Rather than eliminating hard copy, the digital revolution has caused it to proliferate. Legions of printers networked into hospital departments, clinics, and private offices spit out reams of "reference media" through which radiologists and referring physicians communicate.
Thermal technology, with its ability to print high-quality color and gray-scale images on paper and film media, is driving this trend. Burgeoning PACS and teleradiology networks, falling printer prices, and miniature electronics that shrink these printers to fit on the corner of a desk have made it practical.
Thermal printers have been all over the exhibit floors of past RSNA meetings, displayed not only to sell themselves but to sell the equipment to which they are attached. Last year, some 80 RSNA exhibitors featured thermal printers from just one company, Codonics. Others, from Sony Medical and Kodak, were also in evidence, and this year's meeting promises more of the same.
The printers span a wide range of performance and prices. Codonics' low-tier color and gray-scale Horizon SF, which sells for $19,000, prints 8 x 10-inch media. The gray-scale Horizon GS, built to handle 14 x 17- and 8 x 10-inch films and paper, is priced at $31,000. The company's top-of-the-line Horizon Ci gray-scale and color imager, capable of generating 14 x 17-, 11 x 14-, and 8 x 10-inch films and paper, lists at $37,000.
The company is trying to crack the CT and MR marketplace with its Horizon Ci and GS models. Timothy Jablonski, vice president of marketing and new business development, seeks head-to-head competition to underscore the speed and versatility of Codonics printers versus more traditional products.
"When prospective customers see our imagers, they wonder how on earth these imagers can do what their refrigerator-sized imagers can do, how they can keep up with demand," he said. "But customers soon find out that the Horizon printers are not only faster, but the image quality is as good or better, and they're more versatile in that they deliver color prints."
The high-performance Horizon thermal printers can generate 100 or more laser-quality images per hour. Built-in electronics provide rapid response, delivering images within seconds of print commands. At the RSNA meeting this year, the company hopes to turn dependability into a selling point, offering five years of free service with each Horizon purchased.
"Five years of free service is about the cost of the Horizon," Jablonski said. "The free service contract is an incentive to give people the confidence to try the product."
Codonics relies primarily on OEMs for the sale of its products. Relationships with the vendors have grown over the past two decades since the company launched small-format thermal printers for boutique markets, primarily ultrasound and nuclear medicine. These have been the primary markets for other vendors of thermal printers, including Mitsubishi, Kodak, and Sony Medical.
These companies produce or distribute not only printers but also the media they print on. Last year, Mitsubishi introduced Diamond Jet inkjet paper, designed to provide low-cost, high-quality images to referring physicians as part of patient reports and as patient handouts. Diamond Jet papers have specially formulated coatings that enable the ink to dry instantly, eliminating smudging problems. The paper works with any inkjet printer, but it is optimized for the Canon N1000, which Mitsubishi sells for medical applications.
At this year's meeting of the RSNA, Kodak will unveil a color printer that produces 82 x 11- and 82 x 14-inch prints. The Color Medical Imager 1000 laminates the prints to prevent smudging. The company is targeting nuclear medicine and ultrasound, but the product could be used outside those areas to render 3D images, according to Laryssa Johnson, Kodak director of marketing for digital output. The thermal imaging technology built into the product generates 314-dpi resolution. It measures 29 x 17 x 10 inches high and weighs 25 pounds. The price of the unit has not been set, pending FDA clearance.
Sony Medical last year introduced the FilmStation large-format radiology film printer, which relies on thermal print head technology to instill 4096 shades of gray on blue film. DICOM connectivity makes the product compatible with any digital modality or PACS. Because of its compact footprint of 25 x 10 x 27 inches, FilmStation fits into cramped quarters such as the edge of a desk or under it. One unit can print 70 sheets of 14 x 17-inch film per hour, or two FilmStations can be linked to generate as many as 130 films per hour. The company has positioned this one- or two-unit product, priced under $31,000 per imager, as a cost-effective improvement on larger and slower dry film imagers.
Sony will again feature the FilmStation at its booth, alongside two thermal printers designed for ultrasound. The black-and-white UP897MD is about 10% smaller than its predecessor, the UP895MD, and prints images in two seconds, twice as fast. The second product, the color thermal printer UPD55, is about 30% smaller than its predecessor, the UP51, and makes 5 x 7-inch color prints faster.
The design changes are indicative of a trend in the printer industry, according to George Santanello, director of marketing for Sony Medical. In ultrasound, size matters more than ever before.
"Manufacturers are trying to build smaller ultrasound systems, and we need to accommodate them with more compact printers," he said. "It's all about size, speed, and patient throughput."
To maintain demand for their products, the developers of printers have had to keep pace with rising procedure volumes at medical facilities. Integrating methods for high-speed data transfer spooling technologies has helped in this effort, and sizing the product to the user environment has helped it fit in. But meeting the needs of that environment is the key. At the high end of printing, the deciding factor in future sales may be thermal printers' ability to deliver color and to print on paper as well as film.