CARS returns to its Berlin roots but retains focus on future

A series of presenters saluted the Computer Assisted Radiology and Surgery conference Wednesday and offered their prescriptions for the future as the meeting celebrates its 20th anniversary.

Elizabeth Beckmann, a copresenter of the Heinz Oeser Lecture at the opening session, contends that computer-assisted radiology and surgery would not exist without the work of the late Sir Godfrey Hounsfield, inventor of CT.

The CARS meeting drew more than 900 preregistrants and 500 papers from 30 countries, said organizer Heinz Lemke, Ph.D. With a focus on both the past and the future, opening session presenters outlined their views of the digital and computer revolution in medical imaging and the response to it that is needed from radiology and other specialties.

Lemke is a Berlin-based physicist who brought CARS (then CAR, minus the surgery) into existence in 1985 and has continued to shepherd it along, first in Berlin and then at sites throughout the world. He described an organization that must broaden its appeal to other disciplines while continuing to address innovation as its principal thrust (see related article, "CARS founder emphasizes focus on innovation").

A pair of researchers from the U.K. questioned whether CARS would even exist had it not been for the imaging revolution launched by the late Sir Godfrey Hounsfield, inventor of CT. Their answer: probably not.

Siemens executive Erich R. Reinhardt, Ph.D., suggested that integrated systems are the path to better healthcare quality at lower cost.

Among the highlights of the opening session:

• The focus of CARS - computerization and digital management of image-related information - might never have reached radiology without the CT innovations developed by Hounsfield, said Beckmann and Dr. Stephen Golding, who delivered the Heinz Oeser lecture.

Hounsfield, who won the Nobel Prize for his work in CT, initiated a revolution in medical imaging that continues today, and not just in CT, according to Beckmann, of Lanmark in Beaconsfield, U.K., and Golding, from the University of Oxford, who spoke in a joint presentation.

By providing road maps of soft tissue, CT made the preoperative evaluation of surgical processes possible, beginning with the prediction of tumors' resectability. It also made possible guidance of percutaneous instruments that enabled preoperative diagnosis and percutaneous treatment of pathological fluid collections.

In addition, CT paved the way for high-tech imaging, including MRI, Golding said. Large expenditures for imaging machines has previously been unthinkable, but CT induced a culture change that made high-tech medicine acceptable.

"We would not be here if it had not been for the benefits of Mr. Hounsfield's invention,"

Beckmann said.

• A growing interdependence of medical and information systems will help define future directions for CARS, said Reinhardt, president of Siemens Medical Solutions. A key will be integration of workflow across the enterprise; information flow will parallel workflow.

Large clinical databases that define and describe clinical problems, develop and validate algorithms, and continuously learn will be an important element of that integration. All of this needs to take place under the mantle of patient-centered care, Reinhardt said.

• A leading indicator of what must happen in the next generation of CARS systems can be found in image-guided intervention, according to Dr. Michael Vannier, a radiologist at the University of Chicago Medical Center and president of the International Society for Computer Aided Surgery.

The technology tends to be disruptive because it replaces an earlier technology; uterine fibroid embolization, for example, can replace hysterectomy. This type of technology tends to catch on quickly, and those who adapt to it will do well. Those who do not will be in peril, Vannier said