Blurring lines, new modalities, new spins on current modalities and software improvements define leaner show

In fact, according to RSNA data, total attendance fell 5 percent in 2008 from the previous year, to nearly 58,800 from nearly 62,000, during the show, which took place here between November 30 and December 5. Among the total, exhibitors posted the largest percentage drop at 12 percent, to nearly 24,700 from slightly more than 28,000 in 2007. Attending radiologists and other healthcare professionals slipped 1 percent to nearly 27,600 from 27,900 the prior year. The only increase showed up in the guest category, up 7 percent to more than 6,500 from nearly 6,100.

Still, the thousands of attendees witnessed a continued blurring of the lines between imaging, information technology, oncology and surgery functions. They also were treated to a flurry of new modalities and new spins on current modalities, as well as software improvements stressing flexibility, modularity, portability and above all else, integration.

High-speed computed tomography seemed to give way to high-definition CT with low-dose capabilities, and adding an attached-at-the-hip spouse in the form of positron emission tomography. In fact, the imaging industry continued to push PET without CT to the brink of extinction.

Ultrasound’s ongoing renaissance was seasoned with such new modality concepts as molecular particle imaging, photon counting, proton beam and several women’s imaging breakthroughs. Nanotechnology, as well as simulation or "serious gaming" as researchers dubbed it, new three-dimensional rendering and even creative imaging uses of iPhones turned heads.

What follows are a few observations and revelations about what was hot in diagnostic imaging and IT-related market segments, along with peeks at practice management, oncology and surgery tie-ins by Healthcare Purchasing News.

This doesn’t refer to the actual images, mind you, but to the clinical and technological delineations between imaging, IT, oncology and surgery. For the last five years, RSNA, unintentionally perhaps, demonstrated a growing fusion between the four specialties with image-guided surgical procedures and image-guided radiation delivery in the surgical suite, all of which is interconnected electronically to an organization’s computer systems, including patient records and physician orders whether onsite or remote.

Amid high-speed CT and open-bore and high-end magnetic resonance imaging (MRI), ultrasound continues to simmer to a slow boil in popularity. Generally considered to be a mature modality dedicated to midsection imaging and focused on women’s healthcare, ultrasound manufacturers rolled out new applications, features and techniques beyond just real-time 3D imaging (a k a 4D), touch-screen capabilities, affixed and interconnected barcode readers, digital video capture capabilities, user-friendly easy access to controls and ergonomic designs.

One company promoted an ultrasound unit that measures shear waves and produces elastography maps that show tissue stiffness or elasticity without transducer compression. Another company exhibited a unit that displays blood flow and vessel diameter changes in high-definition/high-resolution output. Other companies showcased ultrasound units that generated multiple slices of images similar to CT, while another touted the latest version of its technology that fuses real-time ultrasound images with the spatial and contrast resolution of CT, MR or PET and includes the capability to track and mark a patient’s anatomy during an exam.

Joining the allure of relative newcomers PET and tomosynthesis were a gaggle of up-and-coming imaging modalities with impressive-sounding names. Among the group were the seemingly redundantly named molecular particle imaging (MPI), photon counting, proton beam, positron-emission mammography (PEM) and breast-specific gamma imaging (BSGI).

According to studies released at RSNA, MPI is designed to detect and quantify individual cells in an effort to use cell therapy to regenerate damaged organs in lieu of transplants; photon counting is designed to convert the traditional black-and-white X-ray image into color to distinguish elements within the body and eliminate electronic noise in low-dose imaging applications; proton beam is designed to facilitate 3D imaging of microscopic structures; PEM is designed to image the breast regardless of breast density or a woman’s hormonal status, two factors that limit the effectiveness of standard X-ray mammography and MRI; and BSGI is designed to detect cancers not found on mammograms or by clinical exam, such as invasive lobular carcinoma and additional lesions when only one might be found.

While healthcare organizations may be struggling to adopt and implement electronic medical records to populate an electronic health record, software developers aren’t slowing their progress to incorporate new capabilities into the traditional EMR and EHR offerings. In fact, image-enabled personal health records generated some buzz and represented a next iteration of the technology in that patients could house and access X-ray, CT and MR images within their own medical files.

Studies may have shown that surgeons who play video games improve their dexterity, reaction time and surgical techniques, but more recent research highlights some additional legitimate benefits. Simulations or "serious" gaming can add a new dimension to diagnostic imaging – not just in 3D visualization but also in extending traditional learning and thinking. Many of the leading flat-panel display and software vendors rely on video game cards to bolster image quality but now this 3D simulation is being used to teach complex anatomy to radiologists, such as interactive anatomical "fly-throughs," and shooting a variety of bacteria and viruses that intelligently respond to the player. Imagine the infection prevention and sterile processing opportunities.

Nanotechnology made headlines and turned heads with theoretically credible medical applications. In fact, some researchers postulated that nanoparticles could function quite effectively as diagnostic and therapeutic agents, from imaging applications (attaching optical probes) to drug delivery to radiation delivery. They potentially could augment, if not replace, endoscopic pill cameras, tablets and radioactive seeds, for example. One researcher predicted cardiovascular imaging applications as one example, but cautioned against potential toxicity issues not found on the larger molecular level.

Several companies promoted low-dose CT units or vendor-neutral software overlays for clinicians to capture standard diagnostic images without necessary high doses of radiation to limit noise. These companies promoted CT-dose reduction "filters" as most effective for pediatric applications.

Remember those days when you wanted to work on your office PC while outside the office but couldn’t? Those days are history as a growing number of companies, including some well-known computer manufacturers, demonstrated software applications that enabled end users to access their files from literally anywhere – within a different internal department or unit, at an outlying clinic or at home. Using Internet- and intranet-based access points a clinician can open a file in one location, be interrupted, move to another location and reopen the file at the same point where he or she left it without compromising data integrity and security.

Several years ago, hand-held computers were all the rage but the Palms were nowhere to be found this year. In their place: Apple’s iPhones and Macs, along with a plethora of tablet PC applications, and even Dell with a suite of healthcare service applications, including administrative, financial and operational software and hardware packages.

Digital anything continues to make inroads, unspooling the future of film use. But film isn’t dead yet by a long shot as computed radiography and film digitizers (as the intermediate step between CR and digital radiography or DR) remain solid in sales. While DR may be popular among healthcare facilities bookending the market – from the larger urban and suburban research institutions to the smaller, upscale and more nimble diagnostic imaging centers – CR and digitizers seem to satisfy most in the middle, particularly among the cost conscious in a shaky economy. At the same time, digital mammography, along with step-sibling computer-aided detection (CAD) continues to struggle for clinical and scientific credibility versus film among conflicting reports and studies even as more hospitals and imaging centers migrate to filmless operations.

Integration between diagnostic and oncologic imaging modalities and IT has been kicked up a notch, particularly in the areas of data protection, retention and security during disasters. Also prominent were the "convergence trio" of flexibility, modularity and portability. As healthcare facilities circle the wagons to financially retrench themselves in a faltering economy – something last seen during RSNA shows in the very early 1990s – strategies and tactics to control costs re-emerged as winning formulas. That includes retrofitting existing equipment, investing in second-hand equipment and finding applications for equipment across several departments, such as a portable DR that could be transferred to the surgical suite, exam room and emergency department. Hand-carried ultrasound units are becoming more mainstream even as portable CT begins to make waves by bringing imaging services to the patient rather than vice versa, particularly in the ER, but also in the operating room and at the bedside.

Showing radiologists a photograph of the face of the patient of whom he or she is reading the image leads to more compassionate and theoretically more improved work. However, privacy issues need to be addressed. At the same time, in the isn’t-it-obvious category research showed that emphasizing systematic approaches and eliminating shortcuts, even among the most experienced radiologists, avoids emergency imaging misses, particularly involving the brain and spine.