Feature | March 24, 2008 | Rick Dana Barlow

Web Exclusive: RSNA 2007: What Tech Trends Emerged?

Amped-up software, modular upgrades, women’s healthcare defining progress

CHICAGO – Three-digit-slice and high-definition computed tomography may have turned heads at The Radiological Society of North America’s annual meeting and exhibition at Chicago’s McCormick Place during its usual post-Thanksgiving holiday berth (Nov. 25-30, 2007), but souped up CT scanners didn’t necessarily overshadow some of the key – and newsworthy – technology trends at the show.

RSNA 2007 stressed several themes that have become quite familiar in the last few years.

One involves cultivating the growing partnerships between diagnostic radiology and radiation oncology with its new “Bolstering Oncoradiologic and Oncoradiotherapeutic Skills for Tomorrow (BOOST) program that included four days of educational courses highlighting case-based reviews, scientific papers and practical tips. RSNA officials who created and developed BOOST emphasized that radiation oncologists need to work together with diagnostic radiologists because if they know where cancer is located they can treat it better. Another theme addressed how to deal with reimbursement threats and job security fears by emphasizing continuous quality improvement measures.

Once again, RSNA closed out 2007 spotlighting some noteworthy developments that continue to emphasize the impact of information technology on the industry, as well as revitalizing some fundamental modalities and products.

The yearly conference and exhibition provided nearly 28,000 radiologists and other related healthcare professionals and slightly more than 28,000 exhibitor representatives with glimpses into what’s hot in diagnostic imaging and IT-related market segments, along with peeks at practice management, oncology and surgery tie-ins.

What follows are a few observations and revelations at the annual near-year-end diagnostic imaging extravaganza by Outpatient Care Technology.

Women’s healthcare generated significant traction – not just imaging but also image-guided surgery. And amid the popular “think pink” refrain for breast cancer was an undercurrent on the color red, as in heart disease, which is the leading killer of women. That meshed quite well with the cardiac-driven high-speed CT technology.

In fact, many of the larger manufacturers showed they were putting considerably more marketing and research and development muscle behind their women’s healthcare technology repertoire. With such an infusion of economic investment, scientific know-how and technological development to empower women battling certain diseases, the key strategy going forward is how to get all of this technology into the hands of the clinicians providing care – clinicians facing reimbursement cutbacks, worker shortages, IT challenges and paperwork headaches.

Also, it seems like ultrasound may be enjoying a clinical and technological renaissance in the face of the higher-end modalities as vendors rolled out new models with new features and benefits.

And as software capabilities become more robust in decision-support to help clinicians deliver accurate, high-quality care for their patients, there are looming questions about whether the details computers capture will influence clinician practice too much and how that information may be used by payers in malpractice cases or even in databases when negative outcomes are recorded.

While tomosynthesis may have been the buzz at RSNA 2006 when several of the key industry players projected that the three-dimensional breast imaging technology would make its commercial debut in time for the 2007 meeting, the big splash didn’t happen. That’s because those key industry players poised to unveil tomosynthesis units for breast applications said they expect providers will have to wait until late 2009 – at the earliest – for the technology to gain marketing clearance.

One company displayed a new MRI model that enables surgeons to conduct biopsies, as well as let them insert claustrophobic patients feet first. It’s their alternative to the open MRI, which tends to require a heavier magnet or moving the plates closer together for better image quality.

Another company demonstrated an upright breast biopsy system – similar to standard mammography – that is available as an option outside of the U.S. but may become available in the future.

Workstation multifunctionality reigned supreme. Whether it involved computer-aided detection (CAD), mammography or the various other modalities, newer workstations seemed to emphasize being “vendor-neutral” and “modality-agnostic” as “soup-to-nuts,” image capture to output technologies. Also, most offered Web-based functionality that allows clinicians to view data and images from any desktop or on any personal computer.

If ultrasound was the new black at RSNA 2006, then bone densitometry represented something of a Cinderella at RSNA 2007. Arguably a mature technology and procedure for an aging marketplace, it’s eyeing a resurgence in popularity. One major vendor indicated it was working on a 3D imaging capability while another was specializing its model to analyze the finger bones rather than the abdomen/torso area.

Not surprisingly, software continues to progress far enough beyond what clinicians need right away but not far enough out to be relegated to the “cool, but not for me right now” sci-fi philosophy. One company promoted its software that helps doctors order the right tests, assisting them to justify their decisions and tracking behavior and performance.

However, questions were raised about whether this advancement broached Big Brother territory, a sensitive topic in a medical-error-fearing, Medicare-reimbursement-challenged market. That a software application could motivate clinicians to second-guess themselves or payers to question clinical decisions in the guise of encouraging clinicians to think critically, mentally balancing clinical and financial viewpoints while not compromising patient care, may signal the start of a long-running debate. But with The Joint Commission stepping up accountability and quality efforts and the Centers for Medicare and Medicaid Services denying reimbursement for care and treatment stemming from medical errors, such a debate is unlikely to be quashed.

One company demonstrated an intriguing software capability: Imagine a cone-beam CT image of a curved spine that allows the clinician to reformat and straighten onscreen so he or she can see the spaces between the vertebrates.

A number of the larger-volume vendors promoted technology upgrade paths to retain customers. Given the aftermath of reimbursement cutbacks, a growing number of vendors with broader and larger product lines are motivating providers to upgrade units rather than switch to a competitor’s product. While upgrade paths certainly aren’t a new phenomenon vendors were highlighting this strategy as a cost-effective alternative – switching out components or changing software applications and packages to minimize costs incurred from retraining end users. Vendors also view it as a way to compete with the secondary market in controlling expenses.

Magnetic resonance of the breast enjoyed a popularity boost, thanks in part to the American College of Radiology’s guidelines for annual mammograms and breast MR exams. Breast MR remains a hot topic and a technology to watch, particularly as it relates to CAD and paired with breast biopsy.

Computed radiography is not dead. Far from it. While you may be able to stick a fork in film, CR remains healthy and hearty for a number of vendors who expressed significant demand for their systems in the face of digital radiography’s growth. Some vendors emphasized, however, that DR, historically popular among hospitals, slowly has been making inroads into the outpatient arena as it becomes more affordable.

CAD is gaining traction, too. Despite the controversial and CAD-critical New England Journal of Medicine study last year, which generated more media heat than customer rejection, CAD sales remain brisk as vendors predicted to Outpatient Care Technology a healthy future for CAD for mammography, breast MR, ultrasound, chest, lung, colon, and down the road, prostate. One vendor touted CAM, or computer-aided measurement, capabilities, which automatically sizes lesions, eliminating the need for manually directed measurements by clinicians.

RSNA 2008, which occurs Nov. 30- Dec. 5, in Chicago’s McCormick Place, pushes boundaries with a more worldwide approach as reflected in its educational theme, “Personal Learning in the Global Community.”