Kathlyn Stone

The onslaught of faster, smaller, more precise, and more portable ultrasound imaging technology continues. Nearly three dozen RSNA exhibitors will be showing ultrasound scanners whose portability has lately crowded onto center stage along with image quality and once optional capabilities, such as 3D/4D.

The growing demand for 3D/4D in obstetrics and cardiology has made such technologies commonplace for the way ultrasound is now done. The general public has become fascinated with these capabilities, as shown by the widespread popularity of 3D/4D fetal scans among maternity patients. It's no secret that the expectation of brilliant images for consultation with patients is nearly as great a need for physicians now as detail to make diagnoses.

Two other societal trends, seemingly at odds, can be credited with driving innovations in ultrasound technology: widespread promotion of early screening and diagnosis, and growing public concern over the risk of radiation exposure from radiographic screening examinations.

On the leading edge of these trends has been SonoSite, whose development of hand-carried ultrasound set the pace for miniaturization through much of the past decade. The company focuses on point-of-care ultrasound systems but still emphasizes sales into the radiology marketplace.

SonoSite introduced five new ultrasound systems in October, including one designed for general-purpose imaging, its M-Turbo, which supplants the MicroMaxx, previously the company's highest performance system. Other new releases, part of a new "S" class, are optimized for critical care, anesthesia, emergency medicine, and interventional procedures. Despite these offerings and obvious crossover from point-of-care specialties into radiology, the company will not have a booth this year at the RSNA meeting, a decision made for reasons not publicly disclosed.

Philips Medical Systems will be at the show, emphasizing productivity, as it has in past years, looking for advances in automation that improve image quality and presentation. Its iSlice multislice display, part of Vision 2007, provides quick review of volumetric data, allowing clinicians to select from a multi-image display to quickly find the best views. Another display method, called Invert imaging, provides a better look at the fetal heart.

This year Philips will continue to emphasize increased simplicity and productivity, showcasing its "one-transducer solution," the C5-1, which can be used to image any patient, according to the company, including the technically difficult ones. The device will trim exam time by 30% to 50% utilizing view guides and prompts. Philips' IT, called ViewForum, will borrow from the MR/CT model of image display, allowing ultrasound scans to be reviewed in the same environment as files from other modalities.

Zonare Medical introduced the first convertible ultrasound platform (Zone Sonography) at RSNA 2004. This year, it will show advanced upgrades to its convertible platform, including new transducers, image storage capabilities, and image quality improvements. Other enhancements include auto-optimization of 2D imaging, automatic spectral Doppler tracing, and wireless-ready connections. The z.one system offers high image quality in a compact package that can be converted back to a full-featured, cart-based system or docked into Zonare's new "miniCart."

GE Healthcare will feed the hunger for miniaturized ultrasound systems with its five laptop-sized systems. Designed for obstetrics and gynecology specialists interested in real-time 3D/4D ultrasound, the compact Voluson is GE's latest version featuring a high-resolution 4D transvaginal probe aimed at the early detection of fetal heart disorders.

The new system includes sonography-based computer-aided diagnosis (SonoVCAD) for obtaining volume images of the fetal heart. GE will promote the Volusion i for its improved clarity, which company execs say puts it on par with a CT or MR image.

Vivid i enhances the efficiency and reach of physicians by offering the functionality and high performance of full-featured, larger scale ultrasound systems for cardiovascular scans, but in a portable and wireless design. New features added to the Vivid i include stress echo, tissue velocity imaging, intima-media thickness measurements, and tissue tracking.

Logiq P5 is GE Healthcare's affordable compact ultrasound option for general imaging needs, spanning ob/gyn exams, urology procedures, breast imaging, cardiac assessments, and vascular studies. Its mobility also makes it practical for emergency medicine. The Logiq i model incorporates high resolution for general patient care in radiology, musculoskeletal, neonatal, breast, and vascular imaging.

The Logiq e, another laptop-size model from GE, is geared for emergency and sports medicine evaluations, as well as interventional and surgical procedures, including regional anesthesia and repair of nerve injuries.

Its mobility makes ultrasound-guided procedures possible in remote areas with limited medical facilities.

Siemens Medical Solutions will present its new handheld system, the Acuson P10, as suited for initial diagnostic care and triage of cardiology and obstetrics patients in intensive care units, ambulances, and medical helicopters.

The hand-carried system, which weighs just 1.6 pounds, features a 3.7-inch diagonal flip-up monitor with a black-and-white LCD. The thumb is used to navigate user controls, much like the operation of a personal digital assistant. The device's lithium ion batteries allow about an hour of scanning before requiring a recharge.

The Acuson X300, Siemens' midrange portable, is an ultracompact, lightweight system applicable for daily clinical use in basic cardiology exams and in radiology, internal medicine, or ob/gyn departments. The system is portable enough not just for a patient's bedside, according to the company, but for an ambulance as well.

Ultrasonix Medical will show its Sonix CEP, a compact portable system designed specifically for emergency, critical care, and trauma settings. It is best suited for abdominal, adult cardiac, musculoskeletal, ob/gyn, superficial structures, and vascular care applications.

"But technicians do not have to struggle and push the bigger machine or handle the complexity of using the traditional systems," said Dr. Rob Reardon, director of emergency ultrasound at Hennepin County Medical Center in Minneapolis.

Sonix CEP features include 3D/4D imaging, 3D freehand imaging (which is advantageous for examining large organs), dual/quad color, wireless video streaming, and a 30-minute rechargeable battery.

For ob/gyn, Siemens will highlight the 5.0 version of its Acuson Antares platform for ob/gyn and breast imaging. The eSie Touch elasticity imaging feature, includes a speed-of-sound adaptation designed for fatty breast imaging.

Bundled with spatial compounding, the Acuson Antares provides 13 lines of sight-applied at greater steering angles-and enhanced tissue contrast, speckle reduction, and motion correction. When coupled with the company's syngo Auto OB measurements, introduced at RSNA 2006, the device can deliver automated biometry measurements for fetal growth assessment, including biparietal diameter, head circumference, abdominal circumference, and femur length. Amnioscopic rendering, a customized feature of the latest version, offers detailed 3D and 4D imaging views of the fetus. Another feature of the new model is multislice imaging, which displays 2D matrix images from any plane in a volume, similar to a CT scan.

Devoted to women's health and breast imaging, U-Systems will demonstrate its SomoVu 3D, an affordable option for radiologists focusing on breast cancer detection and diagnosis. The automated device scans the breast using a 15-cm probe. After a preview scan to determine the patient's breast tissue density, the device automatically sets the imaging parameters. The scan starts with a single push of a button and lasts about 60 seconds, rendering up to 350 ultrasound images that can be reviewed in 3D.

U-Systems' device is built on proprietary technology, called SomoSynthesis, that combines several ultrasound frames to reduce noise and increase signal-to-noise ratio, resulting in high image quality and contrast resolution.

Toshiba America Medical Systems will highlight its 4D volume-imaging applications for ultrasound. The 4D applications were designed to improve transvaginal/ob, small parts, and abdominal imaging procedures by reducing variation in the acquired images. The systems give physicians the option to analyze data after a patient is discharged. The company will feature a line of microconvex, endocavity, and linear 4D transducers.

Toshiba's featured product will be the upgraded Xario XG, which features a 19-inch monitor and comes standard with a bundled software package. The package consists of Advanced Dynamic Flow, which displays blood flow with directional information; ApliPure, which uses real-time spatial and frequency-compounding technology to deliver clearer image quality; QuickScan, a one-touch auto-optimization feature for 2D and Doppler imaging; and Trapezoid, for wide or expanded field-of-view imaging.

A premium high-performance system, the Aplio XG incorporates the intelligent component architecture platform for accelerated start-up, throughput, and image processing. Users can select slice thickness and the number of images to be displayed. An ergonomic control panel and 19-inch LCD increase user comfort.

Enhancements include new 4D technology and 3D multislice ultrasound. The Aplio upgrade may be shown as a work-in-progress, depending on whether FDA clearance comes in time for the meeting. If it does, shipments could begin in December.

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Ultrasound strums familiar chords in RSNA exhibits

Demand for digital x-ray is soaring, about 10 years later than most industry insiders predicted. Better late than never, for sure, but the reasons behind the rise of this class of products are as much economic as technological. Volume sales are bringing down the price of digital x-ray systems, just as the adoption of PACS is making digital radiography more a need than a want. Vendors are responding with more powerful equipment bearing attractive prices.

A growing number of high-end systems that integrate diagnosis and treatment delivery are coming to market. At the RSNA meeting, industry leaders and competitors will tout new features they've added to address demands for improved dose and motion control, as well as mobility and compactness. Premium offerings include systems and services for fully integrating digital and other images and records within healthcare institutions.

Agfa HealthCare will emphasize the power of its MUSICA2 algorithms to optimize computed radiography images. Gathering those data will be a wide range of CR systems, including the CR 30-X, a compact tabletop device. Also showcased at the Agfa booth will be the DX-Si, a CR system featuring an image identification and quality control tool, intuitive interface, and integrated x-ray source. The versatile system is built for general radiography, as well as emergency and pediatric departments.

Canon Medical Systems will demonstrate high-performance detectors, including its CXDI-40EG and CXDI-40EC, which can be mounted in a table or wall stand. Units feature an imaging area of 17 x 17 inches. The company will show the lightweight CXDI-50G DR, with a 14 x 17-inch imaging area, and the CXDI-50C DR, which is optimized for pediatric and orthopedic patients.

Carestream Health will showcase its DR 9500, a digital radiography system with x-ray tube and detector fixed to a ceiling-mounted U-arm. The system, which has already begun shipping, is built for flexibility, leveraging its U-arm to move around the patient for easier patient positioning and increased throughput.

Fujifilm Medical Systems USA will seek to remold the community's perception of digital radiography, which views CR and DR as distinct on the basis of their detectors. Fuji argues that the end result, a digital image created efficiently, should be the common denominator. Toward that end, the company will show its latest developments in phosphor-based detection, integrating this technology in turnkey configurations that will compete with DR systems based on flat-panel detectors.

GE Healthcare will likely feature its Definium family of digital x-ray products. The Definium 5000, with its large area 41 x 41-cm detector mounted on a U-arm, takes minimal space, suiting the unit particularly to radiology and orthopedic clinics.

Philips will extend its Eleva platform and user interface across all radiography and fluoroscopy systems, providing a standardized workflow for x-ray users with state-of-the-art IT technology and embedded security standards. Eleva-based systems presented at RSNA 2007 will include the DigitalDiagnost, Philips's high-end DR solution, as well as its portable x-ray unit Practix Convenio DR, which will be shown with a work-in-progress wireless DR detector.

Siemens Medical Solutions will emphasize versatility in its Axiom Luminos DRF, a remote radiography/fluoroscopy system outfitted with a dynamic flat-panel detector optimized for fluoro imaging of obese patients. The company will also highlight its Axiom Aristos FX, upgraded last year to the Plus version.

Radlink will feature a cost-efficient, low-maintenance CR that delivers high-resolution diagnostic images. Shimadzu will show its direct conversion flat-panel detectors as part of an extensive line of x-ray equipment. Analog and digital products run the gamut from ceiling-suspended systems to R/F units.

Swissray International will show its ddRCompact series of digital radiography systems, cleared earlier this year by the FDA. The new series of products features a highly efficient patient positioning system and algorithms for stitching together images taken over extended orthopedic examinations. The company will promote the series as high-quality products for cost-constrained facilities, particularly outpatient clinics trying to cope with the effects of the Deficit Reduction Act.

Toshiba America Medical Systems will display as a work-in-progress a low-contrast imaging feature for its Infinix products. The new feature will allow CT-like imaging on soft tissues at the point of treatment.

Ziehm Imaging Group will feature its high-end Vision 3D C-arm, released earlier this year as part of the Vision line of products. The company will focus on high image quality at the lowest possible dose, achieved through real-time motion detection and image optimization through noise reduction algorithms.

Imaging3 will feature its Dominion system, a cost-effective mobile diagnostic imaging device using an O-shaped gantry to acquire 3D images. Dominion emulates CT performance yet supports standard fluoroscopy.

Quantum Medical Imaging will highlight features of its digital universal radiographic systems shown at last year's RSNA meeting. Special attention will be focused on a new in-room touch-panel control that includes digital image preview.

Kathlyn Stone

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