New reality emerges from RSNA booths stuffed with new products to make near-term clinical differences

The exhibit floor at the RSNA meeting provided a stark contrast to that of the preceding year. Exhibits were mobbed. The fear of flying that had kept 10% of the usual attendees away in 2001 appeared to have been replaced by a fear of being left behind. And that fear was well founded.

PACS has come into vogue, a fact made obvious by the steady traffic at PACS exhibitors during the show and by the diehards who lingered at PACS exhibits as workers ripped up carpet and forklifts rolled Thursday afternoon. After some 15 years in limbo, PACS has finally arrived. Developers of these systems at last enjoyed the kind of attention other vendors of digital equipment experienced for much of the past decade.

The reasons are several: the need to handle an increasing volume in data from multislice CT and MR scanners driven by parallel imaging techniques, increasing interest in DR and CR, tighter reimbursements that put a premium on efficiency and throughput, and an abundance of low-cost computing platforms. Perhaps most important is the realization that improving workflow offers the only way to surmount the current challenges to radiologists, whose diminishing ranks have not kept up with an increasing workload.

And PACS was just one of the attractions. Ultrasound seemed to have finally broken out. Again, faster and cheaper computing platforms were a factor. True real-time 3D imaging has entered the mainstream. Several vendors showed 4D products, but two stood out: Siemens' fourSight for radiology and Philips' Sonos 7500 with Live 3D Echo for cardiology. Rather than acquiring data and waiting for their reconstruction, fourSight and Sonos 7500 provide volumetric images as soon as the transducer is placed on the skin. Equipped in this way, sonographers can practice volumetric ultrasound as they have been trained--in real-time.

Digital x-ray was reenergized with the migration of large flat detectors into radiography/fluoroscopy and angiography, a growing sophistication in CR and DR, and rising prospects of nontraditional implementations of full-field digital mammography. An x-ray angiogram showed the interior of a blood vessel, testifying to the extended dynamic range possible with a flat panel. A computed radiograph, imbued with "intelligent" algorithms, showed enhanced edges, improved contrast, and better density. The commercial prototype of a mammography system designed to support tomosynthesis boosted hopes that a noninvasive technology might be near for reducing the number of unnecessary biopsies. Manufacturers picked up where they left off last year in PET/CT with a flurry of fast PET systems fortified with the 16-slice CTs.

But it was CT and MR where technological potential seemed most ready to meet clinical benefit. Radiologists had waited a year and half, from the 2000 RSNA meeting until midsummer, for the arrival of widely available 16-slice scanners, and they wasted no time snapping them up. The three vendors that had production lines rolling--GE, Philips, and Siemens--each reported hundreds of sales in six months. (Toshiba began routine delivery of its 16-slice CT this month.) The time has come for multislice to take hold at all performance levels and price points, as the four major CT manufacturers cumulatively introduced a scanner at every multiple of two up to 10 with flagships at 16.

In MR, parallel imaging techniques and faster gradients made vendors rethink what could be done with their machines. New oncology applications appear possible with scanners primed as simulators for radiotherapy planning or as whole-body screening tools. Soft plaques shone from the inside of vessel walls; MR microscopy peered into the tiniest recesses of the skin. As it was for all the modalities and PACS, this year's RSNA meeting was a chance for MR vendors to concentrate on what might be. Unlike past years, however, they were talking about what could be seen at their very own booths.