X-ray (CR & DR)
Maximizing radiology department and imaging center resources, seamless integration, and systems that offer flexible viewing capabilities are just some of the common themes among x-ray vendors at this year's RSNA. Many vendors had systems on display that allow the technologist to stay closer to the patient during imaging for better patient care and the potential for lower radiation doses while also increasing patient throughput. Faster scanning times and larger, seamless images are also on tap from several vendors. You didn't have to go far to find flat panel detector technology or portable systems designed for the unique constraints of small facilities and easier access to immobile or trauma patients.

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 x-ray vendors had on display. Companies are listed in alphabetical order.

Agfa HealthCare Business Group at RSNA highlighted its System Monitoring and Management Services (SMMS) that is designed to ensure high availability of the healthcare infrastructure, while reducing the administrative effort required to manage systems such as CR. SMMS is an integrated service that continually manages and monitors Agfa's applications, hardware, operating systems and databases throughout the hospital enterprise, identifying trends that point to potential future conflicts, notifying all stakeholders of the situation, and then providing a map to quickly track down and resolve the problem. By providing proactive monitoring, system management and reporting services, SMMS helps resolve issues quickly, and can manage issues after hours as well as during core business hours.

Agfa also showcased its new CR solution-DX-S, which combines two technologies unique to Agfa-DirectriX needle-based detector technology and Scanhead line-to-line CR stimulation and light collection technology. The DX-S is designed to bring a full range of imaging exams directly to the point of care in general radiography, pediatric and emergency environments, according to the company. The system requires limited adaptation of established workflow procedures. This enables users to derive maximum benefit from the solution, using common workflows. With projection radiography still representing at least 50 percent of general radiology exams, hospitals are seeking ways to make this environment more efficient and effective to meet the growing demand for high quality, affordable healthcare. DX-S helps do that by providing increased image quality, potential for dose reduction, high speed imaging, flexibility through its compact mobile design, portability of the detector, and patient proximity for clinicians.

Alara introduced the CRystalView R200, a CR system for single plate CR reader applications. CRystalView is designed to fill the need for a high-quality CR imaging system with daylight operation, integrated read/erase and throughput of approximately 50 plates per hour (14" by 17" cassette). CRystalView is a desktop CR reader with imaging plates housed in industry-standard sized cassettes of various sizes, from 8" by 10" to 14" by 17". The system is designed to be interfaced to a PACS or other imaging network so that scanned images may be forwarded to a printer or server for reading at review stations. The system also may be operated stand-alone, reading images at a workstation, and archiving to individual media.

In the networked mode, CRystalView conforms to DICOM standards. Patient information may be derived from DICOM modality worklists, image files are output in DICOM 3.0 format. The system can be readily interfaced to existing PACS that conform to these standards. CRystalView also can be mounted on a cart for mobility. The system operates from 100 to 240 VAC lines power, allowing connection to conventional wall outlets. The CRystalView system software provides radiation exposure indication and logging for each image taken. The software logs and tracks technologist exposure data and cassette usage. As each scan is completed, an exposure indication is displayed for operator feedback.

The CRystalView reader operates in conjunction with one or more workstations. The workstations are PC-based and are provided with an 18" flat panel display or an optional high intensity, high contrast 20" monochrome TFT display. The display is the operator interaction point for controlling the scanner, serves as the image display for quality control purposes, and may be used for image read by the radiologist if desired when equipped with the high-quality monochrome display. 

AllPro Imaging showcased its ScanX 14 CR scanner designed in size and price for private orthopedic practice. The ScanX 14 is designed to load and operate in normal room lighting, and produces diagnostic-quality images and features an exclusive design and patented transport system. It uses phosphor storage plates (PSP) that can be reused thousands of times, especially with the built-in eraser that uniformly and thoroughly erases the PSPs.

Anexa introduced targeted functionality in its new DR product line with the addition of the SyneRad OMNI XT and the SyneRad OMNI RT to the SyneRad OMNI product line. These two additions represent added functionality for hospital emergency and outpatient applications in the case of the SyneRad OMNI XT and a dual-detector option for trauma in the SyneRad OMNI RT. The Omni XT is the basic unit with a single detector which is easily upgradable to two detectors, the company says. It has an 800-pound capacity and features an extension arm allowing complete access to the patient. The SyneRad OMNI RT offers a new modular approach to high volume in a dual detector system. It's the only completely redundant dual-plane DR system.

Array Corp. introduced the Ipanema CR system, a CR solution for customers with limited space, patient volume or both. The Ipanema delivers fast, and accurate diagnostic quality images, without needing to add on expensive options. The system is designed for a variety of environments. A self-contained, single-plate reader has a small footprint and is ergonomically efficient. It can be positioned in most control rooms to maximize technologist productivity, while ensuring attentive patient care. It offers standard- and high-resolution imaging modes to meet the demand for excellent image quality. An intuitive approach offers optimal workflow, requiring few steps to ensure quick and accurate handling of patients. Standard features include DICOM storage, DICOM print, DICOM modality worklist, 60 imaging plates per hour, and a 15" touchscreen display.

Canon Medical Systems at RSNA showcased its full line of DR products, including portable DR solutions. Its full-size portable DR system, the CXDI-50G was introduced in 2003 and recently won a 2005 Industrial Design Excellence Award from the Industrial Designers Society of America and BusinessWeek magazine. The Canon CXDI-40G general DR system can capture 17"x17" x-ray images from almost any position or angle. This flexible system was featured in a universal stand and radiographic suite configuration at the show. Canon DR Image Viewer software is an economical and fully-scalable solution which provides users with pixel-to-pixel display of individual or multiple high-resolution Canon DR images. Ideal for orthopedic clinics, the Canon DR Image Viewer features pan, zoom, and measurement tools such as cobb angles. Its optional stitching application makes it ideal for scoliosis and long leg imaging. The Canon Mobile Access Station is designed and engineered for facilities that have limited network capability, but have the need for a portable DR solution. It helps improve workflow of patient data transfer on portable digital x-ray units and to help meet productivity demands of ICU, trauma, and bedside care.

CMT Medical Technologies followed up last year's launch of the SmartRAD and SmartSPOT PrimaX systems by introducing advanced features for these systems this year. The four configurations of SmartRAD now have graphic user interfaces that integrate the operator acquisition console. They also offer Rhapsody, CMT's proprietary contrast-enhancing, tissue-harmonizing image processing software that provides consistent superb image quality for every clinical need, and SmartStitch, an application for extended length imaging (up to 47" x 17") for orthopedic studies of the lower limbs or the spine. Applied to DR, Rhapsody reduces noise, enhances contrast and harmonizes the appearance of diverse tissues on the image. A simple userfriendly interface allows the images to be tuned according to specific needs and personal preferences, and allows the settings to be saved for future use. SmartStitch acquisition is based on moving the receptor and tube laterally, thus solving the challenges of conventional stitching. The maximum projection angle is 7° (SID=72" [180]) and at a patient-to-receptor-face distance of 6" (15cm), geometrical distortion of the stitched image is significantly reduced.

The SmartSPOT PrimaX is an high-resolution digital Photospot and angiography imaging system for the retrofit market. CMT introduced software version 3.1 that includes the ability to handle patients with split sessions, write examinations on CD-R media, automatically select study type according to DICOM MWL "Procedure Description," and support lossless JPEG compression in data backup/restore.

Fujifilm Medical Systems USA introduced a new technology called Focused Phosphor that has been proven to dramatically increase detective quantum efficiency (DQE) and image clarity. The company plans to introduce the technology in its upright and table configurations when available in the second quarter of 2006. Like Fuji's entire line of digital x-ray systems, this new imaging detector is made of a storage phosphor-based material albeit in a crystalline structure that greatly improves signal to noise ratio (SNR). The columnar architecture of the phosphor produces dramatic reductions in light scatter and the thicker phosphor design provides twice the DQE, according to the company. Images appear naturally clearer before any of Fuji's advanced image processing tools are even applied.

As digital x-ray demand increases, Fuji is now offering three new CR systems: Two FCR Carbon models and FCR ClearView-1. FCR Carbon is the smallest, full-featured CR system in the world with two models-Carbon XL and Carbon X-that offer the same capabilities but are differentiated by throughput. The Carbon XL is geared for small to medium sized facilities where higher throughput and high-quality images are a must, while the Carbon X is optimal for remote or low volume areas with less demanding workflow. Both FCR Carbon models maintain Fuji's image quality, while taking only 2.41 square feet of floor space. This makes them small enough to fit under countertops or in examining rooms behind control panels, aiding healthcare sites that have limited space and could not otherwise accommodate a full-size reader. Carbon XL was designed to replace Fuji's best-selling digital x-ray system, the SmartCR.

Fuji's Carbon X model, the lower-volume configuration, offers the same image quality and compact design but with a maximum throughput of 72 images per hour. Carbon X is aimed at smaller office practices or remote locations that require optimum CR reader quality but have limited volume that could not previously justify the installation of higher capacity systems. Both Carbon XL and Carbon X feature the convenience of Fuji's three-step exam processing, will integrate to existing networks and FCR readers, and operate with the same easy-to-use Flash IIP. Additionally, they will perform pantomography in a new imaging plate (IP) size of 15cm x 30cm. The systems are expected to be available for U.S. installations in the first quarter of 2006.

Outside the United States and Japan, Fuji will be selling the FCR Carbon products under the brand name FCR CAPSULA. FCR CAPSULA XL will be the successor to Fuji's best selling FCR XG-1. Like FCR Carbon XL, FCR CAPSULA XL is the most compact model in Fuji history with throughput up to 94 IPs per hour and new functionality to be able to read 15 x 30 cm cassettes for pantomography.

Fuji's new FCR ClearView-1 features the digital x-ray image quality of Fuji's four-cassette, multiplate system, the FCR ClearView-CS, but delivered in a single-cassette design. This CR reader offers the same patented dual-side reading technology and 50-micron pixel sampling of the FCR ClearView-CS, resulting in high spatial resolution and DQE. The reader will receive future clearance for digital mammography applications, offering flexibility in how Fuji's CR mammography (FCRm) technology can be deployed. FCR ClearView-1 also delivers the speed to meet higher capacity demands, with throughput up to 90 8"x10" images per hour. The system is geared for high-volume areas that prefer placing a reader in each exam room. It is also equally well suited as a centralized system for smaller or low-volume facilities. The system will be available in the first quarter of 2006.

GE Healthcare introduced a new family of x-ray products - the Definium series - which are based on years of digital RAD experience and input from the world's largest group of physicians and radiologists. The Definium AMX 700 is GE Healthcare's new performance DR mobile system which will provide an integrated digital solution. The Definium 8000 is the new fixed room DR system which offers powerful room automation and DICOM-based networking features to enhance operator efficiency. The Definium's imaging excellence is founded on the Revolution digital detector, which delivers one of the industry's highest DQE of 77 percent, GE says. It also allows technologists to conduct more exams per hour, provide immediate access to images within seconds, and instantly transmit to multiple locations.

The Definium 8000 is available in a broad range of configurations for ultimate flexibility, from a single wall stand to a full comprehensive radiographic room. With full DICOM 3.0 connectivity, the Definium 8000 connects easily to hospital information systems, radiology information systems, or PACS for seamless and efficient data transfer. The user interface for the new auto-positioning overhead tube suspension (OTS) includes a touch-screen user interface, motorized 5-axis movements, and 90-degree rotating screen. The foundation of the Definium's imaging excellence is GE's flat-panel digital detector. The GE digital flat-panel detector was designed to provide outstanding image quality and efficiency in order to address all x-ray imaging requirements. It was also intended to improve current procedures and drive innovative advanced applications.

The new Definium 8000 offers the following advanced clinical applications:
  • Auto Image Paste which provides physicians with a single view of the human anatomy, particularly the spine and legs, without any visible seam lines. GE's automatic advanced image processing technology provides consistent brightness and contrast for high-resolution images. Technologists have consistently expressed frustration over the length of time to manually paste multiple images together, a requirement to achieve critical accuracy for successful interpretation by the radiologists. GE's Auto Image Paste removes these frustrations, significantly reduces exam times, while providing the required level of accuracy seamlessly and effortlessly.

  • Volume RAD which provides physicians multiple high-resolution slice images of the human anatomy, including the chest, abdomen, extremities, and spine, using an x-ray system. This advanced application is a method of acquiring a series of low-dose projection images during a single sweep of the x-ray tube over a limited angle. A computer then assembles the information to provide high-resolution slice images that can be reviewed by the radiologist at a computer workstation. GE is collaborating with Duke University Medical Center in a trial on Volume RAD for its application to improve detection of pulmonary nodules.
GE Healthcare also introduced its newest portable digital x-ray system, the Definium AMX 700, which provides the company's advanced digital detector for virtually any portable application. The Definium AMX 700 provides an integrated digital solution, a large active image area for a variety of patients, and a user interface designed for the mobile workflow that offers commonality with other GE digital products to ensure smooth initialization. The Definium AMX 700 can acquire high-resolution digital images in just seconds and the flat-panel digital detector efficiently captures the anatomical region of interest at significantly reduced dose levels compared to film screen or CR applications. It also offers a large field view of 16" x 16," digital touch screen display, digital microprocessor controls, and auto protocol assist interfaces.

iCRco Inc. showcased the iCR3600SF, its patented design that incorporates a true flat scan path, an ultra precise scan mechanism, and protective cassettes to produce over 300,000 high-resolution images per plate. iCRco imaging plates are fixed to a rigid back panel. Nothing ever touches the active area of the phosphor plate resulting in an artifact free image, the company says. Unlike most CR products, the iCR3600SF uses no rollers to transport the plate across the scan head. A positive traction drive system ensures perfect artifact free reproduction.

The iCR3600SF has been designed for small format applications as well as to complement existing CR installations. Its 90 plates per hour throughput makes it suited for medium to high volume environments. Its small footprint makes it a good fit for small spaces or installation inside the x-ray room for maximum productivity.

iCRco also showcased the iCR7200, a dual bay unit which is the company's answer to the multi loader machines of its competitors. This marks the first time that a smaller CR manufacturer will take on the industry giants in the larger hospitals and facilities that require a high throughput machine. The advantages of the 7200 include high throughput of 180 (full size plates) per hour, using two high resolution CR bays, and the ability to process two plates of any size, simultaneously. With two separate bays, a facility still has a functioning CR even if one should fail. This means built in redundancy and guaranteed uptime. The modularized design means the iCR7200 is available as a desktop machine or with an integrated cart. The cart is capable of containing an integrated dry film/paper printer (from Codonics) or containing rack mounted components, such as image storage server devices. It also comes standard with the touch screen monitor and user interface.

Imaging Dynamics Company Ltd. reported that it has received 61 DR system orders in North America and that it has been rated first in customer satisfaction in a recent survey of DR clinical users. IDC DR took top honors in the composite score and ranked first in all seven measurement categories, achieving a perfect 10 in Applications Training, Installation/Implementation and System Reliability while no other DR manufacturer received a perfect score in any category. IDC DR also recorded the lowest average sale price in the survey, underscoring its combination of quality and affordability.

IDC showcased its Xplorer Direct Capture technology which replaces conventional film-based x-ray and provides a cost effective alternative to inefficient cassette-based CR systems. It provides the industry's highest resolution radiographic images in the digital format needed for modern EMR networks, without use of film, chemistry, cassettes, or expensive imaging plates. Using innovative and patented passive trigger technology, the Xplorer DR detector is activated by the x-ray beam itself and does not need to be interfaced to the generator. This technology enables IDC to use a modular approach to system design, providing clinical users with the opportunity to build customized systems based on their own unique requirements. It is easy to retrofit IDC DR systems to existing x-ray generating equipment or select new equipment that are consistent with the customer's existing technology environment.

The Xplorer 2200 is a traditional dual-detector solution with a fixed, elevating table, four-way floating top upright bucky, and an independent overhead tube crane. The Xplorer 1800 uses a motorized stand and a mobile table to accommodate all procedures in a cost effective single detector configuration. The independent overhead tube suspension provides additional positioning flexibility, notably for ER and trauma applications. The Xplorer 1600, IDC's most popular DR system, is a space efficient, wall-mounted multi-axis positioning system features motorized movement and variable SID.  The Xplorer 1590 is a motorized DR system designed to meet all radiographic imaging needs. The imaging detector can rotate 90 degrees in the vertical or horizontal direction and the stand can swivel a full 180 degrees for easy positioning. The Xplorer 1500 is the most cost-effective of IDC's DR systems. As an upright imaging system, it can replace the upright bucky providing efficient high throughput cassette-less DR imaging for minimal cost. The OrthoXP is IDC's newest DR system and takes just 80 square feet of floor space and can be fully functional with a ceiling height of less than eight feet.

InfiMed highlighted its latest DR system: StingRay Excel, which builds upon the unique image processing core and flat-panel detector technology of the StingRay DR system but offers a new set of image processing features designed to optimize image quality and productivity. The newest feature set was developed based on research and feedback from the medical imaging community. They include: enhanced "hands-free" imaging software which displays images optimized to the specifications of the facility, ImageEnhance image processing, which optimizes the StingRay Excel images immediately upon acquisition, requiring no post-processing from the technologist, and ImageStitch orthopedic stitching program allowing the combination of two images into one 17" x 34" image. 

The flat-panel DR system can be used to transform new OEM rooms, existing, or refurbished equipment into state-of-the-art digital imaging suites. StingRay enables digital capture, storage, and transfer of general radiographic images. Due to nearly instantaneous image display with the high-speed Trixell Pixium 4600 flat-panel detector, digital exams can be conducted in one-third of the time as traditional film-based x-rays, resulting in increased patient throughput. Images also can be quickly and easily transferred to PACS or a referring physician, minimizing the risk of lost films. Because of StingRay's exceptionally large 14 bit dynamic range and special image processing software, consistently high-quality images are produced. This eliminates the need for retakes, which also reduces the amount of radiation the patient is exposed to. The retrofit option also means a facility can create a digital suite for less than half the cost of replacing an entire room, the company says.

Kodak's Health Group introduced the Kodak DirectView DR 7500 System, a modular digital radiography system that enables medical facilities of any size to configure a digital x-ray solution that meets their individual space, application, workflow, and budget requirements. A works-in-progress at last year's show, the DR 7500 system features a unique wall stand capable of three-axis movement to capture a wide range of upright, horizontal and cross-table projections. The system also features a fixed, elevating table with four-way float that provides flexible patient positioning, and includes an integrated operator console with the same touch-screen interface as other Kodak CR and DR systems.

Kodak also showed its work-in-progress - the new Kodak DirectView DR 3000 System - designed to accommodate a wide range of radiographic procedures in facilities where space and budgets are limited. This flexible DR system features a motorized floor-mounted U-arm with a multi-purpose single detector that moves around the patient. The DR 3000 is supported by a fully featured console, which includes an intuitive, color-coded touch screen.

Another work-in-progress is the Kodak DirectView CR Portable Long-Length Imaging System, an easy-to-use accessory enabling hospitals and orthopedic clinics to capture digital images of long anatomical regions with patients in the supine or upright position. It's a portable system with software enabling virtually seamless image stitching with little impact to radiographer workflow. When coupled with the Kodak DirectView CR Long-Length Wall Mounted Imaging System, it provides a comprehensive solution for capturing images of any long-length exam.

Kodak also displayed its DirectView CR 975 system which maximizes throughput, productivity, and patient satisfaction. A next-generation workflow leader, this system has been developed in direct response to customer feedback and evolving technology. "Drop-and-go" cassette processing reduces radiographer queuing and waiting at the reader. Processed images can be sent automatically to pre-selected destinations and distributed workflow is achieved with a wall-mounted Kodak DirectView Remote Operations Panel, allowing study functions to be performed in the examination room.

Konica Minolta Medical Imaging demonstrated the features of its software upgrade for Xpress CR, which allows users to add free floating text to their images. In addition to its annotation capability, version 2.0 gives radiologists the opportunity to review data on other control stations, and to balance heavy workloads throughout the radiology department.
Konica also discussed IQue, its latest CR innovation which is a CR system that automatically recognizes each exam view and applies the processing algorithms appropriate for that image. IQue has a self-learning capability that routinely adjusts images to a user's preference. Billed as "the world's first self-learning CR system," the IQue is designed specifically for clinics and imaging centers.
Also on display was the company's Regius Model 350 and 370 CR upright reader. The 350 CR system delivers increased workflow and productivity by using Konica Minolta's "hybrid processing." It offers a compact footprint, versatile clinical applications (six exposure sizes, three positions, two orientations, from 17x17 to 8x10) all from a single embedded CR detector, full automation with x-ray equipment for optimal workflow, a 16-second cycle time for 210 exposures per hour, and compatibility with major OEM x-ray equipment to extend current investments.

The Regius 370 CR upright reader uses a new plate technology that increases the DQE of the phosphor-based detector. Konica Minolta will be among the first to make Cs:Br-based phosphor clinically and commercially available in the U.S. In addition to the new plate technology, an anti-scatter lead sheet has been built in to reduce x-ray scattering.

Lodox Systems North America, LLC showcased its Lodox Statscan Critical Imaging System, a digital x-ray system that can conduct a full body scan in 13 seconds. The company says this is particularly worthwhile for trauma centers and emergency departments when there are a large number of critically-injured patients. Since x-ray is typically the pinch point that slows up the assessment and treatment process, Statscan's start-to-finish-time of one minute offers a new ability to speed up the process. Studies have shown that patients x-rayed using Statscan received 93 percent less radiation than patients imaged with CR and it took 60 percent less time to complete an x-ray study compared with CR, the company says. Statscan is based on the linear slit scanning radiography (LSSR) technology, which can quickly generate images up to 1800mm x 680mm with zero geometric aspect ratio distortion in the scanning direction. Technologists can operate Statscan with a single joystick controller.

Philips Medical Systems showcased its new PCR Eleva (Philips Computed Radiography) systems family which combines reliable reader technology and excellent image quality with the new, easy and intuitive user interface - the Eleva workspot. The PCR Eleva workspots deliver UNIQUE processed images directly to the x-ray rooms, and the customizable PCR Eleva adapts to the desired workflow and seamlessly integrates into a DICOM network. All PCR Eleva systems are Vequion competent.

Philips presented its direct DR solution, the DigitalDiagnost. It offers fully automatic image stitching functionality for long leg and spine images and a new motorized positioning of the multi-purpose single detector. All Philips DigitalDiagnost systems come with UNIQUE, the multi resolution image processing for outstanding image quality at the lowest possible x-ray dose. Philips also introduced a new DigitalDiagnost called the DigitalDiagnost Compact. This direct radiography system is especially attractive for small hospitals as a cost-effective entry into DR. Its centerpiece is the fixed detector column with its flexible, multi-purpose arm that supports positioning from a great variety of angles. It's a versatile system that, when combined with a trolley, covers a wide range of radiographic applications - from table to wall stand to lateral projections. It's geared for low to medium throughput, and can serve as a multi-purpose back-up DR system for a radiology department.

Philips also launched the Practix Convenio to the North American market. The Practix Convenio is a fully motorized, battery-powered mobile x-ray