Greg Freiherr has reported on developments in radiology since 1983. He runs the consulting service, The Freiherr Group.
Slice Wars, Dose Wars…No Wars
Computed tomography (CT) is caught in the throes of an uneasy peace. The war days, when the big four – Toshiba, Siemens, GE and Philips – fought for market share with mega-slice machines, are gone. It looked for a while that a war waged with dose reduction technologies might propel the industry forward, but it just hasn’t happened.
Slice wars propelled the industry – 4 slices, then 16, then 64 — with momentum sustained through a couple of half-steps in between. An abundance of 64-slice scanners, created by the last great surge in CT buying six years ago, satiated much of the appetite in the United States for new scanners. The result for vendors was an unnerving plunge that since 2006 has cut the $1.7 billion market for new CT units by more than half.
When the bottom fell out of the market, dose reared an ugly head and CT algorithms, initially developed to improve image quality, were leveraged to bring down patient radiation exposure. The most advanced of these were and continue to be computing-intensive. They render the best results when built into new systems rolling off production lines. But the installed base has not embraced dose-saving technologies as it did slices. And for good reason.
Many features designed to control patient X-ray dose had been onboard CT scanners for years. They simply weren’t being used very much. Just as we use only a fraction of the capabilities available to us in our word processing software, so had the radiology community overlooked many of the dose-cutting technologies that were right at their fingertips.
Increased awareness of these capabilities, and the need to use them, have led many in the community to adopt their use. Upgrades – and the purchase of some new systems – have led to further reductions in dose. But the response to dose has been far from that to slices.
As we make plans again for our post-Thanksgiving pilgrimage to Chicago’s McCormick Place, we can expect to see dose reduction technologies bannered across the booths of RSNA exhibitors and talks by presenters. But those messages will be conveyed in an atmosphere of peace not war…much to the dismay of exhibitors.