Computer-aided detection is moving into high-visibility mammography and DR systems, as imaging heavyweights form development and distribution alliances with CAD vendors. Amid these corporate moves, developers of CAD continue to advance the technology. Exhibitors at the RSNA meeting showed investigational products that adapt CAD to imaging modalities such as CT to evaluate lung nodules and colon polyps for the presence of cancer, and MR to help interpret MR mammograms.
CADx Medical Systems
Since the Second Look CAD system was approved by the FDA in February, CADx Medical Systems has strengthened its position in this growing market. It has done so through a merger with long-time research and development partner Qualia, the release of Second Look version 4.0 software, integration with the PenRad Mammography Information System, purchasing agreements with major resource and imaging utilization management companies, and development/distribution alliances with Fischer and Lorad. At the RSNA meeting, CADx announced a partnership with GE and unveiled remote CAD mammography as well as CAD CT for the lung and colon.
- Through an exclusive agreement, GE Medical Systems will be integrating CADx Systems' Second Look software in its Senographe 2000 full-field digital mammography line.
- A work-in-progress remote technology promises to allow small mammography centers to send up to 15 cases daily for offsite CAD analysis with Second Look software. The product is slated for delivery at the end of 2003.
- CAD products for CT in the lung and colon are scheduled for release in 2004.
Specializing in radiology informatics systems that enhance workflow, data analysis, and quality control, Confirma announced its first CAD product, CADstream.
- The evidence-based radiology system features automated image processing tools for quantifying data in MR images, particularly breast MRI.
- The company is exploring other applications for CADstream, such as tumor morphology assessment.
Capitalizing on its relational database platform, iCAD integrates CAD into existing or planned informatics systems, digital imaging resources, and workflow.
- Newly released MammoWriter is a compact, stand-alone CAD solution that small health and mammography centers can purchase for $100,000 or lease for three years for $80,000.
- MammoReader II incorporates two mammographic digitizers and a high-speed, dual-process computer workstation, handling as many as 39 breast cancer screening cases per hour. It also includes a scanner/analyzer workstation with a backlit panel, available through iCAD's exclusive distribution arrangement with Instrumentarium Imaging.
- New software increases by more than 25% the speed of iCAD's systems to digitize and analyze mammograms. The software automatically prints CAD results in hard-copy form, incorporates users' preferences in displaying CAD results on both screen and paper, and intensifies CAD markers in dense and dark areas of breast tissue.
- CADLease, which is available through Instrumentarium and funded by iCAD, reduces payments for the company's CAD systems in the first year so small health and mammography centers can avoid large initial capital outlays.
Developer of CAD software for the ImageChecker processing and visual display system, R2 has installed products in more than 700 facilities to interpret more than five million mammograms to date.
- Newly released PeerView software immediately displays high-resolution images of suspicious regions of interest as part of the company's ImageChecker CAD product. PeerView was announced on Oct. 3 and displayed at the RSNA meeting.
- ImageChecker DM was expanded to include OmniCAD, a universal platform featuring an open architecture that will allow ImageChecker to accept either film or digital images. OmniCAD also will provide the basis for ImageChecker to accept and analyze images from other modalities such as CT. Deliveries of ImageChecker DM with OmniCAD are scheduled to begin in the first half of 2003.
- The ImageChecker CT display workstation, which received 510(k) clearance from the FDA during the RSNA meeting, reviews lung nodules in multidetector CT examinations. Its algorithm flags potential areas of interest and measures and characterizes information about specific lesions.
- Reference Library, a work-in-progress software tool for ImageChecker, provides immediate access to mammographic cases with similar findings from a database of biopsy-confirmed image results.
In keeping with its specialty in CAD systems optimized for breast cancer screening, Scanis introduced the newest versions of Mammex TR and Mammex MammoCAD.
- Mammex TR version 1.4 has a new easy-to-use operator interface and a reduced false-mark rate. The product is available in several European languages as well as English.
- MammoCAD version 2.0 reduces mammogram processing time and enhances clinical performance. A new graphic monitor interface requires fewer actions to operate the system. The 2.0 product is commercially available in Europe.
Seeking to expand its repertoire beyond film digitizers, Vidar Systems is combining its core technology with that of CAD.
- A hybrid digitizer/CAD system, dubbed Vidar CAD Pro, is in the works. The device, which could be released as early as the end of 2Q 2003, will provide advanced pattern recognition and image analysis of abnormalities appearing on mammograms digitized by the system.
- CAD PRO will feature software provided by an as yet undisclosed developer of mammography CAD. It will include Vidar's next-generation, proprietary high-definition CCD technology for film digitization.
PET/CT dominates new offerings with iterative step to 16 slices
Major vendors picked up where they left off last year in the development of hybrid PET/CT systems, extending technology to its furthest capabilities or tweaking existing products for specialty applications. Premium performance 16-slice CT scanners were added to PET scanners, either as commercial products or on the drawing board, and a compact PET/CT optimized for oncology was displayed. The goal behind each was simple: to improve efficiency either by reducing scan time or conserving space and lowering cost to the customer.
The company, a longtime leader in PET development, albeit behind the scenes as a supplier to Siemens, is determined to step from behind the curtains with its own products while maintaining its fruitful relationship with the German vendor. CTI also designs and manufacturers cyclotrons and PET chemistry systems.
- A 16-slice version of its ECAT Reveal, introduced last year, headlined this year's introductions by the company. Like its predecessor, the Reveal XVI is built around a positron detector composed of proprietary lutetium oxyorthosilicate (LSO) crystal technology.
- CTI claims the upgraded system, which sells for an average of $2.6 million, will lead to more accurate tumor detection and localization, improved biopsy sampling, and better patient response to therapy. It potentially could also detect emerging blockages in the coronary arteries.
- The RSNA meeting officially marked the product launch, and the company has begun taking orders. The system, which was cleared by the FDA in October, will be marketed to both hospital- and nonhospital-based radiologists.
Gamma Medica Instruments
The company targets niche markets with its line of LumaGem scintillation cameras. A primary focus is women's healthcare.
- Its work-in-progress LumaGem 3200s sports close to a full-breast field-of-view. The system is compatible with most upright mammography machines for positioning close to the breast and imaging close to the chest wall. The company expects 510(k) clearance during 1Q 2003.
- The GammaCAM/OR is a high-resolution gamma camera for performing lymphoscintigraphy in the operating room.
GE Medical Systems
Only a few years ago, GE was struggling to be taken seriously as a major vendor of nuclear medicine equipment. Corporate acquisitions of SMV and the nuc med assets of Elscint, along with a renewed focus on PET, have helped make the company one of the premier players in the segment.
- The Discovery LS 16-slice work-in-progress promises to pull GE even with CTI and Siemens in the 16-slice PET/CT market. The product is scheduled for commercial release in early 2003. The system is optimized for both 2D and 3D imaging, providing microvoxel resolution, cubic CT data sets and multiplanar reformatting. The 16-slice Discovery LS will come equipped with cardiac perfusion software, allowing one-stop integrated evaluation of coronary lesions and their impact on myocardial perfusion and function.
- The Discovery ST is a redesigned PET/CT system optimized for cancer imaging. Integrating either a four- or eight-slice CT scanner capable of both 2D and 3D imaging, the system provides increased sensitivity, speed, resolution, and diagnostic confidence when treating cancer patients, according to the company. It is relatively compact, minimizing the space needed for siting.
- Readylab is a relocatable PET tracer production laboratory, designed to overcome the continuing shortage of FDG production facilities. Readylab is intended to serve smaller, less accessible communities.
Hitachi Medical Systems America
Hitachi entered the PET marketplace in 2002 with the Sceptre PET system, a value-priced PET scanner sourced from CTI PET Systems. The product, introduced at the June meeting of the Society of Nuclear Medicine, comes with the Avia fusion workstation.
- Sceptre uses a partial-ring detector composed of LSO. The detector, which covers an area of approximately 180º, rotates around the patient, using slip-ring technology, and is constructed to allow isotropic 3D data acquisition. Error correction to account for scatter and random counts is built in.
- Avia is designed for processing and viewing data from any diagnostic imaging facility. It permits centralized diagnostic interpretation of discrete or fused PET, CT, MR, and nuclear medicine images in display formats that are selected or customized by the user to improve interpretation workflow.
Philips Medical Systems
Building on successes engineered by ADAC Laboratories, which it acquired in 2000, Philips continues to provide one of the most extensive lines of gamma cameras and PET scanners in the industry.
- Billed as the world's first open hybrid system, the Gemini PET/CT was introduced in 2001. Thanks to its unique dual-ring configuration, the system can be used as a hybrid scanner or divided into separate CT and PET scanners, with the PET component sliding back and forth on a track, to enable maximum system usage.
- The SKYLight is another example of unique design. Introduced in 2000 as the first gantryless gamma camera, SKYLight was displayed again this year.
One of the first companies to develop commercial PET systems, Positron continues as a single-modality vendor of positron technology. The company showcased its air-cooled mPower whole-body scanner, which supports neurology, cardiology, and oncology exams. The scanner was introduced at the 2001 RSNA meeting.
- A fusion package, which sells for about $100,000, spares buyers the expense of purchasing hybrid systems. The package is compatible with all vendor products and enables buyers to add an MRI component later on.
Siemens Medical Systems
Once the undisputed leader in nuclear medicine, Siemens fell behind upstart ADAC in the mid-1990s, only to become a market leader again at the turn of the century with the success of its e.cam gamma camera and PET/CT biograph. Siemens supplies its core technology gamma cameras and workstations to Toshiba for private labeling.
- The biograph Sensation 16 PET/CT, introduced at the RSNA meeting, established the company at the high end of this market segment. The new system, which integrates the Somatom Sensation 16 CT scanner with the ECAT Accel PET scanner, is available for about $2.7 million.
- The lightweight, compact, and economical but high-throughput biograph LSO Mobile PET/CT was also introduced. The company describes the unit as the industry's first mobile PET/CT system.
- On the SPECT side, Siemens showed its e.cam Signature with digital detectors. The system features e.media technology, which enables patients to watch movies and listen to music while undergoing nuclear medicine scans. Signature includes seven models ranging from dedicated cardiac systems and full-featured variable-angle systems to high-energy or coincidence versions.
Long a leader in PET pharmaceutical distribution, Syncor also provides ancillary technology useful in the practice of nuclear medicine.
- The ASM (advanced survey meter) is designed for nuclear medicine laboratories, radiation safety officers, diagnostic x-ray and hospital emergency room technicians, and environmental health physicists. It goes beyond signal-point measurements to incorporate a peak hold function for surveying packages and advanced data logging capabilities with user-defined protocols. Its cousin, the SAM 992, contains an internal 1R GM detector.
Toshiba America Medical Systems
Through its strategic alliance with Siemens, Toshiba America provides its own version of the e.cam gamma camera, dubbed T.Cam. Toshiba mirrored developments by Siemens, displaying its e.soft Signature Series workstation for the T.Cam variable-angle, dual-detector gamma camera, which is designed to deliver high performance and efficiency.
- The e.soft Signature Series workstation enables clinicians to conduct comprehensive studies using the system's advanced postprocessing capabilities, including display of multimodality images and fusion of nuclear medicine and CT or MR images. Additional capabilities include localization of areas of interest in three axes.