| View from the cafe to the exhibition floor |
This year’s annual radiology tradeshow at McCormick Place in
Chicago drew about 10 percent fewer attendees than last year, which is most
likely attributable to the unfavorable dollar exchange rate, which makes it
expensive for non-US attendees, and the fact that last year was kind of a
banner year as it was the 100th anniversary meeting.
It was my 32nd meeting and I consider this year’s as one of
the uneventful ones. I had a hard time finding any new products let alone
innovations. Of course, vendors would like you to believe otherwise but I couldn’t
find anything exciting about a new release of an existing device or product or
vendors catching up with the competition or technology that was already
introduced several years back. In any case, here is my top ten list of
noteworthy observations:
1.
VNA is out for the PACS vendors: Several PACS vendors have started to
realize that the Vendor Neutral Archive (VNA) is here to stay, and instead of
trying to offer one themselves, it is better to accept its presence in the
marketplace from other specialized vendors, and work either around, or with them.
To offer a VNA as part of your PACS product line does not make that much sense
anyway as it kind of defeats the purpose of uncoupling the image
management-archiving component in a “vendor neutral” offering if all components
are yours. A PACS vendor does not have any incentive to uncouple these, and
instead of implementing an open standard for synchronizing the PACS and VNA
such as IOCM (image object change management) it will
continue to tightly couple that and use its own proprietary communication
anyway.
As a consequence it seems as if the ground between PACS and VNA vendors has
been divided and both are starting to live with it. It was also interesting to
see that some of the archive vendors are starting to provide dashboards, add
analytic tools to create additional value, something that makes sense: it is
all about using “big data” and remember, digitization of imaging has been
widespread for at least 15 years while the EMR implementations only started to
take off for the past five years in the US, so there is potentially much more
to work with.
2.
What happened with the deconstructed PACS? The
good news is that the doom and gloom as was portrayed during the recent SIIM
meeting about PACS being dead, and that it might be better to build a best of
breed solution using what was coined as a deconstructed PACS, was absent during
this meeting. It takes a lot of work to tie all the pieces together and system
integration is challenging, something that is exactly what PACS vendors have
been doing for many years. The ability to provide image exchange between
multiple vendors with access and prefetching from multiple, old, obsolete and
retired PACS systems is what providers are looking for. That includes access to
imaging from different specialties and departments, which can be challenging as
some of the large institutions might have 50 or more locations and/or
departments that create images. It seems that the consensus was that a
“constructed” PACS makes more sense than a “deconstructed” PACS for most institutions.
3.
Do we need yet another certification? During the
event, the new RSNA Image share Sequoia project was launched with a
presentation by Dr. David Mendelson from Mount Sinai. This is an activity
sponsored by RSNA that will initially focus on validating image sharing between
different institutions using IHE profiles such as XDS, XCA and XPHR. It is kind
of a follow-on to the ehealth exchange, which is mainly for exchanging
documents between what was quoted as used between 35 percent of all US
hospitals. Talking with some of the vendors, there seems to be a concern about
yet another venue for testing and validation in addition to the annual IHE connectathon,
which happens in multiple locations (USA, Europe, Asia, where a vendor can be IHE
certified using the ICSA lab tools. The good news is that the core of the
Sequioa tools are going to be based on the MESA toolset as used by the IHE connectathon,
nevertheless, I can understand the concerns from a vendor perspective. Time
will tell which method or venue, if any, will eventually prevail.
| The "O-Arm" (Pac man?) |
4.
The evolution of the C-arm: Most innovations are
not really revolutionary but rather evolutionary. A good example is the evolution
of the C-arm, intended to provide limited fluoroscopy and also basic x-ray
imaging in the ER and OR. There are now variations called “O-arm” which has a
movable opening and “G-arm” which combines two detectors and sources to take
two views.
| Specialized orthopedic unit |
5.
Cone beam CT scanners are becoming more popular:
The initial cone beam CT scanners, which take volumetric scans using only a
single rotation uses a
flat detector instead of the small, cylinder arrangement
used in a conventional CT scanner. They are predominantly used for dental
applications as the high resolution is very well suited to create data for
dental implants and it is relatively affordable for this specialty ($100-200k).
Its application is now being extended for head imaging as well as extremities.
There were at least two vendors that showed it for orthopedic applications and
vendors are also promoting it for more extensive head and sinus imaging. The
dose reduction compared with a regular CT is significant, i.e. 4 to 5 times, as
a matter of fact, one vendor markets it as a low-dose CT system.
6.
Thermography is becoming mainstream:
| New Thermography therapy modality |
| Promotion of DBT claiming that 39% of woman are covered by DBT |
7.
Digital Breast Tomosynthesis (DBT) is becoming
the norm: Hologic has set the standard in this field and other vendors are
still trying to catch up, but there is no question that DBT will replace
conventional 2-view breast x-ray imaging. I would have expected that breast MRI
would actually be a better candidate to replace it but I guess the cost and
contrast issues just makes it not yet a viable alternative. Finally, most PACS
vendors are now facilitating the new DICOM objects that are created by the DBT
modality instead of having to deal with the proprietary solutions that were
used initially. But, facilitating these studies, especially prefetching them,
is still challenging as they are about ten times the size of a conventional
mammogram study. In addition, despite the fact that the radiology community has
accepted that there are probably a couple more findings detected using this
technology for every thousand studies, I have not found anyone who really likes
to read and report on them, mostly due to the fact that it takes 3 to 4 times
longer to read these studies.
| Affordable wireless DR plate technology |
9.
3-D models replacing films? 3-D printing has
been demonstrated for several years but the technology is now becoming
mainstream, as it is making its way into the consumer world. You can buy a 3-D printer
at Amazon or Walmart for under $1,000. There was a lot of talk about this
technology at this year’s event. It is interesting that apparently, computer
visualization is not as good in replacing real-world, touchable models that are
used by surgeons, for example, to determine the best way to operate on a
defective heart. This use of 3D printed models was recently featured by CNN as being
especially useful for unusually complicated procedures.
| Medical casters? Really? |
is that the “medical grade” label sells. It is often just a marketing tool. For example, there are medical grade CD and DVD’s, which are basically the same as you can buy at Best Buy or Walmart but with a different label or color. The company I was working for at one time used to simply spray-paint the standard computers (which were DEC pdp-11 at that time) in a white color to be able to charge more for medical grade. Of course, if there is indeed a difference, such as when using medical grade monitors, which typically allows for DICOM calibration and automatic luminance control, the term makes sense. But in general, I’d always be suspicious when I see these labels on what appears to be commodity products.
| Macy's window display. |
RSNA belongs to Chicago: RSNA would not be RSNA without the
grumpy (this is an understatement) cab drivers, expensive food, almost
unaffordable lodging that you find in Chicago.
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