RADIOGRAPHY

BY BRIAN CASEY

Proliferation of approaches can be confusing as vendors
offer different versions of digital technology

X-ray market welcomes new digital technology

This year's meeting will mark the first time that many digital x-ray developers will be able to remove the works-in-progress labels and display their systems as commercial products. Several companies received 510(k) approval for products in 1998, including Swissray, Sterling, Konica, Oldelft, and Trex. More products are on the way, including those manufactured by major multimodality vendors.

The proliferation of digital technologies can be confusing. Some systems use storage-phosphor technology to digitize x-rays, a technique found in computed radiography. Others employ charge-coupled devices (CCDs) for digitization, while the newest wave of systems are based on flat-panel detectors with either amorphous silicon or selenium. Each approach has its benefits and drawbacks, and it will probably be years before clinical usage determines which systems are best for the range of x-ray applications.

Although conventional x-ray will probably be overshadowed by the new digital systems, vendors have not ignored their bread-and-butter products. Look for advances at the show in 3-D angiography, multipurpose systems, and image processing workstations.

WHAT TO LOOK FOR

Agfa. ADC Solo is Agfa's official name for the compact CR unit introduced last year as ADC Vera. With a throughput of 60 imaging plates an hour, Solo is designed for low-volume environments, such as ICU/CCU or ER departments. Two features of the system that Agfa will emphasize are its DICOM data output and a new scoliosis package that enables users to take five exposures and patch them together.

Canon. This Japanese company will display its work-in-progress amorphous silicon-based flat-panel detectors as part of upright and table x-ray systems. Canon will also show the systems integrated with the company's PACS offering.

CMT. New from CMT is SmartSpot View, an independent processing and review workstation that can be integrated with the Israeli company's SmartSpot CCD-based digital module for R/F and angiography systems.

DpiX. This year will be the first time that flat-panel detector developer dpiX has exhibited at an RSNA show. It will display its FlashScan 20 and FlashScan 30 arrays, which are based on amorphous silicon technology. DpiX supplies the arrays in various configurations to major vendors.

Eastman Kodak. A new version of the company's Model 400 CR reader, called Model 400 Plus, will highlight Kodak's offerings in digital x-ray. Kodak has improved the image enhancement software on the system, which also features a new imaging plate autoloader.

Kodak executives said work is continuing on flat-panel digital detectors, which were described on booth displays in the company's exhibit last year.

Fuji. This CR pioneer has added new systems to the 5000 series of readers, which was first introduced at last year's meeting with the debut of FCR 5000. The new readers are faster and less expensive than the company's 9000 series. They enable users to employ the company's HQ high-resolution 4K imaging mode without reducing the throughput of the system. FCR 5501 is an upright reader for chest exams, while FCR 5000R is a single-plate reader designed for remote locations, similar to Fuji's older AC-3 system, but with the newer features of the 5000 line.

GE. GE filed a 510(k) application in September for its amorphous silicon-based flat-panel detectors, which the company will incorporate into its x-ray line. GE will display a digital chest system using the detectors and will emphasize the greater efficiency of digital detectors compared to screen-film cassettes in capturing x-ray photons.

In conventional analog x-ray, GE will launch Easy C, a new mobile C-arm designed with improved ease of use and maneuverability. Silhouette VR is a new x-ray table targeted at the value-oriented hospital and clinics segment. In angiography, new features for the Advantx LCA and DLX systems include fluoro noise reduction with motion detection, as well as enhancements in the DICOM output of the systems. Advantx LCN+ is an enhanced version of GE's LCN neuroangiography system, with a redesigned gantry and 3-D reconstruction on GE's Advantage Windows workstation.

Konica. This film and PACS vendor will display its Regius Model 330 digital x-ray system for the first time with Food and Drug Administration clearance after showing it at earlier meetings as a work-in-progress. Regius is designed for upright chest and abdominal digital imaging, and is based on stimulable phosphor technology, roughly similar to that used in CR. But the system's imaging plates do not need to be removed and taken to a separate reader.

Lumisys. ACR-2000 is a new desktop CR unit to be introduced. Lumisys plans to position the system as a low-cost replacement for x-ray film digitizers in small imaging centers and remote clinics that can't afford a fully featured CR unit. ACR-2000 weighs only 75 lb. Lumisys will sell the unit through its network of OEM partners.

Oldelft. The Digidelca-C digital chest system will be the highlight at Oldelft's booth this year. Digidelca-C uses CCD technology to turn x-rays into digital data, and sales of the device began this year after the company received FDA clearance for the system in April. New on Digidelca-C is the application of Oldelft's Amber (advanced multibeam equalization radiography) technology to the system. Amber preprocesses Digidelca-C's x-ray beam, allowing for better penetration of the mediastinum, according to the company. Digidelca-C with Amber will be available early next year.

Philips. DuoDiagnost is a new conventional x-ray system that combines radiography and fluoroscopy applications in a single product, according to the company. The system consists of an x-ray tube mounted on a tube column that is attached to the back of the patient table for R/F studies. In radiography exams, the tube column can be decoupled from the table for chest imaging or other applications. The system is designed for clinics and small hospitals that want a versatile, yet economical system. For digital studies, DuoDiagnost is available with the company's new DXI CCD digital module. Philips submitted a 510(k) application to the FDA for the system prior to the meeting.

A new stand-alone workstation for 3-D reconstructions is available on Philips' Integris V5000 angiography system. The workstation is based on a Silicon Graphics computer and is designed for guiding interventional neuroangiography studies. A new line of high-brightness display monitors for the Integris line will also be introduced.

Philips' digital x-ray efforts are being spearheaded by Trixell, the joint-venture company formed by Philips, Siemens, and Thomson. Look for Trixell detectors on display in Philips' booth.

Shimadzu. Shimadzu will roll out Digitex Pro RF, its first digital radiography/fluoroscopy system designed and marketed specifically for North American customers. Features include 1K CCD technology optimized for gastrointestinal and nonvascular interventional applications. Shimadzu will tout the benefits of integrating its CVision C-arm table with its Digitex Pro Multi digital R/F system.

Siemens. Siemens will debut a digital chest unit containing a 17 x 17-inch flat-panel detector developed by digital detector firm Trixell. Siemens has incorporated the detector into a receptor modeled on its Vertix Pro wall-bucky system, while the workstation software is based on Siemens' MagicView PACS software. Siemens hoped to apply for FDA clearance of the system prior to the RSNA show. It also has plans to develop a bucky table version with the Trixell detectors.

In conventional x-ray, Sireskop CX Compact is a mid-tier R/F product. New functions have been added to Siemens' Polystar Top digital module for the Fluorospot Top multipurpose system, including a new storage device and better DICOM networking capabilities.

Sterling. This will be the first RSNA meeting at which Sterling can display its DirectRay digital radiography systems as commercial products, as the systems received 510(k) clearance in July. Sterling has completed the first installations of iiRad DR1000C, a dedicated digital chest system using DR detectors, and will discuss its work at a Canadian hospital, where the systems have been installed in conjunction with a PACS network.

In addition to offering DR as part of new systems, Sterling is examining the market for retrofitting installed x-ray systems with the amorphous selenium detectors. Rather than offer retrofits for a large number of legacy x-ray systems, however, Sterling plans to negotiate retrofit deals with major equipment owners that have a large number of a single model of a system. One such entity is the U.S. government, which has many GE Monitrol radiography positioners that could receive DR detectors. Sterling's work on the retrofits will be displayed as a work-in-progress.

Swissray. Swissray will again feature its AddOn-Multi-System. The company displayed the CCD-based multipurpose digital x-ray system as a work-in-progress last year. Since then it has received FDA clearance and begun installing products at hospitals and imaging centers. Swissray has added a remote-control feature to AddOn-Multi-System and has also introduced emergency-room features for the unit.

Thomson Tubes. The Pixium 4600 flat-panel detector developed by Trixell will be highlighted in Thomson's booth. Trixell was formed through a joint venture organized by Siemens, Philips, and Thomson, and Trixell intends to offer the detectors to other medical imaging OEMs for incorporation into their products. Shown as a work-in-progress will be Pixium 4700, a flat-panel detector for R/F applications.

Toshiba. New products in the x-ray section of Toshiba's booth will include EPS-1000 and AngioLink 1000, both of which are PC-based digital modules for Toshiba's R/F and angiography systems, respectively. The company will also demonstrate its work in integrating its conventional x-ray systems with Agfa's CR technology. Efficiency 450D is an R/F system with the EPS-1000 module for digital R/F studies. But Toshiba has removed the system's spot film device to enable users to substitute Agfa CR plates instead.

Trex. Trex 4000M is a new digital chest system based on CCD technology developed by Imix, a Finnish medical technology firm. Trex has licensed the technology for incorporation into its x-ray product line. The system features a 2K x 2K detector matrix in 16 bits of depth that can acquire and display an image in 10 seconds. Trex has received clearance for the system and began shipments in September. Another digital x-ray system, to be shown as a work-in-progress, is Trex 5000ST for emergency-room trauma studies. Unlike Trex 4000M, the trauma system uses a flat-panel solid-state digital detector in a 17 x 17-inch matrix.

New analog systems to be featured by Trex include Trex ITC (interventional tilt C), a tilting C-arm designed for interventional R/F procedures, and a dedicated angiography system to be sold by Trex's Continental division. Evolution HV is a new remote R/F table.

Varian. Varian plans to highlight fluoroscopy applications for the amorphous silicon flat-panel technology it is developing. The company in September began shipping the first VIP-9 panels, which are designed to replace 9-inch image intensifier tubes in R/F systems. Varian is working with 17 companies, four of which are large medical equipment manufacturers that are integrating the panels.