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Confirma and iCAD create hybrid analyzer of MR and XR mammography


About one out of every five U.S. sites offering x-ray mammography has the capacity to perform breast MR, according to an executive at iCAD, a developer of computer-aided detection products based in Nashua, NH. The company and its newfound ally in breast

About one out of every five U.S. sites offering x-ray mammography has the capacity to perform breast MR, according to an executive at iCAD, a developer of computer-aided detection products based in Nashua, NH. The company and its newfound ally in breast analysis, Confirma, are counting on a lot of these sites wanting to make use of both modalities.

The two software developers have designed a multimodality hybrid of each other's proprietary technology. The Second Look 500 M combines CAD algorithms for digital mammography with analytical algorithms that streamline the analysis of MR images of the breast. The system is bolstered by a database containing patient information.

Making MR and digital x-ray images and analyses available concurrently promises to improve efficiency and streamline the integration of patient data, according to Janet Sterritt, vice president of marketing at iCAD.

"We have gathered all that is needed to evaluate MR and conventional mammography and put it at (the diagnostician's) fingertips to create a master reading place," she said.

Confirma and iCAD have agreed to comarket the product, while maintaining sales of their respective products. Sales of the Second Look 500 M will be driven primarily by iCAD dealers and distributors, particularly SourceOne, which has an agreement to sell several of iCAD's other CAD-based systems. Shipments are scheduled to begin in July.

The alliance with iCAD exposes a critical segment of the imaging community to Confirma's MR-based technology, said Mary Gatewood, Confirma director of marketing.

"Breast MR has taken off over the last couple years, but a lot of our customers are mammographers who are taking on breast MR," she said. "The iCAD people are talking to the right people."

The Second Look 500 M incorporates the early breast cancer detection capabilities of the iCAD Second Look family and the analytical capabilities of Confirma's CADstream technology for breast MR imaging. Results of the CADstream analysis are available on the Second Look review station, allowing radiologists concurrent access to mammography and MR analyses. The review station is designed for placement near a conventional mammography film alternator to provide the opportunity to assess the digital and film results at a single location.

"The integrated viewer clips onto the front edge of an alternator, so rather than having a plethora of viewers, you have the whole case consolidated in front of you," Sterritt said.

CADstream, the engine powering the MR side of the product, is designed to enhance the efficiency and workflow of breast MR. It does so by automating data analysis, improving image management, and correcting for patient movement. This assists in the interpretation and analysis of these typically data-intensive studies. CADstream's automated features include image registration, subtraction, angiogenesis mapping, development of interactive real-time contrast curves, multiplanar reformatting, and volumetric reconstruction, including the creation of maximum intensity projections.

iCAD's flagship CAD platform, Second Look 500, analyzes either or both digitized mammographic films as well as mammograms obtained using digital sensors. The company's existing base of customers using these products can buy a hardware-software upgrade that melds x-ray and MR mammography.

The two companies will address not only this existing base of customers, but also the estimated 2000 sites that have access to both conventional mammography equipment and MR scanners, according to Sterritt.

Just as iCAD is experimenting with a new way of presenting its CAD technology, it is dabbling in a new kind of pricing structure. There is an upfront capital cost, as Second Look 500 M is priced at $220,000. But there is also a per-procedure charge of $150 for each breast MR CAD analysis completed on the CADstream component. This charge entitles customers to continuing service, support, application training, and updates. Current owners of Second Look systems can upgrade to include MR analyses for about $70,000 and the same per-procedure charge as first-time buyers.

The pricing scheme is unusual in that vendors typically choose one method of payment or the other. Confirma came up with the idea of mixing capital expense and per-click charges and has employed it at most of its 80 customer sites. Gatewood does not expect any problems in winning acceptance of the approach as it pertains to the Second Look 500 M.

"We will still have the same product support setup (for the 500 M) as we do for CADstream, which is how we will be able to monitor clicks and provide more clicks," she said.

Conforma and iCAD entered into a strategic alliance early this spring. The resulting Second Look 500 M collaboration is the latest of several iterations of the Second Look 500, which works off digitized film mammograms. The basic platform is designed to allow a batch of mammography films to be loaded. The system then digitizes up to 12 films per hour and analyzes the resulting data sets using algorithms that highlight areas of concern. The D version includes the functionality of the film-based platform as well as the ability to process digital data obtained using full-field diagnostic units built by GE Healthcare and Fischer Imaging. The AD version allows simultaneous processing of analog and digital mammography images.

The company's latest hybrid XR/MR version is its first integrated women's health product. Sterritt described the unit as the first step. She did not elaborate, however, about what would be next, stating only that the company's vision is to bring CAD to the market as a means for increasing productivity and getting better answers faster.

iCAD itself is the product of corporate integration. On December 31, iCAD merged with CADx Systems and its parent company Qualia Computing. The consolidated company has two CAD-based products in the works: Second Look CT Lung and Second Look CT Colon. These will not be integrated with the breast analysis platform, according to Sterritt.

"I don't think it would be terribly interesting, if you are a mammographer, to include lung or colon cancer on a reading station, because the mammographer is not the one who will read these cases," she said. "We will continue to develop a product line focused on breast cancer and others on different types of cancer."

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