Greg Freiherr has reported on developments in radiology since 1983. He runs the consulting service, The Freiherr Group.
How to Create Meaningful Innovations in Imaging
A suspected pulmonary embolism on a conventional CT image (left (or top), red arrow) is confirmed on a spectral CT by the presence of a corresponding wedge-shaped perfusion defect (right (or bottom), red outline). The spectral image was reconstructed when conventional CT images were not enough to form a definitive diagnosis. All data was acquired simultaneously using a Philips IQon Spectral CT scanner. (Images courtesy of Dr. Gopal V. Punjabi, Hennepin County Medical Center)
It isn’t enough for engineers today to simply design what might be technologically possible. Their innovations must be “meaningful,” said Kees Wesdorp, business group leader of Diagnostic Imaging at Philips. They have to provide the right information, at the right place, and at the right time — fast, reliably and affordably. (You can read the first blog in this series, "How Playing the Long Game Works for Philips and its Customers," here.)
Critically important, asked Wesdorp: “How can we help imaging services become much more effective, efficient and productive?”
Philips’ IQon Spectral CT is one answer. The premium CT scanner provides clinicians with spectral data every time a patient is scanned, without the need for upfront decision-making or patient pre-selection. This can be a time and cost saver.
“If conventional CT images are not diagnostic, spectral images that might confirm — or dispel – a suspicion can be reconstructed,” said Gopal V. Punjabi, M.D., chief of body imaging at Hennepin County Medical Center in Minneapolis, Minnesota.
Alternatively, spectral images might be routinely reconstructed from existing data to spare the patient — and the provider — a second scan. For example, a clinician would have the ability to create a non-contrast image from a contrast enhanced CT by utilizing the virtual non-contrast spectral result.
Spectral CT On-demand
Conventional images routinely serve as a starting point for making a diagnosis. But in the emergency department (ED) at Hennepin County Medical Center, conventional images may not always provide all the information radiologists need. Spectral CT images available from the IQon Spectral CT can be — and are — reconstructed if and when needed, sometimes days after the initial scan.
The IQon’s detector simultaneously records photons of different energies. The resulting data allow quantitative analysis and tissue characterization, which increases diagnostic confidence.
The Hennepin ED often uses spectral data to create “virtual” non-contrast images. The images, which are reconstructed from data captured during scans in which contrast was injected, help when Punjabi must determine whether incidentally detected adrenal nodules are benign or malignant. These nodules, often found in emergency patients complaining of abdominal pain, are just one type of incidental finding.
“Clinicians are drowning in a tsunami of incidental findings,” he said. “It is not uncommon to miss some of them that can be really significant — ones that end up being cancers.”
On-demand spectral imaging helps keep this from happening, according to Dr. Punjabi. Iodine maps, reconstructed from spectral data, are used at the Hennepin ED to determine whether kidney lesions, for example, are cancerous. They have also been used to characterize perfusion defects in the lung.
“The likelihood of pulmonary embolism is not that high, but you want to be sure,” said Punjabi, noting that on-demand spectral CT “really dramatically increases confidence.”
The Hennepin ED has also converted non-diagnostic scans into diagnostic ones using reconstructed images from spectral data obtained at lower energies. This, like other applications of spectral CT data, can save time and cost by eliminating the need for follow-up scans.
“But, to me the biggest benefit of spectral CT is being sure that patients with incidental findings get appropriate care,” Punjabi said. “It is personally fulfilling.”
Other Meaningful Devices
To be meaningful, technology need not be advanced or sophisticated — at least not to the level of IQon Spectral CT. Philips’ Ambient Experience patient in-bore solution calms patients during MR scans by surrounding them inside the scanner bore with images of landscapes, seascapes or other relaxing visual themes. To round out the experience, relevant sounds are piped into headphones worn by patients during the exam.
Herlev Gentofte University Hospital in Denmark designed the scanner environment, implementing the Ambient and audiovisual in-bore experience to improve patients’ MR experience. The effort helped reduce patient motion and increase efficiency. In a recent case study at Herlev hospital, researchers reported a 70 percent reduction in rescans with MR Ambient and in-bore experience.*
Intuitively these results make sense. Less anxious patients are more relaxed, making them less likely to move during an MR scan. This reduces motion artifact, which improves image quality and promotes greater diagnostic confidence. As the number of rescans goes down, so do costs. At the same time, revenues rise from increased throughput.
But there’s a higher purpose than the bottom line, said Philips exec Wesdorp: “We just have an ethical obligation to make the best possible experience that we can for the patient.”
Making Innovations Meaningful
Innovations have to promote the gathering of clinical results that help patients, he said. The results must be accurate and reliable. And the equipment and devices must be easy for staff to use and make the procedures more comfortable for patients. Philips conducted its own patient experience of imaging research to understand what’s most important to patients when undergoing imaging procedures.
Meeting the criteria for meaningful innovation is tough, Wesdorp said. Meaningful devices must drive patient throughput and lead to confident diagnoses — inexpensively and fast. “We have to take a people-centric approach to our solutions,” he said. “What makes it meaningful is if it leads to better patient care.”
* Compared to the average of the other five MR scanners without ambient and in-bore experience. Relaxed patients, reduced motion, improved productivity. Fieldstrength MRI Magazine — June 2016. Philips notes that results from case studies are not predictive of results in other cases; results in other cases may vary.