Thursday, November 29, 2012

The OTech 2012 RSNA Awards.

The isles are always bustling with traffic

The 2012 RSNA in Chicago will most likely go into history as one of the lesser exciting and uneventful meetings compared with some previous years. Despite that, I was still able to find a couple of noticeable products worth sharing. Before you read the list I would like to add a disclaimer that this list is purely subjective and created with my engineering bias, so I tend to look more for new gadgets and exciting technology rather than clinical break-throughs. So, for any totally non-geeky persons, this list is probably boring, but for those who like new toys and gadgets, you’ll probably appreciate these.

Incredible engineering inside
1.       The Best Improvement Award goes to… the new 320-slice CT scanner. The Japanese might not be known for the most innovative and/or creative product designers and engineers, but they are masters in taking an existing concept and continuously improving, enhancing and refining it. This new Toshiba CT is a great example of that. It has a record scan time of about .25 seconds. Just imagine four rotations every time you say out loud “twenty-one, twenty-two, twenty-three, etc.” The G-forces on the X-ray generator, which is mounted on the gantry, must be enormous with that amount of weight and speed. The bore has been widened as well, so it is ideal for obese heart patients who need a cardiac scan, of which we regrettably have plenty in this day and age. No question that this is a major engineering accomplishment.

CCFL and LED next to each other,
no visible differences on the outside.
2.       The Ultimate Green Award goes to… the new series of LED displays. CCFL (Cold Cathode Fluorescent Lamp) technology is on its way out and being replaced by LED’s. For consumer lighting, this might still be a few years away as the price difference is still rather significant­­—imagine paying $20-$50 for a light bulb? For professional applications, however, such as display backlights, the advantages are significant. I would expect that in another year these CCFL based displays go the same way that old CRT’s went about 10 years ago. Every display vendor showed several samples of this new technology, but I found Eizo having the most complete LED based product line, with monitors of up to 8 MPixel using this technology. It is to be expected that the 10 MPixel displays, which are primarily used for digital mammography, will be available soon as well. Depending on the display type, the LED’s consume 50 percent to 30 percent less power. I noticed a significant difference in temperature just by touching the front screen indicating the energy efficiency. These LED’s are definitely more durable, and they don’t degrade as fast, therefore requiring less frequent calibration. The latter saves support and maintenance costs. Overall, a much better carbon footprint.

Definitely not a zero footprint
3.       The Most Over-hyped Award goes to…the “zero-footprint” viewers. Unlike the green technology, which is measured by carbon footprints, the “zero-footprint” concept refers to the fact that a viewing application can run on multiple platforms, including tablets and smart devices, without leaving a trace behind. There is no software to be downloaded and/or executed on the local client, which addresses the fear factor that most IT processionals have with potentially introducing malware and/or viruses. From a support perspective this is also highly preferred as a new release only needs to be installed on the server side. However, this concept is not new and merely a logical evolution to the browser-based web viewers. But because of a smart marketing ploy, suddenly every PACS vendor is hastening to announce that they too have released their zero-footprint viewer. Next year, this will be old news, similar to the VNA and cloud hype we saw in previous years. Oh well, we need a new marketing ploy every year to keep the users engaged and confused.

The control monitor on the bottom
manages the gestures while the top
shows the results of browsing
through a  series of slices
4.       The Innovation Award goes to…the mouse-less, gesture-based interface. One of the recurring themes in the RSNA informatics sessions is the lack of innovation in radiology and how we should take applications in the IT and consumer field to heart and apply them to this specialty. The gesture based interface showed as a commercial product for use in the OR by GestSure Technologies, as well as the poster in the informatics section using a similar technology in a research setting by a group of Swiss pathologists are prime examples.  A user can control a viewer application by simple left and right mouse controls being assigned to his or her left and right hands. I tried it and got the hang of it within a few minutes, while according to the manufacturer, it takes about 15 minutes to get trained and familiar with it. I am sure that it also depends on how familiar one is with this type of application, for example, I will bet that my 7-year-old grandson who beats me regularly in his WII games can pick this up in half the time and become more proficient than I ever will be. We need more of these kinds of toys.

Display shows an install
in Afghanistan
5.       The Most Ruggedized Award goes to… the vendor who deploys numerous Teleradiology systems in the areas where our soldiers are serving, such as Afghanistan and surrounding countries as well as previously in Iraq. I am talking about MedWeb, who has been able to provide systems that can reliably can transfer images from these areas of conflict to the medical centers in Europe for review and consults. With ruggedized implementation, I don’t only mean the hardware, but also the software, especially the communication protocols. The workflow also has to be foolproof, which is quite different than when using Teleradiology for emergency medicine in typical setting. The so-called workflow “exception cases” where patient information is unknown at the time of diagnosis are the rule instead of the norm in this environment.  The reason for the study or admitting diagnosis, which is typically part of the examination requisition, is frequently missing as well. Many PACS systems automatically create an exception or flag images as “unverified” or “broken” if information such as the Accession Number, or patient information is missing, again, this is the norm in this environment. I have a great deal of respect for these folks, especially their support people who install and maintain these systems on-site. There is a lot to be learned from these applications for use in a non-battle zone as well to make the product more robust and durable.

Pick your ambiance...
6.       The Ultimate Feng-Shui Award goes to … The vendor who does not only pay attention to product design but also includes its surroundings. Anyone who ever has had a CT or MR done, and while laying on his or her back, had to stare at a sterile ceiling with those blinding fluorescent lights knows what I am talking about. I am talking about Philips, who has been in the lighting industry since 1891 and is actually the world’s largest lighting producer as of today. Philips argues that it is not just about the light, but it is also, more importantly, about the ambiance. There have been studies done about the impact of lighting on productivity, and I can imagine that similar studies could be done about anxiety and potential stress levels that may be reduced by the proper ambiance. I can even imagine that more relaxed patients would cooperate more, listen to instructions by technologists better, and therefore have a positive impact on the workflow and efficiency. Now I am waiting for the vendor who could also take care of the typical “hospital” smell by providing an aromatic soothing environment as well.

Dental cone-beam CT
7.       The Most Disruptive Technology Award goes to…. Cone beam CT, which has evolved from dental only applications to spine imaging, extremity imaging, and for ENT applications as well. Because of its relatively small size, it is possible to image patients in a standing position as well, therefore imaging the impact of putting weight on certain joints. However for dental applications it seems to be the most disruptive as it could possibly replace the traditional Panorex devices in most offices with a full blown CT as this scanner has the capability to also take panoramic images in addition to the slice data which can be used for 3D imaging. The precision that can be achieved to create 3-D models is less than .01 mm, which is definitely much better than can be achieved with conventional CT imaging. Especially for dental implants, this increased accuracy is a major benefit, as they will create a much better fitting implant. The bad news is that this opens a whole new can of worms because those dentists now have to deal with these high tech, heavy-duty, dose-generating devices.

Additional spine stretching included
8.       The Best Pragmatic Product Award goes to... The company Dynawell, who came up with a very simple device which simulates the upright position while laying on your back using a set of adjustable straps and a scale. It couldn’t be any simpler, therefore you won’t need to invest in the new extremity CT or “stand-up” MRI and be able to achieve the same result. This simple solution is a good example of thinking outside the box and coming up with relatively simple solutions. We need more of these to lower the cost of these procedures.

Quite a large footprint
9.       The Most Promising Technology Award goes to… The many multi-modality devices which are becoming mainstream, such as the CT/PET, CT/SPECT and now also the CT/MRI. These modalities are not new by themselves, but the combination of these devices create a fixed reference point so that sophisticated mapping and fusion of these images, which would allow not only the anatomy but also function to be presented in a single view and is relatively simple to accomplish. It definitely greatly enhances the utility of the nuclear medicine images, which are traditionally very small, noisy and have a very poor resolution because of the limitations that a human body has with regard to dealing with radioactive tracers and agents. These systems are not inexpensive and especially the PET/MR requires a lot of square footage to operate, but for certain diagnoses, these examinations will very likely become the standard care. However, these devices will definitely not help in lowering the cost of healthcare.

A typical DR plate in its storage bin
10.   The Most Over-Priced Product Award goes to… Digital X-Ray Plates, aka DR. It took about 30 years for CR technology to become mature, commoditized and affordable. I worked on one of the first CR units made by FUJI in the 1980’s, which took a complete air-conditioned room to be installed and was in excess of $100k. Today, you can get a simple tabletop CR unit for about $15,000 to $20,000, which includes several plates, software, training, and warranty. Digital plate technology or DR, has matured with regard to its technology as the image quality is good, plates are now wireless and do not require a cable anymore, they are relatively robust and drop-safe and not as heavy as they used to be. However, they are still in excess of $50,000 for a plate. There are many small clinics around the world, especially in emerging countries that still use film in locations where even only $1.50 for a film is a major expense, if one can get film and chemicals to those locations to start with. This is in addition to the fact that two-thirds of the world population does not have access to basic radiology services, creating a need for an estimated 80,000 affordable X-ray units, for which digital technology could be a potential solution. The first manufacturer who is willing to price a plate based on the potential sales opportunity of tens of thousands of these plates will be able to create a true revolution in healthcare. As with many of these innovations, it might have to be someone from the outside, similar to what Apple did with the phones killing Nokia, or Canon with camera’s killing Kodak.

GE deserves a honorable mention for
their kid-friendly MRI
In conclusion, RSNA 2012 did not show a lot of revolutionary developments, but rather several significant improvements, and a couple of fun and small innovations. I am sure I missed some, don’t hesitate to point them out to me, or if you have any comments and/or opinions about these awards (even if you agree, I like to hear it!).