I saw a lot of imaging  equipment at RSNA. But I also saw some of the pieces that comprise an imaging  machine. You know, components. You may not think about them all that often….but you should.

Good components make your machines functional, but they can also prolong the life of imaging equipment –helping you keep costs down.

I met with the Dunlee team and we talked about CT tubes. These babies can be expensive! So you want to choose your replacement CT tubes carefully.

At RSNA, Dunlee introduced the Reevo 240G. It’s designed to offer imaging  facilities lower costs per exam as well as longer tube life and performance. As Dunlee puts it, it’s a“smart option for shrinking budgets.” A way to help you manage CT lifecycle costs.

The Reevo 240G was created as a replacement for use in the GE LightSpeed VCT, LightSpeed VCTSelect, LightSpeed RT16, LightSpeed Xtra, and Discovery VCT CT systems. The Reevo 240G is identical to the original tube in fit, form, and function, and the warranty also matches the original equipment manufacturer’s warranty.

So why am I writing about components?

Every month, we conduct a reader poll at Imaging Economics. Most recently, we asked readers “What modalities or technologies are you most interested in seeing at RSNA?” The top draw: Ultrasound – with 27% of our readers saying that’s the modality they had on their minds while visiting the biggest medical show on earth.

WHY, you ask? Maybe because ultrasound is cost-effective and non-invasive. Maybe because ultrasound is used for multiple applications – from breast cancer to testicular cancer, from sports injuries to OBGYN applications, and, of course, all those “ultrasound guided” interventional procedures.

Or, maybe because ultrasound just keeps getting better and better. Cases in point: Supersonic – stretching the limits of ultrasound with shear wave elastography technology; Zonare – keeping clinicians a step ahead when it comes to pediatric imaging; U-Systems – breaking ground with new breast cancer screening studies.

I tend to think of ultrasound as the “kinder, gentler” modality. (No noise or claustrophobia like MRI). …Ultrasound: As a patient, ya gotta love it. And for practitioners, it’s working some nice wonders. …What did you learn about ultrasound at RSNA 2009? 

 They were out and about at RSNA – some 40 companies listed themselves on the RSNA website as providers of teleradiology services or solutions. And there they were on the exhibit floor, showcasing capabilities. While I only had time to meet with a handful, I learned a few things.

 Teleradiology is a whole new ball game. Gone are the days of simply providing overnight preliminary reads for busy hospitals. Today’s providers are sophisticated businesses that offer an array of services from sub-specialty expertise to final reads. Online Radiology spoke with me about their ability to offer both onsite and off-site services and fill a demand for telemammography.

 Interestingly, new business models are emerging as well. Rely Radiology Group specializes strictly in reads of X-ray and ultrasound. That seemed limiting, to me. Their rationale: A big focus now is on managing imaging utilization, so there will be more and more demand for X-ray before expensive modalities like CT. The company says many of today’s radiologists are unaccustomed to reading X-rays, and sees itself as well-positioned to fill the void.

We all know there’s a place for teleradiology providers in today’s fast-paced imaging world. But teleradiology has always brought with it controversy and concerns for practitioners. …What did you learn about teleradiology at RSNA? What are your concerns about the evolution of the industry? 

One of the trends that I saw at RSNA this year was redefining interfaces That is, taking another look at the way radiologists interact with their workstations. And what are workstations? They're basically very powerful computers that process images and data.

 The problem is that these computers are all based on generic computers and generic industries. You got your mouse and you've got your hard drive and you've got your monitor...okay, you've got your two really hi-def monitors. But what if there were a new way to interact with your computer?

Voice recognition is one way to evolve the radiology interface. Though I haven't tried it, I've been told by many that once you've got it and you get used it, you wonder how you ever did without it.

And what about that pesky thing under your hand and that big passive screen in front of you? What if there were something else to replace the mouse and make it more...radiology friendly. Do you want one big touch-sensitive pad that can expand or contract and manipulate views with your finger tips? Or how about instead of a flat screen, would you rather sit back with goggles with a 3-D image and motion detecting gloves?

Or do you just want to have the comfort of something familiar that works, that's mobile, and doesn't need anything special beyond an internet connection? Tell us your thoughts in the comments section below.

Too much radiation isn't just a problem for patients, but also for physicians and techs. Interventional radiologists and radiation techs keep track of their exposure through relatively low-tech badges known as TLDs or Thermo Luminescent Dosimeters, a type of passive dosimeter. But you don't know if you're too close to the beam or received too much over time. Enter "Dose Aware" from Philips.

Dose aware is an active system. The display, below, is set up in the interventional suite and communicates with the Dose Aware wireless badge clipped to your pocket. Get too close, the display turns red. Orange is somewhere in between, and green is good. You can also keep track of anyone else in the room with a badge.

Dose Aware is also cumulative, so you don't have to wait until the end of the month to be told you've gotten too much radiation exposure. You know it from a minute-to-minute level. So if you see you're getting too much, you can immediately take steps to reduce your dose and/or bring radiation protection in place. Medical personnel can also more readily manage their doctors and techs with real time data, taking out a lot of the estimation and argument about which Docs need to take a break for their own sake. 

A consistent theme that I've heard throughout my travels through the RSNA halls this year has been flexibility. No matter how great the technology, nobody wants to be tied to a whistle or bell that they won't use or won't use that often. Moreover, if they've got a working system that's still got 5 good years left, there's little appetite to do a forklift upgrade, even if the entire Radiology department writes a letter to Santa/the Hospital CFO and say how good and efficient they'll be next year.

Vendors have heard these calls for moderation and flexibility. As a result, you no longer need fork lift upgrades for many MR systems on the RSNA floor. Keep the 1.5 magnet and just upgrade the software and coils, perhaps another server, and you're good for another 5 years. Decide to expand in 3 years? No worries. Options are modular. 

Carestream's DR-X Evolution suite is another example of flexibility. It's being offered in a lot of configurations. By mid April 2010, you'll be able to get a DR suite that can range anywhere from the upper mid 100's to the mid 300's, depending on how many the detectors and automation you're looking for.

Still got life in your analog system? Not ready for a full DR suite? No problem. Carestream's DRX-1 Detector is a wireless, cassette size 14x17 detector that can be used for a room retrofit, and because it's cassette sized, it can drop right into your old analog buckey without modification to your overall system.

So, remember the old Rolling Stones Song, "You Can't Always Get What You Want." At RSNA 2009, that may be so, but as Mick Jagger said, "If you try sometimes, you just might find that you get what you need." What did you want for RSNA Christmas this year? Did you find what needed instead? Let us know below.

It reminds you of the transporter device Star Trek, but in fact, it is EOS from BioSpace Med.

Patients walk into the cabinet or sit on a chair inside the cabinet. A few clicks of the mouse, and the patented scanning detector travels down the length of the cabinet, capturing both AP and lateral views of the entire body or whatever portion desired.  No more stitching, and radiation dose is dramatically reduced, not only because of the technology, but also because both views are simultaneously acquired. Physicians also get the benefit of viewing full, weight-bearing spines.   

Without the need to position the patient, throughput and workflow is also significantly increased. Additionally, complicated measurments, such as the Cobb angle in scoliosis, are automatically processed.

The company sees EOS as being ideal for orthopedic offices and scoliosis patients. The low radiation dosing may be especially attractive to the pediatric scoliosis market, where young children are imaged periodically to monitor their condition. EOS also has 3D reconstruction software available.

The iPhone has certainly changed cell phone life for consumers, but will it make a difference for radiologists? Thanks to thin-client PACS architecture and a wave of new dedicated iPhone apps, it's now possible to view studies on your iPhone. But will that mobile computing power change your Radiology work life? I've gotten mixed reactions to the new iPhone trend. 

Interviewing Docs on the RSNA floor, I got everything from a shrug to a wow. None say that they will be giving up their workstations or laptops to scroll through 1000s of CT slices, and there was a strong reaction to not even giving a preliminary read for an x-ray unless it was a very clear break. 

Others were more open, saying that if they received a quick consult and could zoom in on a particular CT slice, they would offer an opinion. They say it would be especially useful when away in social situations and vacations. And yet, one doc said that he'd rather not even have the iPhone for that very reason. When he's off the clock, he's off the clock. An iPhone with a robust image processing app might get him in deeper trouble with his wife, who already complains about bringing work to the home lap top. 

There's also the prospect of the iPhone being a teaching tool. Walk over to Mckesson's booth at RSNA, and you'll see an iPhone combined with mini handheld "Picop" projector. The idea is that while you're doing rounds with students, you can project an image on the wall --or even the patient's chest--to show students the anatomy or a bone image or ultrasound, as in the case below. As one product manager said, this is just the beginning. The resolution might be terrible now, but it's only a matter of time before the projector technology improves.

Are you looking forward to the iPhone changing the way you read? Let us know!  

  Among the hot topics at RSNA 2009: Dose control and cloudcomputing. …Its dizzying getting a grip on the complexities of both.

We’ve been hearing about the first for some time now, but with recent events at Cedars-Sinai it’s no wonder dose control is a particularly big issue right now. I talked with Siemens’ experts about a new dose reporting tool for CT that’s in development. Rather than seeing the dose that was delivered to the patient after the fact, techs will be alerted with a message when the dose is at a crucial point. We also discussed a technique that involves scanning at intervals vs. constantly. As one member of the Siemens CT team put it, “Skin dose can add up and this technique allows you to pass over a sensitive area –like the lens of the eye – and scan at a greatly reduced dose.” Siemens is working to build this capability into their dual source platform with a goal of January 2010.

In a press briefing, GE Healthcare announced a multi-center study to investigate the performance of Model Based Iterative Reconstruction (MBIR) as a method to maintain or improve diagnostic information available to clinicians while dramatically lowering radiation dose in routine CT imaging. Sites in the U.S., Europe and Asia will participate.

If dose control isn’t complicated enough for you, walk the show floor and reach for the “clouds.” I’m talking about the vendors that are showcasing cloud computing solutions – essentially the new wave in data storage and sharing. The idea is almost limitless space and easy access to data for multiple parties – a tool that facilities collaboration in an era demanding efficient health information exchange. Each cloud vendor I talked with explained the concept in its own way. And not surprisingly, they all told me theirs was the best cloud solution. (Ya gotta love that blue-sky attitude!)

What have you learned about dose control and cloud computing? Post a comment. …Or, tell us about other hot topics you’ve discovered at RSNA. 

It’s tough enough to have a child with cancer or that requires some kind of imaging exam to properly diagnose and check disease progress.  

Imaging companies like Toshiba have responded to the needs of pediatric imaging with a dedicated superfast 320 slice Aquilion CT, which not only reduces radiation exposure, but is also designed to be kid-friendly with animal designs on the gantry.

Toshiba has gone a step further. Aside from putting animal prints on the actual gantry, they're also offering facilities a mini-model CT scanner.

This is more than just a toy, of course. The idea is that this mini-demonstration, complete with animal patients and a sliding gurney, will help kids—and their parents—to understand the process and prepare children to hold their breath and …to try to relax.

Want to go a step further? Philips has its own toy MR scanner, but with this one, the "patient," a toy elephant, actually gets "scanned" and then an image is immediately revealed on a nearby monitor that shows the same area where the child will be scanned. Different toys correspond to different imaging exams. No kiddie RIS/PACS, however. Perhaps that will come at RSNA 2010.