X-ray: Vision for CR, DR and Specialty Systems

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X-ray, radiology's bread and butter, is very much back on the radar screen of smart physicians and administrators seeking to improve imaging quality while streamlining workflow and productivity. With market penetration reaching only 2 percent for digital x-ray systems, there's a lot of room for growth. Market growth numbers are sighting about 15 percent next year as well. Prices that originally could only be paid by large facilities are coming down so that small to medium-sized hospitals and imaging centers are now investing in DR as well as older and very versatile brother, computed radiography.

A variety of new digital x-ray systems, both CR and DR, and enhancements to existing units debuted at RSNA. The majority are coupled with PACS, but not always as facilities invest at the pace they can.

The features show-goers honed in on are signal-to-noise ratio, detective quantum efficiency and spatial resolution, as well as overall speed, efficiency and cost-effectiveness for the business-minded. 

(Note: companies appear in alphabetical order.)



Analogic Corp.
debuted a new multipurpose, direct digital radiography (DR) system, SyneRad, the gained FDA marketing clearance just before showtime.

The system features the new GR17 amorphous Selenium flat-panel detector, which was developed by Analogic's Canadian subsidiary, Anrad Corp. Designed and developed by Analogic, the new SyneRad OMNI DR system is being sold by ANEXA Corp., an Analogic subsidiary, which sells digital imaging products directly to end-users in select U.S. markets. The system was designed for emergency medicine and orthopedic applications.

ANEXA's SyneRad OMNI with SELENIUM2 detector technology provides multi-frame acquisition capability in full 17 x 17 inch fields, allowing it to perform joint stability and motion studies, the company said.



Canon Medical Systems showcased its full range of DR systems at RSNA that feature its amorphous silicon (a-Si) flat-panel sensor.

Canon's CXDI-40G general DR system with multiple wall stand and table configurations is designed for a wide range of general radiography applications. The system can capture 17 x 17-inch x-ray images from almost any position or angle, the company said. The DR system includes a Bucky table, upright tilting wall stand, universal stand, and a ceiling suspended multi-positioning unit.

The CXDI-40C is coined as Canon's premium DR system. The CXDI-40C features a 17 x 17-inch imaging area and is designed for most general radiographic applications. Versatile and flexible, it comes in multiple wall stands.

In the portable arena, Canon highlighted its CXDI-50G Portable DR System. The CXDI-50G is designed for applications extending from trauma to bedside exams. It has a 14 x 17-inch imaging area and weighs 10.6 lbs. With a large imaging area and lightweight design, the CXDI-50G extends the range of exams possible with DR. It is large enough for chest and abdominal x-rays. But the compact design also makes it as easy to position as a conventional film cassette or CR imaging plate when performing lateral or axial imaging of limbs and other areas, the company said.

The CXDI-31 can be freely positioned, just like conventional screen-film cassettes. It is designed to capture images at angles that are difficult to get with fixed devices and supports lateral and axial imaging of limbs, shoulders, the skull, neck, and extremities. The CXDI-31's high-resolution makes it perfect for neonatal and pediatric applications.

The company has installed about 1,700 DR units to date.



CMT Medical Technologies presented two new families of DR products at RSNA, the SmartRAD and SmarSPOT PrimaX.

The SmartRAD family includes the SmartRAD Elite single- detector, upright system for chest applications, the SmartRAD OmniX single-detector multipurpose universal arm system for all radiographic exams and the SmartRAD GeminiX dual-detector system for a full range of radiographic exams, fast and easy operation and high patient throughput. The full family is available for sale worldwide.

The SmarSPOT PrimaX high-resolution digital photospot and angiography imaging system is designed for the retrofit market. The system is compatible with any existing vendor room, increasing the department efficiency by at least 30 percent for highest throughput while reducing significantly exposure to radiation both for patients and operators, CMT said. Availability is expected in the first quarter.



Del Medical showcased three DR units at RSNA, the EPEX and DRV digital radiography systems and the Apollo remote fluoro unit.

The EPEX Digital Radiography system is geared for in-patient, orthopedic, and ER applications in hospitals and imaging centers. It utilizes a single-detector with articulation offering a wide variety of general purpose radiography procedures and projections. Unlike other two-detector digital systems, the single detector EPEX has the ability to do cross-table, upright and off-angle projections, Del said.

The DRV system is an integrated, general-purpose x-ray system built upon Del Medical's RadView legacy system. All DRV systems are either digital DR flat-panel ready or field upgradeable. System configurations include an elevating table, a choice of high-frequency generators, floor-mounted or ceiling-mounted tube stands, wall receptors and other accessories like linkage-free electronic tomography, Del said. The system also offers one-hand operation, modular components, service laptop diagnostics and x-ray field laser light positioning.

The Apollo is the next-generation remote-controlled system from Del Medical's Villa Sistemi Medicali Division. Four sides open access and a low tabletop ease patient loading operations, as well as procedures requiring support personnel to operate in the table area, Del said. User-defined preset table positions allow the most frequent operations to be quick and efficient. Dose reduction is accomplished by low absorption table-top materials, reduced skin-to-film-distance, fully automatic collimation, retractable grid, and automatic parameters set in both fluoro and radiographic exposure modes. Apollo matches with Del's DIVA digital acquisition systems to obtain a filmless RF or DSA room and full DICOM connectivity for seamless integration into PACS networks.



Eastman Kodak Company at RSNA showcased two works-in-progress for x-ray - a new DR system and new x-ray film that promises to cut radiation dosage in half, and demonstrated the KODAK DIRECTVIEW Capture Link System that enhances department productivity.

The works-in-progress KODAK DIRECTVIEW DR 7500 System will provide single- and dual-detector options that enable medical facilities of any size to configure a DR solution that meets their individual space, application, workflow and budget requirements, Kodak said.

The DR 7500 system will feature a wall stand with a retractable bucky capable of three-axis movement to capture upright, horizontal and cross-table projections. The detector can be controlled manually or synchronized to the overhead x-ray tube so that a push button control will automatically center the beam to ensure accurate source-to-detector alignment, Kodak said. The system also will feature a fixed, elevating table with four-way float for flexible patient positioning. The detector bucky can be extended from the table to accommodate extremity exams. An auto-positioning feature will enable the equipment to automatically move into position when a technologist selects a preprogrammed exam.

The DR 7500 also will feature an integrated operator console that will control all imaging functions to expedite workflow and support improved patient care. It will share a touch-screen operator interface with other KODAK DIRECTVIEW CR and DR systems.

Kodak's line of DR systems currently includes the KODAK DIRECTVIEW DR 7100 system for table, upright and extremity radiography exams, the KODAK DIRECTVIEW DR 5100 for chest and other upright examinations for both ambulatory and non-ambulatory patients and the KODAK DIRECTVIEW DR 9000 U-arm system with a full range of motion for chest, extremity, abdominal and trauma exams.    

Kodak also demonstrated at RSNA its KODAK DIRECTVIEW Capture Link System, which enhances productivity by giving technologists the ability to identify and process cassettes, and to review images, at any linked CR system or KODAK DIRECTVIEW Remote Operations Panel, Kodak said. It also streamlines workflow, namely in trauma cases, when a study contains DR and CR images because it enables CR images to be identified and viewed, along with DR images, at the KODAK DIRECTVIEW DR system console.

The works-in-progress KODAK Hyper Speed G Medical Film general purpose medical imaging film can equip healthcare providers to reduce patients' radiation exposure by up to 50 percent, according to the company. Kodak calls it the first high-resolution radiographic film in 20 years to offer a significant radiation dose reduction. Its increased speed also will reduce the need for retakes when images are blurred due to patient motion. It is designed to be used with existing screens and cassettes in most cases.

Kodak has not yet released availability dates for either product.



Ferrania LifeImaging launched a pair of new CR systems at RSNA, the LifeInVision CR and CR Plus. The tabletop CR units can be used as a dispersed or decentralized CR solution with installation in the exam room or in a more typical centralized formation with units serving several rooms. The LifeinVision CR provides up to 75 plates per hour. An optional mobile car makes the system fully portable anywhere in the facility. Linked to a centralized PACS, images can be reviewed, stored or archived easily, while patient demographics can be easily imported directly from the radiology information system.



Fujifilm Medical Systems introduced the works-in-progress FCR Pocket ID, which combines Flex UI software with remote capabilities of PDAs to increase patient safety as well as demonstrating a works-in-progress Temporal Subtraction image processing tool and announcing the addition of two hospitals in an investigation to reduce radiation exposure in pediatric imaging with Fuji CR.

Fuji debuted its customizable Flex UI digital x-ray software application, a works in progress, with the convenience of PDAs to create the FCR Pocket ID. With the Pocket ID, patient data can be accessed quickly and verified at the patient bedside, permitting caregivers to increase efficiency while reducing the potential for medical errors, Fuji said. Technologists will have the ability to access patient worklists and identify exposed imaging plates in cassettes from remote locations, such as patient rooms. Thus, it eliminates the need for paper notes to boost patient safety and technologist efficiency.

Patient safety is further increased when bar coded wristbands are available, Fuji pointed out. Technologists can use the built-in barcode reader of the PDA to scan the wristband, which in turn will highlight the name on their worklist, ensuring they are performing the right exam for the right patient. Further, they can ID cassettes at the bedside, confirming accurate identification at the time of the exam.

By automatically "subtracting" the differences between current and past comparative Fuji Computed Radiography (FCR) chest images, the works-in-progress Temporal Subtraction (TS) image processing directly increases diagnostic certainty for the interpreting physician, the company said. In studies, physicians noted the ability of temporal subtraction to provide numerous diagnostic advantages, such as the ability to produce images in which: nodules hidden by bones or the heart were less likely to be missed; infiltrative shadows could be distinguished from breast tissue and pectoral muscles in the lower lung field; low-contrast, small or abnormal shadows could be better detected; and tumors could be distinguished from superimposed pulmonary apex bones.

TS uses a warping algorithm to eliminate the effect of differences in patient positioning while encompassing sophisticated image processing tools to intelligently compare changes in anatomy. For easier distinction of the present and past images, the date is automatically indicated at the top of each image displayed. Many clinicians have expressed interest in combining TS with existing tools, such as Energy Subtraction (ES), to maximize the computer-based detection capabilities of the processing. Fuji's ES processing, which provides three displays of a PA chest exam with a single exposure to the patient, is one of an extensive list of diagnostic support tools in Fuji's Image Intelligence portfolio, which now also includes

Temporal Subtraction. Pattern Enhancement for Mammography (PEM) is another works in progress which detects and improves the conspicuity of minute structures within the breast tissue, such as microcalcification clusters, is another of Fuji's advanced processing tools designed to improve diagnostic certainty for the radiologist.

Fuji also announced that the University of North Carolina Hospitals, Chapel Hill, and Providence St. Vincent Medical Center, Portland, Ore., have agreed to investigate the potential for digital x-ray to reduce radiation dose in pediatric imaging while achieving image quality that is equal to, if not better than, the image quality achieved with traditional film screen technology. These facilities, along with Children's Hospital Boston that announced its research initiative last fall, will conduct independent investigations into the use of Fuji computed radiography (FCR) with patented, dual-side reading.



GE Healthcare launched its Interventional Suite, featuring the OEC 9800 MD digital motorized mobile imaging system and providing the quality and convenience of a fixed room at a fraction of the price, the company said. GE also introduced a new remote edition of GE's R&F product family, the Precision RXi Series.

The Interventional Suite includes the OEC 9800 MD motorized C-arm, ceiling supported monitors, four-way floating imaging tables and contrast injectors. GE said the system brings capabilities to the OR that are generally found in a fixed angio or cath lab which allow better image quality, faster procedure times and optimal use of staff and resources. Applications include: endoluminal abdominal aortic aneurysm, carotid artery stenting, renal angioplasty and stenting, SFA and lower leg revascularization, cerebral coils and glues, cerebral infusion therapy, coronary diagnostics, coronary angioplasty and stenting.

The motor-driven, joystick controlled C-arm movements provide fixed room convenience and complete physician control of all C-arm functions. The 1k x 1k, 16-bit imaging resolution throughout the imaging chain produces four times the resolution of previous mobile systems, GE said. The new x-ray cooling capacity accommodates interventional cases without overheating, as the unit provides a cooling capacity 80 percent higher than standard C-arms.

The new remote edition of the Precision RXi Series is a radiographic and fluoroscopic system for gastrointestinal and vascular exams, namely in hospitals and imaging centers where space is limited because of the unit's compact size. Variable speed scanning movement, controlled from identical tableside and control room console panels, assures that gantry movements are swift and precise. The Precision RXi user interface and imaging components are compatible with other Precision products, requiring minimal training for customers who are familiar with the Precision 500D classical, or Precision MPi Interventional systems. A DSA option enables the clinician to manage subtracted images and acquisition sequences in the area of vascular and interventional protocols.



Hologic launched Radiologic Vertebral Assessment (RVA) on its Discovery Series Densitometers. RVA provides a companion procedure to the conventional bone mineral density (BMD) measurement for assessment of a patient's osteoporotic fracture risk. RVA aids physicians in earlier detection of fragility fractures in the spine via a high-resolution image of the spine taken in seconds as a part of the bone densitometry exam.

Reimbursement for RVA is covered under a recently created CPT code (76077) for vertebral fracture assessment that is performed using dual-energy x-ray densitometers such as Discovery.

RVA is enabled by Hologic's OnePass Fanbeam Technology and radiographic standards such as variable collimation plus single-energy imaging. OnePass fanbeam technology utilizes nearly eight times the number of detectors as competitive rectilinear DXA systems, reducing the imaging time by more than 800 percent, Hologic said.

RVA is available as an upgrade for previous generations of Hologic's QDR series densitometers and will be available in early in 2005.



Imaging Dynamics (IDC) at RSNA announced the 100th sale of an Xplorer CCD DR system, up from about two dozen at showtime a year ago. In the past 12 months, IDC has expanded throughout North America and internationally as well. IDC now does business in 15 countries on 5 continents, with installations in Germany, Australia, Italy, France, Korea and China.
   
IDC also announced its strategy to go indirect for sales (with a strategy of "DR at CR economies") and manufacturing with a variety of strong partners. The company also touted the Xplorer series detective quantum efficiency is now 70 percent, far higher than when the line with introduced to the market.

IDC has reported nine consecutive quarters of increased sales and record levels of product installations. The IDC Xplorer 1800, launched a year ago at RSNA and the newly launched Xplorer 1600 currently account for the majority of sales, while many private-labeled DR models have been recently introduced that incorporate the IDC Xplorer detector and IDC Magellan II workstation software.
   
IDC also announced it signed a contract with SourceOne Healthcare Technologies expanding SourceOne's rights to distribute IDC's CCD-based Xplorer Digital Radiography (DR) across the U.S.



InfiMed debuted a new DR system as well as showcased at RSNA its newest digital cardiac systems: the PlatinumOne Cardiac, PlatinumOne ComboLab and PlatinumOne EP systems.
   
The latest addition to the DR product line is the StingRay Excel. The Excel builds upon the image processing core and flat-panel detector technology of the StingRay DR system, but adds a new set of image processing features that are designed to optimize image quality and productivity, the company said. The systems were designed for use as an upgrade to an existing room, or as an integrated full-room OEM solution. The software platform can accommodate a wide range of detectors, including both static and dynamic flat panels.
   
Some system features include: ImageEnhance image processing, which optimizes the StingRay Excel images immediately upon acquisition, requiring no post-processing from the technologist; ImageStitch orthopedic stitching program allows the combination of two images into one 17 x 34 image to allow accurate measurement to be taken; integrated generator interfaces with pre-programmed technique settings to further streamline exam time; full DICOM feature set including Store, Print, Query/Retrieve, Worklist, Perform Procedure Step, and Storage Commitment Class; new Edge Enhancement feature allows for separate optimized enhancement of bone or soft-tissue detail independent of one another; and, Exam Specific Processing allows for each exam to be customized to the specifications of the site, which streamlines exam set-up.
   
The PlatinumOne series are in-room digital acquisition systems for complex interventional procedures. Developed to accommodate any type of cardiac cine or fluoroscopic imaging, the systems offer fast acquisition times and advanced image processing features, expanded DICOM 3.0 interface and enhanced quality with InfiMed's Innovision digital CCD camera. The systems were designed for use as an integrated full-room OEM solution, or as an upgrade to an existing lab, InfiMed said. The software platform can accommodate a wide range of detectors from dynamic flat panel to 2K CCD.
   
The PlatinumOne EP system is designed to provide advanced imaging features and low-dose, pulsed fluoroscopic acquisition required for complex electrophysiology procedures as well as a robust, easy-to-use set of image processing features.
   
The PlatinumOne ComboLab system builds on the cardiac and EP systems by adding real-time digital subtraction for interventional vascular procedures as well as full cardiac functionality. A complete, real-time digital angiography package rounds out the system.  



Konica Minolta Medical Imaging at RSNA introduced what the company calls the world's first "self-learning" CR system, the IQue CR, as well as a QA program for the Xpress CR system.

Targeting imaging centers and clinics, the new IQue CR combines ease-of-use with the high performance of a dual-bay reader to dramatically boost productivity, Konica Minolta said. It automatically recognizes each exam view and applies the processing algorithms appropriate for the image, which reduces the learning curve in converting from conventional to digital x-ray technology. IQue has a self-learning capability that routinely adjusts images to a user's preference, enabling any technologist, with or without prior CR experience, to consistently produce optimized diagnostic images. Users simply select the area to be imaged via a touchscreen figure of a human body, and the system automatically goes to work.  The simple user interface and 'self-learning' feature require minimal training. The system also features auto-masking, modality work list, password protection, advanced imaging processing of more advanced CR systems.

The IQue shares a CR reader with the Xpress CR system, and features dual-bay design, 24-second preview time, and the world's only cassette-release key for optimal uptime and high reliability, the company said. The imaging plates, which come with a two-year warranty, are rigid, lightweight and reliable.

The CR QA program allows users to monitor the performance of their CR systems as outlined by recommendations of the American Association of Physicists in Medicine (AAPM). It includes a manual, which provides more than 12 test procedures, an all-inclusive phantom with several test patterns, and an MS Excel- based data tracking worksheet. The worksheet automatically calculates the results to determine whether a test has passed, the company said.   

Konica Minolta recommends that QA tests be performed upon installation of the system and during the entire time that the product is in active use.



Lodox System North America at RSNA featured an upgrade for its Statscan low-dose digital x-ray system and a new image enhancement tool.

Rad-MP is designed to extend the functionality and flexibility of Statscan in trauma and emergency x-ray settings. It includes an adjustable, 20 x 28-inch (50 x 71 cm) radiolucent imaging table that can be used either horizontally or vertically and a hydraulic patient imaging chair and pedestal stand for imaging patients in an upright sitting or standing position. This facilitates imaging of upper-body extremities, erect chests/abdomens and weight-bearing spine and joint procedures. The upgrade is commercially available.

Lodox also showcased its new Lucid image enhancement tool for Statscan (which comes standard on the system) that presents x-ray images in the best possible view, simultaneously showing bone and soft tissue. Featuring automatic, hands-free image processing, Lucid is intended to boost visualization of the lateral cervical-thoracic spine junction by nearly 100 percent vs. conventional 2D radiography, the company said.

The Rad-MP system upgrade for the Statscan Critical Imaging system creates a dual-purpose system for radiographic exams of trauma patients and ambulatory emergency room patients as well.



Orex Computed Radiography used RSNA to launch its "filmless cart" - a cordless, wireless, mobile CR scanner, as well as some new software and a mammography CR works in progress. The Orex ZR is a mobile CR scanner on wheels that can move throughout a medical facility without external power or network connections. It features a 4.5-hour battery life in full load and Wi-Fi networking.

Orex also launched the new Orex Or-PACS software which is built on a scaleable, user-friendly DICOM 3.0 platform and comes bundled with Orex CR units. With applications in general radiography, orthopedics and radiation therapy, the software integrates acquisition and PACS functions such as image analysis archiving and seamless remote image communications. The Orex Or-PACS solution also streamlines expansion with support for multi-modality viewing stations, dual high-resolution monitors, guaranteed telerad send/receive, single-media archiving and scalable short- and long-term storage.

Orex also showcased its lightweight ACL CR scanner line, which includes a works-in-progress mammography configuration, the ACL Mam. The system will be available outside of the U.S. in the first quarter of 2005. The company said it expects to meet FDA regulatory requirements soon. The ACL CR can be configured to process imaging plates at 20 (ACL2), 41 (ACL4), 60 (ACLxy60) and 75 (ACLxy75) plates per hour on one device.



Philips Medical Systems
rolled out the new DigitalDiagnost VM, which began shipments in June, for economy minded facilities. The single-detector system offers CR/DR integration using a multipurpose single-detector configuration. A single acquisition workplace can handle scheduling, verification, and general post-processing. The system can accommodate different cassette sizes and operate via a wireless network.

Philips also showcased a works-in-progress FD20 flat-panel detector on the MultiDiagnost Eleva and the Allura Xper (X-ray Personalized) FD20, a high-end flat-detector system for general vascular, neurovascular, and cardiovascular applications, with a compact 12 x 16-inch detector with 90 degree pivot. It features tools such as 3D-RA (rotational angiography) and StentBoost for visualizing stents. The MultiDiagnost Eleva  is designed for vascular and interventional procedures and RF exams. It has a 180-degree isocentric C-arm rotation, BodyGuard anti-collision system, DoseWise and ViewForum, a new multimodality workstation that provides integrated viewing and processing and allows the user to create a unique personal profile to allow information to immediately be viewed as required.

Lastly, Philips showed its MammoDiagnost FD Eleva digital mammography system that is pending FDA clearance. Sales are expected to begin in the U.S. late next year.



Quantum Medical Imaging at RSNA debuted a new line of digital imaging systems, the Q-Rad-Digital series, with three configurations.

The Q-Rad-D two-detector system has a direct digital x-ray panel in both the elevating table and wall stand. The Q-Rad-IQ dual-detector system has a direct digital imaging receptor in the elevating table and a second digital imaging receptor within a tilting and rotating wall stand that occupies a horizontal track system behind the table. It is geared for emergency rooms and high-end radiology facilities that need the ability to do specialized exams, cross-table lateral and decubitis exams, the company said.

The Q-Rad-SQ offers a single digital detector located within a tilting and rotating wall stand. It uses a mobile elevating float-top table with a 700-pound capacity. Quantum bills the system as cost-effective for a rural hospital, imaging center, orthopedic facility, or clinic emergency treatment facility.

Quantum also debuted the TechVision Touch Screen for the Q-Rad line. TechVision is a multi-color touch screen control, which allows the technologist to control x-ray generator parameters at table side. In addition, when used with the new Q-Rad DIGITAL radiographic system series, or the Revolutionary QV-800 Universal Digital System, the Operator will be able to actually preview patient images on-screen at table side, ensuring better and more accurate patient positioning.
 


Siemens Medical Solutions introduced a new digital, mobile flat-panel detector for the AXIOM Sireskop SD, angiography and x-ray product enhancements and a new intra-operative x-ray system.

Siemens showed off the new digital enhancement and mobile flat-panel detector (FD) for the AXIOM Sireskop SD, as well as DiamondView software upgrades for the AXIOM Aristos product line. With the addition of these upgrades, all Siemens AX systems are now available in a digital format.

The AXIOM Sireskop SD is a universal system designed to streamline operations and patient flow in fluoroscopy and radiography. It provides a single imaging solution for procedures from pediatrics to bariatrics, Siemens said. The table measures 80 cm in width and has a capacity of 500 pounds, or 400 pounds in full tilt.

The enhancement enables facilities to improve workflow by decreasing steps in image processing with no film or cassettes, and having all images available in one patient folder, rather than needing to merge images on the PACS workstation. The system also provides an integrated workstation solution that allows technologists to focus more on the patient during post-processing. A tableside-controlled system features comprehensive dose reduction and high-capacity, x-ray tubes to allow flexibility for various patient types without sacrificing image quality. In addition, the AXIOM Sireskop SD has both a wide table and high weight limit, which are important features for imaging hea