CAD market booms with extensions into lung, colon

The market for computer-aided detection software has been warming up for some time, but much of the heat has come from a relatively small number of stalwart companies. This heat has come, for the most part, from an orderly expansion beyond mammography, the cornerstone of CAD, into other body parts, particularly the lung and colon. Now the potential of this field has attracted additional companies, as well as multimodality firms, that in the year ahead could turn up the temperature substantially.

Cedara Software

Known for its medical imaging systems and PACS workstations, Cedara broadened its clinical packages to include CAD support for breast imaging with the addition of a prototype ultrasound CAD solution.

• The work-in-progress B-CAD has been designed to identify sonographic characteristics that correspond to the ACR BI-RADS lexicon for classifying the degree of malignancy of a suspicious lesion. The system is being developed as both a stand-alone and an add-on to existing OEM applications.

Confirma

Since introducing its core product, CADstream, in 2002, Confirma has distinguished itself in the development of products that streamline the processing of breast MR studies. Its current generation of CADstream incorporates integrated treatment planning features, a multimodality configuration, and interactive maximum intensity projections. The company has also added a breast coil for enhancing the diagnosis and interventional management of breast cancer with MR.

• The streamlined CADstream portfolio automatically summarizes the ACR BI-RADS Atlas lesion classification, as well as the location and size of a tumor volume of interest. Its multimodality configuration allows users to view mammography, ultrasound, and MR exams at the same time on the same workstation. Interactive MIPs include angiogenesis maps correlated for 3D navigation and mammography views.

• Access Breast Coil debuted with a multichannel, phased-array architecture for parallel imaging of the breast, chest wall, and axilla, a large field-of-view, and support for unilateral and bilateral imaging. Its open construction enables cranial-caudal, lateral, and medial access for interventions.

iCAD

Now that product lines from its 2003 acquisition of CADx have been fully integrated, iCAD is offering CAD systems that cross a spectrum of price points. The Second Look 200, recently introduced to the U.S. market at prices beginning at $49,950, is geared for low-volume clinics that perform between five and 20 mammograms a day. Second Look 200 joins the flexible Second Look 400 moderately priced series for high-volume breast imaging centers and the advanced Second Look 500 multimodality product. New products include a quantification and characterization tool for mammography and collaborative works-in-progress for lung CT and virtual colonoscopy.

• The characterization feature quantifies specific aspects in regions of interest, such as the number of calcifications, the size of masses, and the area of involvement in millimeters and applies a border around or through microcalcifications. In use in multiple facilities in the U.S., the product will be rolled out more widely over the next two months.

• A prototype CT lung product, in joint development with TeraRecon, will apply iCAD software to TeraRecon's 3D applications. Slated for initial launch outside the U.S., the CT lung product will be submitted to the FDA for review in 2005.

• An experimental CT colon product applies iCAD's CAD engine to Vital Images' virtual colonoscopy offering to mark suspicious lesions on both 2D and 3D flythrough images of the colon.

Kodak Health Imaging Group

After receiving approval from the FDA on Nov. 29, Kodak has begun shipping the Kodak Mammography CAD System. The system has been in development since the Kodak Health Imaging Group acquired the mammography CAD solution company Miramedica in 2003.

• Kodak CAD includes a case input station that digitizes mammograms, analyzes the data with CAD algorithms, then generates the CAD report, while presenting images for viewing by a radiologist. The digitizer can scan four films in less than three minutes, allowing input of up to 25 cases per hour. It can be used with the Kodak report station or a standard printer or both.

Medicsight

Fresh off receipt of FDA market clearance for its Computer Assisted Reader (CAR) for lung and colon image analysis software, Medicsight announced agreements to integrate its systems with products from three major vendors. Agfa will integrate and distribute both Colon and Lung CAR in its solutions for general radiology and clinical specialties. Vital Images will integrate Colon CAR into its CT colon product InnerviewGI. Viatronix will integrate both CAR systems into its product lines. Medicsight's Lung and Colon CAR are joint-read systems that allow radiologists to review unfiltered, as well as software-enhanced, regions of interest at the same time. The systems, which deploy a series of filters to enhance boundary identification, were shown by Viatronix, Vital Images, and Agfa.

• Colon CAR 1.2 for joint reading of CT colonography includes a Polyp Enhanced Filter (PEF), which automatically highlights any raised spherical region that could be a polyp. The software also offers manual or semi-automatic polyp boundary identification that determines the extent and characteristics of a polyp by extracting it from surrounding tissue.

• Lung CAR offers multiple filters that can be switched on or off to adjust the level of enhancement or intensity. It also provides an advanced spherical filter that enhances regions of interest involving spherical shapes as well as an edge filter for identifying interstitial disease in lung parenchyma and noise filters to eliminate background interference.

Philips Medical Systems

Philips is striking out on its own with a CT lung nodule product. Shown as a work-in-progress, the lung nodule CAD is building on core Philips competencies to minimize the rate of false-positive findings. It is being tested in trials prior to submission to the FDA for approval.

R2 Technology

Boasting the first CAD system to receive approval from the FDA for detection of lung nodules on multidetector CT chest exams, R2 Technology is offering lung nodule detection in a stand-alone workstation or integrated with Sectra and Kodak PACS. The company also has introduced new mammography CAD tools and advanced features for the CheckMate Ultra display unit. It plans to release CAD software for detecting filling defects in the pulmonary arteries.

• ImageChecker CT CAD software automatically takes volume measurements of lung nodules and corroborates the calculation with 3D views of nodules and surrounding structures, such as blood vessels. The Temporal Comparison software module automatically registers and tracks lung nodule progression or regression over time.

• ImageChecker DMax, developed in conjunction with Array Corporation USA, relies on a high-volume, high-performance laser film digitizer that can scan a mammography film every 30 seconds with 50-micron resolution.

• DigitalNow software has been designed to facilitate the transition from film to digital mammography and streamline workflow by eliminating the need to locate light boxes next to high-resolution monitors.

• PeerView immediately displays and magnifies high-resolution images of regions of interest identified by CAD to help dismiss potential false marks when viewing scans on CheckMate Ultra.

Riverain Medical

By investing resources and marketing savvy, Riverain Medical seeks to make chest radiograph CAD a practical utility for routine radiological practices. The company is marketing products originally developed by Deus Imaging Technologies and approved by the FDA for lung cancer detection. It continues to support research by Deus scientists in the Riverain Deus Research Center, which is focusing on the development of a dual-energy subtraction CAD system and CT lung image matching or temporal subtraction.

• The RapidScreen-2000 analog system allows traditional users of chest films to access CAD technology for early-stage lung cancer detection. The RS-2000D is a digital option. Both operate as stand-alone systems, use existing PA/AP chest x-rays, and provide a "second opinion" in the detection of stage I lung cancers ranging in size from 9 to 33 mm.

• A work-in-progress CT lung system overlays CT images obtained at different points in time and compares them volumetrically to generate quantifiable data about subtle changes over time.

VuComp

As it readies the M-Vu mammography CAD system for market, VuComp is fine-tuning its CAD algorithms and upgrading the performance of its processor. The company expects to submit the M-Vu system, which has been designed to improve the detection of small breast masses and clarify vague architectural distortions, to the FDA in 2005.

• Improvements in the M-Vu system include a more compact CAD processor that is integrated with mechanical scan multiviewers and a simplified user interface.