Works-in-progress showcase imagings near-term future

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CHICAGO, Nov. 25—The annual RSNA conference this week in Chicago is the world’s premier launch pad for innovations in diagnostic imaging. The exhibition halls of the 93rd annual meeting at McCormick Place are the venue for the introduction of products and technology that transform the practice of medicine, offering new devices for diagnosing disease more effectively and providing new tools for sharing that information more efficiently.

In addition to the debut of new devices and software, developers this week are showcasing works-in-progress equipment and applications. For healthcare professionals eager to take a peek behind the curtain to see what’s next over the technical horizon, these exhibits offer a tantalizing glimpse of near-term technologies for diagnostic imaging.

Although not yet quite ready for deployment in the clinical continuum, or still waiting approval for use in the United States, the products described below offer a look behind the doors of research and development departments around the globe.


Advanced Visualization

Philips Medical Systems is spotlighting its works-in-progress iSite Colonography and iSite Pulmonary Embolism applications.

Philips iSyntax3D technology, employed in the iSite visualization products, provides rendering performance and scalability without additional server cost and complexities. In addition, iSyntax3D utilizes minimal bandwidth to load volumetric (DICOM) datasets. 

The iSite 3.6 and 4.1 advanced visualization tools are designed to speed the reading of volumetric datasets such as multidetector CT and MRI cases. The toolset sports a dedicated user interface and workflow features specifically tailored to facilitate PACS workflow.

The iSite Colonography and iSite Pulmonary Embolism applications features MIP/MPR/3D Volume rendering, on-demand task guidance, and a simplified volume user interface provide step-by-step help. Philips said it anticipates general market availability of the applications during the first quarter of 2008.

The iSite advanced visualization suite is bolstered by iSite Volume Vision, which features task-guided segmentation and classification tools, the capability for protocol-based and freestyle movie generation and capture. Advanced review protocols will allow for easy review of complex cases and merging and color mapping of CT and MRI datasets is provided. The iSite Volume Vision is scheduled to be available in the first quarter of 2008.


CAD

Medipattern Corporation is showing works-in-progress for computer-assisted detection (CAD) on whole-breast ultrasound. CAD is the key to effectively reading the multiple images acquired during whole-breast ultrasound, according to Medipattern.

Next-generation B-CAD capabilities read the images in cine loops, automatically detecting and characterizing lesions. The CAD results are reviewed by the radiologist for editing and then B-CAD automatically enters the evidence and findings into a natural language report.


Cardiac Imaging

Siemens Medical Solutions is unveiling a works-in-progress syngo PE Detection tool, a second-reader tool for the detection of segmental and sub-segmental filling defects in CT angiography studies of the thorax. The application supports commonly applied CT acquisition protocols for detection of pulmonary embolism. The second-reader product is integrated with the syngo Circulation application to enable an efficient reading and reporting process.

The syngo PE Detection tool is available currently for sale outside the U.S. market, Siemens said.

Toshiba America Medical Systems is introducing low-contrast imaging features as a works-in-progress for its Infinix line.

This new capability will allow soft-tissue imaging in the angiography suite and help physicians provide better patient care by improving CT-like imaging at the point of treatment, as opposed to having to transfer a patient to a CT scanner, the company said.  The feature will be available to customers in December.

Zonare Medical Systems is unveiling a works-in-progress basic cardiac package for its new z.one ultra system, the company’s next-generation convertible ultrasound platform.

Using the P4-1c transducer, the package includes 2D imaging with two harmonic and four fundamental frequencies. It also has M-Mode with a basic calculation package and 2D measurements for evaluating left ventricular function. Additionally, PW Doppler for basic evaluations and measurements is included as well as color Doppler for valvular assessment.


Digital X-Ray

CMT Medical Technologies is presenting DuoRAD, a patent-pending works-in-progress two-in-one imaging technique for its SmartRAD family of DR solutions. DuoRAD enables acquisition of dual-energy images in a single x-ray exposure by using a combined DR-CR unique technique that provides significant dose reduction, while eliminating motion artifacts.

The technology benefits from the high quantum detective efficiency and automatic exposure control of DR imaging, along with tuning of the x-ray spectrum for improved contrast of the CR technique, combined in a single exposure. DuoRAD offers distinction between soft tissues and bones in the same image, detection of calcified lung nodules, better visualization of urinary tract stones, detection of small bone fractures, follow up on the healing process and bone mineral density for osteoporosis, according to CMT.

The developer also is debuting works-in-progress system based on dynamic flat-panel detector (FPD) technology—the SmartSPOT PrimaX FPD-43. The newcomer to the SmartSPOT PrimaX family is a premium digital R/F and angiography imaging solution based on the Pixium 4343 FPD by Trixell.

The SmartSPOT PrimaX FPD-43 also is equipped with a user-friendly graphical user interface capable of performing all clinical R/F and DSA procedures. The system’s basic capabilities include patient registration, image acquisition, archiving, viewing, post processing and DICOM 3.0 connectivity.

Fujifilm Medical Systems USA is highlighting its new Unity SpeedSuite, a works-in-progress U-Arm DR system designed with motorized, multi-position single detector flexibility.

The Unity SpeedSuite is a cost-effective DR solution capable of performing a wide range of exams including both table-based and upright procedures. The Unity DR system includes Fuji’s intuitive IIP workstation that offers image processing tools and is capable of assisting in the delivery of high patient throughput.

It is designed for many clinical applications including general radiography, emergency departments, dedicated chest rooms or even outpatient care facilities, such as an orthopedic office, according to Fuji.

Philips Medical Systems is showcasing a works-in-progress wireless flat-panel detector for its portable x-ray unit, the Practix Convenio DR. The detector is appropriate for all radiography applications where flexibility of projections is required, the company said.

The Practix Convenio DR is designed for increased efficiency in the OR, ER and ICU thanks to instant image access (less than 8 seconds) and wireless connectivity. The system allows for complete workflow at a Philips Eleva workstation (HIS/RIS connectivity) from patient request to image archiving, according to the firm.


Health IT

Siemens Medical Solutions is unveiling it Remind Clinical Decision Support (CDS) works-in-progress application. The software is under development in collaboration with Maastricht Radiation Oncology, a leading radiation oncology treatment center in the Netherlands. The Remind CDS tool helps physicians personalize therapy plans by predicting therapy outcomes and side effects in lung cancer patients undergoing therapy. It can leverage all available electronic information in the patient record, including demographics, clinical factors, imaging information, treatment plans, delivered treatment, genomics and proteomics, according to Siemens.


Molecular Imaging

Cedara Software is demonstrating its Cedara Clinical Control Center (C4)-enabled works-in-progress Cedara PET/CT module and Cedara I-Response.

The C4 PET/CT application was developed to follow radiology workflow and solve image fusion challenges in a PACS environment, according to the vendor.

The Cedara I-Response is designed to help evaluate, assess and monitor the effect of cancer therapy over time using data from multiple modalities. In addition to providing tools for standard anatomical measurements used for tumor assessment in cancer management and research, Cedara I-Response can analyze both PET/CT and MR-based diffusion-weighted imaging (DWI).

The firm said that by providing the capability to visualize changes in tumors resulting from cellular and metabolic mechanisms during the course of treatment, the product provides clinically relevant information that potentially could be used to make mid-treatment therapy adjustments in an attempt to improve clinical outcome.

Cedara I-Response also features patented functional Diffusion Map (fDM) technology based on work done at the University of Michigan. This functionality enables physicians to analyze DWI studies to visualize and quantify changes over time in the microscopic motion of water in healthy and diseased tissues. University of Michigan investigators have demonstrated that fDM can identify brain tumor patients who are responding to radiation (plus adjuvant chemotherapy in some cases) after only three weeks of treatment, more than two months earlier than conventional methods, according to Cedara.

The results of each analysis are included in automatically generated reports, as well as exporting the results to file for import into a site’s existing data repositories. I-Response is available to original equipment manufacturers as a standalone workstation, and also can be integrated into existing PACS solutions using Cedara’s C4 integration platform.


MRI

Toshiba America Medical Systems is previewing its advanced 3-Tesla MR system as a works-in-progress. At the core of Toshiba’s 3T product is a new magnet design that combines a short bore with high homogeneity. In addition, the new system features Toshiba’s patented Pianissimo technology, which substantially reduces noise, solving one of the primary concerns facing 3T imaging today. 

All Toshiba’s Vantage systems include software for contrast-free MR angiography (MRA) procedures with three proprietary Toshiba techniques: fresh blood imaging, contrast-free improved angiography, and Time-SLIP. Toshiba noted that contrast-free imaging is particularly important because gadolinium, the common contrast agent used for MRI and MRA exams, has been directly linked to nephrogenic systemic fibrosis, a sometimes fatal disease that occurs in patients with renal insufficiency.


PACS

Cedara Software is spotlighting its works-in-progress Cedara I-Reach, an example of a C4 host, which facilitates the viewing of diagnostic images over the internet. The latest version of I-Reach includes C4 integration which enables I-Reach to launch into a variety of C4-enabled plug-ins, the company said.
   
C4-enabled applications include Cedara I-ReadMammo, the works in progress Cedara I-Response, Cedara OrthoWorks Pro Planner, works-in-progress Cedara PET/CT, Cedara B-CAD and various Biotronics3D solutions. The Cedara I-Response allows users to automatically generate a variety of quantitative calculations, compare tumor activity at multiple time points and visualize therapy response in individual, configurable layouts, according to Cedara.

Fujifilm Medical Systems USA is showcasing works-in-progress extensions for distributed 3D software via its Synapse PACS. Future extensions to Fuji 3D software cover PET/CT fusion and digital mammography. The company is showing works-in-progress advancements to existing diagnostic MIP/MPR capabilities for Synapse. All 3D applications are designed to be available anywhere on the network that Synapse PACS is available. 
   
Also, as a work-in-progress, Fujifilm is demonstrating expanded information content, which includes an advanced information model that covers the radiology department.

Merge Healthcare is demonstrating works-in-progress capabilities for forthcoming iterations of its Fusion PACS MX, Fusion PACS GL, and Fusion RIS MX products.
   
The upcoming edition of Fusion PACS MX provides workflow-integrated clinical applications. Its platform technology automatically launches the correct clinical application required for viewing each study to yield efficiencies by allowing specialty reading such as mammography, orthopedics and PET/CT to proceed seamlessly within clinical workflow.
   
Fusion PACS MX also brings new viewing protocols that allow the user to step through different views, and the capability to save annotations or measurements as part of the image for improved flexibility, and expanded keyboard mappings for better workflow optimization. The PACS also offers workflow and communication tools such as multiple interrupt sessions and instant messaging and native 64-bit processing to load tens of thousands of images simultaneously.
   
The next version of Fusion RIS MX, being shown as a works-in-progress, incorporates the top requests from a Merge Healthcare User Group Meeting. It also contains additional capabilities such as improved fax service, external order ID tracking workflow and national provider number. Other features include enterprise-wide licensing and scaleable design; flexible scheduling options; embedded modules for applications such as document management and dictation to facilitate seamless paperless workflow; a local and regional security business module that helps to address HIPAA compliance with minimal business disruption; Practice Analysis and Crystal Reports for comprehensive business intelligence and billing capabilities tied tightly to the RIS workflow. 
   
The next release of Fusion PACS GL is designed for presentation, storage, retrieval and distribution of medical images, with extensive options for customizing configuration. Options available in Fusion PACS GL allow users to take advantage of visualization tools such as MIP and MPR. The system also accommodates individual customer preferences. Every Fusion PACS GL solution contains archiving capabilities, which are scalable as image storage needs expand.

Neurostar Solutions is debuting 3D imaging processing functionality as a works-in-progress at the 2007 RSNA conference.

Developed in collaboration with Kjaya Medical, 3D functionality is fully integrated into Neurostar’s Virtual Radiology Network (VRN) application as a location-free, pay-as-you-go application service provider offering.

The option allows radiologists to process multi-slice images anywhere and at any time in a full range of protocols, including multi-planar reformatting, maximum intensity projections, volume rendering, thin-slab visualization and more. The 3D service stores raw imaging data from an acquisition site to Neurostar’s off-site servers. From there, using standard computer workstations and internet connections, users can reconstruct the data using Neurostar’s web-based tool while taking advantage of the processing power of Neurostar’s offsite servers and backend software. Finally, processed 3D data are stored back on the servers for access by any authorized VRN user.

Fees for the new Neurostar 3D service will be on a per-use or per-study basis, eliminating upfront investment, the company said.


Women’s Imaging

Merge Healthcare is exhibiting its works-in progress Merge Mammo 7.1, a multimodality vendor-neutral mammography workstation application.

The application includes support for 10-bit video cards as well as support for 64-bit versions of Microsoft’s Vista operating system, more customization options for viewing and measurement tools, improved viewing protocols and support for 12-bit printing. 

Hologic is showcasing its investigational breast tomosynthesis system with a selenium-based detector. Visitors can view a demonstration of how 2D and 3D imaging (breast tomosynthesis) can be accomplished. Also being investigated is Hologic’s full-automated breast density assessment tool, Quantra. The new tool uses a complex model of the x-ray imaging chain to calculate the amount of dense tissue penetrated at each pixel in the image, which is independent of how the image was acquired. Using images from Selenia, Quantra gives the total volume of fibro-glandular tissue in cubic centimeters, as well as the total volume of the breast, removing the vagaries due to human estimation.

Philips Medical Systems is providing a look at their works-in-progress MammoDiagnost DR, a digital solution for mammography designed for high-volume screening.

MammoDiagnost DR features Philips Eleva workflow at the console and integrates seamlessly into existing PACS via DICOM. It features an amorphous selenium detector with 85µm pixel size; a large field of view: 24x30 cm; and automatic exposure control and compression optimization. The company said it expects FDA clearance for the product in 2008.