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New imaging technologies announced at RSNA in Chicago

By Jerry Zeidenberg

It’s being called the first real implementation of a Vendor Neutral Archive in Canada. Fujifilm Medical Systems, through its new acquisition, TeraMedica, has won the contract to install a system that can store and manage all types of images and data, at the Peterborough Regional Health Centre, in Peterborough, Ont.

The solution will include components such as PACS, 3D imaging, cardiovascular (cath lab and ECG), and a mobile enterprise viewer. Christie Innomed has represented Fujifilm in Canada since 1964. (www.christieinnomed.com)

Fujifilm was publicizing the win at the recent Radiological Society of North America (RSNA) meeting, held last December in Chicago, where over 50,000 attendees congregated for continuing education in diagnostic imaging and to visit the trade show in the vast exhibition halls.

Christie Innomed and Fujifilm were also showing an innovation in flat-panel DR, with what’s said to be the lightest portable detector panel on the market. Available in 14 x 17 and 17 x 17 sizes, the wireless detectors are 20 percent lighter than Fujifilm’s previous panels. Moreover, the FDR-DEVO II units have an anti-bacterial coating, and their internal memory enables them to store up to 100 images before uploading.

Many DI companies wait for the RSNA conference, held each year just after the American Thanksgiving, to make major announcements about new products and technologies.

For its part, Carestream had some very interesting product introductions – most notably, a small and moveable cone-beam CT (CBCT) system for imaging extremities. The machine sits like a super-sized doughnut on the floor, but has an opening for a patient to walk through; this enables weight-bearing studies to be done, such as examinations of knees and other leg joints.

The doughnut flips up, using a motorized mechanism, so that a patient can also sit upright and have image taken of outstretched legs and arms.

“Orthopaedics is a major area of focus for our company because of the prevalence of musculoskeletal conditions among people of all ages,” said James Burns, Carestream’s chief technology officer for the Digital Medical Solutions business. “We are actively involved in evaluating CBCT and other types of imaging technologies that may be able to provide diagnostic information that is not readily available using existing imaging systems.”

The CBCT is powered by simply plugging it into a standard wall socket, and it can be moved around a hospital as needed.

The benefit? It can take the load off high-powered CT systems that are needed for more sophisticated exams.

And at US$210,000 to $250,000, it can be used in outpatient clinics. “This would be much faster for the patients, since they can be imaged right there, and they don’t have to be referred for an outside exam,” said Burns.

While the CBCT is currently a work-in-progress, Carestream is applying for U.S. FDA approval and Health Canada certification this year. It has already been conducting tests at the University of Buffalo, Johns Hopkins University Hospital in Baltimore, Md., and at a site in Helsinki, Finland.

For its part, Agfa HealthCare has announced the launch of its portal designed for both patients and clinicians as part of its larger Enterprise Imaging platform. The portal consolidates access to images and data across the enterprise, using a federated model. The information remains in the various databases in which it originates, and is pulled into the portal for the user on an as-needed basis.

Various diagnostic images can be called up, pulled from multiple databases. So too can lab and pharmacy data, test results and patient encounter notes.

“It’s not just for images, it can be used for a wide variety of information, by both clinical users and the patients themselves” said Lisa Shoniker, regional vice president of sales for Canada. As well, it can be used to enable patients to fill out forms, and if applicable, to upload images before arriving at hospital for appointments and tests, saving time and trouble for themselves and administrators.

“It’s less stressful for patients to fill out questionnaires at home when they’re relaxed,” said Shoniker. “And they can do it before coming to the hospital, so if there is a problem or complication, it can be flagged before they arrive for the test or procedure.”

Jason Knox, radiology product manager, noted that the portal can be used to link clinicians enterprise-wide, or even region-wide, as it connects various systems in an effortless manner. “It’s an exchange solution that can be built into our larger enterprise system or stand on its own,” he said. “It simplifies collaboration.”

In the future, patients will be able to make or change appointments, check lab and test results, and interact with their physicians and nurses.

Agfa HealthCare had Canadian implementation news of its own at RSNA. Namely, the province of Alberta is installing a province-wide peer review solution from the company.

At Philips, a good deal of excitement was generated by the appearance of the Lumify ultrasound for Android devices, one of the first smartphone-based ultrasound systems with software apps downloaded from an online portal. The hardware probes are sent to users via courier, and the customers pay for it all through a monthly charge. It’s currently available at an introductory price of US$199 per month.

Physicians can test the system for a few months, and if they like how it works, continue to use it. If they don’t find it useful, they can cancel and send back the probes.

Philips currently offers two Lumify probes, one flat and the other curved. The flat probe is optimized for vascular imaging, thyroid, breast and musculoskeletal imaging. The curved probe is aimed at abdominal imaging and obstetrics.

According to Philips, the power of the system is found in the probes, and a great deal of ingenuity was put into miniaturizing the electronics to achieve high performance.

At RSNA 2015, Philips also introduced ScanWise Implant, among the first MRI-guided user interfaces to simplify the scanning of patients with MR conditional implants. These include knee and hip replacements, spine implants and pacemakers.

According to Philips, the new software helps streamline exams and supports diagnostic confidence of this growing patient population. ScanWise Implant helps to improve hospital workflow and diagnostic confidence.

MRI is often used to diagnose conditions such as neurological disorders, cancer, and muscle, joint and back pain. These conditions are most prevalent in older patient populations, and the population with large joint replacements and implanted cardiac devices is expected to increase by about 70 percent over the next five years, the company said.

However, implants can create a number of challenges with MRI exams. For example, it’s difficult for clinicians to understand and scan within the safety limits defined by each implant manufacturer. These limits are not always clear or easy to implement on the MR scanner, causing patients with MR conditional implants to often be denied MRI exams. In fact, every year 300,000 patients in the U.S. are denied access to MRIs because of a cardiac implantable electronic device.

However, these patients can be scanned, if the radiographer has enough information; with ScanWise Implant, the operators input the information and the system automatically makes the needed adjustments. Philips is currently seeking approval for the solution with the U.S. FDA and with Health Canada.

Meanwhile, workstation specialist Barco was touting the virtues of its advanced workstations, such as the 12 megapixel Coronis Uniti. These systems are currently being installed in Winnipeg, as high-end stations capable of reading any type of exam – including demanding applications like breast MRI, breast ultrasound, CT and ultrasound, and vascular and gynecological ultrasound.

The Coronis Uniti stations have new, intuitive features that enable radiologists to streamline their workflow and complete entire studies on a single display, increasing their reading efficiency while reducing stress, strain and fatigue.

For example, they can direct a cursor across multiple screens using the same handheld mouse. The Uniti workstations are four times as bright as any other display on the market, Barco says, giving radiologists more certainty when they’re reading exams.

Siemens introduced a new MRI application called GOBrain that enables clinically validated brain examinations in just five minutes. It was developed in collaboration with the Department of Radiology at Massachusetts General Hospital in Boston.

It’s made possible, in part, by Siemens’s high-channel density coils and MRI scanning software, called DotGO. The company says that essential image orientations and contrasts are acquired at the push of a button. Patient throughput is improved, and costs per scan can potentially be reduced. Siemens said that shorter scan times are better tolerated by patients, and can help reduce rescans and/or sedation, which can be time-consuming and costly.

Brain scans account for around 20 to 25 percent of all MRI examinations, Siemens asserted, and fast examinations are essential for maintaining an efficient workflow. The number of brain MRI examinations is expected to grow in 2016, with an expected 45 million neuro exams out of the 180 million MRI studies of all types expected worldwide.

In addition to its announcement about a health cloud (see our story in this issue on page 18), GE Healthcare also introduced innovations in MR.

In particular, GE Healthcare launched ViosWorks, a cardiac MRI solution that addresses several cardiac MR challenges at once – and reduces the time of a cardiac exam from 60 minutes down to just 10 minutes.

According to the company, ViosWorks delivers a three-dimensional spatial and velocity-encoded dataset at every time point during the cardiac cycle, yielding high resolution, time-resolved images of the beating heart and a measure of the speed and direction of blood flow at each location. ViosWorks captures seven dimensions of data (three in space, one in time, and three in velocity direction).

With this free-breathing scan, typically acquired in less than 10 minutes, ViosWorks can simultaneously provide key elements of a cardiac MR exam: anatomy, function and flow. This provides four advantages.

• The exam is simplified for the patient by using a single 3D free-breathing scan.

• The error-prone and time-consuming aspect of slice positioning is removed.

• Co-registered anatomic images provide the ability to assess cardiac functioning 3D and contextualize flow abnormalities, and as a result, the cardiac exam can be reduced from over 60 minutes to approximately 10 minutes or less.

• New algorithms allow large datasets unimaginable before to be evaluated in real-time via the cloud based ArterysT software.

For its part, Toshiba announced a new, high-powered Iterative Reconstruction technology for lower dose CT imaging – a system it has dubbed FIRST. (It’s short for Forward Projected model-based Iterative Reconstruction SoluTion.)

The system produces high-res reconstructions in three minutes, instead of what normally takes 30 minutes today, commented Arthur Voorpool, CT clinical product specialist at Toshiba of Canada Limited.

“It’s a major advance,” said Voorpool, adding that the images are acquired with small amounts of radiation. “It’s low dose at the same time.”

The FIRST system is still pending FDA approval in the U.S. and Health Canada licensing.

Toshiba also showed what it’s calling the industry’s first seamless integration of interventional radiology (IR) and CT technology into one solution.

Called the Infinix CT, the system combines the Infinix Elite angiography system and an Aquilion ONE Vision Edition CT scanner. It allows clinicians to plan, treat and verify in a single clinical setting.

“You can do angio and CT without having to move the patient,” commented John Morra, a senior clinical consultant for Toshiba of Canada Limited, Medical Systems Division.

What’s more, the CT exam is fast; the Aquilion ONE ViSION Edition is capable of capturing an entire organ in one rotation with 640 slices and 16 cm of true anatomical coverage, producing image quality that far exceeds CT-like imaging of the interventional lab.

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