This years RSNA meeting capped a banner year for CT technology development. The introduction of new multislice CT scanners has revitalized the modality in a way not seen since the introduction of spiral scanning in 1989. With subsecond scanning and multichannel detectors, CT vendors have dramatically shortened imaging times, prompting radiologists to explore new applications for the technology.
The RSNA meeting marked the first opportunity for many clinicians to see the multislice scanners introduced in the fall by GE, Toshiba, and Siemens. Picker International also entered the multislice fray with Mx8000, its name for the scanner originally developed by Elscint through a technology-sharing deal with Siemens. Picker completed its acquisition of Elscint just prior to the RSNA meeting (SCAN 12/16/98).
While multislice CT was the show-stopper, vendors also displayed their latest work in other new CT technologies. Advances in interventional CT were a priority, as were new software protocols for conducting coronary artery calcification studies on conventional mechanical scanners. Many vendors reported that their R&D engineers are investigating the next generation of multislice technology, using large-area detectors and cone-shaped x-ray beams. These systems could give CT yet another performance boost.
On the market side, most executives surveyed expected the CT market to turn in solid growth in the U.S. in 1998, with growth rates estimated at 15% to 20%, resulting in a U.S. CT market valued at around $670 million and a global market at about $1.7 billion. The markets growth rate may accelerate in 1999 as multislice CT prompts many facilities to replace their older single-slice scanners.
GE Medical Systems
- Milwaukee-based GE has installed nine of its multislice LightSpeed QX/i scanners since launching the product in September (SCAN 9/16/98), according to Vivek Paul, general manager of GEs global CT business. The company expected to have 13 of the scanners installed in the U.S. and eight internationally by the end of 1998.
- Based on early results, GE sees multislice technology changing CT imaging in three major ways. It allows the routine use of thinner slices, which results in crisper CT angiography images; it gives clinicians the ability to do scans with much more anatomical coverage, improving studies such as peripheral contrast runoffs; and it is capable of faster speeds, which can cut patient breath-hold exams or open up new applications, such as multiphasic liver studies.
- SmartScore is GEs new cardiac-scoring package, designed to produce a coronary artery calcification score that can help clinicians detect early signs of coronary artery disease. SmartScore is offered only on GEs high-end single-slice spiral scanner, HiSpeed CT/i, but will probably be migrated to the mid-range HiSpeed scanners and to LightSpeed, where it will benefit from faster multislice scans, according to Paul.
- The 1998 meeting also marked the first RSNA conference for the mid-range HiSpeed scanners, which were introduced in May (SCAN 5/13/98).
- As a work-in-progress, GE displayed its Advantage Fusion protocol to fuse CT and MRI data.
- Imatron responded to the introductions of calcium scoring packages from other CT vendors by touting what it said are the advantages of using its electron beam technology for the technique rather than the mechanical scanners sold by its competitors. The South San Francisco, CA, companys scanners are still much faster than the new multislice scanners on the market, and that translates into better exam reproducibility and the power to catch coronary artery disease at an earlier stage, according to Lewis Meyer, president and CEO of the company.
- CT angiography is also better on Imatrons ultrafast scanners, Meyer said, and the company displayed 3-D reconstructions in its booth.
- Imatrons Version 12.4 software improves the scanners ability to conduct general-purpose scans, making the companys product more versatile.
- On the business side, following the conference, Positron shareholders are scheduled to vote on Imatrons proposed acquisition of Positron. Imatron hopes to relaunch Positron early this year, with the goal of reducing its stake in the PET developer to 19%.
- Another deal, the sale of Imatrons HeartScan subsidiary to LifeTest America, has not gone so well. LifeTest has had trouble securing financing for the deal, so Imatron has begun to exploring other options, Meyer said.
Philips Medical Systems
- Without a multislice scanner in its portfolio, Philips highlighted interventional applications for its single-slice scanners. The Shelton, CT, company displayed a new kit for its mobile CT scanner, Tomoscan M, that makes the scanner more suitable for use in interventional environments such as vascular labs, according to Joseph Nagle, director of new markets in CT/MR.
- On the companys Tomoscan AV Expander line, Philips received 510(k) clearance in mid-November for Biopsy View, a CT fluoroscopy package that images at six frames per second.
- Philips included panels in its booth touting the benefits of multislice scanning with the companys MRC x-ray tube and fast reconstruction processes. Philips plans to offer Expander users an upgrade path to a multi-array detector, with a commercial offering at least a year away, Nagle said. Philips has a multislice R&D program under way, and the company is examining each of the three different approaches to multislice scanning.
- Mx8000 is the Cleveland vendors multislice offering. It takes off from technology developed by Elscints CT division, which Picker acquired just prior to the conference (SCAN 12/16/98).
- Picker received FDA clearance just before the conference for its Live-X flat-panel digital fluoroscopy technology, which is used in the companys fluoro-assisted CT (FACTS) interventional suite. Picker displayed a Venue FACTS suite on a PQ 6000si scanner in its RSNA booth, with the configuration including a FACTS digital C-arm and Pickers PinPoint stereotactic biopsy arm. Picker expects to deliver 40 Venue FACTS systems worldwide by the end of the companys fiscal year in March 1999.
- Picker also displayed ultrasound guidance for PinPoint as a work-in-progress, according to Gary Kaufmann, director of marketing and sales for the companys CT division. Adding ultrasound gives interventional radiologists a noninvasive alternative to x-ray for guiding biopsies, he said.
- UltraZ is a new single-slice scanner unveiled at the meeting. A major selling point of the system is its unlimited spiral capability, meaning that it can scan in spiral mode continuously, based on the ability of its computer to process data for as long as necessary. UltraZ is available in a range of tube and generator configurations and is upgradable to Mx8000. The scanner is shipping and is priced at about $600,000 for a single-slice version.
- HeartBeat-CS is a calcium-scoring package that the company is already selling for its entire product line. Picker is also developing a work-in-process cardiac-imaging package that uses postprocessed gating of data, Kaufmann said.
Shimadzu Medical Systems
- Shimadzu has made upgrades to its SCT line of scanners, including solid-state detectors on the SCT-7000 series and an increased field-of-view on the SCT-6800 series. The field-of-view on SCT-6800TXL has been expanded from 42 cm to 50 cm, while SCT-7000TS features solid-state detectors that recently cleared the FDA. The first TS scanner shipped at the end of 1998, and Shimadzu has installed 60 worldwide, according to Don Karle, director of sales and marketing at the Torrance, CA, company.
- Shimadzus mid-range SCT-6800 line started shipping in June. It varies from simple slip-ring systems to spiral units, Karle said.
- Shimadzu discussed CT fluoroscopy as a work-in-progress. One site is operating in Japan, and the company has filed a 510(k) application for the technique, which will be offered on the SCT-7000 line.
- Shimadzu is working on multislice CT technology in its R&D labs, but a commercial product is probably two years from market, Karle said.
Siemens Medical Systems
- Somatom Plus 4 Volume Zoom was the highlight in the Siemens booth. The multislice scanner, introduced in October (SCAN 10/14/98), has received FDA clearance, and the first scanners will be installed in January and February. Production quantities will be shipping this summer, according to Sabine Duffy, marketing manager for CT at the Iselin, NJ, company. Siemens will offer Volume Zoom both as an option to a new Plus 4 or as an upgrade for Plus 4 users in the field.
- Siemens received 510(k) clearance for its CT perfusion package on Nov. 25, Duffy said. The technique can be used on Plus 4 and the mid-range AR.Star for early evaluation of ischemic stroke. Siemens hopes that clinicians using the package will be able to begin stroke therapy earlier, enabling them to repair brain damage.
- Other new applications shown for AR.Star include new software that improves the scanners performance for applications such as CT angiography, as well as CARE Bolus, a technique that helps clinicians scan when a contrast bolus is at its peak intensity for better image quality.
- The latest results from cutting-edge research with a combination CT/PET scanner were also displayed. Siemens has built a scanner that includes a CT system with a ring of PET detectors to provide both anatomical and functional information in a single scan (SCAN 6/24/98). The work-in-progress system is installed at the University of Pittsburgh. The hybrid scanner can provide CT-based attenuation correction, as well as anatomical boundaries for PET reconstruction. The company displayed images of metastatic lung cancer and primary pancreatic cancer in its booth.
Toshiba America Medical Systems
- Aquilion is Toshibas new half-second CT scanner that will serve as the platform for a multislice offering to be introduced later this year. The scanner will begin shipping as a single-slice unit in February at a list price of $1.25 million, and Toshiba expects to start marketing the multislice version by the end of summer, at a price that the company says will be competitive with other multislice offerings.
- Toshiba is moving its entire line of scanners to solid-state detectors, Silicon Graphics workstations, and subsecond scanning, according to Charles Corogenes, director of the CT business unit at the Tustin, CA, company. These features will be available on all Toshibas scanners by the end of 1999. The one-second X series will be sold through the end of 1999.
- Toshibas CT products have been included in a large bulk buy of equipment from hospital chain Tenet. The deal includes Aquilion, as well as Asteion, a new subsecond CT scanner that will be positioned below Aquilion (SCAN 11/25/98).
- Toshiba revealed that it is working with 3-D workstation developer Vital Images of Minneapolis on a cardiac-scoring package that would be offered with its CT scanners. The collaboration is a nonexclusive arrangement, and Vital Images plans to offer cardiac scoring to other companies as well.