Gaining momentum

By Mark Palacio
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Mark Palacio is Executive Editor of Applied Radiology.

Communication of radiologic results and X-ray dose reduction strategies took center stage at the 95th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA). Held from Nov. 29 to Dec. 4, 2009 at McCormick Place, in Chicago, IL, the annual meeting conveyed a sense of hope as the medical imaging community pulled itself out of a tumultuous 2008 fraught with layoffs, sagging profit margins and increased governmental scrutiny of medical imaging and its effects. These leaner, meaner corporate entities are now ready to address the challenges that will face radiologists in 2010 and beyond.

In the realm of X-ray dose reduction, every major computed tomography (CT) vendor showed some form of iterative reconstruction software in order to drive down the dose on new CT scanners. Other hot topics on the exhibit floor were picture archiving and communications systems(PACS) integration tools to bring disparate systems across a network into harmony. Other vendors demonstrated better integration of advanced visualization tools on the PACS workstation itself, perhaps signaling an end to the era of using a separate workstation for advanced reconstruction. In the women’s health arena, several vendors demonstrated their latest digital mammography systems, which will be platforms for tomosynthesis, which finally seems to be ready for primetime utilization.


Philips Healthcare (Andover, MA) released several dose-optimizing features for its CT scanners. Notably, the iDose iterative reconstruction technique on the RapidView IR console enables 20 times faster reconstruction than current hardware and lowers X-ray doseup to 80% while maintaining diagnostic image quality. iDose is available for Philips’ Brilliance iCT and 64-channel scanners and delivery is expected in the second half of 2010.

SharpView (Linköping, Sweden) showed results from studies of its adaptive filters, which can significantly reduce radiation from CTscans.The technology is based on mathematical algorithms that filter noise, making imaging with lower radiation possible. Dose reductions between 30% and 70% have been confirmed in international studies and clinical investigations, according to the company.

The Aquilion® ONE dynamic volume CT system, from Toshiba America Medical Systems(Tustin, CA), with its 16 cm of anatomical coverage using 320 ultra-high resolution 0.5 mm detector elements, could help change the management of stroke patients. The scanner can show an organ’s dynamic blood flow and real-time function – which could be critical for stroke management in ED settings. With the NeuroONE acute stroke imaging protocol the scanner combines noncontrast CT, cerebral blood flow analysis and 4-dimensional digital subtraction angiography (DSA) into a single exam. By combining these exams into a single low-dose protocol, full stroke workup can be performed in <5 minutes.

Bracco Imaging S.p.A. (Princeton, NJ) unveiled its customer-driven, customer-focused product platform, which integrates preprogrammed multidetector CT protocols for Isovue®-370 (iopamidol injection) into the EmpowerCTA® Contrast Injector with the IRiSCT® Data Management System from ACIST Medical Systems Inc., a Bracco Group company. This integrated solution offers the radiology community protocol options that maximize the utility of injectors and MDCT scanners, as well as auto initialize, auto fill and auto purge features. When combined with the IRiSCT system, this software can link all injectors in a department across a facility’s existing network, enabling radiologists, administrators and technologists to gain workflow efficiencies, imaging optimization and patient safety benefits.

GE Healthcare (Chalfont St. Giles, U.K.) announced a multicenter study to investigate the performance of its Model Based IterativeReconstruction (MBIR) as a method to maintain or improve diagnostic information while dramatically lowering radiation dose in routine CT imaging. The multicenter study will determine the effectiveness of the MBIR method and will be conducted in sites in theUnited States, Europe and Asia.

Siemens Healthcare (Malvern, PA) released its Iterative Reconstruction in Image Space (IRIS) for dose savings of up to 60% compared with techniques that do not use IRIS. Siemens also demonstrated innovations on the SOMATOM® Definition FlashDual Source CT scanner. The SOMATOM Definition Flash requires only a fraction of the radiation dose that systems previously required to scan even the tiniest anatomical details. With a fast scanning speed of up to 45 cm/sec and a temporal resolution of 75 ms, the system can complete scans of the entire chest region in about 0.6 sec.

X-ray, fluoroscopy

Konica Minolta Medical Imaging USA (Wayne, NJ) announced that the Xpress CR now offers a more compact, higher performancedesign that includes advanced C-plate technology for sharper, more efficient image processing. The Xpress CR 210 also provides the flexibility to separate the location of consoles and readers for optimized productivity based on the number and type of examinations, floor spaceand workflow demands. The company’s new C-plate series has a columnar crystal phosphor layer that efficiently delivers excellent sharpness and granularity for high quality images.

Toshiba America Medical Systems Inc. (Tustin, CA) spotlighted the RADREX™-i digital radiographic system with a mixed detector configuration and the Kalare™ R&F system. The RADREX-i enhances workflow with the RexView, a color LCD screen located on the overhead tube crane (OTC). Since the image appears on the OTC, technologists have immediate access to it, potentially decreasing overall exam time.

The Kalare R&F is ideal for emergency settings, since it combines a superior user interface and duplicates the color LCD touch screen generator on the Spot Film device, allowing point-of-care changes to the X-ray settings and programs.

FUJIFILM Medical Systems USA (Stamford, CT) previewed the FDR AcSelerate, which is a fully automated table and upright system with a lightweight ergonomic design to improve positioning and operation. Fuji also showcased its line of computed radiography (CR) imaging systems, including the FCR Go portable digital X-ray system. The FCR Go will now be offered with colorful, child-friendly designs for pediatric facilities.

Siemens Healthcare (Malvern, PA) featured the Artis zeego®, a multiaxis system with robotic-assisted positioning that enables variable working height, unique parking positions for hybrid rooms, and that delivers large-volume syngo DynaCT image results. Also highlighted was the Ysio®, a DR solution with intuitive color touchscreen controls. Ysio is available in a variety of combinations: as a wallstand with an integrated detector; a wall and table system with a wireless detector (wi-D); and as a mixed detector solution for high throughput and flexibility. Ysio’s patient table is rated up to a 660-pound weight capacity.

Philips Healthcare (Andover, MA) spotlighted the EasyDiagnost Eleva, which is a combination of a high-end digital vertical stand (or digital in-table detector) and a ceiling suspended detector for high-quality digital radiography (DR) as well as fluoroscopy (F,DRF) applications. The multipurpose system enables users to perform gastrointestinal work, as well as chest and skeletal exams, in just 1 room. In addition, the DRF design consists of various single features to help enable lower X-ray doses, including pediatric fluoroscopy settings, Grid Controlled Fluoroscopy and dose measurement.

Nuclear medicine

GE Healthcare (Chalfont St. Giles, U.K.) announced dual-detector capabilities and an enhanced application suite for its Discovery™ PET-CT 600 series scanners. The Discovery PET-CT 600 family, includes the Discovery PET-CT 690 with BrightSpeed Elite™ CT. GE also announced the first planned clinical installation of the new Discovery NM/CT 670, a hybrid imaging platform that combines the BrightSpeed Elite 16-slice CT and a newly designed SPECT gantry for greater positional flexibility.

Philips Healthcare (Andover, MA) showcased the GEMINI TF PET/CT, which streamlines the processes involved in staging, planning,therapy and follow-up in oncology care. With Generation 3 time-of-flight technology, the GEMINI TF system is the company’s fastest PET scanner, capturing data in <500 picoseconds, without compromising image quality or attention to dose radiation efficiency. Philips also highlighted the BrightView XCT SPECT/CT. The system uses Astonish image reconstruction technology to provide 50% better spatial resolution in cardiac SPECT studies compared with SPECT studies using filtered back projection.

Siemens Healthcare (Malvern, PA) demoed the Biograph™ mCT, which enables facilities to serve both the nuclear medicine andthe radiology department with one system. It offers High-Definition PET, time-of-flight technology, and CT configurations of up to 128slices. Siemens also highlighted Symbia®.net, a new client-server solution for its SPECT and SPECT-CT imaging applications. allows for anytime, anywhere processing.

Bayer HealthCare Pharmaceuticals Inc. (Wayne, NJ) announced that the first patient had been enrolled in an international phaseIII clinical trial to evaluate the efficacy and safety of florbetaben (BAY 94-9172) for PET imaging in the detection of beta-amyloid plaques in the brain. The phase III trial is an open-label, multicenter, nonrandomized single-dose study to assess the safety and to determine the sensitivity and specificity of the visual and quantitative assessment of regional tracer uptake of florbetaben in the brain using PET imaging.

PACS/RIS, accessories

Vital Images Inc. (Minneapolis, MN) featured new clinical enhancements to the Vitrea Enterprise Suite, including an Endovascular Stent Planning application for the assessment of abdominal aortic aneurysms and thoracic aorta aneurysms, automated bone removaland tumor segmentation, anatomic mapping features designed to quickly segment anatomic structures, and significant usability and clinical efficiency enhancements.

Codonics Inc. (Middleburg Heights, OH) announced the immediate availability of the Infinity C and Infinity LX Medical ImageServers through Siemens Healthcare(Malvern, PA). The Infinity Medical Image Servers store and retrieve standard Siemens DICOM files in an exceptionally fast, compact storage device. Infinity provides a cost-effective, safe repository for Siemens image data, and fundamentally improves workflow by locally storing all modality data including thin slices and raw data.

MedWeb (San Francisco, CA) announced its new Health Screening Suite, which extends the power of PACS to common screening tests that can help clinicians assess a patient’s overall health. Comprised of 6 modules – Calcium Scoring, Bone Density Scoring, VirtualColonoscopy, Abdominal Fat Density Scoring, Stress Tests and Echocardiograms – the application can be added to a facility’s existingPACS or integrated with Medweb’s PACS.

FUJIFILM Medical Systems USA (Stamford, CT) extended its Synapse product portfolio with Synapse™ 3D®, which offers more than a dozen modules delivering both radiology- and cardiovascular-specific applications such as 2D, 3D, 4D, virtual ultrasound, liver analysis, lung analysis, coronary CT/MR analysis and cardiac fusion. Fuji also debuted Synapse™ Communications®, which is a comprehensive tool set for critical results reporting, peer review and embedded task list management.

MEDRAD Inc. (Warrendale, PA) demonstrated its PACS injection-record integration capabilities. The Connect.PACS™ product is part ofthe company’s Certegra™ Informatics Platform. Certegra products automate record keeping; integrate injection records into PACS; personalize contrast dosing (P3T™); integrate CT scanner and injector operation (ISI); and enable remote equipment service. Connect.PACS immediately transfers a patient’s CT contrast-injection record to PACS, eliminating the need to manually enter injection information. The injection record transfer enables radiologists to view injection protocols alongside the patient’s PACS image set for real-time and retrospective image analysis.

CoActiv (Ridgefield, CT) added a host of new features to its EXAM-PACS Web-based PACS. Those features include an iPhone exam-viewing system, instant voice report creation, support for running EXAM-PACS on Windows 7, and on Mac OS X with both the current free version of the OsiriX DICOM Viewer and the new FDA-cleared OsiriX viewer. The solution also features improved spine labeling with cross-sectional axial reference labels that automatically appear as a coronal or sagittal series are labeled.

MEDecision Inc. (Wayne, PA) provided the key technical infrastructure for the Integrating the Healthcare Enterprise (IHE) Image Sharing demonstration. The demonstration featured one of the first image-enabled personal health records (PHR) and showcased MEDecision’s interoperability with Microsoft® HealthVault.

Candelis Inc. (Irvine, CA) showcased its cloud-hosted data services, which can receive images and reports from a hospital or imaging center PACS and act as a universal access point for referring physicians. Referring physicians are automatically notified when studies and reports are available, which they can then easily review with Candelis-provided toolsets.

Mirada Medical (Oxford, U.K.) distributed free copies of its new Casebook case viewer program. Casebook is a plug-in to Microsoft®PowerPoint® that simplifies presenting clinical cases for teaching and symposiums.

TeraRecon Inc. (San Mateo, CA) and M*Modal (Pittsburgh, PA) showed a demo of how the companies can integrate quantitativeanalysis into the image interpretation process. TeraRecon’s Aquarius iNtuition, an enterprise-wide server-based advanced visualization and decision support technology, provides clinical applications that are capable of performing user-defined clinical workflow and measurement protocols to achieve quantitative interpretation with online RADLEX lookup for terminology and export of results using the Annotation Image Markup (AIM) schema. The exhibit also featured the integration of Aquarius iNtuition with M*Modal’s Any Modal CDS speech understanding system that accepts AIM data and translates additional physician dictation in real time into astructured document in HL7 CDA format.

BRIT Systems (Dallas, TX) announced a new browser-based application for simple, cost-effective viewing of patient images and reports on any computer with an Internet connection and a Web browser.Webworks, designed for viewing by referring physicians and their patients or for low-volume review by radiologists, performs real-time updating of patient lists and uses clustering technology fortrue redundancy and load balancing. BRIT also announced that it has added EMR-type tools to its Roentgen Works family of products. The additions include: Roentgen RIS EMR tools such as computerized physician order entry, creation and sharing of Continuity of Care Records, patient portals, enhancements to capturing patient allergy and drug information and patient communication tools.

Siemens Healthcare (Malvern, PA) introduced syngo®.via, which is the company’s new imaging software for multimodality reading of clinical cases. syngo.via automatically loads images into the appropriate application and sorts them into the corresponding layout – preprocessed according to disease-specific requirements, thereby eliminating the need to manually choose the application, load data and select corresponding layouts. syngo.via integrates imaging devices and IT, and it has no-click integration with Siemens new PACS:syngo®.plaza. Through this integration, images are auto-routed and automatically available on syngo.via.

Thinking Systems Corp. (St. Petersburg, FL) showcased its upgraded ThinkingPACS™ and ThinkingRIS™ solutions designed andoptimized for multimodalities, especially for molecular imaging. New features include solutions for PET-CT and SPECT-CT fusion; nuclear cardiology processing, quantification, and template-driven structured reporting; general nuclear medicine processing and review;and echocardiology Web-based review and structured reporting.

Carestream Health Inc. (Rochester, NY) demonstrated future upgrades to its latest PACS platform and showcased its new RIS. Upgrades to the newest version of CARESTREAM PACS will equip radiologists with tools to enhance productivity by bringing reporting capabilities into a multisite solution that already includes clinical information, image data and interpretation tools. These reporting capabilities will complement the existing ability of CARESTREAM PACS to perform cross-site reading through a unified global worklist. Carestream Health also showed its new SuperPACS™ Architecture, which can streamline workflow by allowing radiologists in any on-site or remote location to read from a global worklist that provides a unified set of imaging studies created from multiple vendors’ PACS located throughout the enterprise.

Visage Imaging®Inc., (Parsippany, NJ) a wholly owned subsidiary of Pro Medicus Ltd. (Andover, MA), has partnered with Definiens, (Munich, Germany) to develop advanced oncology solutions for the clinical and preclinical imaging domain. Definiens will use the Visage®CS enterprise visualization application in its forthcoming Definiens LymphExpert™ Version 2.0. By quantifying lymphnodes not only according to RECIST and WHO guidelines but also by their volume, the new integrated solution allows for efficient lesion analysis including automated quantification of lymph nodes. Visage’s technology provides a thin-client based interface for full local andremote access.

Sony (Park Ridge, NJ) released the UP-D25MD digital color dye sublimation printer, which is optimized for ultrasound applications.The UP-D25MD offers an ultra-compact footprint and a range of enhanced features. It adds a new option for laminated media, providing long-lasting picture quality with high resistance to water and fingerprints.

Barco (Kortrijk, Belgium) upgraded its Nio line of medical-grade displays with a new 5 megapixel offering. The Nio 5MP uses a new LCD panel based on IPS (in-plane switching) technology. With this technology, grayscale images are presented with more brightness, improved contrast and better black uniformity, under any ambient light condition. Furthermore, the new panel has extra-high resolution of2096 × 2800 pixels, while at the same time still supporting the 2048 × 2560 standard.

GE Healthcare (Chalfont St. Giles, U.K.) announced that the Centricity® Precision Reporting solution is now integrated within Centricity PACS. This solution weds efficient workflow with a sophisticated speech-understanding engine to capture patient data throughout the radiology reporting and image archiving processes. GE also debuted Centricity® OneView Global Reading™, which enables access to images and information across disparate systems and multiple vendor solutions within a single worklist.

Acuo Technologies (Bloomington, MN) announced AcuoShare, which allows image sharing across a network of hospitals. AcuoShare is based on the company’s DICOM Services Grid™ Software. The solutions enable secure access from various PACS tomedical images from sources throughout the healthcare enterprise.

Philips Healthcare (Andover, MA) introduced the Philips Media Distribution Center (MDC), which is a PACS solution that comes in at a low price point and offers modular functionality. The MDC PACS delivers an easy-to-use, easy-to-install image management systemat a low cost of ownership to help fulfill the requirements of image viewing, distribution and archiving.

Women’s Health

FUJIFILM Medical Systems USA (Stamford, CT) spotlighted a new DR-based full field digital mammography system: the Aspire-HD. The system employs a new 24 cm × 30 cm, amorphous selenium detector with Direct Optical Switching and a 50 micron pixel size. Additionally, the system’s bucky design addresses patient comfort while assuring maximum access to the chest wall. Fuji also showed its Aspire ClearView CR-based FFDM system, which provides 50 micron resolution and dual-side detector reading.

GE Healthcare (Chalfont St. Giles, U.K.) introduced the Senographe® Essential®e mammography system with a 3 megapixel (MP) monitor. The system offers the doctor’s office, screening clinic, mobile unit or hospital all the benefits of the Senographe Essential platform and in an upgradeable package, e.g. initially using the system for screening and then adding interventional components.

Philips Healthcare (Andover, MA) introduced the Integral Breast Workspace, which includes the MammoDiagnost VU, multimodality breast applications and DynaCAD Enterprise Solution for advanced data analysis on a single work spot. The Integral Breast Workspace is also a multivendor workstation. Philips also showcased the MammoDiagnost DR1, its digital solution for mammography.

Siemens Healthcare (Malvern, PA) released the syngo® MammoReport reporting workstation. The workstation enables multimodality reading of MRI and ultrasound images in 1 location. Siemens also showed its MammoTest™ digital prone table biopsy system with a large, 11 cm breast aperture. Additionally, the company demoed its women’s imaging configured ACUSON S2000 and ACUSON X300™ premium edition systems. Further, the ACUSON S2000 ABVS system takes operator dependence and variability out of breast ultrasound, with automated breast volume scanning.

Agfa HealthCare (Mortsel, Belgium) promoted results from a study using its IMPAX for Breast Imaging workstation to compare the interpretation times of screen-film mammography and soft-copy digital mammography. In this phase-3 study of 295 patients, researchers found that digital mammography decreased the amount of interpretation time needed.

Carestream Health Inc. (Rochester, NY) has expanded its portfolio of women’s healthcare solutions with the announcement of new“work in progress” screens for its CR mammography imaging systems. The new EHR-M3 screens will feature reduced noise and a higher DQE for improved image quality. Availability is slated for first quarter of 2010.

Dilon Technologies (Newport News, VA) was bolstered by positive results from several studies presented at RSNA. Notably, the company’s Breast-Specific Gamma Imaging (BSGI) was shown to significantly contribute to the detection of malignant or high-risk lesions in patients with negative or indeterminate mammographic findings, according to results of one multicenter study.


Philips Healthcare (Andover, MA) demonstrated the latest version of the iU22 ultrasound system featuring advanced breast imaging capabilities, including elastography. Elastography on the iU22 system with L12-5 transducer and Advanced Breast Tissue Specific Imaging (TSI) preset enables clinicians to differentiate relative stiffness of tissue through sonographic examination.

GE Healthcare (Chalfont St. Giles, U.K.) announced expanded capabilities on its LOGIQ��E9 general imaging ultrasound systemwith new transducers and software enhancements to provide improved image quality and productivity to pediatric, vascular and cardiac imaging.

Hitachi Medical Systems America Inc. (Cleveland, OH) demonstrated its Real-time Virtual Sonography (RVS) feature. It allows Hitachi ultrasound systems to import volume data sets from modalities like MRI or CT and then correlate that data with a live ultrasound image. As the patient is being scanned with ultrasound, RVS identifies the position of the probe and simultaneously reconstructs a corresponding slice from the imported volume to match the live ultrasound image.

U-Systems Inc. (Sunnyvale, CA) announced a significant upgrade for its somo-v™ Automated Breast Ultrasound System (ABUS). The INSIGHT Class release incorporates a series of image quality and analysis enhancements that help radiologists visualize and differentiate complex breast tissue, enabling fast and accurate image review.

Siemens Healthcare (Malvern, PA) highlighted a new release of its premium ACUSON S2000™ ultrasound platform featuring significant advancements in Acoustic Radiation Force Imaging (ARFI) and contrast imaging, as well as a complete new imaging line for OB/GYN. With Virtual Touch Tissue Quantification functionality, the system provides a numerical value related to tissue stiffness at aprecise anatomical location.

ZONARE Medical Systems Inc., (Mountain View, CA) upgraded its ultra system with advanced software applications and transducers that deliver premium image quality and performance across a variety of clinical applications. New capabilities included contrast-enhanced imaging studies, comprehensive elastography applications and 3D imaging.


Hitachi Medical Systems America Inc. (Cleveland, OH) announced that it will provide a no-cost upgrade to users of its 1.5T Echelon system. The upgrade will include Hitachi’s RAPID™3D and RADAR™ capabilities, along with the ORIGIN 2.0. RAPID 3D provides multidirectional acceleration for parallel imaging. RADAR Spin Echo, Balanced SARGE and prime FSE/FIR add to Echelon’s motion-compensation tools. The Origin 2.0 software release includes additional pulse sequences, clinical capabilities and workflow enhancements.

Philips Healthcare (Andover, MA) spotlighted the Achieva XR 1.5T MRI scanner which can be upgraded to a 3T system. The ability to adopt 3T technology via a software and accessories upgrade can help save healthcare providers between $750,000 and $1 million when compared with removing an existing system and installing a new scanner. Philips also spotlighted the Elite Breast, which is a complete clinical solution for Philips 1.5T and 3.0T MRI systems. The solution can reduce total exam time by 10 minutes, which could result in a 30% improvement in clinical throughput.

Siemens Healthcare (Malvern, PA) introduced Tim®4G, Total imaging matrix technology and Dot™, Day optimizing throughput engine. Both technologies are now available on the new MAGNETOM® Aera 1.5T and the new MAGNETOM Skyra 3T MR systems. The combination of Tim 4G and Dot delivers patient-centered care and significantly improved productivity across the entire MRI workflow. Tim 4G, now available with up to 204 coil elements and up to 128 receive channels, takes flexibility, accuracy, and speed to the next level. Dot offers patient personalization, user guidance, and exam automation to help optimize every part of the practice.

Toshiba America Medical Systems Inc. (Tustin, CA) demonstrated its patient-focused MR systems, such as the Vantage Titan™ MR. These systems incorporate design elements such as Pianissimo™ technology, which reduces noise by up to 90%; proprietary contrast-free magnetic resonance angiography techniques; and Toshiba’s Atlas Technology, which eliminates the need to reposition patients during exams by integrating the coils into the table. These features reduce exam time and make the exam more comfortable for the patient. The Vantage Titan’s OpenBore offers a 71 cm aperture and a large clinical field of view (55 cm × 55 cm × 50 cm).

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Gaining momentum.  Appl Radiol. 

February 08, 2010

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