Tracking Technology Trends on the Exhibit Floor

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  The Carestream Health PACS platform offers native 3D imaging and advanced cardiac features.
Whether you made it to RSNA 2008 or not, seeing all of the new and enhanced technologies offered on the exhibit show floor was impossible. So here’s an overview of the technology trends and what vendors had on display at the expanded exhibition show floor that this year stretched from the north and south halls of McCormick Place across the walking bridge to Lakeside Center. To get more details on specific products and vendors in each category, visit RSNA360.HealthImaging.com.

RIS/PACS making connections with the enterprise

The technical exhibit halls of McCormick Place and Lakeside Center this year played host to a wide range of enterprise-capable imaging informatics systems ready for deployment for a variety of clinical imaging specialties offered by vendors from around the world.

In the RIS/PACS realm, the majority of vendors showcased new versions of their existing software that expand the application of their systems to diagnostic imaging beyond the radiology department.

From single-physician practices to multi-national integrated care delivery networks, leading-edge RIS/PACS products are at the heart of digital diagnostic imaging. In addition, the melding of PACS with other clinical informatics systems—such as electronic medical records and practice management applications—was on display to demonstrate integration throughout the healthcare enterprise.

Clinical reporting systems and PACS have become integrated components of the healthcare delivery system as the fundamental infrastructure for imaging data and reporting. Although radiology is still the central focus of these applications, its success in this field has opened new vistas for the deployment of these critical systems.

DR weds digital throughput with wireless convenience

Digital radiography made a big splash at RSNA 2008 with a host of vendors launching wireless flat-panel detectors. The slick, new systems answer users’ demands for increased flexibility, convenience and productivity by removing the cable from the x-ray process—literally untethering DR. The affordable wireless innovation is expected to boost DR deployments across the country. Some vendors are delivering the detectors, while others showed off works in progress with varying rollout dates.

But wireless wasn’t the only technology to make a digital splash in Chicago. One vendor aims to mimic wireless freedom with a new non-wireless solution that features detachable cables that can be removed during patient positioning and attached after the patient is in position. Another route to increased flexibility was featured as a mixed digital detector work in progress, which combines dual-detector productivity with portable flexibility.

DR vendors also touted a host of other new features to ramp up throughput and satisfy radiology’s quest for cost-effective investments. Features like automatic collimation, automatic tracking and organ-specific programming streamline radiographic imaging, helping techs complete studies in minimal time and fewer retakes.

Also on the financial side, vendors showed off systems designed for easy retrofit into existing rooms. CR’s continued viability was apparent, too. New systems that increase portability and automate manual process should keep this segment competitive.

Finally, vendors rolled out new features for departments seeking new C-arms or fluoroscopy solutions. Highlights included several dual-detectors or “2-in-1” systems that pair fluoroscopy and DR capabilities to optimize room utilization. New C-arms follow general radiographic trends; automation, user-friendliness and image quality features were on full display. Departments in the market for new digital x-ray solutions in 2009 are sure to find the ideal solution for their imaging needs.

?CT Diagnoses more, better, faster…and minimizes dose

After stealing the show in 2007 with next-generation volumetric CT solutions, vendors continued to highlight the applications or user successes of their newest CT systems. Some shared clinical results of early adopters, proving the cardiac merit of the scanners. They also shared early adopters’ plans for expanding clinical work, indicating that the systems may be used in neurology and other applications. At least one CT vendor announced plans for a large scale trial of its volumetric system. All touted the speed and efficiency of their units. In a nod to radiologists suffering from slice overload syndrome, vendors have developed new features to automate manual processes. Liver segmentation and plaque assessment are greatly streamlined with some new tools. CT providers also launched a bevy of features aimed at slashing patient and operator dose. Results are impressive with the newest scanners cutting dose for typical cardiac CT studies to less than 1 millisievert.  

Other vendors showed automated contrast injection tools, RFID contrast injectors and personalized patient injection protocols. These CT helping hands are a win-win investment that minimize patient dose while boosting technologist workflow.

??Advanced Visualization offers new vision

Advanced visualization applications were offered across the spectrum of imaging. Distribution of advanced visualization technology throughout the enterprise is now the order of the day, with thin-client applications the overwhelming focus of the market space. A recurring theme among vendors was enhanced workflow and throughput. Developers have tuned their tools to make the utilization of advanced visualization as ubiquitous for interpreting clinicians as the display of a digital x-ray.

A cornucopia of specialized applications was showcased, either as works in progress or as ready for deployment. If a digital imaging dataset is available, there is seemingly a developer who has created software for its manipulation.

Cardiac, brain, oncology, tissue, bone, muscle and organ images from a range of modalities were shown in a variety of reconstructions, including maximum intensity projection, minimum intensity projection, multiplanar reconstruction, and volume rendering. Temporal and functional enhancements, fly-through capabilities, advanced segmentation and image co-registration functionalities were among the tools showcased that offer a new paradigm for diagnostic interpretation.

Several, more simplified, but still highly functioning advanced visualization solutions that leveraged gaming industry technologies that don’t require sophisticated image processing boards and are installed by downloading software from the web, were also featured.

Speech expands to new horizons

Speech recognition is a proven operational asset these days in radiology departments and imaging centers. New solutions foster greater customization and deeper integration with RIS/PACS, thus streamlining image reading and workflow.

At RSNA, many of the speech vendors touted the ability of their tools to expedite radiology workflow and empower the radiologist by giving him or her more control. If the solution is embedded within PACS, it can streamline reporting workflow—such as dictate-edit-sign, correctionist, resident-attending and digital dictation, as well as allowing at-home reporting and remote sign-off.

User-friendly GUIs, autotexts, canned reports and intelligent case routing are speeding report creation and communication with referring physicians and specialists. Some vendors featured embedded GUIs that allow integrated voice recognition for the RIS and reporting tools.

Companies also showed features that allow radiologists to inject paragraphs and normal phrases from a clipboard of their own commonly used text to be inserted in the structured report or with a normal finding that will accompany a voice dictation. Other vendor offerings included updated radiology dictionaries, improved administrative functionality and custom data entry coupled with workflow management.

Healthcare IT bridges disparate information pathways

Vendors at this year’s show recognized that healthcare organizations are looking for technologies that bridge the gap across the enterprise, while providing them with the biggest bang for their buck.

Across the exhibit floor, it seemed the lines were blurring between modality management, image management and information management, with different tools and IT capabilities geared specifically toward giving the medical imaging industry access to the critical disparate information systems and modalities. It was evident that many vendors are arming themselves with vendor-neutral hardware and software tools that can provide increased visibility and transparency across any modality or platform, while maintaining data integrity and security, anywhere, anytime—even via the web. Many vendors showcased IT solutions designed to connect to disparate PACS and other information systems at multiple sites, offering a common worklist—be it general, modality or subspecialty—from which users can access all relevant patient information and exams.

Dashboard applications that allow imaging facilities to track operations, in some cases real-time clinical data, for clinical and operational key performance indicators, were also center stage at this year’s show. One vendor highlighted a software solution that can aggregate data from disparate information systems, offering a real-time view of actionable information at the critical point in patient care. Another vendor featured a system that monitors network performance, along with monitoring system slow-downs and outages.

Other vendors focused on resolving multiple workflow and regulatory challenges across the enterprise with tools that closed the loop on critical test results management, technologist performance management, as well as quality reporting and professional services.

PACS Peripherals fill every niche

RSNA attendees were treated to a smorgasbord of digital image management helping hands in Chicago. Digital mammography claimed center stage with vendors showing laser imagers geared to mammography’s exacting specifications. One vendor showed a scanner designed to minimize the pain of the hybrid environment. The device scans analog films, enabling digital-to-digital comparisons for sites operating in hybrid mode. Other tools included CD burners that allow physicians to share mammography images and information with their patients.

Vendors showed a host of other CD burning solutions, including a few geared to the obstetrical market. Many scale to more than 100 CDs daily and offer embedded tools that burn important information like the facility name or patient demographics on the label. Other CD/DVD solutions capture streaming video and are ideal for use with C-arms, x-ray fluoroscopy, angiography, ultrasound, endoscopy and vascular imaging systems. One company shared a medical image reporter that reconciles, transfers and stores medical images from a disk, helping office staff handle the onslaught of patient CDs that arrive on a daily basis.

Other helping hands included a digital press that allows users to print high-quality images for patients and referring physicians. The newest printers ramp up speed and flexibility, accommodating a range of film or paper sizes. Many boast small footprints, and some output onto multiple media: film and color and grayscale paper.   

The array of devices on the show floor demonstrated that digital image management remains a complex process. It often is a step-by-step effort to move to a truly digital work environment. Fortunately, peripherals are there to lend a helping hand, as well as transition to and streamline digital workflow.

Storage stretches its legs

Managing storage on an enterprise level, vendor neutrality and cost-efficiency led the way for archiving and data storage vendors at this year’s RSNA. Many vendors talked up their DICOM compliancy and vendor neutrality.

To serve the healthcare enterprise, large-scale multimedia storage systems for hospital groups, regional healthcare organizations and national medical archives can consolidate data from disparate systems into a single point of storage. The archive systems are designed to store clinical DICOM data objects, including DICOM encapsulated non-imaging objects such as waveforms, structured reports and PDFs.

Vendors also demonstrated upgraded capabilities to archive and manage clinical data using the IHE-defined XDS protocols. They touted that standards such as the XDS protocol may be used to store and retrieve the fixed content file types, and HL7 is used to receive and store reports with clinical patient data and other documents from clinical information systems. Those systems demonstrated on a service-oriented architecture can be deployed in a modular fashion, offering aggregated content from clinical, operational and financial applications.

MR: New apps revolutionize imaging

Throughout the exhibit floors of McCormick Place and Lakeside Learning Center, MRI took center stage. Vendors highlighted enhancements for 1.5T and 3T systems aimed at speeding exam time and workflow, improving image resolution and coil technology and increasing the power of gradients. Vendors answered the call with a variety of imaging systems and advanced visualization software targeting breast MRI, as well as MR-specific applications for neurology, cardiology oncology and orthopedic imaging.

Breast MRI systems look to improve image resolution and reduce common artifacts, resulting in the production of crystal-clear images of both breasts, axillae, chest wall and mediastinum in a single bilateral scan. Some new applications promise to optimize acquisition with a high signal-to-noise ratio for acquiring high-quality water and fat images, which would let the user prescribe thinner slices for high spatial resolution imaging. New breast imaging coils provide high temporal and spatial resolution for dynamic analysis and lesion characterization.  

One new 3T system promises to project multiple RF transmit signals to enhance uniformity, bolstered by a new technology the vendor says can be individually tuned to each patient’s anatomy, thereby addressing dielectric shading at the source.

Functional MRI (fMRI) made a splash in the clinical arena, as well as in the technical exhibits. These solutions could allow a single clinician to conduct an entire fMRI procedure from stimulus presentation and image acquisition to data analysis and reporting of results.

Ultrasound makes it big with small devices

Big advances come in smaller packages when it comes to ultrasound scanners—with smaller footprint compact and portable systems no longer meaning a dip in performance, but instead advanced, deeper applications. A variety of specialized portables were on display for ob/gyn, echocardiography and 3D/4D system. Around the exhibit floor, vendors showed enhancements that fine-tune image acquisition, especially for cardiology and breast imaging. Real-time elastography imaging is helping to differentiate lesions within the breast.

Elastography is being used in applications beyond breast imaging, including clinical cases in thyroid, prostate, musculoskeletal and liver, including a strain ratio tool that allows radiologists to quantify the difference in stiffness between a mass and surrounding normal tissue. Other ultrasound techniques, such as advanced harmonic imaging, use pulse inversion technologies, which is activated by setting the flip switch to “harmonics high” and uses a larger bandwidth that provides good axial and lateral resolution.

Vendors also touted smaller footprint units with high-detail resolution and color flow that can allow clinicians to distinguish between cystic and solid lesions, especially in small areas such as the thyroid, breast and ovary. Whether performing a routine vascular exam, charting fetal development or determining the status of a torn rotator cuff, the system can handle general and shared-service imaging needs.

Biopsy and interventional techniques were highlighted, too, as more physicians prefer the advantage of ultrasound image-guidance with needle-guidance systems. A host of new transducers for deep and shallow images and quantification tools also we on display.
 
Women’s imaging: Breast MRI takes the limelight

The specialty of women’s imaging represents arguably one of the most innovative and dynamic segments of radiology. The past decade has seen the introduction of digital mammography, computer-assisted detection (CAD) technology, and the expanding utilization of modalities such as PET, SPECT, ultrasound and MRI.

Developers across the exhibit halls introduced new and refined tools, techniques and technologies that promise to maximize the clinical potential for breast imaging and interventions from the panoply of modalities spanning the spectrum of diagnostic imaging. Breast MRI systems saw enhancements, as well as introductions, with pink being the new color on the block for MRI units. Clinical studies are proving the merits of breast MR and heavy booth traffic was reflective of that, with attendees taking a closer look. Elastography to differentiate breast lesions via ultrasound was showcased by a variety of vendors, as were PET- and SPECT-based systems for differentiating cancerous lesions. Digital mammography systems showed greater flexibility, connectivity and workflow enhancements too.

Molecular Imaging fuses diagnosis and treatment

The potential and possibilities of this field were well represented at RSNA 2008. The fusion imaging capabilities of modalities such as PET/CT and SPECT/CT, which provide anatomic clarity to the discipline’s functional focus, continue to open fresh vistas for innovative applications in patient care.

A variety of vendors offered a glimpse of solid-state detector technology research in their SPECT and PET offerings, opening the possibility for the fusion of these modalities with MRI systems. Technology and software developments also showcased portable and specialized devices for breast, thyroid, oncology, and cardiac applications, as well as the capabilities to provide higher-resolution imaging.  

Also of note was the ongoing deployment of service and support for nuclear medicine equipment and supplies, which will extend access to this field of medicine beyond its traditional concentration near academic centers in urban areas.

Thinking large with new displays

Display vendors had something for everyone to see at RSNA. Several showed off 10 megapixel (MP) works in progress as the vision of the future looks to converge images and patient data onto one display. The impressive flat panels may be high on mammographers’ wish list as they pair two essential 5 MP systems but eliminate the bezel between the monitors. High-resolution 6 MP systems that rolled out last year and are now available for sale were on full display in several booths. The systems optimize flexibility, allowing users to configure them as a single, 6-MP or dual 3-MP monitors. Other eye-catching options included an ultra-large, 56-inch, 8-MP display geared to vascular applications that accepts up to 27 inputs. Surgeons found new heavy duty, 80-inch display solutions targeted to their exacting specifications.

Vendors plugged the improved resolution of color display, with many predicting that the color vs. grayscale tide will turn this year as it becomes more feasible to replace grayscale displays with high-brightness color systems.

Another hot trend was DICOM-compliant clinical review systems. Many clinical departments are turning to off-the-shelf systems for their clinical review display needs; however, vendors aim to edge into the market with an array of competitively priced, DICOM-compliant 2MP systems. Vendors also highlighted an array of features designed to streamline the display maintenance process, minimizing the labor burden of flat-panel maintenance. Labor saving (and headache sparing) tools include integrated ambient light sensors, improved auto calibration tools and streamlined hot swaps.

Another display innovation that garnered a collective “wow” included two autostereotactic 3D viewing solutions that eliminate the need for 3D glasses.

CAD expands around the body, moves into the mainstream

Computer-assisted detection (CAD) vendors showed more advanced solutions, many with recently attained FDA and CE Mark approvals, as well as touting the benefits of CAD through various clinical trials. The scope of system offerings now span from mammography, lung, colon and prostate to breast CT, MRI and ultrasound. One company even previewed a work-in-progress lymph-node CAD module.

CAD companies are now focused on reducing false-positive nodule identifications, so the systems can serve as true second readers. Assistance in reviewing chest x-rays could help with detection of lung cancer, the most common cancer which must be detected early to be stopped.

Many of the companies are integrating their software with advanced 3D/4D applications to gather a true volumetric measurement of potentially malignant nodules. To further assist radiologists with image interpretation, mammography CAD market, especially full-field digital mammography, was of particular focus at this year’s annual meeting of RSNA.

As adoption grows, vendors are beginning to unveil their next-generation enhancements.