Vendors showcase the latest medical imaging technological advances each year during the annual Radiological Society of North America (RSNA) meeting in Chicago, always held the week following Thanksgiving. After spending a week walking the show floor and meeting with scores of vendors, the following are some of ITN Editor Dave Fornell's choices for the most innovative new radiology technologies introduced in 2011.
VIDEO: Photon Counting Detectors Will be the Next Major Advance in CT
Todd Villines, M.D., FACC, FAHA, MSCCT, said photon counting CT detectors were a key new technology discussed at the Society of Cardiovascular Computed Tomography (SCCT) 2020 virtual meeting. He said the technology will likely replace conventional CT detectors in the next decade. Advantages of photon counting detectors include the ability to enhance image quality at the detector level with much clearer details than conventional CT technology.
These new detectors also can take a single scan and bin the various energies to reconstruct a range of mono-energtic scan renderings similar to dual-energy CT, but on a wider spectrum of kV levels. This spectral aspect of photon counting also allows material decomposition based on the chemical elements that make up various materials in the scan, including calcium and metals that make up stents, orthopedic implants and replacement heart valves. This enables easier, automated removal of metal blooming artifacts and the ability to clearly image inside calcified arteries.
Villines is the Julian Ruffin Beckwith Professor of Medicine, Division of Cardiovascular Medicine, University of Virginia, editor-in-chief of the Journal of Cardiovascular CT (JCCT), and SCCT past-president.
Other Key Trends and CT Technology at SCCT:
The American Association of Physicists in Medicine (AAPM) is taking steps to help guide the future of its specialty, said AAPM President Tony Seibert, Ph.D. During the group's 2011 meeting, Seibert explained there is a shift in healthcare priorities from research to a more clinical emphasis. AAPM is encouraging younger members to get involved and keep research as an important part of medical physics, so advances can be made to eventually improve patient care.
Imaging is expanding its role in radiotherapy systems, which will require additional medical physics in that area, he said. In addition, AAPM is working with both government agencies and industry in efforts to push forward new protocols, and technology.
For more information: www.aapm.org
Tony Seibert, Ph.D., president of the American Association of Physicists in Medicine (AAPM), explained the key initiatives of the group during its 2011 annual meeting. These include:
• AAPM is working with its members to reduce patient radiation dose across radiology modalities.
• It is developing physics-based Web training modules for diagnostic radiology residents.
• Members are working to create residency programs for both radiation therapy and diagnostic radiologists.
• AAPM is also working with several states to create license certification programs to ensure who is a qualified medical physicist.
For more information: www.aapm.org
Society of Nuclear Medicine (SNM) President George Segall, M.D., chief of the nuclear medicine service at the VA Palo Alto Health Care System, and is a professor of radiology and professor of cardiology (by courtesy) at Stanford University School of Medicine, offers insights into the trends he saw at the society's 2011 annual meeting.
Trends in nuclear imaging include the creation of PET/MRI systems, use of time of flight (TOF) imaging, new technqiues to image amyloid plaque in Alzheimer's Disease, and the movement toward multimodlaity imaging rather than radiologists specializing in justy one modality.
One of the biggest issues discussed at the 2011 National Consortium of Breast Centers (NCoBC) annual meeting was the controversy over proposed mammography recommendations to increase the age for when women should begin regular mammogram screenings. NCoBC Program Director and Incoming President John Bell, FACS, explains how this issue was approached and discussed for presentation at this year's meeting. NCoBC President Don Dizon, M.D., FACP, also discusses some of the highlights from the 2011 show and the fact it was the most well attended event in the show's 22-year history.
The 2011 National Consortium of Breast Centers (NCoBC) annual meeting broke all attendance records, according to Yuri Parisky, M.D., vice president of NCoBC. He said the event highlighted the biggest trends in breast cancer imaging and treatment from specialties including radiology, radiation therapy, oncology, pharmaceuticals and plastic surgery. Parisky said digital mammography, which makes up about 75 percent of the U.S. market, continues to grow. In addition, tomosynthesis and molecular breast imaging are gaining ground. Three major trends in breast imaging and oncology include attempts to lower imaging radiation dose exposure, earlier detection of cancer and more minimally invasive interventions to both preserve breast tissue and reduce scarring.
Paul Chang, M.D., professor of radiology, vice chair of radiology informatics and medical director for enterprise imaging, University of Chicago, is a lead investigator on a closed-loop imaging research study that looks at all stages of imaging to optimize the imaging system at a hospital. The goal of the Philips-sponsored trial is to reduce errors and improving quality care and outcomes. He said it is important to optimize all stages of the imaging process. Chang explains the process they used for reviewing efficiencies and inefficiencies in the radiology department.
Watch another interview with Chang in the 2019 VIDEO: How Hospitals Should Prepare for Artificial Intelligence Implementation.
An interview with Peter Herscovitch, M.D., chief of the positron emission tomography (PET) department, senior attending physician, National Institutes of Health (NIH) Clinical Center, who discusses key topics in molecular imaging, including how how the introduction of new radiotracers will affect the use of PET and SPECT in nuclear imaging and patient therapies. He was the chair of the 2010 committee on scientific program at Society of Nuclear Medicine (SNM - SNMMI) annual meeting.
An interview with Peter Herscovitch, M.D., chief of the positron emission tomography (PET) department, senior attending physician, National Institutes of Health (NIH) Clinical Center, who explains why it is important to develop comparative effectiveness trials of PET. He was the chair of the 2010 committee on scientific program at Society of Nuclear Medicine (SNM - SNMMI) annual meeting.
American Association of Physicists in Medicine (AAPM) President Mike Herman, Ph.D., radiation oncology medical physicist, Mayo Clinic, explains the role of the society and its goal to improve patient care. Activities include sharing the latest scientific research, developing best practices, education, setting guidelines for certification and the roles of various staff under mediacl physicists, and how physicists can better serve their hospitals. The main focus in sessions at the AAPM annual meeting include patient safety concerning radiation dose and how to lower these doses in practice. Herman said AAPM is also calling for a national patient safety event recording process to make it easier to see where there are mistakes so they can be addressed. The society is also Herman said the process needs to be easy to access and use. He spoke to ITN at the some 2010, 52nd annual AAPM meeting
Collabortaion between physicians using interdisciplinary approach to diagnosing and treating breast cancer is crucial to good patient care, explains Don Dizon, M.D., FACP, president of the National Consortium of Breast Centers (NCBC) at the 20th annual meeting hosted in 2010. He said NCBC stands as a testament to collaboration, cooperation and camaraderie from mammgraphy screening through biopsy and treatments for breast cancer.
"Most people have no idea what a tremendous impact radiology and telemedicine have on poor and remote regions of the world," said Rebecca Cornelius, M.D., professor of radiology, neuroradiology, department of radiology, University Hospital, University of Cincinnati, College of Medicine. Cornelius was one of the physicians on the panel and video presentation "Zero Footprint Radiology and Telemedicine Build a Platform for Sustainable Care," which Imaging Technology News (ITN) hosted at the SIIM 2010 annual meeting.
The panelists described how physicians based in the United States used teleradiology and telemedicine technology to treat patients located in a remote clinic in Honduras. The panelists made the case that this technology suite is the basis for sustainable health care outreach programs in the future. ITN Editor Cristen Bolan then presented a video illustrating how physicians and technicians equipped The Roy and Melanie Sanders Frontera Medical Center in Honduras with the digital imaging and informatics infrastructure.
Several providers donated the suite of imaging technology. The equipment included a telemedicine system and ultrasound probe from Global Media, the VirtualPACS Web-based picture archiving and communication system (PACS) from MedWeb, a portable digital x-ray system from MinXray and a computed radiography (CR) unit from iCRco.
In this video, Dr. Juan Vasquez gives a live demonstration of how the imaging suite quickly and seamlessly operates. Vasquez started by taking an X-ray image, processing and reviewing it on the CR, and uploading the data set to the PACS in under 10 minutes. The guest of honor, Honduran Minister of Health Arturo Bendaña, himself a trained physician, easily toggled through the streamlined digital workflow. Vasquez explained how the transition from film to digital x-ray would save the clinic on significant costs incurred from developing film. Vasquez then examined a patient's thyroid gland with the ultrasound probe connected to a laptop computer. Next, he used a high-definition telemedicine camera to capture superficial anatomical images. Finally, he uploaded the images and consulted with physicians over Global Media's video-conferencing system. Jeffrey E. Heck, M.D., executive director and founder of Shoulder to Shoulder, explained to onlookers this was a model for delivering high-tech care, including expert specialty consultations, to some of the most remote and isolated areas of the developing world.
"With the addition of this technology, poor people have access to the same set of services that any well-equipped health center in the United States has access to," Heck said.
The panelists included: - Rebecca Cornelius, M.D., professor of radiology, neuroradiology (Clin Geo), University Hospital; University of Cincinnati, College of Medicine; Department of Radiology - Phillip Silberberg, M.D., head of Shoulder-to-Shoulder Radiology, pediatric radiologist, Kosair Childrenâ??s Hospital, - Roland Talanow, M.D., Ph.D., department of radiology, The Cleveland Clinic - Hayley Holland, MPH, director of grants and projects, Shoulder-to-Shoulder - Kim Guevara, corporate philanthropy officer and director of emergency management, Medweb. For more information: www.shouldertoshoulder.org
Related Radiology and Telemedicine in Honduras:
Dr. Frederic Deschamps of the Institut Gustavy Roussy, France, explains his use of the Innova TrackVision application to plan and guide needle trajectories during vertebroplasty and oncology procedures in the interventional lab under angiographic fluoroscopy.
Performing needle procedures in the interventional suite frees up your CT system and provides better access to the patient. However, under fluoroscopic guidance, it may be challenging and time consuming to find the right entry point and advance the needle to avoid critical structures.
TrackVision 2 provides live 3-D needle guidance during your procedures. It lets you advance the needle down a planned trajectory overlaid on live fluoroscopy, visualizing any deviations from the desired path.
Highlights of the system include:
• Support multiple trajectories.
• 3D trajectories are registered in real time to C-arm and table movements, field of view and Source-to-Image Distance in real time.
• Visualize patient motion with the bone anatomy overlay and correct it at table side.
• Send bull eye's view angle to the gantry in a single click.
Dr. Thierry DeBaere, head of surgical radiology at the Institut Gustave Roussy in Villejuif, France explains how he uses the GE Heathcare Innova Vision to perform a portal vein embolization on a patient with liver cancer.
Advanced breast imaging capabilities added elastography to the list, fused MR/CT image data combined with angiography navigation systems to guide percutaneous oncology, and 3.0 Tesla MR debut at the 2009 Radiological Society of North America (RSNA). All these innovations headlined the news at RSNA. To find out where these trends are leading radiology and radiation oncology, Imaging Technology News spoke with The MarkeTech Group's (TMTG) CEO and Founder Dr. Christian Renaudin. In an exclusive interview, Dr. Renaudin analyzes what these key market trends mean to diagnostic imaging. The MarkeTech Group is a CASRO certified international marketing research and consulting firm focused exclusively on medical technology. As a leading ad hoc Voice-of-Customer solution provider in medical imaging, The MarkeTech Group attends the annual RSNA meeting to investigate what new technological innovations in diagnostic imaging manufacturers are displaying on the show room floor. For more information: www.themarketechgroup.com
There is no doubt that medical imaging procedures save lives. However, one size does not fit all. Because children are three to five times more sensitive to radiation than adults, and cumulative radiation exposure can have adverse effects, it is critical for doctors to lower radiation levels when imaging a child. That is why in 2007, the Society for Pediatric Radiology (SPR) initiated the Alliance for Radiation Safety in Pediatric Imaging. Not long after, the American College of Radiology (ACR), the American Society of Radiologic Technologists (ASRT), and the American Association of Physicists in Medicine (AAPM) joined the Alliance.
The Image Gently campaign is the Alliance's initiative to raise awareness for lowering radiation dose used in pediatric imaging. The aliance is actively working with imaging manufacturers to standardize dose assessment and display for children. Although disagreements about the accuracy of the risk models or the degree to which the risks of radiation are emphasized are ongoing within the medical community, the message of the Image Gently campaign is clear: Reduce or "child-size" the amount of radiation used when obtaining a CT scan in children. To child-size the amount of radiation used, Image Gently encourages doctors to ask their medical physicist to determine the baseline radiation dose for an adult for that site's equipment and compare that dose with the ACR Standards.
While these guidelines are clear, it is not certain how widely doctors have implemented these radiation-reducing measures to date. To gage the impact Image Gently on medical imaging practices, Imaging Technology News (ITN) spoke with Marilyn Goske, M.D., chair of the Alliance, and Neil Johnson, M.D., president of the Society for Pediatric Imaging, both practice at Cincinnati Children's Hospital.
ITN: How serious a risk does radiation imaging pose to children?
Dr. Goske: One of the first things we need to remember is when children have imaging it is being done for an indicated medical condition and for a benefit for that patient. That is really what the Image Gently campaign revolves around. Once a study if medically indicated it behooves all of us in pediatric imaging to promote radiation protection and try to lower the dose and still maintain the quality of the exam so that we get the diagnostic information that we need. We know from studies, particularly from the atomic bomb survivors in Japan, that if children receive radiation from a bomb blast such as that one, they are more sensitive to radiation. Now medical imaging is different as it's a different form of energy and quite diffrent in how it's given for the imaging test, but it's the best we have. The data from that tells us that we need to be overly cautious and conservative, and that if we are going to use this technology, we want to use it in the safest way possible.
ITN: How exactly is the Alliance standardizing dose assessment and display for children?
Dr. Goske: We are working together under the direction of Keith Straus, who is the medical physicist at Boston Children's Hospital, Mr. Tom Toth, who is the former chief physicist at GE Healthcare, and Stephen Vastaghat the Medical Imaging Technology Alliance (MITA). The four major CT vendors have signed on to come up with more standardized dose displays so that when we complete a CT scan and we look at the images on task and that we have the information we need to interpret the information more accurately. Under the current system the CT dose that is displayed, which is the CT dye volume and the DLC are based on 32-centimeter adult-size phantoms. So if the patient is on the table and is exactly the same size as the phantom, the dose display is reasonably accurate. But in our patient population where you have an infant who weighs 5 lbs., for example, the younger they are, the smaller they are compared to the size of the phantom, and the more discrepant the dose display is. According Mr. Strauss in a paper that he published, the dose display can be off by a factor of three. So we are actually underestimating radiation dose for those small patients. We are working with numbers to get those displays more accurate so that radiologists, radiologic technologists and medical physicists have a better idea of what our smaller patients are really getting in terms of radiation dose during CT scans and other imaging procedures. Dr. Johnson: It's a very simplistic but important idea that we give our patients the right dose. We use the analogy of flying. We all fly in a commercial aircrafts, so we take risks. But there is a huge benefit when we minimize the risk. What we are trying to do is minimize the dose of radiation to children. We are not trying to stop these scans when they are needed medically. We are trying to do them with the minimum dose possible.
The HITECH Act, part of the American Recovery and Reinvestment Act (ARRA), and its impact on radiology is foremost on the minds of everyone in healthcare. Critical questions surrounding the language of the act remain unanswered. To gain better insight on the matter, Imaging Technology News spoke with healthcare IT research and development expert Don Woodlock, vice president and global GM of GE Healthcare Integrated IT Solutions.
Imaging Technology News (ITN): Will PACS and RIS qualify for reimbursement under the ARRA?
Don Woodlock (DW): The centerpiece of and the spirit of the HITECH Act is about adoption of general purpose EMR that go across the hospital or physician office EMRs for multi-specialty groups. The definition of meaningful use does mention images; all of the patient's test results have to be in the EMR, including images and imaging reports. Images need to be part of the electronic health record; [there is] mention of RIS/PACS, but it's not clearly spelled out that the stimulus will pay for RIS/PACS. I think the area where we need most clarity is in the outpatient- imaging environment. They are physicians, they see patients, and RIS and PACS is all they have, and they don't have another electronic medical record in that environment. Itâ??s my feeling that stimulus funds should be provided for physicians [who] use technology even though it isn't a traditional EMR.
ITN: On June 16th, the definition of Meaningful use? was released and included reimbursement for imaging described as multimedia (e.g. X-rays). A public comment period followed to assist Congress in clarifying this definition. What is the industry doing to represent radiology and convince Congress to include radiology's needs under the stimulus package?
DW: We are part of several groups that will provide feedback on helping Congress clarify this definition. We are part of Access to Medical Imaging Coalition, which is a group of imaging vendors. I talked to the chair of SIIM, Dr. Erickson from the Mayo Clinic and SIIM was going to get involved in defining meaningful use.
ITN: How will growing volumes of patient data impact radiology?
DW: There will be a big indirect effect on radiology. Radiology has been well automated for many years with RIS and PACS installed over the last decade. But they are basically working with physicians that have not automated at all, and I think the main impact that this Act will have is that there will be EMRs everywhere — hospitals and referring physicians will have EMRs as well. The way radiology interoperates and the workflow of the community will be a lot better when everybody has an EMR. A couple of examples are the radiologists [who] need the complete patient record to do a good job reading the patient exam. That includes patient history, problems, information about the order; patient allergies will be accessible to the radiologists in the click of the button. The orders will come in, in a cleaner fashion; right now they come in on paper, and radiology can help provide decision support in the ordering process, so that the right test is ordered for the right patient and the report will come in with all of the information that the radiologist needs. Then, inside radiology they will still use RIS and PACS to read and report on the exam, but then on the way back, the images and the reports will be embedded in the EMR so they will be widely available to every ordering physician that should have access. So the work of the radiologist will be more widely available to physicians that need it and the communication between the radiologists and the rest of the care team will be more effective once everyone is well-automated with IT systems.
ITN: Will the referring physicians be viewing all of the images on the EMR?
DW: That's right. [For] All the physicians outside of the radiology, their view of the world will be through the EMR. They will go through the EMR to see the full patient record including the imaging tests, the reports and will probably launch a browser to the images. So, we don't see the EMR becoming a PACS; the images will still be in the PACS, but there will be links to those images and Web browsers embedded in the EMR, so it will be easy for physicians to have access to this information.
ITN: Will the viewer in the EMR also have diagnostic capabilities?
DW: Probably not. In terms of a 6 mega pixel workstation, that will still exist in radiology. But these other physicians will have Web based tools and they may have access to diagnostic workstations and Web viewers, but that's not really what they are after. They want to see the images, and sometimes use 3-D tools, but they are not using it for primary diagnosis.
ITN: How will interfacing radiology PACS and EMRs impact workflow?
DW: The workflow will be much more streamlined. So, on the inbound side with the orders and the EMR information, we can eliminate paper with electronic order, we can make sure the right test is ordered.