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Toshiba describes market strategy in CT, outlines upgrade philosophy


Toshiba has begun clinical tests on a 64-slice version of its Aquilion CT. An image from this scanner, which is installed at Fujita Health University in Toyoake, Japan, was shown at the Japanese Radiology Congress April 8 to 10 in Yokohama.Exactly when

Toshiba has begun clinical tests on a 64-slice version of its Aquilion CT. An image from this scanner, which is installed at Fujita Health University in Toyoake, Japan, was shown at the Japanese Radiology Congress April 8 to 10 in Yokohama.

Exactly when the Aquilion 64 CFX will debut commercially has not yet been determined, but company executives are confident the jump from 32 to 64 slices will pose no substantial difficulties. The Quantum Detector that powers the 32-slice configuration, which is scheduled to begin shipping later this year, incorporates 64 individual 0.5-mm elements. Field-upgrading 32-slice versions to 64, therefore, should be relatively easy.

Toshiba plans to focus initially on the 32-slice version while making preparations to shift to 64. Preproduction models of the Aquilion 32 CFX have already shipped to luminary sites in the U.S. and Japan. They began operating at Fujita Health University in November and at Johns Hopkins University in February.

The argument for buying an Aquilion 32 CFX is persuasive, according to Koji Honjoh, group manager of Toshiba's international business group for CT. The new system offers 1.8 meters of scan coverage, achieving a longitudinal resolution between 0.35 mm and 0.4 mm even in body regions prone to streak artifacts.

"We are convinced that (Aquilion) 32 is far superior to the current 16 in clinical value, not only for cardiac but for radiology procedures," he said.

Clinical testing of the 32-slice version has produced a virtually artifact-free lumbar myelogram of a patient with double fusion rods in the spine. A nine-second scan of a cirrhotic liver shows portal venous phase in extraordinary detail. Scans of abdominal aortic aneurysms demonstrate fine vessels leading to the kidneys.

The company's suite of Sure algorithms precisely handles tedious and difficult tasks from optimizing exposures and dose to tracking bolus infusions of contrast. One of the most recent introductions, SureCardio, turns CT data sets into motionless volumetric coronary angiograms. In one patient, this algorithm demonstrated not only the two stents that were implanted but soft plaque that had begun to creep into one of them.

"The aim is to make cardiac CT easy," said Jeff Hall, Toshiba CT application development specialist.

Driven by such performance, the popularity of Toshiba's CT products has been steadily increasing. The company's CT market share in the U.S. jumped two points over the last six months, according to Toshiba estimates, bringing the company to 18%. This puts Toshiba in the number three position in the U.S., slightly ahead of Philips but trailing Siemens and market leader GE Healthcare, which continues to dominate the U.S. market.

Jumping successively from the current 16 to 32 and then quickly to 64 slices is essential to Toshiba's strategy for improving its position among the ranks of CT providers in the lucrative U.S. marketplace. The advantage of a 64-slice configuration comes primarily in time savings. An Aquilion 16-slice scan of the heart takes 25 seconds, according to Honjoh. A 32-slice scan cuts the time to about 15 seconds. Going to 64 slices reduces scan time to the single digits.

"This reduces the chance of running into irregularities or variations in heart rate," he said. "That is why we have decided to go to 64."

But just adding slices will not be enough. The company must continue evolving and adding to its Sure software techniques. Its work-in-progress SurePlaque is an example. Using a 31-second semiautomatic process, the algorithm creates curved reconstructions through the region of interest, segments the vessel, then draws the outer wall of the artery and quantifies the plaque over a defined length of the vessel. The next steps are to calculate total plaque volume over the length of the scan-and distinguish between lipid-rich and fiber-rich plaques.

The Sure family is designed to be forward-compatible, assuring continuing capabilities from 16 to 32 and 64. They will remain so for the 256-slice scanner, which Toshiba is already testing. The prototype has limited resolution-but that is expected to change as the technology is refined.

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