ProFound AI is an FDA-cleared artificial intelligence (AI) system for reading 3-D breast tomosynthesis images. At RSNA19, ITN Contributing Editor Greg Freiherr spoke with iCad Chairman and CEO Michael Klein about the system, which has been clinically proven in a large reader study to produce an 8% average improvement in sensitivity, 7.2% average reduction in recall rate and 52.7% reduction in average radiologist reading time. 

The Arietta 850SE provides facilities with numerous features and functionality to get the most out of a system. The CMUT probe performs the role of multiple probes while the single-crystal C252 probe gets increased penetration. eFocusing simplifies scanning techniques and shearwave elastography provides unique feedback on tissue stiffness.

At RSNA19, David Widmann, president and CEO of Konica Minolta Healthcare Americas, discussed innovation, stressing the importance of academic relationships. 

Ajay Choudhri, M.D., chairman of radiology, Capital Health, Hopewell, N.J., explains his center's experience using an artificial intelligence (AI) application to help auto detect intracranial hemorrhage. There are several AI stroke auto detection apps now available with FDA clearance or in development that were shown at the Radiological Society Of North America (RSNA) 2019 meeting. These are being adopted by hospitals and multi-center radiology practices the U.S. to flag suspected cases of ischemic stroke or brain bleeds for immediate reads. 

The software also offers a second set of eyes for more difficult to detect cases. Quickly determining is a stroke is ischemic or hemorrhagic is critical to the path of treatment. If caught early enough, TPA can be injected into patients to clear clots causing an ischemic stroke, but can cause massive brain damage or death if injected into a patient with a brain bleed. At advanced neuro-interventional centers, quickly determining the type of stroke is needed to know if they need to revascularize a patient or manage a hemorrhage. 

Related Content:

How Artificial Intelligence Can Predict and Detect Stroke

MaxQ AI's Intracranial Hemorrhage Software to be Integrated on Philips CT Systems

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This is a hologram of a fracture from a computed tomography (CT) scan displayed by the start up company Voxon at the 2019 Radiological Society Of North America (RSNA) meeting. The technology uses a half millimeter thick glass plate that pulses up and down very rapidly while projecting 4,000 images per second. It can display standard DICOM radiology files or STL files used for 3-D printing.

There were at least four vendors showing holographic screens to display advanced visualization 3-D renderings of anatomy from medical imaging. All four of these screens could be viewed in true 3-D using normal vision without the need for special glasses or a virtual reality visor.

The images in this example flickers because of the different frame rates of the system and the iPhone used to film it, but the actual images appears much more stable.

This technology was also included in the VIDEO: Editors Choice of the Most Innovative New Radiology Technology at RSNA 2019

Photo Gallery of New Imaging Technologies at RSNA 2019

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Kevin Little, Ph.D., assistant professor and medical physicist, Department of Radiology, at The Ohio State University, explains how hospitals can better manage their computed tomography (CT) imaging protocols across their fleet of CT scanners from various vendors. He moderated a session on this topic at the 2019 Radiological Society of North America (RSNA) meeting.

He stressed the importance of CT protocol management to an imaging practice and showed examples of tools that can be used to develop consistent protocols across multiple systems. Little said it is important to develop awareness of the Management of Acquisition Profiles (MAP) IHE profile and features that should be requested from CT scanner vendors.

CT protocols, which include all clinical and technical parameters for a given study, are the starting point for achieving high-quality images with reasonable radiation and contrast doses. An imaging practice that desires to follow the "as low as reasonably achievable” (ALARA) principle and produce high-quality images should have standardized protocols across their enterprise. Accreditation standards require a periodic review of all scanner protocols. However, variations among vendors, models, and clinical indications mean that managing and optimizing dozens of parameters for each protocol on every scanner in a health system is challenging. Even when variations between systems are limited, managing protocol names and parameters across multiple systems can be difficult. The purpose of this symposium is to identify tools and techniques that may be used to manage protocols across multiple systems and to provide a framework for protocol optimization.

Mahadevappa Mahesh, Ph.D., chief of medical physicist and professor of radiology and medical physics, Johns Hopkins University, Baltimore, treasurer of the American Association of Physicists in Medicine (AAPM),a board member of the American College of Radiology (ACR), presented a late-breaking study on how medical imaging radiation dose has started to drop over the past decade. He is the co-chair of the National Council on Radiation Protection and Measures Report (NCRP), and presented the most recent NCRP data analysis at the 2019 Radiological Society of North America (RSNA) meeting.

The new NCRP 184 report covers the period between 2006 and 2016, the period of the most current CMS data. It shows a decrease of about 20 percent in the radiation dose the U.S. population receives from medical imaging, compared to the NCRP 160 that covered the period of up to 2006.

Key findings of the study include:

   • CT dose dropped about 6 percent, despite a 20 percent increase CT scans since 2006;

   • Drop of more than 50 percent for nuclear imaging scans, mainly due to fewer procedures being performed;

   • A 15-20 percent decrease across X-ray imaging modalities.

Mahesh says this shows the impact of using "as low as reasonably achievable" (ALARA) principals, new dose guidelines outlined jointly by numerous medical societies, and dose reduction initiatives like Image Wisely, Image Gently, and the American College of Radiology (ACR) Dose Index Registry.

He said there was growing concern a decade ago when the last council report was published, which showed a steep increase in radiation dose. This was mainly due to a rapid increase in the use of computed tomography (CT) and other types of X-ray based and nuclear radiotracer medical imaging. This prompted the ACR to create the Image Wisely program and push for the use of more thoughtful imaging doses based on patient size, using the "as low as reasonably achievable” (ALARA) principle. While CT dose was lowered, he said the biggest decline over all was in nuclear imaging.

Related Medical Imaging Radiation Dose Resources:

VIDEO: Radiation Dose Monitoring in Medical Imaging — an interview with Mahadevappa Mahesh, Ph.D.

The Basics of Radiation Dose Monitoring in Medical Imaging

How to Understand and Communicate Radiation Risk — Image Wisely

Radiation in Medicine: Medical Imaging Procedures

FDA White Paper: Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging

Radiation Dose in X-Ray and CT Exams

Radiation Dose from Medical Imaging: A Primer for Emergency Physicians

Radiation risk from medical imaging

FDA: Medical X-ray Imaging

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ITN Editor Dave Fornell and ITN Consulting Editor Greg Freiherr offer a post-game report on the trends and technologies they saw on the expo floor of 2019 Radiological Society of North America (RSNA) annual meeting. This includes artificial intelligence (AI), augmented reality, holographic imaging, cybersecurity and advances in digital radiography (DR) with a glassless detector plate, X-ray tomosynthesis, dual-energy X-ray and dynamic DR imaging. 

VIDEO: Editors Choice of the Most Innovative New Radiology Technology at RSNA 2019

Photo Gallery of New Imaging Technologies at RSNA 2019

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This is an example of the Mirada DLCExpert deep learning software that automatically identifies organs, segments and auto-contours them as the first step in creating radiation oncology treatment plans. This example of a segmented prostate computed tomography (CT) scan being used to plan radiotherapy was created without any human intervention. It was demonstrated at the American Association of Physicists in Medicine (AAPM) 2019 meeting. 

This example shows OAR Space hydrogel (outlined in blue) injected to create space between the prostate and the rectum to prevent damage to that radiation sensitive structure. The gel is hard to identify on the CT scan because it looks like part of the rectum or prostate. But the softwares AI has been trained to identify it when present.

The DLCExpert software was cleared by the FDA in July 2018 and was first shown at ASTRO 2018. It automatically identifies anatomical structures and contours them to save staff time. The files created by the software are vendor neutral and can be imported into any vendor’s treatment planning system. Read more about this software. 

Find more news and video from AAPM

This is a quick walk around of a mobile 32-slice computed tomography (CT) scanner used for surgery, brachytherapy and proton therapy on display by Mobius Imaging at the 2019 American Association Of Physicists in Medicine (AAPM) meeting. The system simply plugs into a standard wall outlet and all of the required hardware and software is built into the gantry. There is no need for an equipment closet, cabinet or server tower. The company said the CT system was created by some of the same developers who built the O-arm mobile CT system, but they said this CT scanner is much more compact.

This is a quick walk around of the new Siemens Somatom Go.top cardiovascular edition compact computed tomography (CT) scanner on display at the Society Of Cardiovascular Computed Tomography (SCCT) 2019 meeting in July. It is aimed at cardiology office based imaging and was released this past spring at the American College of Cardiology (ACC) meeting.

The system has removable tablets on each side of the scanner where the tech can adjust the machine, review scout scans and trigger the scanner. The idea is to improve workflow and allow the tech to remain at the bedside longer to be with the patient, rather tucked away in a remote control room using an intercom.

The entire system is built into the gantry seen here, so there is no need for extra equipment in a closet, cabinet or server tower.

It comes in a 128 slice configuration with 4 cm of anatomical coverage per rotation.

It uses the Stellar detector and tin filtration to eliminate low energy photons and help lower dose. It can be programmed to aid workflow by automatically removing bone, create cured planar reconstructions, lung CAD and other post-processing features so more time can be spent on reading scans. The scanner also comes with a HeartFlow FFR-CT starter pack.

Find more information on this system in these related articles:

New Cardiovascular CT Technology Entering the Market

New Technology Highlights on the ACC 2019 Exhibit Floor

Nate Bachman, graduate research assistant in the Human Cardiovascular Physiology Lab of the Dept. of Health and Exercise Science at Colorado State University, describes how he and fellow researchers used multiple types of cardiac imaging to evaluate the health of athletes who compete in endurance events lasting six hours or more, and what the results may suggest for future screening.

Watch the VIDEO: Key Topics for Radiology Administrators at AHRA 2019, an interview with AHRA President Chris Tomlinson, CRA, FAHRA, and President-elect Jacqui Rose, CRA, FAHRA.

Mark Ibrahim, M.D., FACC, assistant professor of medicine and radiology, associate program director, advanced cardiac imaging fellowship, University of Utah, explains what radiologists and cardiologists need to know what is needed from CT imaging prior to ablation procedures for atrial fibrillation (AF) and ventricular fibrillation (VF). He spoke at a joint session of the Heart Rhythm Society (HRS) and the Society of Cardiovascular Computed Tomography (SCCT) at the 2019 SCCT meeting. 

Find more SCCT news and videos

Cynthia McCollough, Ph.D., director of the Mayo Clinic CT Clinical Innovation Center, professor of medical physics and biomedical engineering and the 2019 president of the American Association of Physicists in Medicine (AAPM), shares her insights on the latest advances in computed tomography (CT) imaging technology. She spoke at the 2019 AAPM meeting. She also did an interview at AAPM on her president's theme for the 2019 meeting - VIDEO: Bridging Diversity in Medical Physics to Improve Patient Care.

Find more news and videos from AAPM.

Related CT Technology Content:

New CT Technology Entering the Market

VIDEO: Advances in Cardiac CT Imaging — Interview with David Bluemke, M.D.

Expanding Applications for Computed Tomography

VIDEO: Overview of Cardiac CT Trends and 2019 SCCT Meeting Highlights —Interview with Ron Blankstein, M.D., direct

VIDEO: 10 Tips to Improve Cardiac CT Imaging — Interview with Quynh Truong, M.D.

FFR-CT: Is It Radiology or Cardiology?

VIDEO: ITN Editor's Choice of the Most Innovative New Technology at RSNA 2018

VIDEO: Using Advanced CT to Enhance Radiation Therapy Planning — Interview with Carri Glide-Hurst, Ph.D.

VIDEO: Tips and Tricks to Aid Cardiac CT Technologist Workflow

Managing CT Radiation Dose

VIDEO: ITN Editor's Choice of Most Innovative New Cardiac CT Technology at SCCT 2017

New Developments in Cardiovascular Computed Tomography at SCCT 2017

VIDEO: Role of Cardiac CT in Value-based Medicine — Leslee Shaw, Ph.D.

Advances in Cardiac Imaging Technologies at RSNA 2017

VIDEO: The Future of Cardiac CT in the Next Decade — Interview with Leslee Shaw, Ph.D.

VIDEO: What to Consider When Comparing 64-slice to Higher Slice CT Systems — Interview with Claudio Smuclovisky, M.D. 

Cynthia McCollough, Ph.D., director of the Mayo Clinic Computed Tomography (CT) Clinical Innovation Center, professor of medical physics and biomedical engineering, and the 2019 president of the American Association of Physicists in Medicine (AAPM), explains the "building bridges" theme of the 2019 AAPM meeting. 

This theme was the focus of her president’s address at the 2019 AAPM meeting. She spoke on the theme of diversity and how to break down the barriers between various minorities, male-female, religion, national origin, etc. She gave many photo examples of how we pigeon hole people into neat categories and that we often say we have equally in society, however her images showed recent images of big political summits where there are no women present, or they were the secretaries in the background. She said in medical practice, department administration and collaboration on projects, people need to be cognoscente of bias they have engrained by culture for which they may not even be aware.

She showed a slide of the AAPM membership makeup by generation and said members need to keep in mind the way each generation thinks and communicates varies by their generation's life experience and upbringing. McCollough said understanding these differences can help bridge perceived gaps in communication. 

Find more news and videos from AAPM.

Quynh Truong, M.D., MPH, associate professor of radiology and medicine at Weill Cornell and director of cardiac CT, NewYork Presbyterian Hospital, offers 10 tips to help improve image quality for cardiovascular computed tomography (CTA) exams. She spoke on this topic at the Society of Cardiovascular Computed Tomography (SCCT) 2019 meeting.

Lawrence Tanenbaum, M.D., Radnet vice president and chief technology officer, discusses some of the artificial intelligence (AI) products in radiology that are now commercially available and how AI developments will impact PET, MRI and CT imaging. He spoke at the 2019 Radiology AI-Med conference.

He said AI is helping medical imaging in the following areas:
   • Identify urgent findings and flagging these on the top of worklists.
   • Computer aided detection capabilities that go beyond the traditional to improve efficiency, boost diagnosis and highlight unexpected findings. 
   • Improving diagnostic image reconstruction
   • Tools to enhance the speed, resolution, radiation dose and overall quality of advanced imaging.

Learn more about what AI tools vendors are developing to help medical imaging in the following links:

Technology Report: Artificial Intelligence at RSNA 2018

VIDEO: Editor’s Choice of the Most Innovative New Artificial Intelligence Technologies at RSNA 2018

VIDEO: Artificial Intelligence May Assist in Pediatric Imaging — Interview with Sudhen Desai, M.D.

VIDEO: Editor's Choice of the Most Innovative New Technology at RSNA 2018

VIDEO: AI That Second Reads Radiology Reports and Deals With Incidental Findings — Interview with Nina Kottler, M.D.

VIDEO: RSNA Post-game Report on Artificial Intelligence

VIDEO: AI, Analytics and Informatics: The Future is Here — Interview with Michael Recht, M.D.

This is a quick look inside the magnetic resonance imaging (MRI) neuro-interventional suite at Henry Ford Hospital in Detriot, Mich. This neuro-procedure room connects through a door to a traditional operating room and the patient can be transferred using a trolley cot system to move between the two rooms. The MRI is a Philips 1.5T Achieva and the MRI suite includes MRI-safe surgical instruments, furniture and anesthesia system.

Find more Henry Ford Hospital related content.