Every booth tells a story

Stepping into the North Hall of the RSNA exhibit last week, I was taken by the expansive calm. The hall was open, unlike the South Hall with its highly regimented rows of exhibitor booths. There was room to move, to think, to look around. But amid the calm, there was a current pulling me forward.

As I walked on, the aisle narrowed like a river canyon. Eddies of people swirled along the banks, flowing in and out of booths. Those who ventured out a bit were swept into the general flow, joining me and the others pulled downstream into the gaping maw of the GE booth.

It was spectacular, punctuated by a video of a woman, several stories high, gently blowing dandelion seeds that turned into the genetic underpinnings of personalized medicine. This is, after all, GE's message, and has been for a long time. But never before had the company made its point so effectively.

In this projection, GE was far from alone, of course. The booths that populated both halls of the McCormick Center last week were molded to bring people in and get messages across. None was as well executed as GE, but many were as significant.

Philips created a peaceful mood around its Achieva XR, an MR system that can be upgraded from 1.5T to 3T. Toshiba's exhibit was all about the long haul, sticking to its bigger and better CT detectors, exemplified by its prototype 256-slice scanner that looms on the horizon. Siemens projected with absolute certainty that outcomes and productivity were the future, extending paths in dual-energy CT and new MR applications while hinting (rather strongly) that its palm-size ultrasound would make the practice of medicine more efficient.

In its booth, Hologic pitched the concept of the whole is greater than the sum of its parts. The company has integrated its extensive mammography offerings with those of CAD pioneer R2 Technology, biopsy expert Suros, and intellectual property relating to the MammoTest system built by Fischer Imaging. The latter appeared in the Siemens booth because the federal government forced Hologic to sell rights to the system to the Germany-based multinational to allay anticompetitive fears. Hologic still has license to the technology, allowing the intellectual property to appear in its own products.

Some booths were like dots on a canvas whose message couldn't be appreciated without stepping back. Xoran showed the prototype of a CT device specialized for surgery. Neurologica demonstrated its mobile CereTom CT for bedside imaging (and also, not coincidentally, suited to the OR). Koning showed dedicated breast CT.

Each little niche-filler had its own special appeal. I loved thinking about how creative these companies might become in promoting these systems. Being a David Bowie fan, I couldn't resist telling the guys at Neurologica my jingle for their scanner. ("Ground control to CereTom," sung to the tune of the same name, swapping "Major" for "Cere," of course.) They seemed to like it.

Then there was computed radiography, a testament to the new order of radiology. If CR had followed the path of other mature technologies, it would have given way to flat-panel digital radiography years ago. That it hasn't demonstrates the fortitude of CR vendors from marketing and technological perspectives, as well as the cost-consciousness of would-be purchasers.

Emboldened by the continuing strength of CR in the U.S. market, however, some of these vendors have mapped a collision course with the makers of flat-panel devices. They are repackaging phosphor-based CR technologies into their own brands of DR systems, while trying to redefine DR by workflow rather than underlying technologies. I was advised by the folks at Fuji to talk about the company's new U-arm as a DR product, not a CR product, as it features a "DR detector" (albeit one composed of a phosphor-based plate and laser-light reader). Function over form, was their essential message - hardly a novel idea.

MR vendors have effectively positioned cylindrical systems against open MRs for years, first with compact footprints, then with wider bores, now with feet-first positioning. The strategy worked. Demand for open MR in this country has collapsed.

CR vendors are taking a page from this playbook in their battle with DR. Expect a variation on that theme in women's health as Fuji goes into high gear to sell its CR mammography product in the U.S. Already company execs are referring to it as full-field digital mammography.

So the world of radiology changes, sometimes in function, other times in application. But always the bottom line comes down to perception.

Throughout the conference, I was asked again and again what the biggest things I saw were. Each time I shrugged. Occasionally there are new developments - hybrid PET/CTs of years past or Siemens' dual-beam CT - but these soon give way to iterations.

The biggest things at this year's RSNA meeting, as at past ones, have to do with how technologies are perceived. Most remarkable, and least detectable, are the undercurrents that feed those perceptions.