 |
| View from McCormick place to the city |
I have a love-hate relationship with the annual RSNA
radiology tradeshow. I don’t really care about
the long lines to wait for the
shuttle bus and Starbucks, the expensive food, and of course the cold weather
outside, even though it was relatively warm this year. And of course the
walking, as my Fitbit® logged 7.5 miles on average going from one end to the
other end of the exhibit halls. But the good things definitely make up for the
bad parts, i.e. the networking with others in the industry, catching up with
who is where and doing what, and last but not least, seeing what’s new from the
vendor exhibits. |
| View at the exhibit hall |
There were no spectacular new developments this year, rather
more a continuation of and, in some cases, merely a slight improvement in
functionality and features. Especially in the imaging IT space, the lack of
significant progress has been frustrating for users who complain about workflow
issues and lack of integration. Every manufacturer talks about a Vendor Neutral
Archive or VNA, which is supposed to serve many specialties and an EMR, which
is supposed to provide a patient-centric approach towards information
presentation with a “simple” universal viewer plug-in, but in talking with
users, reality is different.
An example of the criticality of proper workflow support was
shown in the recent Ebola case in Dallas, where supposedly the information that
the admitted patient, Thomas Duncan, had just arrived from West Africa was not
communicated between the admitting nurse and the treating ER physician,
resulting in the discharge and fatal result as has been widely publicized. The
hospital admitted that they made significant changes in the EMR configuration
(which is EPIC) to prevent this from happening again.
But let’s talk about what’s new, or noticeable, at least in
my opinion that was shown on the exhibit floor:
1.
We need Vendor
Neutral Video (VNV) in addition to a VNA – Many users are considering a
VNA, however, there are still many disparate systems without digital
connections that only can be integrated by combining their video signals, which
could be coined as a VNV solution. This is especially important for the OR, which
has several measurements to be recorded, such as EKG’s in addition to live
video feeds and DICOM image displays that all need to be available for a surgeon.
 |
| Multiple video sources combined |
 |
| Demostrating Google glasses using a DICOM viewer |
2. Google glass for DICOM image display – Over the past few years, vendors have shown
gesture-driven user interfaces based on commercial gaming console detectors, this year, a couple of researchers showed not only hand but also “finger” based interfaces, and the ultimate interface using Google glasses. Talking with radiologists, many suffer from wrist and arm injuries caused by the daily repetitive mouse and/or trackball movements required to go through image sets. The alternatives are not quite ready for prime time yet, but it is clear that we need a better alternative; otherwise, in another 5 or 10 years, a major part of the radiologist community is going to be on disability leave.
3.
Monitor
size and resolution is ever increasing – Extra-large size monitors (70, 84,
or even 110
inches across as shown by Beacon) are useful when the user is relatively far away such as in the
OR, but also in a conference room setting. With
regard to resolution, Barco showed that last year’s 10 Megapixel is this year’s
12 Megapixel, with a different aspect ratio, optimal for displaying larger size
icons, which allows for easy scrolling. An interesting application for color in
mammography was to label the prior image in a different color, (e.g. yellow) vs
the current study (e.g. blue), which reduces the chance of mixing up the new
and old images. By implementing its own driver, Barco also showed how to create
a “loupe,” which does not magnify but increases the luminance considerably,
simulating a “hot light” as used for film.
inches across as shown by Beacon) are useful when the user is relatively far away such as in the
 |
| 12 MPixel display (note icons on bottom) |
4.
Cone beam
CT is expanding beyond dentistry – Cone
beam CT scanners are already widely
used for dentistry applications, especially
where high resolution is needed to simulate implants. There is a growing
application field for ENT where, especially for the inner ear, high resolution
is preferable. Now with ever-increasing bore sizes, it also can be a less
expensive alternative for extremity imaging compared with traditional
multi-slice CT scanners as shown by Claris.
 |
| Ever larger cores for the cone beams |
5.
Breast ultrasound
imaging becomes multiplanar – Ultrasound images are typically 2-D, or, if
acquired as a loop, have a time component. Because of the hand-held operation,
registration of these images with each other is very hard if not impossible.
What if the images are acquired using a registration device that controls
exactly the direction and relative distance from each other? The result are a
set of images that can be used to do a multiplanar reconstruction or even a
3-D, similar to what is done in CT or MRI. The registration device as shown by
Sono Cine looks conspicuously like the first-ever ultrasound unit. Regardless,
this brings a completely new dimension to ultrasound, especially for breast
imaging, this could be a great advantage.
 |
| Scaning a breast phantom using a commmercial Ultrasound wth a fixed registration |
 |
| Entry cautions |
6.
Safety is
critical – The solutions shown at RSNA range from sophisticated high-tech
imaging solutions to simple devices that can have a major impact on patient and
personnel safety. An example of such a pragmatic device is access control to
MRI rooms as shown by Aegis. Incidents whereby people got hurt because of
flying metal objects such as chairs, big oxygen cylinders and others that are
attracted to the strong magnetic field are not uncommon. Proper protection
could make a major improvement and satisfies the increasing scrutiny by Joint
Commission inspections.
 |
| Definitely not caustrophobic |
8. True multi-modality multi-plane system – The illustration shows a
 |
| Seems kind of crowded |
9.
DR in a box – For veterinary and other
mobile applications, such as a nursing home, the
Carestream DR in a box is a
good solution. The plate is a wireless DR plate, with a PC used for QA and
preliminary viewing. The battery life of the plates are sufficient for more
than 100 exposures, which should be OK for human use; for veterinary use, it
might barely cover all the views needed to image the joints for only 2 horses.
In the latter case, one would require extra batteries for the plates to be
available.
 |
| Container with digital, wireless plate adnd computer |
 |
| A true table top |
 |
| Having the honor to finally meeting Dr. Wilhelm Roentgen in person |
