Imaging Procedures Poised for Growth

With a fluctuating and uncertain economy, many facilities are seeking imaging procedures that will spur growth. So what’s growing? Hand-held ultrasound system exams, virtual colonoscopy procedures and digital mammography studies, for starters. Health Imaging & IT talked with several industry watchers about which procedures are growing, for which applications and why.

Ultrasound: Portable power

The trend of taking ultrasound to patients rather than vice versa has been growing, says Lars Shaw, vice president of marketing for Zonare. Improvements in ultrasound resolution and penetration, and therefore confidence, has expanded use of the modality in traditional areas, such as ob/gyn and vascular applications. Newer areas, such as emergency care, critical care and surgery, are growing twice as fast or more than traditional markets, Shaw says. Overall, portable ultrasound has been growing by more than 20 percent a year and in 2007, use in emergency medicine increased 40 to 50 percent.

Dave Willis, vice president of innovation and competitive strategy for SonoSite, says people are “really starting to adapt ultrasound as a tool because it is a fairly inexpensive, noninvasive and safe modality to use as a guidance tool for interventional procedures.” Ultrasound can meet that need, he says, thanks to a combination of smaller, more affordable, more durable electronics. Another plus is that portable ultrasound is often done by physicians, rather than sonographers, who require good image quality, quickly, without a complicated user interface.

Terri Bresenham, vice president, global diagnostic ultrasound, GE Healthcare, says the newer specialties adopting ultrasound benefit from the addition of visualization in a low-cost, nonradiating approach. Ultrasound can improve the speed and quality of care and lower costs, she says.

Physicians typically do their own scanning in the European markets, Bresenham says, which provides a lot of efficiency because there is no delay between acquiring the scan and interpretation.

Current technological advances in the works are exciting, Bresenham says. The market is designing around specific clinician needs, she says, which is why GE currently offers eight different hand-carried ultrasound systems with more planned.

Sometimes patients—and clinicians—need convincing that the smaller units pack comparable clinical functionality as larger, more traditional sized units. Bigger doesn’t always mean better; smaller is far more convenient and, now, clinically effective, too.

Virtual colonoscopy to climb

What essentially amounts to a “seal of approval” from the American Cancer Society (ACS), along with growing awareness and better reimbursement puts virtual colonoscopy (VC) in a position to experience dramatic growth.

The recent endorsement by the ACS of VC as a colon cancer screening tool is crucial to the future of VC, says Peter Martin, PhD, director of business development, Colorectal Carecycle, Philips Healthcare. “We expect that if there is reimbursement by any of the major health insurance companies, that will actually drive a shift of people away from using only optical colonoscopy,” he says.

Currently, compliance with optical colonoscopy is believed to be less than half of the eligible population, at about 14 million screenings a year in the United States. Organizations are promoting colorectal cancer awareness and spreading the word that it is the only disease in which removing polyps can actually prevent cancer. That should increase acceptance of screening programs and “the hope is that will increase the total number of colonoscopies to around 20 million a year within the next few years,” says Scott Pohlman, director of CT clinical science for Philips Healthcare.

Colorectal cancer screening rates are much lower in Europe—about 15 percent of the eligible population. Some of that is due to less acceptance of the value of removing polyps, but again, there are indications of change. For example, Germany and the United Kingdom are launching national screening programs.

Another plus for VC is that any 16-slice or greater scanner is appropriate for the procedure. Currently, virtual colonoscopy procedures require the same bowel cleansing prep routine that patients dislike with the traditional optical method. However, software developments will cut the need for bowel cleansing as well as improve the extent of visualization of the bowel. A “fillet view” lets users view the 3D dataset as a cut-away cross section and in a single view, see the entire surface of the inside of the colon. “That is especially helpful for looking behind folds obscured by virtual flythrough modes. In optical colonoscopies, the colonic wall is viewed from one direction only [top to bottom] which can result in missing lesions hidden behind folds.”

Digital drives mammography

Digital mammography is poised for double-digit growth around the globe, says Christiane Harms, business team marketing manager for mammography at Philips Healthcare. In the United States, less than 30 percent of the mammography market has converted to digital, she says. And, several European countries are in the process of starting screening programs, which require fast procedures and high workflow. When a new screening program starts, all sites offering screening rapidly convert. Sales in that particular country will fall dramatically for the next 5 to 7 years. Meanwhile, another country, for example, France in 2009, will begin a screening program for another sales boom. Plus, Asia is a large emerging market, Harms says.

The basic driver is economic, Harms says. Digital images can almost always be manipulated, reducing the incidence of repeat exams and excess radiation exposure. The improved workflow and ease in storage also are draws, she says.

CT catalyst

Peter Kingma, vice president of CT for Siemens Medical Solutions, anticipates continued growth in cardiac CT imaging. “The success and efficacy of this modality is now so high and so well established, particularly in Europe, that I expect similar growth in the United States. It’s an important component of any cardiac workup.”

Cardiac CT has proven through clinical studies its key role in diagnostically ruling out CAD less invasively than the other tests currently available. “Even though cardiac CT represents a small portion of [the total number of CT] scans, it receives a very high level of attention from both the medical community and manufacturers,” Pohlman says.

That’s driven, Pohlman says, by work towards improving the ability to image coronary arteries through better temporal resolution, more coverage on scanners and more dose-efficient systems.

Dual-energy drivers

Dual-energy imaging—using x-ray sources to apply two different x-ray energies simultaneously—“is of great interest to us,” says Kingma. “This enables us to do quite exciting imaging in terms of hemorrhage management—detection and analysis—to distinguish between new and old bleeds.” It also allows for very fast and very successful lung imaging based around perfusion, he says. “We also are using this to provide perfusion blood volume imaging in the heart. Basically, looking at the myocardium and determining which areas of heart are underperfused and mapping this out. This can then link to a coronary CTA done at the same time.”

Dual-energy imaging also aids in imaging vessels close to bone. For example, a clinician might be interested in viewing the carotid artery right at the base of the skull where it’s difficult to distinguish between the bone and the vessel. Advancements have allowed for electronic separation of the two, for great time savings for both physicians and technologists, Kingma says.

Also on the horizon

Claus Grill, vice president, Angiography, Cardiac, and X-ray Systems for Siemens Medical Solutions, expects more and more nonvascular work in interventional radiology. “In parallel to that, there is a shift of procedures from cardiology, such as cardiac caths going into surgical departments, where we have new, high demand on high-end imaging equipment for minimally invasive procedures.”

Grill also has observed a drive for percutaneous heart valve replacement. Although that has not yet cleared the FDA regulatory hurdle, “we’re already seeing demand from hospitals for high-end imaging equipment.” CT-like imaging functionality, he says, allows for soft-tissue imaging using a high-end angiographic C-arm. “This is growing because it impacts workflow and improves soft-tissue imaging right there on the interventional table.” Users can map and overlay images right where the imaging procedure takes place. “I can’t even imagine labs not using 3D imaging or soft-tissue imaging.”

Pohlman anticipates greater potential for CT, too, in screening for lung cancer. CT currently plays a widespread role in diagnosis but large trials are studying whether CT can detect cancer earlier stage and change outcomes for the leading cancer killer in the U.S.

Another potential area of growth is advanced imaging for stroke, Pohlman says. “Currently, guidelines are such that available treatments are recommended for use only within three hours.” As a result, only 2 to 3 percent of stroke patients actually get available treatment. Trials investigating this area also are underway. Stay tuned.