The Radiological Society of North America's annual meeting at McCormick Place in Chicago is one of the biggest medical shows in the world. For those who couldn't attend - or who did attend but couldn't see it all - DOTmed presents, hall by hall, some of the most exciting gadgets, devices and applications. Welcome to North Hall.

Philips Healthcare: PET-MR and digital broadband MRIs

By far the thickest crowds in Philips Healthcare's block-long booth at RSNA 2010 could be found mobbed around the Ingenuity TF PET-MR. The new modality, making its official debut at this year's conference, was housed in its own glass showroom, like any new-model car at the Chicago auto show. The unit features a rotating turntable letting patients connect with the separate MRI and PET scanners.

This was one of two PET-MRs on the floor (Siemens had the other one. Look for more about that tomorrow). Radiologists who spoke with DOTmed News said PET-MR could be superior to PET-CT in visualizing certain cancers, such as basal skull tumors and superior sulcus tumors of the lung, but more research is needed.

So far, there are only three units installed at test sites, with a fourth on the way to the University of Ohio.




The device is still awaiting 510(k) clearance from the U.S. Food and Drug Administration. Plus, reimbursement issues still have to be sorted out. Philips expects most sites will use it part of the time for straight MRI scans and part of the time for research.

The equipment also costs a pretty penny - about $4.5 million, Philips said. Still, the company said they've already received 12 orders.

Also, on the MRI front, Philips introduced its Ingenia 1.5T and 3T with digital broadband, allowing direct conversion on the coils for the first time, the company said.

Philips says the device, which researchers began working on eight years ago, results in a 40 percent better signal-to-noise ratio and faster scanning times. Scanning takes around 8 minutes for a liver, versus 20 minutes from other magnets, the company said. Philips also hopes that the device will allow for cheaper upgrades over the 8-10 year life of the system, as it does away with the external spectrometer cabinet.

So far, units are installed at three test sites in the United States. It's pending FDA clearance, and the company expects it to be commercially available by July 2011. The 1.5T model will go for around $1.5 million and the 3T for $2.5 million, Philips said.

Photoacoustics research

Although the magnets were drawing the crowds, over in a different corner of the booth, Philips' research division was quietly discussing future technologies, mostly still in the conceptual or preclinical phase.

One of the technologies discussed aims to make sampling sentinel lymph nodes in breast cancer cases easier. As the Philips research team explained, when doctors want to see if cancer has spread from a tumor in the breast to the lymph nodes, they often have to conduct a biopsy of the lymphatic tissue, which usually involves a minor surgery. According to Philips' estimates, there are about 100,000 to 120,000 such procedures a year, and for around 76 percent of biopsies, the results are negative.

Theoretically, a new technology could help make the procedures less invasive. Philips is looking into using ultrasound for a technique called photoacoustics to help doctors visualize the lymph nodes so they can guide the biopsy needle without surgery.

As Steve Klink, the spokesman for the Philips Research division puts it, the aim of photoacoustics is to "listen to the color of light." In essence, it works like this: when struck with light of the right wavelength, tissues will heat up and expand, and release ultrasound waves, which can then be picked up by an ultrasound transducer.

For the biopsy, Philips would use a modified ultrasound unit with a red laser. First, the patients would be injected with a methylene blue dye that's taken up by the sentinel lymph node. Then, doctors would beam the laser into the tissue. When the light from the beam hits the dye, it releases ultrasound waves so doctors can see the dye and thus know where the lymph node is.

Will it work? So far, it's only be tried in rats, and researchers were able to image lymph nodes about 4 centimeters deep -- the typical depth of lymph nodes in breast cancer cases, Philips said.

Agfa Healthcare: Mammo CR comes to the U.S.

Belgian film company Agfa Healthcare was pushing Impax 6.5, the latest update to its PACS workstation, as part of the company's new focus. At a lunch talk with the company's president Christian Reinaudo and other top executives, the firm said its informatics division was seeing 30-35 percent yearly growth. "We must be the leader in PACS," Reinaudo said. Meanwhile, film imaging sales had flat-lined after several years of decline, partly because China, India, Russia and other developing countries were buying film-based stuff even as sales continue to plummet in the developed world.

Of its new products on the floor, of note was the DX-M, Agfa's mammo CR product. It's not available in the U.S. yet, as Agfa still has to get 510 (k) clearance -- but that's the interesting part.




From DOTmed News' discussion with vendors, one of the most important announcements for RSNA actually happened well before the show. This was in early November when the U.S. Food and Drug Administration downgraded full field digital mammography from class III, it's riskiest category, which includes most pacemakers, to class II, which includes most diagnostic imaging devices.

This opens up the U.S. market to lower-cost CR mammography products that had previously only been available in Europe. Up until now, vendors had to go through hugely expensive premarket applications, often with clinical trials, instead of filing paperwork for the quicker, cheaper 510(k) clearance for class 2 (as Agfa can do with the DX-M).

For CR mammography, this limited the field to just one vendor, Fujifilm, for almost four years, until Carestream got its mammo CR product approved about a month ago. Now, several OEMs are expected to join the mammo CR space, and should help make digital mammography more affordable. "Watch the fun start now," one vendor joked with DOTmed News.

Agfa said DX-M is already available in most of the world outside the U.S. It's scheduled for launch in second quarter 2011, and should go for under $100,000.

McKesson: "Future Horizons Center"

DOTmed News visited McKesson's "Future Horizons Center," a section of its booth devoted to experimental products. Few professions have a workflow as measured and pressed as a radiologist's, so it's no surprise many of the offerings were focused on improving productivity.

One prototype on display was a keyboard apparatus designed with mammographers in mind.

The device, very early in the prototype phase, is now a series of white panels surrounding a keyboard. The panels each represent some common task the radiologist performs, and are outfitted with proximity sensors, so they respond when a user touches it. The hope is that radiologists can more efficiently work while staying focused on the screen. "If we can give them a piano with pedals, they would use it," said George Kovacs, director of product marketing.

Also in the prototype stage was a mobile PACS viewer of sorts. Many other vendors also have PACS viewers -- non-diagnostic, of course, as the FDA won't yet allow diagnostic reads on mobile devices. But this one throws an image from an iPad onto a diagnostic workstation with one click (it passes the credentials of the doctor instantly to the workstation: only one sign-in required).

Dr. Jeffery Yu, a radiologist from The Queen's Health System in Honolulu, was interested in the demonstration and had a few suggestions -- such as adding the referring physician's name to images on the master list. The key thing was the speed at getting what you want to see. "How many clicks is it for me to find that image?" he asked.

The future of these products is up in the air, of course. McKesson said both products were born of a program where company engineers -- much as with Google -- are free to spend 10 percent of their work time on personal projects. Some of these ideas never really go anywhere, but others have enough of a business case to attract funding and go on to successful launches, the company said.

Sectra: Virtual autopsies

On display at Sectra's booth was a gadget you'd expect to see on a future episode of "CSI": a virtual autopsy table. The rotating table is essentially a very large, almost cadaver-sized touch screen hooked up to a PACS server. It lets forensic scientists or doctors quickly examine 3-D reconstructions of computed tomography images.




At the show, Sectra showed visitors the CT scans of a man who succumbed to multiple stab wounds. Using various filters, you could see the smashed ribs, the gashes cut by the knife in the skin, and even air pockets left as the flesh closed around the hole made by the blade.

The Swedish company says the device, which was shown at the European College of Radiology conference in Vienna earlier this year, is not meant to replace autopsies, but rather to help scientists figure out the best way to start cutting into the cadaver without destroying evidence.

The device will also be marketed toward university hospitals and trauma centers. A Sectra spokesman said in trauma cases multiple teams often need to consult over the best course of treatment. The device is made in a way to accommodate consultations from large numbers of people: the screen's icons can be made to obey physics, so you can pass them across the board to a colleague or even crash them against each other if you're feeling bored.

But the Hollywood product does require a Hollywood budget. A table, which can be purchased now, runs about 160,000 euros, the company said.

Click to see highlights from South Hall. And come back tomorrow to see what you missed at the Lakeside Center.