SCAN SPECIAL REPORT: December 1996

PACS dominates RSNA technical exhibits as healthcare focuses oninformation technology

The need for greater efficiency is driving interest in image andinformation management

In case anyone is keeping score, the 1996 edition of the RadiologicalSociety of North America meeting marked the second straight yearthat medical imaging's largest conference has been dominated byPACS and related information technology issues. Interest in imagemanagement exceeded even that of last year's high-water mark,and indicated that rumors of a slowdown in the PACS market havebeen greatly exaggerated.

At this month's Chicago meeting, PACS finally shed its imageas a boutique technology and took its place as a necessary componentof the radiology department of the future, the glue that holdsthe big iron together. The major scanner and film vendors areleaping into PACS with increasing abandon, while smaller companiesare trying to carve out profitable niches without getting steppedon.

What's driving interest in PACS? Predictably, the two majorfactors are healthcare consolidation and the ever-growing impactof managed care. Merging hospitals and radiology groups need PACSand information systems to stay connected, while the same technologieshelp managed-care providers offer quality care more efficiently.

Besides PACS, major trends at the 1996 meeting included therapid growth of healthcare consulting businesses operated by medicalimaging OEMs. Major new efforts were unveiled by Siemens, Philips,Eastman Kodak, and other companies, with the goal of using theexpertise vendors have developed in reengineering business practicesto help healthcare facilities reduce waste and increase efficiency.These new businesses represent the next step forward from themultivendor service and asset management initiatives that werede rigueur at the 1995 conference.

Nuclear medicine and information systems company ADAC Laboratoriestook the concept of vendor partnering to a new level with itsannouncement that it has purchased Medical Transition Strategies,a management organization that develops radiology networks. Lookfor many vendors to eye ADAC's moves in this area closely as theystrive to identify new markets.

In the traditional world of new product introductions, Toshiba'snew Opart cryogenless superconducting open MRI scanner was oneof the hottest debuts. Fonar appeared at its second straight RSNAmeeting and raised eyebrows by introducing a stand-up MRI scanner,while Siemens discussed its work in developing a dedicated MRIhead system.

Ultrasound probably experienced the broadest range of new productintroductions, with Hewlett-Packard jumping into radiology ultrasound,Toshiba beefing up its position at the high end of the modality,and Acuson giving the RSNA a look at its Sequoia and Aspen scanners.

The development of flat-panel digital detectors was also anotable theme, with Sterling emphasizing its work on a 14 x 17version of Direct Radiography, and Fuji countering with advancementson its computed radiography systems. Other companies discussedtheir plans to develop digital detectors, and medical imagingobservers should expect this market to heat up in 1997.

The following pages of Scan Special Report offer a brief reviewof new developments in major modalities that were on display onthe technical exhibit floor in McCormick Place.

PACS vendors integrate imaging with IT
Perhaps the most important trend evident in the booths of PACSvendors was the growing integration of PACS products with radiologyand hospital information systems and even telemedicine applications.Vendors realize that in order for PACS technology to achieve widespreaduse, it must be offered as part of an enterprise-wide informationtechnology solution, rather than as a department-level installation.

Vendors are also developing software that uses the Internetand intranets as low-cost means of image distribution. In whatcan be seen as a step toward the creation of the electronic patientrecord, several companies displayed software for developing multimediapatient reports using images, sound, and text that can be sentas files over the Internet and intranets. PACS and informationsystems vendors will have to resolve concerns over patient privacyand data encryption before this technology can achieve widespreaduse, however.

Many PACS industry observers believe that a confluence of factorscould finally lead to a boom in PACS purchasing in 1997. The industryhas finally begun commercial implementations of standards suchas the ACR-NEMA's DICOM 3.0 protocol; the price of computer hardwarecontinues to drop; and hospitals are seriously looking at makingPACS acquisitions.

In addition, several major vendors, such as Philips and EastmanKodak, appear to have put their PACS houses in order after yearsof trying to do so. Look for a battle royal in the coming yearas these firms and others take runs at a market that to date hasbeen dominated by a handful of companies.

Access Radiology

• This Waltham, MA, vendor of the Framewave line of film digitizersand framegrabbers used the 1996 RSNA meeting to debut an archiveand an at-home teleradiology workstation, both of which use thewavelet compression algorithm also employed by the Framewave products.

Agfa

• Agfa, of Ridgefield Park, NJ, inked a value-added reselleralliance with multimodality vendor Toshiba America Medical Systems.Toshiba will have nonexclusive U.S. rights to sell Agfa's ImpaxPACS product in situations where it is also selling multimodalityequipment.

• DryStar 3000 is a new 14 x 17 version of the company's thermalprinting technology, with 320-dots-per-inch resolution and a throughputof 50 14 x 17 films an hour.

• Agfa is developing a new version of its ADC computed radiographyreader, called ADC Compact. The work-in-progress system has halfthe footprint of ADC 70, with a 10-cassette input and a throughputof 50 plates an hour.

• Scopix LT 5200 is a new laser printer for digital mammographyapplications, with a resolution of 630 dots per inch. The printershould begin shipping in the second quarter.

Algotec

• MediSurf is a new software product developed by this Raanana,Israel, company for using the Internet and intranets for teleradiologyand in-house access to medical images and clinical data. MediSurfuses a server connected to a hospital's network and applets writtenin Sun's Java programming language to allow clinicians to view,edit, and process images from remote locations, according to KobiMargolin, marketing manager.

Analogic

• Analogic of Peabody, MA, showed a new version of its Webradserver, developed in collaboration with Dome Imaging Systems,that allows users access to diagnostic-quality images via Webbrowser technology.

AOP Medical

• AOP Medical of Gardena, CA, introduced a teleradiology componentfor its PF-PACS line.

Applicare Medical Imaging

• This Dutch PACS company discussed its OEM relationship withKodak. Applicare's RadWorks 2.0 line of medical imaging and teleradiologysoftware received 510(k) clearance this year.

Brit Systems

• Brit of Dallas emphasized its new relationship with IBM'sWorldwide Government Industries division. The two companies arecollaborating on a filmless hospital PACS at the VA Medical Centerin Dallas.

Cemax-Icon

• This Fremont, CA, company is still waiting for the initialpublic offering market to rebound before launching an IPO, accordingto president and CEO Terry Ross. The firm has plenty of cash inthe bank, thanks in part to a private equity investment in Septemberby partner Imation, which now owns just under 20% of Cemax-Icon,Ross said.

• On the new product front, Cemax-Icon displayed its new ArchiveManager 2.0 and AutoRad 3.0 products, which will begin shippingin early 1997, according to Oran Muduroglu, vice president ofsales and marketing. AutoRad is a primary-diagnosis workstation,while Archive Manager is a scalable object-oriented archivingjukebox developed with Imation.

• Cemax-Icon also displayed a work-in-progress JPEG image compressionalgorithm that allows JPEG compression at ratios of up to 40:1.Cemax-Icon is waiting for the industry to settle on a standardfor wavelet compression before developing a product based on thattechnology, Muduroglu said.

CompuRad

• At the top of the agenda for CompuRad was ClinicalWare,a new product that uses Web browser technology to allow cliniciansto access data from any information system in a hospital. TheTucson, AZ, company reported that it has reached an agreementwith film vendor Sterling Diagnostic Imaging to develop an interfacebetween ClinicalWare and Sterling's Quick Linx networking system.The deal is expected to provide a secure means for distributingmedical images via the Internet.

DeJarnette Research Systems

• DeJarnette of Towson, MD, displayed enhancements to itsMedishare HIS/RIS gateway.

Dicomit Imaging

• Dicomit Imaging introduced a HIS/RIS interface to its DICOMImage Manager, and announced that it has introduced DICOM ImageManager HF to store and record images from CT, MRI, computed radiography,and nuclear medicine as well as ultrasound. The Richmond Hill,Ontario, company also emphasized the number of OEMs that wereusing DICOM Image Manager in their RSNA booths.

DR Systems

• A work-in-progress product called Assimilator was this SanDiego company's contribution to the flood of new RSNA productsthat allow users to create private intranets for image distribution.

• As part of its continuing effort to move its PACS line fromthe DOS platform, DR Systems showed Universal Manager, an all-in-onemultitasking system that runs in Windows 95 and Windows NT, aswell as a Windows ultrasound color image input and display system.

Dynamic Healthcare Technologies

• Dynamic of Maitland, FL, introduced two new features forits Maxifile RIS, and demonstrated the enhanced version of Maxifilein combination with its PACsPlus+ image management and distributionsoftware.

Eastman Kodak Health Imaging

• Kodak has finalized the DICOM version of its Digital Scienceimage management software and is ready to begin selling the line,according to Martin Coyne, president.

• A work-in-progress dry laser printer was displayed in Kodak'sbooth, a product that the company hopes to begin shipping nextyear. Users of Kodak's 2180 wet lasers will be able to upgradeto the new system, according to spokesperson Dawn Beck. Kodakis also developing a laser printer for full-field digital mammography.

• Kodak has developed a HIS/RIS gateway for its computed radiographysystem 400, with availability in the first quarter.

GE Medical Systems

• The Milwaukee company has renamed its PACS division IntegratedImaging Solutions, and showed several work-in-progress workstations.GE officials declined to comment on continued rumors of its reportedoffer to acquire Lockheed Martin's PACS business.

Imation

• Imation's major emphasis was its DryView dry-laser printerline. The Oakdale, MN, vendor announced that it has begun shippingthe 8 x 10 version of the product, DryView 8300, for nuclear medicine,ultrasound, and C-arm applications. Imation also introduced awork-in-progress 11 x 14 printer, DryView 8500, for computed radiographyapplications.

• A digital mammography DryView is also being developed, accordingto Steve Burns, product development manager. That system wouldhave 600-dpi resolution and a 50-micron spot size.

• Imation announced that it has created an alliance with Cemax-Iconfor European sales of that company's image management products.Imation is the exclusive dealer for Cemax-Icon products in Europe,according to Clifford Pinder, vice president of operations.

• Image Acquisition Manager Plus is a new device that convertsimages from legacy CT, MRI, and other modalities into the DICOMprotocol.

Imnet Systems

• Imnet made its RSNA debut by showing MedVision, a PACS offeringthat integrates full-resolution medical images with informationfrom electronic medical records. The Atlanta-based company capitalizedon its experience as a provider of electronic information anddocument management systems to create a PACS solution that isintegrated across the hospital enterprise, said marketing managerKevin Stultz.

ISG Technologies

• In a case of unfortunate timing, ISG Technologies of Mississauga,Ontario, found itself embroiled in a proxy fight for control ofthe company that was launched by a group of dissident shareholdersin the middle of the RSNA conference. That battle should be resolvedat a Dec. 23 shareholders meeting.

• On the product side, ISG showed version 2.1 of its VRS lineof workstations. The new version includes stack views of images,cross-referencing of images using scout views, and a new VRS200Windows NT-based clinical review station for home and office applications.

Konica

• In teleradiology, Konica of Wayne, NJ, demonstrated as awork-in-progress a software suite that is due for release in early1997. The system includes a scanning component for digitizingplain films, direct capture for video-based or electronic imagingmodalities, a remote viewer, and a dedicated teleradiology server.Konica will begin marketing the package as a stand-alone productand, by next year's RSNA meeting, expects to integrate it intoits PACS and clinical network product lines.

Line Imaging Systems

• Atlanta-based Line announced an OEM agreement that allowstelemedicine vendor InTelemed of Oklahoma City, OK, to sell Line'sWinRad teleradiology software under the name InTeleRad. The customizedversion of WinRad will support both home and hospital teleradiologystations.

Lockheed Martin Western Development Laboratories Medical ImagingSystems

• Lockheed Martin's PACS unit displayed its Web-Link Internet-basedimage distribution software for referring physicians, which willship in the second quarter as an extension to the Hoffman Estates,IL, company's Vantage PACS line.

• Lockheed Martin also displayed its information systems integrationproduct, R/HIS-Link, via the HL-7 standard to Meditech's RIS module.Teleradiology has been added to Vantage through Access Radiology'sFramewave teleradiology product.

• DICOM-Link is Lockheed Martin's implementation of DICOM's store,query, and retrieve engine, which the company demonstrated throughdirect DICOM links with Fuji and GE.

MarkCare Medical Systems

• This Bloomfield, NJ, company displayed IntraScan II, a tele-radiologyand PACS system that MarkCare acquired when it bought Simis MedicalImaging earlier this year. IntraScan II employs Unix servers basedon SQL relational database management control, Unix and WindowsNT viewing workstations, and RAID and CD-ROM jukebox archives.Data General is a systems integrator for IntraScan II.

Medweb

• Medweb unveiled a wavelet-compression-based plug-in forNetscape Navigator 3.0 that the San Francisco company claims couldmake obsolete expensive medical imaging PACS workstations. Theplug-in enables clinicians using PCs to view and manipulate imagessent over a hospital intranet.

Merge Technologies

• Merge Technologies showcased CaseWorks, a work-in-progressapplication that allows radiologists to create summary reportson film using a hand-held reader instead of a workstation, saidBill Stafford, vice president of sales and marketing for the Milwaukee-basednetworking company.

Olicon Imaging Systems

• Olicon emphasized the completion of a Windows NT versionof its PACS software, which improves the speed of the product,according to Leo Ferrini, vice president of sales.

• The San Clemente, CA, company also unveiled an alliance withIDX Systems to integrate Olicon's PACS line with IDX's IDXradRIS. The relationship will result in a single PACS/RIS productthat will enable radiologists to retrieve images and RIS datafrom a single workstation. Development work is expected to becompleted in 18 to 24 months.

• Olicon also introduced PACSView, software based on Windows95 for on-call teleradiology uses outside a hospital or imagingcenter.

Philips Medical Systems

• Philips of Shelton, CT, has completed its return to thePACS market thanks to a relationship with Swedish software developerSectra-Imtec. Philips displayed the company's Sectra PACS softwarein its booth and has begun competing for major PACS installations,according to Fred Goeringer, director of healthcare connectivitysolutions.

Raytheon E-Systems Medical Electronics

• E-Med surprised its teleradiology competitors by announcingthat it will begin giving away its MultiView home review softwarein a move to gain market share.

• Development of E-Med's DICOM-compliant PACSPro/DX PACS productis expected to be completed this spring, according to presidentRonald Ford. The work is being done at an E-Med sister companyin Garland, TX.

Rogan Medical Systems

• Rogan of Waukesha, WI, announced additions to its HyperPACSline of digital imaging and storage equipment that make it possibleto access 2K x 2.5K images in less than a second. The two newpieces of software include HyperDispatcher, which automaticallyforwards images to the appropriate workstation, and HyperView,which allows preloading of image sets at display stations.

• Rogan also inked a deal with InTelemed in which that telemedicinevendor would resell HyperPACS as InTelePACS.

Sectra-Imtec

• Appearing at its third RSNA meeting, Sectra played up itsnew relationship with Philips. In addition, the company showeda new version of its workstation software that can be preset fora physician's image viewing preferences.

• Web and teleradiology links are also under development, asis a Windows NT version of the company's software, which now runson Unix.

Siemens Medical Systems

• Siemens of Iselin, NJ, displayed panels on using computerizedsmart cards to carry patient information such as demographic data.Smart-card readers installed throughout a hospital would obviatethe need to reenter data as the patient moves through the hospitalsystem, according to David Armour, marketing manager.

• Siemens also showed a real-time HIS/RIS interface to IDX'sIDXrad product, as well as MagicArchive, a long-term archivingsolution that uses a robotic arm to access stored images.

Sterling Diagnostic Imaging

• A 14 x 17 version of Sterling's Direct Radiography technologywas given spotlight treatment by the Glasgow, DE, company.

• On the hard-copy output side, Sterling announced that it hasfinished its acquisition of Polaroid's Helios assets.

• A non-laser dry printer developed through a relationship withTektronix was also on display in Sterling's booth.

Nuclear medicine pursues FDG imaging
Despite a surge of optimism after the Society of Nuclear Medicinemeeting in June, most gamma camera vendors at the RSNA conferencecharacterized the U.S. nuclear medicine market as flat in 1996.The sluggish environment may be disappointing, but is still animprovement over the sharp declines in the modality in 1994 and1995.

The nuclear medicine industry is hoping that high-energy imagingof F-18 fluorodeoxyglucose will be the white knight that rescuesthe modality, much as SPECT did in the 1980s. The market is gravitatingtoward coincidence detection FDG techniques, which will allowconventional gamma cameras to product PET-style images of fluorodeoxyglucose,albeit at lower resolution.

ADAC Laboratories and Picker International were the only vendorsat the RSNA meeting with FDA clearance for coincidence detectiontechniques. Look for more companies to join this exclusive clubin 1997, however, as several already have 510(k) applicationson file.

ADAC Laboratories

• ADAC showed preliminary results from clinical trials itis conducting to support its Molecular Coincidence Detection method.To improve MCD's image quality, the company is now using an iterativereconstruction algorithm, rather than the filtered back-projectionmethod employed previously, according to Jeff Nelson, vice presidentof marketing.

• The Milpitas, CA, company also introduced Pegasys Online, softwarethat allows nuclear medicine physicians to create reports forreferring physicians that can be accessed on a World Wide Webserver.

• ADAC also announced its acquisition of Medical Transition Strategies,an Atlanta company that organizes radiology networks such as GeorgiaRadiology Network. ADAC formed a new business unit, ADAC RadiologyServices, to develop networks linking payors and radiology groups.

Digirad

• Digirad of San Diego is developing Notebook Imager, a solid-statedigital gamma camera using detectors made with cadmium zinc telluride.Digirad showed an entire system at this year's meeting, as wellas clinical images, after displaying only a detector head lastyear. Digirad has filed for 510(k) clearance for the camera.

Elscint

• Elscint showed images acquired from Vanderbilt Universitywith CoDe3, its investigational coincidence detection techniquefor its variable-angle VariCam and opposable fixed-angle Helixsystems. Elscint compared the images with PET images also acquiredat Vanderbilt.

• The Israeli vendor is preparing for its entry into the Japanesemarket, where it has signed an agreement with Philips that allowsthe Dutch company to distribute Elscint gamma cameras. Philipswill begin shipping Elscint cameras as soon as regulatory approvalis received, according to Nathan Hermony, head of Elscint's nuclearmedicine division. The companies hope that VariCam will help themseize some of the large market share held in Japan by Toshibaand Shimadzu (which markets Picker cameras), neither of whichhas variable-angle dual-head systems.

GE Medical Systems

• GE rolled out an entire family of new work-in-progress gammacameras based on its Millennium hybrid digital detector design.Millennium MG is a variable-angle dual-head; Millennium MT isan opposable-angle dual-head; Millennium MPR is a rectangular-detectorsingle-head; and Millennium MPS is a square-detector single-head.

• GE displayed coincidence detection images collected with itsMaxxus camera, and displayed an upgraded Optima NX system.

• The company has developed a next-generation version of itsinvestigational solid-state digital gamma camera, and hopes tomove the system into clinical trials in the third quarter of thisyear, according to Arvind Subramanian, manager of global productmarketing for nuclear medicine.

Park Medical Systems

• Canadian gamma camera firm Park Medical is betting thatits work-in-progress Molecular Coded Aperture Technology willgive it a technological edge, due to MCAT's application to bothlow and high energy ranges, according to CEO Richard Mullen.

• Mullen also discussed Park's FDG distribution alliance withBelgian cyclotron developer Ion Beam Applications and radiopharmaceuticalfirm Medi-Physics, Amersham Healthcare, which was added to thealliance the week after the RSNA meeting.

Picker International

• Picker is preparing to begin shipments of its Positron CoincidenceDetection technology in February, after getting clearance lastSeptember. The company highlighted the use of PCD in a planar-stylewhole-body manner using a list mode data acquisition and rebinningalgorithm. The technique, called PCD Survey, could be used asa screening tool for cancerous lesions or for tracking metastases,according to Josh Gurewitz, marketing manager.

• Picker also showed ongoing work in scintimammography, and displayedits new Odyssey FX computer platform for the first time at a U.S.meeting.

Siemens Medical Systems

• Siemens' nuclear medicine division of Hoffman Estates, IL,highlighted its E.Cam variable-angle gamma camera, which has beenoptimized for both conventional SPECT and high-energy imaging,according to vice president of marketing Randy Weatherhead. Siemensexpects to have E.Cams installed in all major world markets bythe end of the first quarter.

• Siemens is developing coincidence detection using conventionalsodium iodide detectors, but is also investigating high-energyimaging with LSO/YSO detectors developed by cyclotron firm CTI,Weatherhead said.

• Siemens has experienced strong demand for PET cameras, accordingto Weatherhead, perhaps as a result of the turmoil at GE's PETbusiness. The company expects to ship 25 of the 40 PET camerassold worldwide in 1996.

SMV

• SMV's entry into the coincidence detection race is VolumetricCoincidence Reconstruction, and the Twinsburg, OH, company hasimplemented reconstructions for VCR images to correct for randomsand 3-D uniformity, a process similar to that used in PET, accordingto Lonnie Mixon, director of marketing. SMV has submitted VCRfor FDA clearance and hopes to begin shipping in the middle partof 1997.

Toshiba America Medical Systems

• Toshiba did not display any gamma cameras in its booth,but instead used panels to showcase its ongoing work in implementingartifact correction techniques to allow the quantification ofSPECT images.

• Company officials promised that a new product announcementwill be forthcoming from the nuclear medicine division in thenext several months.

Trionix

• Dedicated nuclear medicine company Trionix of Twinsburg,OH, scaled back the size of its booth, in line with ongoing cost-cuttingefforts at the company. In a press release, Trionix said thatit has reduced operating costs and employee levels dramaticallyin order to remain debt-free. The release also stated that becauseover half of the company's 150,000-square-foot headquarters spaceis underutilized, it is leasing the space to reduce overhead costs.

• On the product development front, Trionix emphasized the FDAclearance in November for QuaSAR, a package that addresses problemsaffecting accurate image quantification, including scatter, attenuation,and geometric collimator response.

Vendors ramp up full-field mammography
Full-field digital mammography is on the cusp of commercialization,with vendors like Trex Medical and Fischer Imaging preparing tosubmit 510(k) applications for their technologies. After yearsof waiting, the market will finally be able to see for itselfwhether full-field digital lives up to its promise.

Trex and Fischer will hardly have the full-field market tothemselves, however. A walk through the exhibits at the RSNA meetingindicated that many other vendors are developing full-field digitalsystems that are only a few steps behind the market leaders.

The development of full-field digital systems is having a rippleeffect on other mammography technologies. For example, severallaser printer manufacturers are developing high-resolution printerswith 600-dots-per-inch resolution to capture the higher imagequality of digital mammography. Printer vendors are hoping tobegin shipping these units in conjunction with the commercializationof the first full-field digital systems.

Other companies are exploring telemammography applicationsthat would send digitized images to remote locations for reviewand interpretation. Advances in telecommunications technologiesshould help resolve the bandwidth issues that might impede telemammography.

Biopsys Medical

• Biopsys debuted at last year's meeting with Mammotome, abiopsy gun that uses a novel vacuum method of removing breasttissue for biopsy. This year, the San Juan Capistrano, CA, firmintroduced Ultrasound-Guided Mammotome, a version of the productdesigned for use with ultrasound-guided biopsy tables.

• Biopsys also displayed IntelliPad, a personal digital assistant(PDA) based on Apple's Newton MessagePad, that is designed tohelp mammographers create patient reports, according to EllenPreston, vice president of marketing. IntelliPad allows mammographersto report findings directly into the PDA and create reports thatcan be sent to referring physicians, eliminating 95% of transcription,Preston said.

• IntelliPad can be interfaced to Biopsys' Breast Center Managersoftware to enable the creation of outcomes reports that helpa mammography center comply with the Mammography Quality StandardsAct, Preston said.

Elscint

• Elscint emphasized Master Exposure Control, a feature forits Glory and MAM-CH22S mammography systems that automaticallydetermines x-ray filtration, kVp, mAs, and exposure settings.The company claims that the technique reduces the need for retakes.Master Exposure Control will begin shipping in January.

• Elscint will begin international deliveries of Glory by theend of this month, and is also planning to file for 510(k) clearanceby the end of this year, according to Yoav Zuckerman, generalmanager for Elscintec Systems.

• Elscint also displayed a work-in-progress digital mammographydevice for spot applications on Glory.

Fischer Imaging

• Fischer's SenoScan is a dedicated full-field mammographysystem that uses a slot-scanning approach. Since SenoScan wasdebuted at the 1995 RSNA meeting, Fischer has worked on improvingthe system's image quality and has been placing units at clinicalsites to gather patient data for its FDA submission, accordingto Anthony DeCarolis, vice president of sales and marketing.

• The Denver vendor also displayed a work-in-progress needlelocalization device for use in MR-guided breast biopsy. The companyhas developed a table fitted with a core biopsy gun that can bedocked to an MRI scanner.

Fuji Medical Systems USA

• Computed radiography vendor Fuji of Stamford, CT, showedinvestigational mammography images collected with its new AC-3/Mreader. The reader will work with all existing mammography systemsby using Fuji's phosphor plate technology in place of a conventionalscreen-film cassette, making it a cost-effective way of doingdigital mammography, according to John Strauss, national marketingmanager for CR products. Fuji is in discussions with the FDA regardingthe amount of clinical data that will be required to support AC-3/M's510(k) submission, Strauss said.

GE Medical Systems

• GE went public with its work on digital mammography by showingSenoVision, a work-in-progress CCD-based detector with an 8 x8-cm field-of-view for digital spot applications. Because SenoVision'sphosphor plate is coupled directly to an 8 x 8-cm CCD, the detectoris far thinner than other CCD detectors, according to Mona Theobald,marketing manager for women's health. GE hopes to begin shippingSenoVision in 1997.

• In the realm of full-field digital mammography, GE is usingflat-panel technology based on an amorphous silicon detector materialrather than CCDs. This detector would be as thin as SenoVision's,and the company plans to develop both detectors as add-ons forits Senographe DMR mammography systems in the field and as anoption on new systems.

• GE featured an investigational full-field digital image, aswell as its ongoing work in developing a telemammography capabilityusing satellite transmissions of digitized images.

• Breast imaging with ultrasound and MRI were also featured inGE's booth.

Imaging Diagnostic Systems

• Exhibiting at its third RSNA meeting, IDSI displayed thefirst patient images collected by its work-in-progress CT lasermammography system, which sends high-speed pulses of laser lightthrough the breast to image lesions. The Plantation, FL, companyis working on reducing noise in images caused by light scatter,according to CEO Richard Grable.

• Grable claims that the early images IDSI is acquiring are atleast as good as images acquired by CT and MRI scanners at a similarstage of development. IDSI hopes to file a premarket approval(PMA) application with the FDA by the middle of 1997.

NeoVision

• NeoVision debuted at the RSNA meeting with Sonopsy, a dedicatedunit for ultrasound-guided needle breast biopsy. Sonopsy providesreal-time ultrasound guidance, as well as 3-D ultrasound imagesthat can be correlated with mammograms.

• The Seattle company touted the benefits of Sonopsy's breastcompression capability, which it claims improves lesion detectioncompared with freehand ultrasound guidance techniques. NeoVisionreceived 510(k) clearance for Sonopsy earlier this year.

Planmed

• An unexpected new entrant into the digital mammography frayis Finnish x-ray vendor Planmed. The company is working on a full-fieldslot-scanning CCD array with fiber-optic tapers that has a 29-micronpixel size and resolution of 17 line pairs/mm, which comparesfavorably with other CCD systems. The company hopes to file a510(k) application a year from now, according to Chris Oldham,product manager.

• Planmed also introduced Sophie Classic, a work-in-progressmid-tier mammography system that will sell for $50,000 to $68,000and is expected to begin shipping in the first quarter.

PrimeX General Imaging

• In the InfoRAD exhibit, start-up company PGI of Carlsbad,CA, displayed a work-in-progress slot-scanning camera for full-fieldapplications that uses direct access sensing detectors, which,like GE's flat-panel detector, don't require x-ray photons tobe converted into light for digitization by CCDs. PGI would liketo supply the detectors to medical imaging OEMs and plans to enterclinical trials in March, according to John Cox, vice presidentof R&D.

R2 Technology

• R2 Technology of Los Altos, CA, displayed its work-in-progresscomputer-aided diagnosis workstation, which uses mathematicalalgorithms to analyze digitized mammography films and highlightsuspicious areas for a mammographer's attention. These systemsare still several years from market, however.

Siemens Medical Systems

• Siemens' digital mammography program is centered on OPDIMA,a work-in-progress spot digital device for stereotactic guidancethat is undergoing 510(k) review, according to Tammy Duffy, mammographybusiness manager. OPDIMA uses CCD technology with a 49 x 85-mmfield-of-view. It can be retrofitted to the company's Mammomat3000 premium mammography system.

• The company also showed panels on the development of a full-fielddigital prototype.

TransScan Medical

• TransScan showed its investigational work in measuring changesin electrical impedances in the breast as a way of detecting abnormalities.The company, of Migdal Ha'Emek, Israel, believes that the technologyis safer and less invasive than conventional mammography becauseno radiation is used.

• T-Scan 2000 is a hand-held unit targeted at private-officepractice, while T-Scan 3000 is designed for radiology suites.Both are works-in-progress.

Trex Medical

• Trex is developing a full-field CCD array that can be addedon in the field to mammography systems manufactured by Trex subsidiariesLorad and Bennett X-Ray. The Danbury, CT, company has the systeminstalled at two clinical sites to collect data on 500 patientsfor its FDA submission, which it hopes to file by the end of March,according to Trex president and CEO Hal Kirshner.

• Trex is also working on a flat-panel detector that could bea successor to its CCD array, but that technology is one to twoyears behind the CCD technology, Kirshner said.

• Trex parent ThermoTrex has scaled back development of SonicCT in order to focus on full-field digital, Kirshner said. SonicCT uses sound waves to image breast tissue but differs from ultrasoundin the way images are reconstructed. The investigational technologyhad been displayed in the Lorad booth at previous RSNA meetings.

• In conventional mammography, Trex subsidiary Lorad emphasizedits M-IV mammography system, which began shipping several monthsbefore the RSNA conference.

• Bennett highlighted Contour Plus, a new version of Contourthat accepts power from the 220-volt outlets used in hospitals,according to Bennett president Walter Schneider. The earlier versionof Contour used a stored-energy battery.

• Profile is a new work-in-progress mid-range freestanding mammographysystem designed to fit into smaller rooms than Contour, Schneidersaid.

Vendors crowd digital detector race
Du Pont's high-profile debut of Direct Radiography at last year'sRSNA meeting focused attention on efforts to digitize conventionalradiography exams with direct-capture systems. At this year'smeeting, several new vendors displayed their work in developingdirect-capture systems targeted at what could be a huge potentialmarket.

Sterling Diagnostic Imaging, Du Pont's successor, reprisedlast year's show by emphasizing a 14 x 17 version of DR. Computedradiography firm Fuji displayed advances in its technology, whileSwissray exhibited a complete system incorporating its Add-OnBucky technology. Other companies displaying or discussing newdigital technology included Canon, Oldelft, Thomson, and Varian.

Canon USA

• Canon displayed a prototype x-ray digital detector thatpiqued the interest of RSNA attendees, but the Lake Success, NY,company declined to provide many details about the system. Accordingto R&D engineer Tatsuya Yamazaki, the device uses a new thin-screendigital sensor, and the company displayed a prototype chest x-rayscanner built with the detector, as well as an individual 43 x43-cm detector.

• The detector produces 11 x 17-inch images with 160-micron pixelresolution. In 1997, Canon engineers will work on optimizing imagequality and will design a new detector cover, according to Yamazaki.

DpiX

• DpiX did not have a booth at the RSNA exhibit, but it doeshave a promising entrant in the direct-capture digital race withits FlashScan 20 sensors, which are based on amorphous silicon.The Palo Alto, CA, company announced shortly before the RSNA showthat it is ready to begin shipments to OEMs in January of a FlashScan20 evaluation kit that will help medical imaging vendors integratethe detectors into completed systems.

Fuji Medical Systems USA

• The Stamford, CT, vendor emphasized the networking of itscomputed radiography readers, with systems in environments simulatingemergency rooms and ICU/CCU situations.

• Fuji DM-FS665 was introduced as a file server in the company'sradiographic archival and communications systems (RACS) conceptthat permits users with CR workstations to archive and accessCR images over Ethernet networks. The server is based on a SunMicrosystems computer with optical disk storage. It is awaitingFDA clearance.

• Fuji showed work-in-progress readers for two new applications:AC-3/M is a digital mammography reader, while FCR DX-A is targetedat bone densitometry.

Oldelft

• This Dutch company displayed Digidelca, a work-in-progressdigital chest imaging system that uses a scanning linear imageintensifier tube and a CCD camera. The system produces a 12-bit2K x 2K image that is DICOM-compatible, according to the company.

Sterling Diagnostic Imaging

• Sterling emphasized a 14 x 17 version of its work-in-progressDirect Radiography technology. As in last year's demonstration,the Glasgow, DE, company transmitted DR images from a 14 x 17prototype at Loyola University Medical Center 11 miles away toSterling's booth in McCormick Place. Sterling is still on scheduleto commercialize DR in early 1998, company officials said.

Swissray

• Swissray debuted a complete x-ray system using its Add-OnBucky CCD-based digital detector, which was unveiled last yearas a retrofit for existing x-ray systems. Add-On System is basedon an Add-On Bucky, which is integrated with a rotating C-arm,SwissVision workstation, and a novel air-cushioned floating tablethat makes patient positioning easier.

• Add-On System will be a more practical offering than Add-OnBucky, as it won't require integration work, according to theHitzkirch, Switzerland, company. It is designed as a multipurposeplatform for a variety of x-ray procedures.

• Swissray is close to filing a 510(k) application for Add-OnSystem and is targeting a list price of $450,000.

Thomson Tubes Electroniques

• Thomson confirmed reports that it is involved in a jointventure with Siemens and Philips to develop an amorphous silicondigital x-ray detector. The collaboration, which is awaiting approvalfrom European Commission officials because of antitrust concerns,would establish a separate company based in France to developthe detectors. The joint-venture company would manufacture thedetectors and first-level electronics, and would provide themto OEMs for systems integration, according to George Spees, salesmanager for image and medical products at Thomson's U.S. subsidiaryin Totowa, NJ.

Varian Associates

• This Palo Alto, CA, company has been working with dpiX ondeveloping the electronic circuitry required to turn dpiX's amorphoussilicon digital detectors into commercial products. At its RSNAbooth, Varian introduced Large Area Sensing Technology (LAST),which integrates dpiX's silicon plate with Varian's circuitry.

• The company's new Varian Imaging Products group plans to providepre-510(k) LAST components to OEMs, which will integrate the technologyinto complete systems. One of the first such OEMs is mini C-armmanufacturer XiTec of Windsor Locks, CT.

Ultrasound vendors cap promising year
The RSNA meeting completed what was an extraordinary year forultrasound technology development. After several years of incrementaladvances, 1996 saw a host of new platform introductions, includingAcuson's Sequoia and Aspen scanners, GE's Logiq 500 MD and 400MD, and numerous other systems. New technologies such as Siemens'SieScape continue to broaden the clinical utility of the modality.

The industry's momentum continued into the RSNA meeting, withnew scanner releases from Aloka, Diasonics, Hewlett-Packard, Medison,Shimadzu, and Toshiba. Optimism about the future of ultrasoundabounded, with 3-D, breast imaging, and contrast imaging amongthe hot topics for this year.

Acoustic Imaging

• Acoustic Imaging exhibited its products as part of FischerImaging's booth, where AI's Performa scanner was shown in a breastimaging capacity. Phoenix-based Acoustic Imaging has been repositionedto focus largely on the imaging of breast disease, in both theradiology and surgical markets, and decided not to have its ownbooth at this year's RSNA meeting, said Karl Jonietz, presidentand CEO. AI will continue to participate in other trade shows,and exhibited at the American College of Surgeons meeting in October.

Acuson

• The Mountain View, CA-based vendor emphasized its high-endSequoia system and Aspen scanner. Aspen includes a new color Dopplertechnology not found on Sequoia: Convergent Color Doppler, whichmelds conventional Doppler with amplitude-based Doppler to allowclinicians to visualize both modes simultaneously.

• For 128 XP/10 users, the company introduced Extended Frequency,an upgrade that improves image quality at higher frequencies,up to 10 MHz. EF will be available initially on Acuson's existingL7 probe.

• The company also released version 2.6 of its Aegis image managementsystem. The upgrade features dual-monitor capability and userinterface improvements, as well as online storage capability ofup to a half-million images.

• Acuson also introduced a DICOM interface that will allow usersto connect to DICOM-compliant PACS equipment.

ALI Technologies

• ALI, of Richmond, British Columbia, showed SWS-150, a portableDICOM capture node, and SWS-250, a sonographer's PC notebook capturenode. Both nodes incorporate the DICOM worklist service classto allow data transfer between hospital and radiology informationsystems.

• The company also showed version 3.0 of its UltraPACS ultrasoundimage management system. The upgrade features multimodality imagingtools to receive and display DICOM images from any imaging modality,as well as a cine imaging function that displays gray-scale orcolor images in real-time.

Aloka

• The Wallingford, CT-based company introduced SSD-1700, awork-in-progress color-flow scanner that has an option availableto support digital management of ultrasound images. The option,called data management subsystem (DMS), allows sonographers tostore up to 1000 gray-scale or 400 color images on a single magneto-opticaldisk.

• SSD-1700 also features an all-digital, 128-channel beamformeras well as color and power Doppler capabilities. SSD-1700 hasbeen shipping abroad for the past several months, with sales approaching1000 units, according to William Jennings, vice president of salesand marketing.

• The company also debuted Volume Mode, a work-in-progress techniquethat creates 3-D ultrasound images without the use of a separateworkstation.

ATL

• ATL, of Bothell, WA, emphasized Digital 3DI, a work-in-progress3-D image processing workstation. Developed in conjunction withVital Images and Silicon Graphics, Digital 3DI runs off SGI'sO2 workstation. The company is targeting a release date in thelast quarter of 1997.

• ATL announced the availability of the Performance 97 upgradefor HDI 3000, which features an advanced obstetrical calculationpackage, new topographic and high-resolution Color Power Angiodisplay modes, and a breast calculations package with ACR bodymarkers.

• Also new for HDI 3000 is Power Harmonic, a new Contrast SpecificImaging feature that further enhances the effect of ultrasoundcontrast agents in cardiology.

• The company showed WebLink, a work-in-progress feature thatwill allow HDI 3000 to function as a Web server. NetLink -- anothercommunications feature for HDI 3000 -- was also introduced. NetLinkprovides direct DICOM output from HDI 3000 and will be availablein spring 1997.

Diasonics Ultrasound

• Santa Clara, CA-based Diasonics highlighted its new scanner,Gateway fx, which utilizes an expanded-aperture beamformer thatcombines the best of analog and digital beamformers, accordingto Ken Marich, director of marketing communications.

• Diasonics introduced a 3-D technique, Flow Luminal Profile,as a work-in-progress. Flow Luminal Profile defines the functionalblood flow along the internal vessel surface and displays thesesurface patterns in 3-D. Other 3-D projects are under way.

• The vendor also announced an agreement with Agfa to marketits Drystar printer for both color and gray-scale applications.

• Diasonics has expanded its support for the DICOM 3.0 printand storage classes to enable its scanners to make direct connectionsto DICOM-compatible workstations.

Esaote

• Esaote, of Genoa, Italy, displayed its Biosound ultrasoundline, featuring its Advanced Contrast Technology (ACT) upgradefor the high-performance AU4 platform.

• The company also introduced MedE-Mail, a Windows NT-based softwarepackage that automatically creates e-mail messages with attachmentsof patient images and related information.

GE Medical Systems

• GE emphasized its Logiq 500 MD and 400 MD scanners, whichfeature Micron Imaging and Adaptive Color Enhancement (ACE), twoenhancements that were first introduced on Logiq 700. Logiq 500MD is targeted at hospitals that require high-performance ultrasoundfor a wide variety of clinical uses. It has a price point in themid-$100,000 range. Logiq 400 MD can be configured for specialtyapplications and has an average price between $80,000 and $90,000.

Hewlett-Packard

• HP jumped into the radiology ultrasound marketplace withImagePoint, a multispecialty ultrasound system with an averageprice under $100,000. Designed as a workhorse clinical system,the portable scanner can provide high-quality images across thefull range of ultrasound applications, including abdominal, obstetricaland gynecological, vascular, small parts, and echo, accordingto Gary Abrahams, marketing manager for the imaging systems division.

Hitachi Medical Systems

• Hitachi emphasized EUB-525, a color-flow scanner that usesa 64-channel hybrid beamformer. EUB-525 began shipping in Augustand averages in price from $85,000 to $90,000.

International Imaging Electronics

• IIE, of Bolingbrook, IL, announced that multiple-monitorreview stations are available for its fullView ultrasound miniPACSsystem. Customers can choose configurations ranging from two tosix monitors, with each monitor capable of viewing four full-sizedimages at once.

Life Imaging

• Life Imaging, based in London, Ontario, unveiled its Sirus3-D workstation, which received 510(k) clearance in November.Sirus offers gray-scale and color and power Doppler acquisitionmodes as well as real-time 3-D image manipulation. The workstationis designed to add on to any 2-D workstation and costs around$50,000.

Medison America

• The Korean vendor highlighted Voluson 530, the 3-D ultrasoundscanner it acquired with its purchase of Austrian firm Kretztechnikin April. The company expects 510(k) clearance by first-quarter1997.

• Medison also showed SonoAce 6000, a black-and-white scannerthat uses a 48-channel all-digital beamformer, and the color-flowSonoAce 7700. Both are works in-progress.

MedSim

• In its second RSNA appearance, MedSim displayed its UltraSimultrasound training simulator. The system began shipping in Augustand has been placed at three sites, according to officials withthe Fort Lauderdale, FL, company.

Perception Ultrasound

• Miami-based Perception introduced its work-in-progress ImageNetViewing Station, a low-cost, PC-based ultrasound image transferand review system for transmission via the Internet and standardphone lines.

• The vendor also showed Virtual File Room, a work-in-progressarchival service that allows subscribers to store patient imagesand data offsite via e-mail transfer to Perception's central storagefacility.

Philips Ultrasound

• Philips focused on SD-800's high performance and economicvalue across a wide range of ultrasound applications. Furtherupgrades to SD-800 are expected in mid-1997.

Shimadzu Medical Systems

• Shimadzu added SDU-2000, a work-in-progress general-purposecolor Doppler scanner, to its EchoView series. SDU-2000 utilizesa 128-channel beamformer and can perform cardiac, abdominal, andvascular studies, according to the company. The system also haspower Doppler capability and will have an average price of about$85,000.

Siemens Ultrasound

• Siemens emphasized SieScape, an image-processing techniquethat allows real-time imaging of extremely large fields-of-view.SieScape enables continuous acquisitions covering nearly unlimitedsweeps across the patient's body. The display pans across theacquisition at standard frame rates and may be frozen over specificareas of interest.

• SieScape received 510(k) clearance in October and shipmentswill begin in March on the company's premium Sonoline Elegra system,according to Lothar Koob, group vice president of the Issaquah,WA, division. About 250 Elegra scanners were shipped worldwidein 1996, Koob said.

• The vendor also showed a work-in-progress 3-D workstation,which uses an electromagnetic sensor mounted on an ultrasoundprobe to acquire spatial resolution and orientation data. TheWindows NT-based workstation then transforms the data sets intoimages, which can be displayed either as multiplanar reformatted2-D planes or volume-rendered 3-D images. The workstation, developedin conjunction with EchoTech 3D Imaging Systems in Munich, willbegin shipping in Europe in spring 1997.

Toshiba America Medical Systems

• Toshiba unveiled PowerVision, a version of a cardiologyscanner that the company has adapted for the radiology market.PowerVision uses a fully digital beamformer and brings to radiologyimaging the high frame rates used in echocardiography. Other PowerVisionfeatures include Tissue Doppler Imaging and Directional ColorAngio, a work-in-progress feature that adds a directional componentto power Doppler imaging. PowerVision lists between $220,000 and$250,000.

RSNA exhibit underscores MRI cross-currents
The 1996 RSNA exhibition featured a few major MRI product launchesin the midst of scaled-down presentations by several leading firms.Toshiba and Elscint weighed in with eye-opening introductions:Toshiba unveiled Opart, a 0.35-tesla superconducting open-stylescanner that operates without cryogens, while Elscint counteredwith Prima 1TG, a work-in-progress 1-tesla magnet that employsa novel twin-gradient scanner.

Overall, it was another year of incremental change, reflectingdecreased purchasing and cutbacks in R&D budgets in the 1993-1995industry slump. Most firms unveiled new sequence packages to exploitthe power and speed of gradient-coil upgrades released in previousyears.

Advanced Mammography Systems

• AMS of Wilmington, MA, showed clinical studies performedon the 0.5-tesla Aurora dedicated MR mammography system. The studieswere conducted at Aurora's first clinical site at the Universityof Texas Medical Branch at Galveston.

• A panel was devoted to a work-in-progress MR-guided breastbiopsy capability for the system.

Direx Medical Systems

• For the second straight year, this Israeli manufacturerdisplayed Marex, a 0.07-tesla open-style scanner. Marex is notcapable of whole-body, chest, or abdominal imaging, but the 26-cmdiameter field-of-view is adequate for brain, spine, and extremitystudies. An operational permanent-magnet system was installedin Israel in the latter half of 1996.

Elscint

• The Israeli company unveiled the 1-tesla Prima 1TG, equippedwith twin self-shielded gradient coils. A 21-mtesla/m gradientset performs normal work, while a supplementary 30-mtesla/m coilhandles small-field-of-view imaging.

• By focusing gradient power in small fields-of-view, the supplementarygradient coils can operate at full power without causing involuntarymuscle contraction, according to Zvi Goldman, senior MR productmanager. The two coils can work together to produce 51 mtesla/mfor MR microscopy.

• U.S. regulatory clearance for Prima 1TG is pending and internationalrelease is planned for the second half of 1997.

Fonar

• Fonar CEO Dr. Raymond Damadian turned the 0.35-tesla Quad7000 on its side, creating Stand-Up MRI. Equipped with a mechanicallift to raise the patient into the imaging area, Stand-Up MRIscans the patient while the spine and joints are in a weight-bearingstate. The Melville, NY, company's work-in-progress system hasimplications for orthopedic and emergency-room applications.

• Notebook Radiology, also a work-in-progress, allows users toport Fonar's operating and applications software to a laptop PCfor applications such as remote-site physician consultations.The port was made possible when Fonar converted itshost computersto a 200-MHz Pentium PC this year.

GE Medical Systems

• GE unveiled enhancements for its 1- and 1.5-tesla SignaHorizon scanners. Signa Horizon LX features a new NextWave workstation-styleuser interface and a host of new imaging sequences. The NextWaveconsole employs a Silicon Graphics Indigo2 workstation and MardiGras graphics engine.

• Four NextWave software applications gained FDA clearance beforethe show. FastPack features motion-resistant techniques to improveurography, MR cholangiopancreatography (MR CP) and breath-holdabdominal imaging. FasTrack introduces Smart Prep IA to improvethe timing of vascular imaging and contrast administration. EchoPlususes a diffusion-weighted echo-planar technique for improved strokedetection, while AW Explorer quantifies dynamic MR studies.

• GE also announced that it is able to market its Signa SP double-donutscanner after receiving 510(k) clearance for the magnet in November.GE officials were coy about their plans for commercializing thesystem, however, stating that the success of ongoing R&D inMR-guided surgery will determine whether a viable segment developsfor the scanner.

Hitachi Medical Systems America

• Version 4.0 software was introduced for the open-style Airis.The work-in-progress package improves fast spin-echo imaging andfeatures fast fluid-attenuated inversion recovery (fast FLAIR),for fluid-suppressed T2-weighted imaging.

• Investigational volume pelvis and cervical/thoracic/lumbarspine phased-array coils were displayed for the 1.5-tesla Stratis.

• The company also announced a collaborative relationship withthe University of Cincinnati Medical Center for operation of anMR interventional suite at the university's campus.

InnerVision MRI

• The company arrived in Chicago with FDA authorization tostart selling Ortho 8000, its 0.17-tesla extremity scanner thatwill be sold in the U.S. by Vision Medical Services of Ontario,CA. Ortho 8000 features a lightweight neodymium boron iron magnet,a small footprint, and a wide aperture for imaging legs up tothe thigh and arms up to the shoulder.

Lunar/Esaote

• New sequences and coil technologies were emphasized by Lunar,the U.S. distributor of Artoscan, a dedicated extremity scannerbuilt by Esaote Biomedica. A dual-channel phased-array coil wasshown as a work-in-progress for knee, wrist, and ankle configurations.Magnetization transfer sequences to brighten the depiction ofcartilage were added.

Magna-Lab

• The Edgewood, NY, company emphasized progress in its internationaldistribution/manufacturing alliance with Elscint Cryomagneticsof Oxford, U.K. A new double-echo sequence was introduced.

Medison

• This Korean ultrasound equipment vendor debuted Magnum,an investigational 1-tesla supercon that was delivered to itsfirst Korean customer less than a year after the product's conceptionin September 1995.

• Oxford Magnet company, a subsidiary of Siemens Medical Systems,built Magnum's 1-tesla superconducting magnet. It is equippedwith self-shielded 15-mtesla/m gradient coils and optional four-channeldigital radio-frequency subsystem.

Picker International

• Picker featured Extended Phase Conjugate Symmetry RapidSpin Echo Sequences (Express), a single-shot, fast spin-echo technologythat produces T2-weighted images in less than a second on thecompany's Vista and Edge high-field MRI scanners. Designed forPowerDrive, an optional gradient package introduced in 1995, Expresswill play a role in MR CP by generating rapid 512 x 512-pixelimages of the gallbladder and liver.

Philips Medical Systems

• Philips featured applications enhancements for its superconductingGyroscan NT series. A new ultrafast turbo spin-echo techniqueperformed on a 1.5-tesla NT with standard gradients acquires 60T2-weighted slices covering axial, sagittal, and coronal planesin 45 seconds.

• A partnership in interventional MR with the University of MinnesotaHospitals and Clinics in Minneapolis was announced. Its new Centerfor MR-Guided Therapy is equipped with a Philips Gyroscan NT 1.5-teslascanner combined with a Philips BV-212 C-arm and an extended table.

Shimadzu Medical Systems

• The firm highlighted enhancements for its 0.5-tesla MagnexAlpha and 1-tesla Magnex 100 series. They include rapid imagingwith spin-echo (RISE), a quicker version of Shimadzu's fast spin-echosequence.

• Advanced Imaging I is a new sequence package for the 1-teslaMagnex AP or XP series featuring fluid-attenuated inversion recovery(FLAIR), turbo multislice FLAIR, and nonselective FLAIR for strongersuppression of cerebrospinal fluid than previously possible onthe systems.

Siemens Medical Systems

• Siemens offered Magnetom Open Viva, a slimmer redesign ofits 0.2-tesla open-style MRI scanner. Cosmetic streamlining anda new removable table and flexible body coils helped designersenlarge the patient opening to 40 cm.

• A new comprehensive cardiac MR package uncovers structuralanomalies, quantifies cardiac function, visualizes complex bloodflow, and provides 2-D and 3-D images of coronary artery anatomyand flow for the company's Vision and Impact Expert high-fieldscanners.

• Siemens also tested the customer response to a prototype dedicatedbrain scanner. Based on the 1.5-tesla Vision superconducting magnet,the experimental system features insertable gradient coils anda birdcage neuro-RF system.

Toshiba America MRI

• The open-style 0.35-tesla Opart features a cryogen-freesuperconducting magnet. A two-stage Gifford-McMahon cryocooleris key to the efficient iron-core magnet design. It maintainssuperconducting temperatures, eliminating the need for a liquid-heliumcryostat and cryogen refills. Laminated pole tips erase eddy currentsto spare the 10-mtesla/m coils from self-shielding.

CT vendors experience slow R&D year
Exhibition space devoted to CT equipment was not the place tolook for blockbuster innovations at the RSNA meeting. The effectof a three-year purchasing slump on product development was evident.Product lines have stabilized as spiral CT technology matures.With the exceptions of Picker's new PQ 6000 scanner and modifiedlow-end launches by GE, Shimadzu, and Toshiba, there was littlein the way of new CT platforms to advance the state of the art.

Evolutionary improvements could be seen, however. Many companiesintroduced 5-million-heat-unit x-ray tubes to raise the limitsof continuous scanning. Productivity improvement was a populartheme. Interest in interventional applications was intense, althoughmore concern was expressed about interventional radiation exposurethan at previous meetings.

Elscint

• CT-TwinRTS is a notable addition to Elscint's achievementsin this modality. The upgrade features 1.5-second cycle timesand a standard 5-MHU x-ray tube. A 7-MHU tube capable of 100 secondsof continuous spiral scanning is optional.

• Progress on Elscint's investigational FlexiScan spiral scanningmode was reported. As a replacement for standard multiplanar reconstruction,FlexiScan enables the user to prospectively select slice orientationand thickness. The system then automatically calculates the optimalspiral protocol to fit prescribed coverage and position.

• Elscint is also cultivating CT-Twin's potential as a guidancetool. The company's investigational CTscope technique displaysaxial images at four frames per second. Its LaserGuide work-in-progressuses a laser to enhance the accuracy and speed of CT-guided biopsies.

• Elscint also plans to give Imatron a run for its money in theheart-scanning market. Elscint showed panels of CT-Twin, equippedwith optional CardiaCT software, quantifying the presence of calciumin the coronary arteries. Published research conducted in Israeland Indiana University in Indianapolis in the past year documentedthe application's high sensitivity to coronary artery plaque.

GE Medical Systems

• GE introduced a new low-end Synergy platform and added productivityenhancements to its premium HiSpeed and medium-priced ProSpeedlines. Synergy S is a helical xenon detector scanner. Equippedwith 2-MHU tube, it performs 1.5-second scanning and 30-slicecontinuous acquisition.

• Subsecond scanning on HiSpeed CT/i is a work-in-progress. Acquisitiontimes are cut to 0.8 second on 360° rotations and 0.5 secondon 220° scans. An investigational x-ray tube rated over 5.5MHU, upgradable gantry refinements, and new software enable CT/ito operate at faster speeds.

Imatron

• The South San Francisco, CA, firm rolled out 12.3 releasesoftware for its Ultrafast CT scanner. The enhancement generates140 images in 15 seconds in a helical mode. The software operatesin continuous volume scanning, single-slice volume scanning, ormultislice volume scanning modes.

Philips Medical Systems

• New Advanced Volume reconstruction software developed byPhilips enables its top-of-the-line Tomoscan SR 7000 and SR 6000systems to acquire and reconstruct 70-cm volumetric studies in72 seconds.

• Volumetric scanning capabilities were added as options to thelow-cost Tomoscan EG and Tomoscan M scanners. Both models acquire35 cm of continuous spiral data while performing two-second rotations.

Picker International

• PQ 6000 was by far the most ambitious new CT platform shownat the conference. Introduced in June 1996, the high-performancescanner showcases Picker's advanced CT capabilities as standardfeatures.

• Designed for PQ 6000, Ultra-Image enhances resolution and eliminatesartifacts from hard-to-scan neurological trauma and postsurgicalcases.

Shimadzu Medical Systems

• The company reprised SCT-7000T, a slip-ring scanner withoptional spiral capability introduced at the 1995 meeting. Thesystem is marketed in two configurations: SCT-7000T/X featuresone-second scan times, and SCT-7000T/H operates at 1.5-secondcycle times.

• Optional 5-MHU tubes and real-time spiral reconstruction arescheduled for March releases on the SCT-7000 series. In a real-timeendoscopy mode, the scanner acquires up to eight frames per second.

• SCT-6800T was shown as a work-in-progress. It uses the samebasic technology as the SCT-7000 series but costs less and fitsinto a 220-square-foot site.

Siemens Medical Systems

• Siemens rolled out its Lightning package for the high-performanceSomatom Plus 4. It generates 106 cm of spiral coverage in 80 seconds.Optional CT virtual simulation allows full-field patient markingfor radiation-treatment planning.

• The Somatom AR Star upgrade features 1.5-second spiral andreal-time display for reconstruction and image viewing duringevery rotation of a spiral scan. Reconstruction times were cutto 2.5 seconds.

Toshiba America Medical Systems

• Recent product improvements complement Aspire ContinuousImaging, a real-time technique for interventional work that gainedFDA clearance in April for the high-performance Xpress/SX. Theoption was added to Xpress/GX in December. Illustrations of biopsies,drainages, and ethanol ablations guided by Aspire CI in a CT-fluoromode were shown in the booth.

• Toshiba added SureStart as a new option for its high-end scannersthis year. It acquires and displays one-second scans at 30 to50 mA to track patient positioning and the arrival of contrastmedia before the system begins normal helical acquisitions.

• Toshiba introduced the low-cost Xvision/EX. Equipped with a640-channel xenon detector, the slip-ring scanner uses the sameconsole and gantry as other Toshiba CT products.

Multipurpose rooms pace x-ray debuts
Among x-ray vendors, new multipurpose rooms highlighted productdevelopment efforts in medical imaging's largest modality. Thenew systems offer greater functionality than dedicated systems,at a lower price.

Fischer Imaging

• CVX is a new work-in-progress angiographic positioner developedby the Denver company. The system is designed to be a low-costalternative to dedicated cardiovascular rooms, and includes a16-inch image intensifier. A 510(k) application has been submitted.

• Digital-X is a new series of digital generators that offersmall size and ease of use to users of Fischer's R/F systems.The generator's control panel features submenus covering parametersused in different x-ray procedures.

GE Medical Systems

• GE's Advantx Legacy-D is a new all-digital multipurposesystem designed to handle procedures ranging from standard R/Fto angiographic and interventional. GE removed the spot film deviceand lowered the image intensifier, allowing increased anatomicalcoverage, lower radiation dose, and higher flexibility.

• GE has added Mobile Digital Architecture to its Stenoscop mobileC-arm. MDA includes an image processor on the console and a programmableuser interface.

• Advantx LCA has been redesigned to do high-speed rotationaldigital subtracted angiography in real-time.

Marquette Medical Systems

• Marquette of Milwaukee appeared at its first RSNA meeting,displaying products from its E for M Imaging Systems division,which Marquette acquired earlier in 1996.

• AccuVision is a new line of products for digital cine acquisition.AccuVision Network is a cardiac cath network that uses CD-recordablemedia, while AccuVision Plus is a digital cine recorder for existingcardiac cath labs.

Philips Medical Systems

• Grid-controlled fluoroscopy was emphasized in the Philipsbooth. The technology reduces x-ray dose while increasing imagequality. It is available on the company's Diagnost 76, Diagnost97, and all MultiDiagnost systems.

• MultiDiagnost 4 is the latest system in Philips' MultiDiagnostline. It features a new user interface and ergonomic design, aswell as an integrated ultrasound scanner for ultrasound biopsyguidance.

Picker International

• Highlights at Picker's booth included Clinix MP, a multipurposesystem capable of radiography, R/F, vascular, and interventionalstudies. The system's image intensifier can be positioned underthe table, and a cassette can be put on the table to make radiographicexposures. Picker installed the first Clinix MP this month.

• Clinix MP will be offered in three configurations: Clinix MPEis an economical digital version for radiographic and R/F work;Clinix MP is the mid-range unit; and Clinix MPV is a high-endinterventional system with a 12-bit V-MAX vascular digital system.

Shimadzu Medical Systems

• Cvision is work-in-progress R/F system that is Shimadzu'sentree into the C-arm table market. One version of the systemwill be targeted at digital angiography and interventional work,while another will be designed for angiography and conventionalR/F studies.

• Elsewhere in Shimadzu's booth, the company displayed completedversions of products that have been shown as works-in-progressat previous meetings. Angiosigma NEO MH-100 is a ceiling-mountedangiographic and cardiac positioner that is now capable of bothrotational DSA and peripheral stepping DSA. Shimadzu is shippingthe Alpha upgrade to the Digitex system for high acquisition rateangiographic and cardiac studies, and the company's Opescope systemnow has a full DSA package.

Siemens Medical Systems

• New products in the x-ray section of Siemens' booth includedthe Siremobil C-arm line. Siremobil 2000 is designed for interventionalprocedures, with surgical, trauma, orthopedic, endoscopic, andvascular applications. The system has a small focal spot x-raytube for continuous, pulsed fluoroscopy and digital radiography.Siremobil Compact is a compact mobile version.

Toshiba America Medical Systems

• This Japanese vendor displayed Dual-C, a new dual-planeuniversal angiographic system that is capable of cardiac studies.The system has two C-arms, one with a 16-inch image intensifierfor radiology work and the other with a 9-inch image intensifierfor cardiac studies.