and recognizes those customers need more options, so it is showcasing offerings of new “value” configurations in 6-, 16- and 64-slice scanners. 

Philips is sharing news in the futures area as well, particularly in spectral CT imaging. The firm says it is showing results from ongoing clinical investigations with simultaneous, multidetector spectral CT scanners.

Also on display is Philips’ dose-saving Step & Shoot Cardiac technique and an application for virtual colonoscopy. Philips says Step & Shoot Cardiac has been shown by its clinical collaborators to save up to 80 percent of the dose in a cardiac exam.

Philips Virtual Colonoscopy software uses exclusive views and proprietary algorithms and the vendor is showcasing new clinical results. In addition, the company is demonstrating new CT software applications for liver segmentation and bone removal.

Brilliance Everywhere, a thin-client solution that delivers advanced applications such as those used in cardiac, vascular, stroke, colon and lung imaging to any workstation on the enterprise, is being showcased, too. Philips says its Brilliance Everywhere solution maximizes radiologists’ time by allowing them to complete more studies without having to leave their current workstation to access needed information.

The company says its future CT direction is focused on the delivery of a single-tube whole-organ coverage system, providing optimal image quality, low dose and intelligent workflow.

Shina Systems (Booth 5756) is featuring a family of products based on its core automated segmentation, classification and registration technologies. CardioCt is a cardiac CT analysis tool that provides a complete solution for reliable coronaries and functional analysis in one synchronized package. This is realized through the implementation of an innovative set of algorithms that define the heart and its comprising parts in a single operation. The advanced anatomical knowledge-based segmentation algorithms begin automatically without user interaction. CardioCt includes a Plaque package which consists from a set of tools that automatically identifies suspicious plaque and stenosis sites along the vessel, and classifies the plaques through a proprietary algorithm.
The new VascularCt is a vascular CT imaging and analysis system enabling assessment of carotids, renal arteries and other peripherals. It includes Stenosis and plaque assessment tools.
Also on exhibit is AngioCt, an application for the integration of cardiac CT Angiography in the cathlab. With minimal user intervention, the application co-registers a 3D CTA reconstructed structure with the real time 2D coronary angiography image. Once co-registered, tissue information, stenosis and plaque are displayed on the “lumen only” angiogram, empowering the cardiologist to see beyond the lumen.
The company is also displaying its CScoreCt , a new application providing a more automated solution for calcium scoring.

Siemens Medical Solutions (Booth 7713) is highlighting the features of its Somatom Definition Dual-Source CT scanner, introduced in late 2005.

The company says the system continues to set the bar for cardiac imaging, where its high temporal resolution enables it to conduct cardiac scans of the patients without beta blockers and regardless of heart rate, and without the need to employ multi-segment reconstruction.

Taking the Definition one step further, at last year’s RSNA Siemens introduced the first six of its syngo Dual-Energy applications. These applications showed how users can generate relevant clinical information by leveraging Definition’s dual-source design.

The syngo Dual-Energy applications were showcased this June at the Stanford Multi-Detector Row CT Symposium and Siemens says it is showing on-going data generated by the new combinations of varying x-ray tube voltages.

Siemens also is showcasing new enhancements for its single-detector, single-source CT products.

Toshiba America Medical Systems (Booth 7130) is demonstrating the Aquilion CT line’s product platform design and showcasing its suite of workflow and storage enhancements.

The company is demonstrating the Aquilion CT line’s Quantum Advantage, delivering a 0.5mm isotropic slice thickness capability for its 4-slice, 8-slice, 16-slice, 32-slice and 64-slice models. 

Also on display are new application packages for the Aquilion line, including: 
  • PhaseXact (part of the Sure Cardio package), which automatically locates the optimal phase of the heartbeat ensuring the best image quality, decreasing image reconstruction time by at least 50 percent and reducing storage requirements.
  • Sure subtraction software reduces the time to diagnose a neurovascular CT digital subtraction (CT DSA) exam by automating and streamlining bone subtraction.  
  • Sure plaque software application, which allows clinicians to easily view vessels for coronary remodeling and quantification.
The company also is featuring educational sessions on its 256-slice next-generation scanner, that underwent beta testing at Johns Hopkins this spring and is expected to hit the market in 2008.