Riverain markets CAD for chest radiography

Riverain Medical has chosen the road less traveled by CAD companies. While other CAD manufacturers extend their algorithmic reach to the lung, colon, and breast, the Dayton, OH, firm is focusing on just one anatomic area: the chest.

Its strategy is simple: encourage hospitals and clinics with digital radiography systems to run a CAD algorithm that scans chest radiographs for lung cancer. About seven million chest radiographs are taken every year in the U.S., 19,000 a day. Win the support of just a small percentage of those doing chest radiography, and Riverain has established a huge procedure base, said Stephen Sledge, Riverain's vice president of business development.

On a digital system, the CAD program would run in the background, taking no extra time. The gains - spotting small lung cancers while they are in the early stages and most amenable to surgical resection - could be invaluable.

All this is relatively new to Riverain, just as Riverain is relatively new to the imaging community. The company was formed specifically to acquire the software developer Deus Technologies, of Rockville, MD. (Deus Technologies remains the R&D arm of Riverain under the Riverain Medical/Deus Research Center umbrella, created when Deus was purchased in July.) Riverain is so named because the CEO of the company, Sam Finkelstein, "liked the sound of it."

The company is focused on the RapidScreen RS-2000, the stand-alone or PACS-linked CAD system that was developed by Deus and approved by the FDA in 2001 specifically for early-stage lung cancer detection using chest radiographs. In clinical trials, RapidScreen demonstrated a 23% increase in detection efficiency for lung nodules ranging from 9 to 14 mm in size.

Riverain maintains a relationship with GE Healthcare that was initially established by Deus. GE packages RapidScreen on its Revolution digital x-ray system. But the company is also supplying RapidScreen CAD to hospital customers with DR, CR, or x-ray systems from other manufacturers.

The company offers both film and digital options. To complement traditional x-rays, it is marketing RapidScreen RS-2000, which includes a processing computer, CCD film digitizer, and laser printer. Riverain also is selling RapidScreen RS-2000 D, a digital background process that sits on a PACS or radiology network and analyzes DR or CR studies for lung nodules. RapidScreen systems use fuzzy logic, neural networks, and advanced image processing and feature extraction.

"One of the challenges and opportunities for the company is to continue to support the film-based part of the business, because not every hospital can justify or implement PACS," Finkelstein said.

Riverain distributes RapidScreen products through a national network of hand-picked x-ray dealers. Once it has a foundation of installations in the U.S., the company plans to move into the international chest imaging market, Sledge said.

In addition to the RapidScreen line, Riverain also is actively developing a CAD accompaniment for dual-energy subtraction that promises to improve the rate of true-positive CAD findings on chest radiographs by more clearly separating soft tissue from bone. The goal is to be ready with a CAD product for dual-energy subtraction as manufacturers release their systems to the market, Finkelstein said.

On the back burner are CAD products for detecting severe acute respiratory syndrome (SARS) and pulmonary embolism. Although the company believes its focus should be on CAD for chest radiography, it is working on a CT image-matching or temporal subtraction option that can overlay CT images acquired at different points in time, quantify volume comparisons, and note subtle changes.

To be flexible and responsive to customers, Riverain is planning to offer leasing arrangements that spread the cost of acquiring its CAD systems over a series of monthly payments.

"We're not just trying to sell new technology and leave the entire financial risk for the initial deployment of the technology to our customers," Finkelstein said. "We want to take away barriers to deploying the technology. We have the wherewithal to help carry the financial burden with our customers and take the journey with them."