RSNA 2009: What tech trends emerged?

Quality calls for streamlined, open-architecture workflow, high-tech modularity and portability and crisp views 

In fact, total registered attendance slid to 56,824 from 59,181 the year before, according to RSNA data, but professional attendance only slipped to 26,363 from 27,427 the prior year. Further, the professional tally sank back to levels last achieved in 2004 when the annual show spanned fewer than three exhibit halls.

Still, the thousands that roamed the exhibit halls and listened during the myriad educational/scientific sessions were inundated with several major themes, including emphases on achieving quality outcomes/results, workflow improvement and performance measurement, integrating operations and technology and souped-up software. RSNA also resurrected its “Mock Jury Trial” that highlighted communication issues at the center of a malpractice case involving lung cancer detection. Last held five years earlier, the RSNA Mock Jury Trial returned, perhaps fittingly, during a year ensconced in healthcare reform debate.

Whether witnessing diagnostic modality/technology debuts and upgrades to seasoned spins on current offerings, attendees spent five days kicking the tires and soaking in information about familiar buzzwords, such as efficiency, flexibility, integration and workflow, as well as quality.

Some of the biggest company names in diagnostic radiology indicated they were poised to offer one of the latest imaging techniques, tomosynthesis – a not-so-new technology benefiting from several years of hype – once the FDA gives it the green light.

Another noteworthy trend: After dazzling attendees for several years with how to use iMacs, iPhones and iPods for imaging purposes, Apple Computer was nowhere to be found. With the recent debut of Apple’s iPad, however, it’s highly likely the company will re-emerge at the 2010 event, drawing even bigger crowds.

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.

WALL DARTS. More bridges between clinical silos continue to be erected, forcing the silo mentality dividing imaging, information technology, oncology, pathology and surgery to dissipate. If anyone doubted that high-tech clinical suite of the 21^st Century represented a fusion of these five areas, no more. In a healthcare reform-minded industry emphasizing electronic health and medical records, image-guided surgery and radiation therapy, as well as in-room laboratory and pathology studies, the future gives new meaning to clinical convergence. In fact, GE Healthcare showcased a work-in-progress application called Omnyx that embraces “digital pathology” in that it transfers slide studies to the digital screen. Ascension Technology Corp. displayed three-dimensional sensors that fuse ultrasound with computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) output.

In a crowded educational session, for example, a quartet of clinicians stressed the need for diagnostic radiologists and radiation oncologists to work together.

SPORTS SCREENS. Those big-screen televisions and multiple-screen and split-screen TV options no longer are limited to family rooms and sports bars. Now they’re moving into the surgical suites. No, not so surgeons can watch five different games at once but so they can eye five different images of a patient’s body at once while he or she lies on the operating room table, including CT, MRI, ultrasound, X-ray and even live video feed from an endoscope.

For example, GE Healthcare debuted a Carrot Medical viewscreen that enabled a variety of split-screen and inset viewing options. The 57-inch LCD monitor at Siemens’ booth boasted the ability to deliver up to 21 different displays on one screen, including cable TV – for those multitasking clinicians. The key advantages include image flexibility as well as the need for only one monitor (not several smaller screens) that can be seen clearly from outside the sterile operative field – not in the way of clinicians that frequently have to move it.

GRANULAR VIEWS. Not too long ago surgeons were able to see bodily organs and implants as fuzzy white – with colors later as an upgrade – shapes. Not anymore. Image clarity has improved to the point that organ and implant boundaries and surfaces can be seen on a vascular and particulate level for higher quality diagnoses. Look for spectral imaging becoming a common term on the clinician wish lists for CT as it grants higher speeds along with minimizing artifacts and noise and without sacrificing contrast. Now calcified plaque and metal artifacts can be characterized more cleanly with shadowing clearly identified.

Meanwhile, Dragonsoft showcased software that enables clinicians to measure by pixel how an organ moves, which helps in the early detection of disease, in terms of tracking blood flow and volume, size and thickness and torsion. On a laptop or a desktop, too.

TARGET PRACTICE. Enhancements to image-guided navigation systems, specifically for the patient’s mid-section, facilitate pinpoint accuracy for surgical tools to cut and fuse tissue, or to target radiation beams directly to cancerous shapes. Look for such concepts as accurate target volume delineation, conformal techniques and tumor contouring to become part of the imaging lexicon as they have in the oncology world. Siemens, for example, showed how a clinician can superimpose a virtual stent onto a live fluoroscopic image to use as a roadmap.

WIRELESS WHIMSY. From mobile imaging detectors to speech recognition devices, wireless connectivity for clinical operations is moving toward mainstream acceptance. The challenge remains enough useable bandwidth in healthcare facilities and signal interruptions. For example, Philips demonstrated its SpeechMike Air, a BlueTooth-enabled wireless dictation microphone/speech recognition device about the size of an iPod that recharges in its docking station, connects to a computer via USB port and alerts end users when the signal drops. One clinician also showed how you can accurately diagnose acute appendicitis from a remote location using a hand-held device or smart phone equipped with special software.

DOSE MINIMUS. At last year’s RSNA, 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. This year, whether involving oncology or radiology procedures, minimizing dose exposure without sacrificing image clarity or quality became a standard, rather than an optional, feature in a number of imaging products. And dose reduction was emphasized as part of international thoracic CT guidelines.

BOXED TOPS. In a tight economy, modularity and scalability of high-cost devices and equipment still reign from a budgetary perspective. Look back during previous recessions and you’ll notice the trend. The difference this time around was that companies incorporated more high-end capabilities and features into the packages, previously considered gravy to the bare-bones meat-and-potato offerings of lean years past. One example involves Siemens showing its latest digital mammography detector that is capable of performing tomosynthesis, which is being touted as a next-generation imaging technique, as well as digital detectors built into surgical tables.

Even so, several major vendors showcased multipurpose rooms fully equipped with technology from a variety of companies that quickly can be transformed to handle different specialties. For example, fixed and mobile devices in interventional radiology and cardiovascular rooms can turn these “hybrid” rooms into urology suites with price tags barely approaching $500,000.

Also, standard CT and PET/CT technology can be upgraded to higher-slice, higher-speed, helical volume units when needed.

Carestream showed its DRX1, a cassette-sized wireless detector that can be affixed to the bucky to create a complete, full-featured and integrated digital radiography suite. Clinicians can start with the detector and add the table and wall stand later.

To cap off the capabilities, leading vendors are rolling out predictive diagnostic services that track equipment performance in the field from the corporate headquarters and alert end users when maintenance is needed.

SHRINKING MARGINS. Following the lead perhaps of contemporary cell phone technology, more imaging devices are incorporating three qualities that make them more palatable operationally but not necessarily readily affordable. They are convergence, miniaturization and portability all touted by some of the biggest vendor names in diagnostic imaging and IT. Compact and light are two characteristics defining these newer high-tech devices. One clinician outlined research showing that elastography-enhanced breast ultrasound can help differentiate cancerous breast lesions from benign results, potentially reducing the need for biopsies. Similarly, another clinical study demonstrated that high-frequency ultrasound with elastography can help distinguish cancerous from benign skin lesions. Yet the speech recognition device companies don’t yet foresee their technology being integrated with higher-end cellular telephones.

REALITY CV. Picture archiving and communication systems (PACS) and their sibling radiology information systems (RIS) shed another layer of technological skin as the newest offerings touted more seamless PACS-RIS integration, as well as live, real-time image access and vendor neutral capabilities, akin to installing a Chevrolet transmission on a Ford engine. Even speech recognition systems from dominant players like Nuance are sporting active intelligence with application-based training features that can recognize and understand accents and dialects as well as retrieve that file, study or test at a moment’s notice wherever the clinician is, as well as record and anticipate physician orders.