Cardiac Imaging Goes Straight to the Heart
Image courtesy of GE Healthcare  
Image acquired on a GE LightSpeed VCT
With heart disease still the leading cause of death in the United States—as well as many other countries — imaging and health IT companies are putting forth an all-out effort to develop and connect cutting-edge diagnostic technology for cardiology. At the forefront of R&D efforts are ways to diagnose cardiovascular disease earlier with more and better information.

Vendors are showing great progress as they continue to arm practitioners with newer, better, faster solutions for cardiac care. Among the inroads are enhancements for CT and angiography, upgraded clinical IT systems geared for cardiology and a host of easy-to-use advanced visualization and analysis tools that show more and do more.

3mensio Medical Imaging (Booth 5750) is featuring demonstrations of an optional vascular package for its 3viseon 3D imaging workstation. The package can be used for vascular analysis based on CT angiography (CTA) or MR angiography (MRA) exams. One-click segmentation of the vessels, (semi) automatic central-lumen line detection, and interactive correction functionality provide an accurate measurement tool for pre-operative planning of vascular procedures, the company says.

Agfa HealthCare (Booth 4106) is showcasing its modular approach to clinical-based informatics with its Impax Cardiovascular Suite.

The Impax Cardiovascular Suite is a cardiology-centric solution for cardiovascular imaging and reporting needs, from multi-modality cardiology and vascular image management to multi-vendor ECG management and structured reporting. The system provides the combination of a cardiology-centric application workflow and enterprise-wide resource management and data archiving. Cath lab- and ultrasound-dedicated modules for this product also are available.

Cedara Software (Booth 1316) is demonstrating software solutions for cardiac imaging applications. Some of these include:
Advanced segmentation technology including libraries for lesion contouring in ultrasound, CT and MR. 
Registration technology offering registration for use in clinical packages that require rigid or deformable registration such as cardiac studies.

A new server-side rendering engine, Cedara ISG is able to serve up 2D and 3D compressed images over the web and is being demonstrated using a customized smart-client I-Response viewer. Cedara also is spotlighting a thin-client G6 viewer work-in-progress that can be run on Windows, Linux and Mac OS in standard browsers.

Emageon (Booth 8508) is showcasing its next generation HeartSuite Vericis Version 6 enabling customers to define their system upgrades to meet their clinical and IT roadmap needs with features that include:
  • Enterprise content management
  • Next generation clinical reporting
  • Additional CVIS functions for HeartSuite Vericis
  • 4D echo visualization and analysis
  • CT angiography
  • Advanced nuclear medicine module
  • Electronic report distribution
  • ECG management
  • HeartSuite pediatric reporting for echocardiography (EchoIMS)

Fujifilm Medical Systems USA (Booth 1129), with the acquisition in of ProSolv CardioVascular earlier this year, is demonstrating ProSolv CardioVascular’s cardiovascular image and information system (CVIIS) for any modality, including cath. They are also highlighting the integrated Corridor4DM (previously known as 4DM-SPECT) capabilities. According to Fujifilm, nuclear cardiology physicians and technologists benefit from access to 4DM review, analysis and quantification tools using the ProSolv CardioVascular workstation for reporting and image management.

GE Healthcare (Booth 1729) is showcasing the features of SnapShot Pulse for its LightSpeed VCT XT 64-slice CT system and displaying its Innova 4100IQ flat-panel digital detector for vascular and interventional imaging. The company also is highlighting its LOGIQ line of laptop ultrasound systems. 

SnapShot Pulse reduces a patient’s x-ray exposure time using prospective-triggered gating. In standard cardiac CT exams, x-ray energy is delivered for the duration of the scan, even during periods when a patient’s heart is at an undesirable phase for diagnostic imaging. SnapShot Pulse introduces a timed, automated response to a patient’s heart rate, ensuring the x-ray is only on for portions of the scan, according to GE. Its functionality is further improved by the company’s step-and-shoot scanning feature, which allows the gantry to move from one location to the next to cover the entire volume of the patient’s heart.

GE also is featuring VolumeShuttle, which addresses the need for wide coverage for both dynamic angiography and perfusion in a single CT scan to enable whole organ anatomical and physiological assessment. VolumeShuttle doubles the coverage width of the anatomy without increasing dose, using a single contrast injection, GE says.

The Innova 4100IQ  flat-panel digital detector delivers 40 percent more field of view for vascular and interventional imaging than conventional 15.5-inch round intensifiers, the company says. This feature provides clinicians with the capability to see more anatomy in a single run with a single contrast injection and allows them to reduce contrast and radiation dose without sacrificing image clarity.

GE’s LOGIQ 7 shared service ultrasound system features enhanced performance for cardiac applications, including an exclusive tool to allow clinicians to visualize the hemodynamics of cardiac blood flow, called B-Flow Color, for real-time more dynamic imaging.

McKesson (Booth 2542) is showcasing its Horizon Cardiology 11.1 CVIS which supports hemodynamic monitoring, cardiac catheterization, echocardiography, vascular, nuclear reporting and CPACS on a single platform. It also supports reconstruction of CT angiography and ventricular function.

Medis Medical Imaging Systems (Booth 7032) is introducing new quantification software—QPlaque MR—that can help detect vulnerable plaques in atherosclerosis patients.

QPlaque MR enables cardiologists and radiologists to measure thickness, area and volume of diseased cardiac vessel walls and plaque components. These results aid medical specialists in detecting plaque composition and high-risk plaques before they rupture, and enables physicians to more effectively treat patients, the company says.

The application post-processes multi-spectral MR images and provides tools for semi-automatically determining the boundaries of vessel, lumen, and plaque components; calculating vessel wall and plaque volumes; and measuring the thickness of the vessel wall and the fibrous cap. QPlaqueMR also provides advanced editing tools, and automatic registration of different MR sequences.

Medis expects the software to be available in the U.S. market and other countries worldwide in the first quarter of 2008.

Merge Healthcare (Booth 1122) is demonstrating the features and functionality of its MergeBox Video, a streaming video acquisition device that enables capture from multiple sources of patient data and images, and is fully integrated into the RIS/PACS workflow. MergeBox provides an efficient way to capture legacy data, as well as integrate specialized imaging, such as endoscopy or cardiology imaging, into an existing RIS/PACS solution, the company says.

Philips Medical Systems (Booth 4129) is featuring its Xper Information Management Vascular Monitoring 5 product and the Xcelera system for cardiovascular care. The company also is showcasing its Brilliance 64-slice CT scanner.

The Xcelera cardiology information and image system streamlines clinical workflow and improves efficiency throughout the cardiovascular continuum of care, Philips says. It reconciles the multi-modality, multi-vendor flow of clinical information at various points-of-care, spanning early diagnosis, treatment, and follow-up.

Xcelera harnesses the strength of its modalities and their respective clinical applications and analysis tools into a comprehensive patient-centric workspace, Philips says. It also integrates with third-party information systems, including electronic medical records, order management, ECG management, and clinical documentation systems. Xcelera offers scalable solutions to address various configuration requirements, Philips Informatics legacy systems, as well as accommodating future expansion. It also can leverage iSite as a long-term archive, shared with radiology, so that infrastructure as well as images can be shared throughout the enterprise.

The system provides HL7 connectivity to meet IHE profiles as well as storage of DICOM and DSR-TIFF imaging/service standards. Xcelera provides the capability to review original image quality/size at acquisition speeds up to 30fps, including biplane imaging, according to the company.

The Xper Information Management Vascular Monitoring 5 product presents intuitive electronic charting, procedural monitoring, and report generation. The new system captures and integrates data at the point of care, while increasing throughput and efficiency.

New for CT are innovations on the Brilliance system in three key areas—tube, detector and reconstruction—as well as a new “value” configuration of the scanner. Philips is sharing news in the futures area as well, particularly in spectral CT imaging. The company is showing results from ongoing clinical investigations with simultaneous, multidetector spectral CT scanners.

Also on display is Philips dose-saving Step & Shoot Cardiac technique that has been shown by its clinical collaborators to save up to 80 percent of the dose in a cardiac exam.

Brilliance Everywhere, a thin-client solution that delivers advanced applications such as those used in cardiac, vascular, stroke and lung imaging to any workstation on the enterprise, is being showcased, too. Philips says its Brilliance Everywhere solution helps radiologists complete more studies without having to leave their current workstation to access needed information.

Philips says its future CT direction is focused on the delivery of a single-tube whole-organ coverage system, providing optimal image quality, low dose and intelligent workflow.

Rendoscopy (Booth 4787) is demonstrating the features and capabilities of its new angiography application.

The application provides automated segmentation of the entire vessel tree, automated track finding and analysis, automated curved MPR with 2D and 3D image correlation, and volume and surface rendering of segmented vessels. The angiography engine handles nearly the entire post-processing with minimal manual interaction. In addition, a file creation option provides users with the ability to make findings available to other workstations as well as on-line and off-line storage media.

ScImage (Booth 2551) is highlighting the cardiovascular capabilities of its PicomEnterprise image management application.

The product is a complete enterprise image and information management solution for cardiology departments, outpatient cardiology clinics, and private-practice cardiologists. The enterprise-wide solution delivers automatic multi-modality image and waveform presentation, measurement tools for echocardiography, single click stress echo viewing protocols, and Integrating the Healthcare Enterprise (IHE) profiles for cardiac cath and echocardiography workflow.

Intelligent hanging protocols allow users to automatically view side-by-side static and dynamic datasets from cardiac cath, echocardiography, nuclear medicine, ECG, cardiac CT or MRI and chest x-ray. The web-based viewing program has built-in M-Mode and Doppler measurements that eliminate the need for expensive fixed position ultrasound workstations. Also new in this release is single-click, stress-echo viewing designed to save clinicians valuable exam review time, ScImage says.

ScImage also delivers a customizable reporting and workflow documentation application called PicomDOC. The module incorporates the DICOM Structured Reporting (SR) standard, but also uses rich-text formatting and macros to quickly and efficiently complete a variety of reports.

The firm has successfully demonstrated its IHE image manager actors for cardiac catheterization and echocardiography workflow with its products at the IHE and Healthcare Information Management Systems Society (HIMSS) Connectathon events. The adoption of these standards allows users to benefit from workflow enhancing protocols currently used in other medical imaging disciplines.

In addition, ScImage has applications for calcified plaque analysis and CT/MR angiography available.

Shina Systems (Booth 5756) is featuring a family of products based on its core automated segmentation, classification and registration technologies. CardioCt is a cardiac CT analysis tool that provides a complete solution for reliable coronaries and functional analysis in one synchronized package. This is realized through the implementation of an innovative set of algorithms that define the heart and its comprising parts in a single operation. The advanced anatomical knowledge-based segmentation algorithms begin automatically without user interaction. CardioCt includes a Plaque package which consists from a set of tools that automatically identifies suspicious plaque and stenosis sites along the vessel, and classifies the plaques through a proprietary algorithm.
The new VascularCt is a vascular CT imaging and analysis system enabling assessment of carotids, renal arteries and other peripherals. It includes Stenosis and plaque assessment tools.
Also on exhibit is AngioCt, an application for the integration of cardiac CT Angiography in the cathlab. With minimal user intervention, the application co-registers a 3D CTA reconstructed structure with the real time 2D coronary angiography image. Once co-registered, tissue information, stenosis and plaque are displayed on the “lumen only” angiogram, empowering the cardiologist to see beyond the lumen.
The company is also displaying its CScoreCt , a new application providing a more automated solution for calcium scoring.

Siemens Medical Solutions (Booth 7713) is spotlighting its Soarian Cardiology cardiovascular informatics system and a works-in-progress syngo PE Detection tool. The company also is showcasing its Somatom Definition Dual-Source CT scanner and new echocardiography systems.

Soarian Cardiology combines an extensive cardiology clinical repository, workflow management technology, and documentation and reporting tools.  In combination with an array of diagnostic modalities, Soarian Cardiology becomes part of a comprehensive cardiovascular information system (CVIS), equipped to collect, store, organize, retrieve, and analyze cardiovascular information, and share it via the internet for Siemens and non-Siemens modality and information systems. 
The works-in-progress syngo PE Detection application is a second-reader tool for the detection of segmental and sub-segmental filling defects in CT angiography studies of the thorax. syngo PE Detection 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. Currently, syngo PE Detection is available for sale outside the U.S. market.

Siemens is spotlighting its X-class and P-class ultrasound systems, including the new Acuson X300 all-purpose ultrasound scanner that is capable of performing vascular age assessments using the syngo Arterial Health Package (AHP) for cardiovascular risk assessment. The technique renders a combined risk score that includes factors such as a measurement of the carotid intima-media thickness, Framingham risk index assessment and comparison with the Atherosclerosis Risk in Communities (ARIC) database. syngo AHP combines all of that information to estimate vascular age, enabling physicians to predict a person’s risk of coronary heart disease.

Also part of the X-class, the Acuson X150 ultrasound system is compact and portable and features a field upgradeable system which allows the flexibility to add sensitive color and power Doppler capabilities and a cardiac screening application. The Acuson X150 features 3-Scape real-time 3D imaging for the construction of real-time 3D images during free-hand acquisition. Its 15-inch flat panel display is mounted on an articulating arm providing a wide range of motion to achieve a comfortable scanning position.

TeraRecon (Booth 7762) is showcasing its iNtuition edition of the Aquarius product suite which includes:
· Support for dual-energy CT scanning
· Automatic anatomy identification and labeling
· CT /PET fusion with automatic registration
· Fusion for blood pooling MRI contrast agents
· Parametric mapping for time-dependent MRI (such as breast studies)
· CT-CT angiography registration and subtraction for “CT-dual subtraction angiography”
· Full cardiovascular clinical workup capabilities on a thin client. 

The company is demonstrating the scalable nature of the solution by deploying a server cluster capable of concurrently rendering hundreds of thousands of CT slices. Data flow to multiple servers is managed with AquariusGATE scheduled routing technology, while rendering load between the servers is managed with automatic, headless load balancing, such that the cluster behaves as a virtual server.

Thinking Systems (Booth 4583) is demonstrating the firm’s recently released new cardiac imaging and reporting functions for its ThinkingPACS product.

The new cardiac imaging and reporting features include template-driven, structured reporting for nuclear cardiology and echocardiography; MUGA processing; phase analysis for SPECT and MUGA nuclear cardiac studies; simultaneous processing and display of attenuation corrected and uncorrected nuclear cardiac studies; and simultaneous processing and display of motion corrected and uncorrected nuclear cardiac studies.

The new features are not only available on the Thinking Systems PACS workstation, but are also available on the ThinkingWeb web server, which allows clinicians to view, process, analyze, and report cardiac studies anywhere in the world, the company says.

Toshiba America Medical Systems (Booth 7130) is displaying its biplane Invinix VF-i/BP x-ray system and introducing low-contrast imaging features as a works in progress for its Infinix line. In CT, Toshiba is showcasing enhancements to the Aquilion CT 64-slice system.

The Infinix VF-i/BP system combines a versatile multi-axis floor mounted positioner that allows head-to-toe and fingertip-to-fingertip coverage and a ceiling-suspended omega C-arm featuring variable isocenter. This combination allows the clinician full access and provides complete anatomical coverage of the patient.  High-resolution imaging is achieved with two flat-panel detectors (FPDs)—a 12-by-16-inch FPD on the multi-axis position and an 8-by-8-inch FPD on the ceiling suspended omega C-arm. All of these features allow maximum flexibility needed for complex vascular and neuro interventional procedures with high-resolution imaging, according to Toshiba.

The company also is introducing its low-contrast imaging feature as a works-in-progress for all Infinix products. 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 feature will be available to customers in December. 

In cardiac CT, Toshiba is demonstrating the Aquilion CT line that delivers a 0.5mm isotropic slice thickness capability for 64-slice scanning. 

Also on display are new application packages, including: 
  • PhaseXact (part of the Sure Cardio package), which automatically locates the optimal phase of the heartbeat, ensuring the best image quality, decreasing image reconstruction time by at least 50 percent and reducing storage requirements.
  • Sure Subtraction software reduces the time to diagnose a neurovascular CT digital subtraction (CT DSA) exam by automating and streamlining bone subtraction.  
  • Sure Plaque software application, which allows clinicians to easily view vessels for coronary remodeling and quantification.

Viatronix (Booth 3303) is introducing the V3D-Cardiac module that the company hopes to release for sale by the end of 2007, pending FDA approval. The module has been developed around the needs of physicians, and contains a number of automated tools to provide optimized cardiovascular workflow and time-efficient analysis, according to the company.

Visage Imaging (Booth 2591) is highlighting a new release of Visage Cardiac Analysis, a CT cardiac application based on thin-client technology.

The upcoming version of Visage Cardiac Analysis will include new tools and optimizations such as calcium scoring, myocardial segmentation, wall thickening computation, improved reporting and efficient manual editing. The integrated cardiac analysis application is not bound to a specialized workstation and is delivered to a desktop via Visage thin-client technology.

Vital Images (Booths 6520 and 8301) is featuring cardiovascular enhancements and tools available on the recently released Vitrea 4.0 and VitalConnect 4.1 products and debuting Vital EP, an electrophysiology (EP) planning tool.

The Vitrea 4.0 and VitalConnect 4.1 releases include significant enhancements to the company’s cardiovascular applications as well as improved web-based cardiovascular analysis and distribution capabilities, Vital says.

Enhancements to the company’s Vitrea 4.0 workstation-client release include cardiovascular workflow improvements such as automatic segmentation and probing of the coronary tree, easier vessel management and labeling, centerline editing and comprehensive reporting with automatic population of findings.

The new EP planning application, Vital EP, contains a 3D advanced visualization and modeling tool for the EP lab, a quickly growing segment of the cardiovascular marketplace. Vital EP automatically segments out the pulmonary veins and creates a 3D anatomic model of the heart for superimposed EP mapping. In addition to its clinical features, Vital EP automatically exports a 3D model for display on the St. Jude Medical EnSite system, which is used to facilitate therapy for the treatment of arrhythmias.

Zonare Medical Systems (Booth 5305) is showcasing its new ultra system, the company’s next-generation convertible ultrasound platform. Based on Zone Sonography technology, the ultra system features advanced software and hardware and transducer technology, including a works-in-progress basic cardiac package. 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.