Cardiac Imaging

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Cardiac imaging made a splash around the floor at RSNA - namely in advances in CT, echocardiography, SPECT and MRI. There was even a preview of computer assisted detection (CAD) technology for echo. With more, higher volume images, too, comes the need to manage them via PACS, and thus the number of cardiovascular information systems is increasing in number and breadth to meet the unique needs of cardiology practice.

With coronary heart disease still the leading killer of Americans (every 34 seconds an American dies from heart disease; 2,500 Americans die each day of heart disease.), cardiac imaging is a priority for patient care as well as healthcare management with almost 6 million hospitalizations each year due to cardiovascular disease. And there are 7.1 million Americans over the age of 20 who has survived a myocardial infarction for whom imaging is essential to monitor their well-being.

Here are a selection of new and enhanced products focused on imaging the heart and getting images and reports to caregivers fast.

Barco highlighted a new visualization software tool called CardiaMetrix designed for the rapid evaluation of multi-phase cardiac CT studies. It is available within the company's flagship 3D software product, Voxar 3D.

Biosound Esaote Inc., a division of Esaote SpA, displayed the MyLab 50 ultrasound system for cardiovascular exams.

Cedara Software, a Merge Healthcare company, showcased a coronary screening analysis tool. Cedara's CalScore Review software, which is designed for coronary screening, provides clinicians with quantification tools for arterial calcium buildup through CT imaging. Findings are organized in a customizable report, and Individual Score reports are based on the industry-standard Agatston as well as Volume or Mass score.

Cerner Corp. highlighted new features in cardiology PACS. Cerner CVNet and Cardiology PACS offers an end-to-end cardiology solution that manages cardiology images and digital media (echo, ECG, nuclear medicine) from a single repository and unifies cardiovascular diagnostic activities, therapeutic interventions and follow up regimens into a single electronic medical record history for improved outcomes. CVNet is fully integrated with the EHR on a common architecture.

DR Systems showcased enhanced cardiology PACS capabilities into its Dominator PACS. The Windows XP-based Release 8 uses "Smart Client" technology that combines web-based and client-server functionality. The next release offers an enhanced cardiology component; full integration of mammography PACS capabilities, including a smooth interface to computer-assisted detection (CAD) systems; enhanced patient management tools for the RIS; an updated user interface that enhances the look and feel of the Windows XP operating system; integration of TraumaCad to provide orthopedic surgeons with digital images, tools and templates for preoperative planning; integration of Vital Images' Vitrea 2, allowing facilities to acquire and manage advanced visualization images with diagnostic reports across the entire healthcare system and enhancement of Web Dominator, the internet application that allows online reading of medical imaging exams on remotely located home or office computers.

Evolved at RSNA highlighted View² PACS that unites radiology and cardiology on one web-based platform. Authorized users can access the system from any PC at any site, with no extra cost and no need for special equipment. View² offers high-resolution 3D viewing, plus two types of static and dynamic 2D viewing. For greater flexibility, information can be accessed either by workflow or by patient record.

GE Healthcare showcased its LightSpeed VCT 64 channel CT scanner, as well as using the show to spring board a new line of CT scanners that are compact in design and appropriate for a wide range of basic radiology applications.

In a single rotation, GE's LightSpeed VCT creates 64 sub-millimeter images, totaling 40 millimeters of anatomical coverage, which are combined to form a three dimensional view of a patient's anatomy. The LightSpeed VCT is able to capture the image of any organ in one second, perform a whole body trauma scan in fewer than 10 seconds, and capture images of the heart and coronary arteries in as few as five heartbeats, GE said.

Since its introduction at last year's RSNA, the scanner has been installed at more than 500 clinical sites, according to the company.

GE also showcased tagged adaptive technologies for its VCT scanner. In the future, the company says the scanner will be able to adapt to a patient's heart rate and anatomy, further personalizing their CT scan. Adaptive technologies also make dose reduction possible, GE said.

At RSNA, the company also launched its new Discovery VCT - the world's first true 64-slice combination PET/CT system for cardiac imaging applications. The Discovery VCT combines the high-speed, high-resolution capabilities of GE's volumetric CT with the metabolic and physiologic capabilities of its PET system. By combining these scanning technologies, the Discovery VCT provides the tools to enable physicians to more accurately diagnose and identify heart disease and other conditions, including cancer and neurological disorders. GE originally designed the LightSpeed VCT, the world's first volume CT system introduced in 2004, to easily integrate with its PET technology. The company recently announced the 500th installation of the LightSpeed VCT, making it the fastest selling product in the company's history. The LightSpeed VCT noninvasively captures images of the heart and coronary arteries in fewer than five heartbeats. In a single rotation, the system creates 64 credit-card-thin images, totaling 40 millimeters of anatomical coverage. These images are combined to form a three-dimensional view of the patient's anatomy for the physician to analyze.

Further, GE announced that London Health Sciences Centre of London, Ontario Canada, will host the world's first SPECT/CT Master Series Educational Program titled, Introduction to Hybrid Imaging: Focus on SPECT/CT. To commence in March 2006, the program will address numerous technical and clinical aspects, and provide hands-on training of this novel hybrid imaging technique. Applications in cardiology are included.

GE's next-generation SPECT/CT hybrid system, the Infinia Hawkeye 4, combines GE's industry-leading Infinia gamma camera with an optimized 4-slice CT, offering speed and quality enhancements. The Infinia Hawkeye 4 SPECT/CT system provides 5 millimeter slices for approximately half the scan time. Infinia Hawkeye systems are integrated with the Xeleris workstations to enhance productivity using Ignite technology, a unique feature that enables the operator to complete a scan-and-review cycle in a single click. The Xeleris workstation delivers state-of-the-art processing speed, innovative productivity tools, and built-in connectivity to various imaging systems, as well as PACS.

Lastly, the company demonstrated the features of its Signa HD MR line. The Signa HDe 1.5T is an entry-level system which takes up 30 percent less space than traditional systems which makes it considerably more "site-able," GE said. Other benefits of the smaller design are a shorter (one week) install time, the inclusions of just one electronic cabinet, an acoustically quieter design, and an overall 25 percent lower cost of operations, without sacrificing items on the application menu, according to the company.
The HDx 1.5T model is a faster, higher-resolution premium MR unit and includes a full range of components including ultra-fast image reconstruction through the new XVRE recon engine, advancements in parallel imaging algorithms, and a new interlocking, high-density head-neck-spine coil system called the Signa HD Array. Highlighted features of the HD line systems include MR-Echo-HD which enables clinicians to acquire cardiac images regardless of movement due to breathing without cardiac-gating or patient breath-holding.

Hitachi Medical Systems America Inc. showcased the "power of three" available in its suite of differentiating capabilities that drive the Sceptre P3 PET/CT hybrid system. DAC technology, non-rigid fusion, and AVIA-PACS architecture combine for high throughput applications in oncology, cardiology, and neurology. The system features a comfortable table, open design, and Skyview gantry. The Sceptre dedicated PET system supplies true 3D acquisitions with patient-specific corrections through pico high-speed electronics. Sceptre capitalizes on the increasing benefits of cardiac PET over nuclear SPECT with its improved sensitivity in CAD, spatial resolution, and faster exam times. The Sceptre does this with one-touch protocols, dual-gantry controls, and laser positioning. The Sceptre Evolve program offers Sceptre users the opportunity to upgrade to a Sceptre P3 in the field.

Kodak's Health Group featured a new works-in-progress for KODAK CARESTREAM PACS that includes cardiac CT functions such as calcium scoring, automated heart axis detection and rib cage removal and coronary analysis tools and reporting. New, too, was the ability to integrate 3D key images, 3D analysis reports (such as 3D vessel analysis and calcium scoring) and the radiology report into a single electronic report for distribution to clinicians and referring physicians.

McKesson Corp. used RSNA as the launching pad for Horizon Cardiology, which grew out of the company's acquisition this year of Medcon, is an integrated cardiovascular image and information management system (CVIS) designed to move healthcare organization closer to a complete enterprise imaging solution. Horizon Cardiology provides diagnostic image management, archiving, procedure reporting and workflow management and integrates reports, waveforms and measurements into the patient's complete record. McKesson' Horizon Cardiology stands as a complete CVIS for cath, hemodynamic monitoring, echo, vascular ultrasound and nuclear cardiology. The web-based platform gives referring physicians access to reports and all patient and image data. Cardiologists can complete and finalize reports from remote locations. The solution enhances productivity, increases throughput and facilitates improved patient care, McKesson says.

Medison showcased a new cardio-vascular edition of the SonoAce Special Edition (SE). The mid-class ultrasound system has been outfitted with new processing technology, as well as CW (Continuous Wave) Doppler imaging and pulse inversion harmonic imaging so that the system can support phased array transducers.

NovaRad Corp. showcased at RSNA its NovaPACS Cardio Viewer that is available as a standalone module or can be added to an existing NovaRad Enterprise workstation. It offers single sign-on access to images on the PACS or over a website, allowing cardiologists to securely access patient images from any computer. Cardiovascular tools offered in the module include:
  • Image calibration based on catheter size - Adjusts accuracy of image for optimal measurement
  • Cine tools
  • Digital subtraction - Shows contrast-filled vessels without interfering background
  • Ejection fraction - Calculates the amount of blood in the left ventricle after it discharges, and
  • Image-sharpening algorithm - Enhances edges 
Images are stored to an on-line RAID 5 Archive. Review and reporting capabilities within the Cardio Viewer facilitate information sharing. Additional functionality and features include capacity to display multiple cardiac images simultaneously; patient history timeline and worklist by exam type, dictation status, anatomic location, referring physician and patient location.

Philips Medical Systems highlighted its Brillance line of CT scanners, as well as introduced new innovations for enhanced CT clinical performance.

Philips' Brilliance CT 64-channel configuration provides expanded anatomical coverage for faster exams performed with shorter breath holds and less motion. The Brilliance CT 64 has 64 x 0.625 millimeter detector banks, giving total z-axis coverage of 40 millimeters, and has a maximum gantry rotation speed of 0.4 seconds. Philips RapidView reconstruction utilizes 3D cone-beam technique for image quality at 20ips. Expanded clinical applications include functional and physiologic imaging, including stroke assessment with 80 millimeter coverage achieved through Jog Scan.

Looking into its crystal ball, Philips unveiled a new technological innovation that portrays a vision about the future of CT.  The first, already in clinical trial at Hadassah Medical Organization in Jerusalem, Israel, is a simultaneous multi-energy detector. The detector is comprised of layers designed to simultaneously detect both low-energy and high-energy x-rays. Simultaneous imaging of both soft and hard radiation improves tissue characterization, Philips said. Combining signals from both detector layers provides a conventional CT image consisting of the full energy of the beam. Simultaneous multi-energy detectors do not require a second beam of radiation and thus avoid the potential pitfalls of time lag, registration artifacts and unnecessary radiation dose.

Another technology Philips showcased in the CT arena was new full coverage detector platform based on Nano-Tile technology that will image an entire organ such as the heart or head in a single rotation. The whole organ detector is based on tiles that can be integrated into panels of any size.

Showing a number of works in progress, Philips previewed an analysis tool designed for cardiologists, cardiac radiologists and CT technologists to perform detailed evaluation of the coronary arteries and advanced ventricular functional analysis. The comprehensive cardiac analysis (CCA) package aims to reduce the time and complexity of a cardiac evaluation, Philips said. Based on automated total heart segmentation technology, Philips CCA provides visualization of the entire coronary tree, morphological analysis of the vessel lumen and cross-sectional views of the artery in question allowing for free lumen diameter/area analysis.

Much of Philips MR-related focus at RSNA was process acceleration and major workflow improvements through a number of new and upgraded technologies. The company showcased SmartExam, a tool for MR which enables simple planning, scanning and processing - which can be easily reproduced with its IQ capabilities that remembers user settings. SmartExam is able to automatically determine the position of a patient's anatomy in the scanner for planning purposes.The company also had on display its k-t BLAST for cardiac MRI which the company said is five times faster than traditional cardiac MRI scans. The product captures cine cardiac MRI in the time of a breath hold, and signal to noise drop off is not an issue.
The company also highlighted its 4D-TRAK MR Angiography that is able to perform 60 times faster than traditional MRA. This product also allows users to visualize the feeding and draining of arteries and veins in arteriovenous malformations to define the blood flow in congenital heart disease.
Another new capability is 2K Imaging, which provides 2048 x 2048 matrix resolution and offers expanded detail over a large field of view.
In ultrasound, Philips emphasized its iU22 Intelligent Ultrasound System which includes what Philips calls "Vision 2005" enhancements. These include new cardiology capabilities such as Live 3D Echo and 3D/4D abdominal image quality, on- and off-cart upgrades to QLAB Quantification Software, and a new L9-3 transducer.

The iU22 has the latest in the company's transducer technology with X3-1 xMATRIX array transducer for real-time, volumetric imaging for general and cardiac applications.

Philips' HD11 XE is a multi-specialty ultrasound system and includes many high-end features at a more affordable cost level. Like the company's premium system, the HD11 XE includes SonoCT and QLAB quantification software, but also STIC (spatial-temporal image correlation) which can be used to define fetal cardiac structures.

Philips also highlighted its Precedence SPECT-CT system which unites high-end, multislice CT with a flexible gamma camera for imaging that can aid diagnosis and treatment in cardiology and oncology. This merged system provides registered SPECT, planar and CT images in addition to individual SPECT, CT, or attenuation-corrected nuclear medicine images. Precedence is designed to perform currently reimbursable nuclear medicine and CT procedures and as a platform for future molecular imaging advances. The system can perform coronary CT angiography, calcium scoring and attenuation corrected myocardial perfusion in one imaging session.

Siemens Medical Solutions at RSNA introduced the Somatom Definition, a dual-source CT system that provides twice the temporal resolution, acquisition speed and scanning power, while minimizing radiation exposure. According to Siemens, the scanner can image full cardiac detail with as much as 50 percent less radiation exposure compared to traditional CT scans.

Siemens' Definition, which uses two x-ray sources and two detectors at the same time, features a 31-inch (78-cm) bore opening and a 79-inch (200-cm) scan range. The system is equipped with z-Sharp technology, the Straton x-ray tube and CARE solutions, which benefit in earlier detection, faster evaluation, and more precise follow-up of disease states.

In the area of cardiac diagnosis, the dual-source CT scanner can image patients with high or irregular heart rates, or even arrhythmia, without beta blocker medications, Siemens said. The system also enables physicians to better identify and characterize plaque, an early indicator of heart disease. In acute care, Siemens said the new scanner will enable the assessment of patients with acute chest pain, abdominal pain, and suspicion of stroke. In clinical research, the scanner's ability to image with two different x-ray energies simultaneously will allow physicians to better differentiate, characterize, isolate and distinguish bone, soft tissue and fluid. 

In October, the first Somatom Definition was installed at the University of Erlangen in Germany. Siemens said the system is being used for technical and clinical research as well as regular patient care. The first U.S. installations will take place in early 2006 and will include Mayo Clinic, Rochester, Minn.; Cleveland Clinic Foundation, Ohio; William Beaumont Hospital, Royal Oak, Mich.; and New York University Medical Center. 

The company also revealed a new CT clinical engine for cardiology that is available on Siemens' Somatom Definition, Sensation and Emotion CT scanners. The CT cardiac engine, with imaging applications that range from coronary arteries to peripheral vessels, provides clinicians with motion-free imaging.

Siemens highlighted MRI applications that make use of the company's Tim (Total imaging matrix) technology and syngo applications.

Siemens MRI systems featured at RSNA included the Magnetron Trio, a 3T whole-body MRI with Tim, which targets clinical applications such as abdominal, cardiac, spine, whole-body and orthopedics. Tim technology is a whole body surface coil design that combines up to 102 seamlessly integrated coil elements with up to 32 RF Channels, and enables flexible coil combinations to encompass local high resolution imaging to large anatomical coverage up to 205 cm (6'9").
Siemens also showcased the capabilities of syngo Expert-i which gives physicians the ability to interact remotely during the MRI examination from virtually anywhere, making it possible to address difficult clinical questions via a networked personal computer while a patient is being scanned. The entire patient set-up, imaging data and all sequences can be viewed in real-time, requiring less training while improving efficiency, quality and throughput, the company said.

Another Siemens MRI application highlight included syngo GRAPPA, a parallel imaging technique that can provide high temporal resolution in cardiac imaging, even in double oblique orientations.

The company also previewed a cardiac CAD product for use with echocardiography examinations. Siemens showed its Axius Auto EF, a cardiac CAD product for use in echocardiography examinations. Axius Auto EF applies a learning-based approach for detecting and tracking the borders of the left ventricle to provide automated and robust measurements of the cardiac ejection fraction. Siemens says the product is available on the Acuson Sequoia ultrasound platform.

In ultrasound, Siemens debuted its new Encompass II release which is part of the ACUSON Sequoia ultrasound platform. The release features high-resolution color flow (HRCF), a technology that applies Chirp-coded excitation to color Doppler to dramatically address spatial resolution and sensitivity. HRCF technology addresses spatial resolution, color bleeding, slow flow sensitivity, color penetration, vascular hemodynamics and deep flow identification. Also featured is the ability to extract and display myocardial mechanics from ultrasound information called Axius Velocity Vector Imaging (VVI) for the shared-service Sequoia ultrasound platform. The quantitative motion analysis tool is intended for use with any transducer for all cardiovascular imaging including adult, pediatrics, transesophageal (TEE), intracardiac echocardiography, fetal and vascular applications.

Lastly, Siemens introduced a three-tiered strategy to transform the detection and treatment of disease by taking healthcare to the molecular level, including clinical and preclinical molecular imaging solutions, and biomarker development. Following the company's acquisition of CTI Molecular Imaging, Inc. in April and the creation of the Siemens' Molecular Imaging Division, it says it is revolutionizing disease diagnosis at the molecular level to ultimately improve patient care.

Siemens' highlighted offerings included the biograph 64 PET-CT system that performs high-resolution CT angiography and myocardial perfusion, viability, and function in one accurately registered exam. Shipments are slated for Q1 of 2006. 

TeraRecon Inc. highlighted its partnership with Fukuda Denshi Co. Ltd. through which the companies introduced a cart-based cardiovascular ultrasound scanner - the Imagic Sigma 5000 series. The system offers high-definition imaging features, streamlined workflow, and ergonomics features designed to boost efficiency, operability, and usability for ultrasound examinations. The cardiac-focused scanner features include tissue Doppler imaging, anatomical M-mode, non-imaging CW capability, and tissue harmonic imaging. The workflow features include comprehensive patient data management and archiving capabilities. The ergonomic design includes a unique motorized height adjustment of the operator console and a high-resolution flat screen that swivels and tilts, the company says.

Terason showcased its recently launched Terason Echo Ultrasound System that is based upon the Teratech Architecture that combines the front-end Fusion processor with powerful PC-based back-end data processing. The Echo system also runs as a Windows application on a standard laptop computer, and can be converted from a portable to cart-based. Terason begin shipping the Echo system in January, and is creating a direct sales force to represent the new product line, the company says.

Toshiba America Medical Systems highlighted its Aquilion 64 CFX CT scanner that is dedicated to cardiac imaging. The scanner utilizes Toshiba's 64-row Quantum detector that acquires 64 simultaneous slices of 0.5 mm with each 400-millisecond gantry revolution. According to Toshiba, the system allows physicians to capture precise, motion-free images of the heart and coronary arteries to identify soft plaque or measure coronary blockage, and detect signs of disease at its earliest stages, reducing the need for high-risk interventional procedures.

The slices will continue to increase, according to Toshiba, who previewed for meeting goers a 256-slice CT scanner. The works in progress, which Toshiba said is the future of CT imaging, would be able to image the entire heart in one rotation.

Toshiba also announced at the show that new workflow, security and dose exposure enhancements have been added to its Sure line of automated scan applications for its full line of Aquilion CT systems. 

New Sure enhancements include: SureWorkflow Image Accelerate, a works in progress that doubles reconstruction speed and allows reconstruction of up to 28 images per second; Enhanced DICOM Data Transfer allows data transfer from the Aquilion 32/64 CT systems to Vital Images workstations; SureSupport Enhancements Physician Education, which is a visiting fellowship program at Shands Hospital, University of Florida; Enhanced NEMA (National Electrical Manufacturers Association) software designed to add an additional firewall between the CT scanner and the hospital or organizational network for added protection; SureExposure enhancements designed to reduce overall dose up to 40 percent and improve patient care; and SureCardio Enhancements that includes adaptable dose modulation software for cardiac CT available to the marketplace, ECG modulation is designed to reduce dose by up to 50 percent for improved patient care.

In MR, Toshiba introduced a new high-end system. The company's new work-in-progress Vantage ZGV MRI scalable high-end system features new product sequences, improved image quality, and the Mach 8 processor, a CPU capable of 1,230 images per second reconstruction. Additionally, the Vantage ZGV offers a gradient strength of 33 mT/m (milliTesla per meter) and a slew rate of 200 mT/m/sec (milliTesla per meter per second) and the magnet delivers high homogeneity over the full 50 cm diameter spherical volume (DSV).  Field upgrade kits to the new ZGV are available to current Vantage users.
The Vantage line of systems offers optional packages for cardiac imaging, advanced Echo Planar Imaging (EPI), Perfusion and Diffusion Imaging, Peripheral MRA, and SuperFASE (Fast Advanced Spin Echo) imaging.  In addition, Toshiba has pioneered research into contrast-free MRA with its Fresh Blood Imaging (FBI) protocol and Body Diffusion.

In SPECT, Toshiba showcased its signature camera, an easy-to-use system for whole body, cardiac, and general applications. Flash 3D algorithms deliver the highest SPECT image quality in the industry, the e.soft platform is the fastest in the industry, and the system allows users to acquire, process, and review images all on one workstation, the company says.
Toshiba demonstrated the newest features for its Xario ultrasound system that have been migrated to Aplio, such as Advanced Dynamic Flow, a wide-band color Doppler technique, along with Panoramic View and Advanced Contour Tracking for cardiology applications.

Vital Images at RSNA showcased VitalCardia, cardiac image analysis software that addresses the requirements for 3D and 4D cardiac imaging and review, has been enhanced to support large data sets acquired for careful cardiac evaluation, and easy communication throughout the enterprise with customizable cardiac reports.