Pamela L. Moore, PhD

 isn’t new, but Philips has expanded its flexibility in new products launched at RSNA 2011.

WPD sharing “is key” to the company’s diagnostic x-ray portfolio, said Christian Neumann, director of strategic marketing and services, Diagnostic X-ray, Philips Healthcare.

Users can share one WPD between different modalities, including the newly redesigned Digital Diagnost 3.0, with a new tray made for the WPD, ceiling suspension, and ambient lighting.
The WPD also slides into the 

 positioned as an entry-point product especially useful in special-needs setting such as bariatics or pediatrics.

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Philips emphasizes newly flexible, wireless detector at RSNA 2011

X-Ray Wireless Detector Now Even More Portable

 drew crowds at RSNA 2011 with OrderRight, its decision support tool. The OrderRight “widget” integrates into EHRs, guides ordering physicians through a series of questions about their patient, and suggests the correct test, based on criteria from the American College of Radiology (ACR). No more trying to keep the latest suggestions straight in your head; patient-specific protocols appear on screen.


Such decision support reduces volume for radiologists, MedCurrent’s Beth Frost-Johnson baldly stated. In fact, a study in the 

Journal of the American College of Radiology

, showed that decision support was associated with a 23 percent to 27 percent drop in utilization of sinus CT and MRIs of the head and lumbar spine. But the cut in volume results from good decisions based on clinical evidence, decisions most physicians can live with.


“This is not an electronic RBM [radiology benefit management] tool,” Frost-Johnson stressed. “We don’t tell physicians what to do; we offer recommendations. … And we also tell them why, and that’s something the RBMs don’t do. … You cut the right fat.”


New reimbursement models focus on cutting costs without hurting quality, she adds. If radiologists are getting paid for better care or sharing in cost cuts, this is the sort of system they’ll need. The activity at the MedCurrent booth suggests a heightened attention to the newer models.

Crowds check out decision support tool at RSNA 2011

Besides, few referring physician want to struggle through a painful RBM pre-authorization or denial; if they know they are following guidelines, they feel more comfortable they are not only doing the right thing, but will eventually get paid. Because the product integrates with EHRs, even extracting basic patient data from referring physicians’ records, it doesn’t require them to interrupt their workflow, improving adoption. Decision support isn’t a new idea, but it previously required physicians to launch an entirely new system, interrupting their work.
 

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CHICAGO-System helps physicians follow evidence.

Imaging Decision Support System Reduces Utilization, But Draws Crowds

CHICAGO - - When Carestream designers set out to make a new portable, digital x-ray unit, they watched videotapes of radiographers moving other mobile carts. Staff craned to see around tall x-ray columns and avoid patients in hallways. They rooted through bags jury-rigged to cart sides to find gloves and other supplies, and narrowly avoided IV lines trying to turn the systems crowded ICUs.


“We tried to answer the problems of portable x-ray – and there are many,” smiled Helen Titus, worldwide marketing manager, capture products, for Carestream, as she watched a radiologist swirl her new product on the exhibit floor at RSNA 2011. “We wanted to make everyone’s lives easier.”

CareStream DRX-Revolution Mobile X-Ray System

 – which is awaiting FDA clearance, with worldwide availability expected in mid-2012 --has a compact design. The top column collapses almost entirely. Two, independent wheel drives systems make it possible to turn the device in a full circle using one hand and while standing in place, Titus said. There are built-in holders for gloves and sani-wipes. And the system’s software uses a grid platform to exactly align the x-ray tube. Users see a video-game-like image that indicates exactly when the tube is properly positioned to reduce scatter.
The DRX-Revolution uses Carestream’s DRX-1 detector, which can be moved to any room-based or mobile imaging system.
 

“It has brought excitement back into x-ray,” said Titus.

CHICAGO-Carestream features newly mobile system at RSNA 2011

New Design for Portable, Digital X-Ray

GE Healthcare today officially introduced Q.Suite, tools designed to improve PET for oncology treatment assessment by creating more consistent readings.


Thanks to its ability to indicate metabolic change, PET can reveal whether a given oncology treatment is working or not, even before a physical change in tumor size can show up in CT or MR images, according to Vivek Bhatt, general manager for PET at GE Healthcare.

But Standardized Uptake Value (SUV) readings have to be consistent for physicians to rely on data showing a change from the baseline. Variation control is needed.


Q.Suite offers stability through:
• Q.Freeze - Designed to be combine the quantitative benefits of 4D phase-matched PET/CT imaging into a single static image, eliminating motion, Q.Freeze is 510(k) pending at the FDA and is not available for sale in the United States. 
• Q.Static - Adds basic motion correction techniques, reducing organ motion effects. The tool is meant to automatically isolate data when organs are in a low-motion state. The result is a single image series with reduced blurring from organ motion. 
• Q.AC - An algorithm is designed to reduce potential variance in attenuation correction measurements, helping ensure that the attenuation coefficients used in image reconstruction are accurate. 
• Q.Check - Establishes a link between the console and workstation to ensure that patient and exam data required for quantitative imaging is saved in the patient file before the exam is finished. 
• Q.Core - Manages both PET acquisition and reconstruction processing at faster speeds.
• PET VCAR - Provides access to quantitative information, managing multiple lesions and multiple patient exams over time. PET VCAR now supports PERCIST.

GE also announced its new Discover PET/CT 710, capable of 128-slice imaging, and stressed its research on developing a fully integrated PET/MR.
 

Q.Suite positioned as improvement in cancer treatment assessment.

GE Introduces Tools to Improve Quantitative PET SUV Readings

Philips Ingenuity TF PET/MR is pending 510(k) clearance in the US, but the company is promoting it at RSNA 2011 with high expectations.

The product will compete with combination 


In Philips’ version the MR and PET scanners are almost 10 feet apart, with the patient table in the middle. The table rotates so the patient is scanned in the exact same position in each machine sequentially. Data then are merged.


The product is especially good for soft tissue imaging, such as for cancer staging. Its low-dose also makes it useful in pediatric applications. The does can be less than half of a PET/CT scenario, because the CT does is eliminated.

Sample soft tissue images for oncology and neurology application:

Philips has plans to offer its existing MR users an upgrade program, should the product be approved.
 

Philips promotes Ingenuity product at RSNA 2011

PET/MR Competition Heats Up

“Last year [at RSNA] I had three appointments booked to talk about ‘what is meaningful use?’. This year, half the customer base is asking very detailed questions about how our products can get them to meaningful use standards," said Kevin Collins, vice president of research and  development, 

 Inc. “The meaningful use issue is going to be very hot.”

Collins said meaningful use, consolidation and teleradiology will be key issues during the 2011 RSNA.

 is, not everyone is jumping on board, he added, because it doesn’t always make sense. Sectra’s customers have “done the math,” he explained. For some, the expense of compliance, coupled with the possible negative workflow impact of typing in multiple qualifiers, means meaningful use simply isn’t worth the expense, Collins suggested. It might be a different matter if the meaningful use measurements seemed to actually improve the care of radiology patients, he added, but, for the most part, they are more relevant in a primary care setting.

Nonetheless, meaningful use does have radiology adopters, and Sectra is helping them by introducing a patient portal. “One of the requirements for meaningful use is to give patients timely access to their medical information,” Collins said. Through Sectra’s Diagnostic Imaging Suite, patient can now get read-only access to the demographic and insurance information, medications lists, allergies, a problem list, and even their exam history and clinical reports.

A second key trend in informatics is practice consolidation. “We have more and more customers with six or seven hospitals and they’re absorbing more,” Collins observed. The key issue for Sectra and other RIS vendors, then, is building products that are flexible enough to deal with the resulting overlap in systems and databases.

Market consolidation, Collins said, is not necessarily or even usually a reaction to new final regulations on accountable care organizations (ACOs). 

 are only one kind of consolidation. “If you join an ACO,” Collins explained, “you join an ACO, you are no longer a profit center. You are a cost center.” If your goal is to control costs, it’s generally better to reduce, not expand, advanced imaging. Still, Collins noted, some radiology practices do think they can provide less-expensive and better quality care, but only a very few “are moving emphatically in that direction.”

For those who are interested in better quality and lower costs, ACO-related or not, Sectra’s Referring Physician Suite might help. Premiering at RSNA, the suite has embedded ACR appropriateness criteria, meant to help referring physicians identify and request the best imaging service for a given condition or suspected diagnosis.

Finally, Collins pointed out the growing influence of and increase in teleradiology services. “Contract-driven reading and workflows have become more important for information vendors to look at,” he said. Essentially, RIS/PACS vendors need to understand and prepare for the way their systems will work with teleradiology systems so that they integrate as well as possible.

Sectra’s vice president of research and development expects lots of conversations about meaningful use, practice consolidation, and teleradiology.

Key Informatics Trends at RSNA 2011

Traditionally, teleradiology has either worked as an after-hours service for radiology practices or as a competitor to them. Hospital systems and others have proven all-too-willing to consider radiology a bit of a commodity and ship readings off, hurting local providers.

vRad thinks it offers a third path, “a different practice model from what we have seen previously,” in the words of Les Mann, vice president of marketing for the company.

Under vRad’s new “alliance” model, vRad acquires radiology practices, but leaves the local providers on site. “The strength of the local practice is critical…to our success in that market,” Mann declared. “It’s the combination of the radiologists on-site and in the cloud that makes the difference.”

In other words, local providers agree to be acquired by vRad in exchange for the ability vRad’s cloud-based infrastructure gives them to perform more services faster and provide more access to subspecialists than they could do alone. With access to other radiologists quickly and online, they can do more, faster.

It makes the practice and its services “the opposite of a commodity,” said Mann. Readings are more timely and efficient. The economies of scale bring improved services and lower costs. And it’s not an old-fashioned merger and acquisition strategy, like we saw with practice management companies in the early ‘90s, he insisted. It’s a “willful partnership.”

Acquired providers generally are compensated based on productivity, Mann added.

vRad launched this strategy in August 2011, with acquisition of New York Radiology Alliance, and deepened it with a September 2011 

. (a radiology practice, no relation to this Web site).

vRad will make the new teleradiology model a centerpiece of its conversations at 

vRad's cloud-based teleradiology alliance model helps radiologists stay put, perform faster services, access subspecialists more easily.

vRad Explains a New Teleradiology Model

Philips’ Ingenia 1.5 T and 3.0 T MR will get a spotlight in the Philips booth at RSNA 2011. Touted as the first ever digital broadband MR, the devices received FDA clearance in April 2011 and started shipping commercially in July. Philips expects 100 installs by RSNA.

Deepak Malhotra, general manager, Premium MRI, Philips Healthcare, says Ingenia allows a 40 percent improvement in SNR and a large field of view (FOV) – the largest homogenous FOV in a 70 cm system. Because it requires less patient set-up, Ingenia also can provide a 30 percent increase in patient throughput, says Malhotra. It can do brain imaging in as little as 2.5 minutes, and spine imaging in 6, he says.

The channel-independent architecture makes upgrades easier, and Malhotra says a 9-day install time is typical.

Philips also will show off Panorama HFO enhancements, specifically a new 8-channel NV coil for neuro-imaging and enhancements for body & breast imaging. Philips will also demonstrate its Sonalleve MR-HIFU system available for international customers for treatment of uterine fibroids and bone metastasis. This technology is not yet approved in the US. 

Philips’ Ingenia 1.5 T and 3.0 T MR will get a spotlight in the Philips booth at RSNA 2011. Touted as the first ever digital broadband MR, the devices received FDA clearance in April 2011 and started shipping commercially in July.

Digital Broadband MR Key Product for Philips at RSNA 2011

Patient and hospital concern over CT dose has created a “perfect storm” for new products in CT, according to Gene Saragness, Philips’ EVP and CEO. Philips iDose

 has had the “fastest uptake I’ve seen in any product.”  The 

Ingenuity CT with iDose4 was originally introduced at last year’s RSNA

The company will put focus on its latest iDose technology at RSNA 2011.

Scott Smith, director of project management, CT, Philips Healthcare, describes low-dose CT as nearly a given in the marketplace now. What’s more important is maintaining the speed and quality of the image while using 

 , he says, keeps the natural appearance of the object, despite its use of iterative reconstruction technology (see chest image to left), and keeps up the speed needed to make CT useful in trauma settings.

“The majority of reconstruction images happen in under 60 seconds,” Scott says.

Philips also will present its Ingenuity CT products as a suite, a sort of continuum of increasing sophistication. Scott describes it as “investment protection,” since customers can upgrade in-room.
 
 

Scott Smith, director of project management, CT, Philips Healthcare, describes low-dose CT as nearly a given in the marketplace now. What’s more important is maintaining the speed and quality of the image while using iterative reconstruction to keep the dose low.

Philips’ CT Focus at RSNA 2011 on iDose4 and Ingenuity Suite

Philips will highlight its newly released 

The Philips unit will go head to head at RSNA with other new entries in the mammography space including Hologic’s 3-D breast tomosynthesis product, 

 (previewed at RSNA in 2010 and FDA approved in February 2011), whole breast ultrasound from U-Systems, Dilon’s 6800 MBI scanner, and GE’s Discovery MB750b, a 

Philips’ system is the first in the US to use photon-counting technology, designed to improve clarity while reducing dose. Photon counting reduces the number of intermediate conversion steps needed to create a digital signal. Each conversion can reduce image quality. The MicroDose system delivers no ghost images and a 50 µm pixel size at 100 percent pixel accuracy, according to Kim Holttum, senior director of global marketing, Women’s Health Care, Philips Healthcare. The field of view is 24 by 26 cm.

Plus, the dose is about half that of full-field digital mammography (FFDM) systems, Holttum says.  Automatic exposure control (AEC) can adjust dose based on breast density.

The units also are fast. With no wait time between acquisitions, exams take only 4 minutes, making it possible to do 12 to 18 exams an hour, Holttum estimates. That’s good for patients, technologists, and the bottom line.

Philips will highlight its newly released MicroDose Mammography System at RSNA 2011. The Philips unit will go head to head with other new entries in the mammography space including Hologic’s 3-D breast tomosynthesis product, Selenia® Dimensions, whole breast ultrasound from U-Systems, Dilon’s 6800 MBI scanner, and GE’s Discovery MB750b, a molecular breast imaging system.