Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Novation Diagnostic Imaging Watch Product and Practice Trends in Diagnostic Imaging Spring 2013 Table of Contents Technology and Clinical Research .......................................................................................... 3 Market Overview and Hot Topics ............................................................................................... 3 Capital Landscape ...................................................................................................................................................................3 Hot Topics and Trends in Technology ............................................................................................................................. 4 Dose Management .................................................................................................................................................................. 6 CARE Bill Update ..................................................................................................................................................................... 6 A Glimpse at Reimbursement for Centers for Medicare & Medicaid Services in 2013.............................. 6 Contrast Media ......................................................................................................................................................................... 7 Technology Summaries ........................................................................................................................... 9 Angiography/Cardiovascular Suites ..................................................................................................................................9 C-Arms (Surgical and Mini) ................................................................................................................................................. 13 Computed Tomography ......................................................................................................................................................... 17 Digital Radiography and Computed Radiography ...................................................................................................... 20 Digital Radiography ................................................................................................................................................................ 21 Computed Radiography ........................................................................................................................................................ 28 Informatics ................................................................................................................................................................................ 31 Magnetic Resonance .............................................................................................................................................................. 34 Molecular Imaging – Nuclear Medicine, PET/CT and PET/MR ............................................................................. 38 Power Injection Systems ..................................................................................................................................................... 42 Ultrasound ................................................................................................................................................................................. 45 Women’s Imaging Products ................................................................................................................................................ 56 2 DIAGNOSTIC IMAGING WATCH - SPRING 2013 Technology and Clinical Research Members that manage the procurement of diagnostic imaging products should have insight into and understanding of the technology and industry dynamics that will affect their investment decisions. Novation is committed to being a source of this information and technology expertise. The staff continuously studies the latest technologies and trends in diagnostic imaging. Data and other information are acquired through meetings with suppliers, monitoring trade publications and attending events such as the Radiological Society of North America meeting in Chicago. Novation is an associate member of the National Electrical Manufacturer Association and participates in the activities of the Medical Imaging & Technology Alliance. The content of this publication has been peer-reviewed by members of Novation’s Diagnostic Imaging Council, which includes medical doctors, clinicians and engineers. The result is this overview of the latest product technology and trends for imaging subspecialties. Market Overview and Hot Topics CAPITAL LANDSCAPE Will capital dollars loosen up in 2013? Is the economy on its way back? The answers really boil down to: “It depends on who you ask.” One survey indicates that 65 percent of health care finance leaders predict their capital expenditures will either remain the same or increase in 2013. Yet, when asked if their organization is cutting back on high-level, high-price technology, 86 percent answered “no.” This makes sense when the top four areas of growth are expected in geriatrics, orthopedics, cardiology and oncology, where lagging technology is not in the best interest of the clinicians and their patients. Another survey indicates that information technology is another important investment area, especially for expanded IT capabilities required for health care reform. IT systems, such as an electronic medical record, are expected to decrease costs and increase the quality of care. These systems should also help health care organizations manage the changes in reimbursement methodologies, such as pay-for-performance and quality incentives. While about 60 percent of leaders say that their coordination of care is strong or very strong, it also creates the biggest challenge. Others, such as Moody’s, are maintaining a negative outlook for the U.S. nonprofit health care industry. The Moody’s outlook has remained negative for the past three years because of modest projections for hospital revenue growth and an expectation that the economy will remain soft. The weak economy contributes to lower patient volumes as patients defer elective health care services, rising charity care and bad debt expense due to a high level of unemployment and the loss of health insurance. In addition, Medicare averages 43 percent of hospital gross revenue, according to Moody’s, representing by far the largest single source of revenue for hospitals, leaving them highly vulnerable to changes in Medicare reimbursement. In this survey, only 36 percent of finance leaders expected an increase in Medicare spending compared with the past year. IT is still prevalent because a majority of the dollars would go toward technology as health care systems strive to meet meaningfuluse deadlines. DIAGNOSTIC IMAGING WATCH - SPRING 2013 3 Several factors are still in play when it comes to whether to spend precious capital dollars: In addition to uncertainty about health care reform, potential decreases to reimbursement levels and the lingering effects of the recent recession, capital spending has historically been linked to profitability. Plans may change if profitability is compressed. Hospitals may have to pull back on major capital projects to offset decreased cash flow levels. Reimbursement concerns top the list of factors influencing where hospitals will spend their dollars. Labor and supplies topping the list of areas where finance leaders believe they can cut costs. But there are also positive trends. Capital spending at children’s hospitals has been robust in recent years relative to general hospitals, according to FitchRatings. Traditionally, strong philanthropic support has enabled children’s hospitals to maintain strong liquidity metrics and low leverage levels. Improved operating profitability is another positive sign. Despite these things, children’s hospitals are still vulnerable to government budget cuts. In 2011 and 2012, a number of hospitals resumed projects and returned to an increased level of spending compared with the previous years. Merger and acquisition activity is likely helping the situation as hospitals have an opportunity to grow their revenue base and increase negotiating leverage with payers and suppliers. Although the larger health care picture is causing concern for all health care leaders, when it comes to the state of their individual organization, finance leaders are optimistic. Almost 60 percent feel their organizations are on the right track, according to the Health Leaders Media Industry Survey 2012. With Medicare and Medicaid reimbursement cuts and initiatives like value-based purchasing hitting finance leaders, their priorities are driven by patient satisfaction, cost reduction as a way to process improvement and payment reform. Given the differing opinions regarding the state of health care, health care facilities and capital spending, it is difficult to make a blanket statement about a direction in the industry. Despite the continued uncertainty, it is clear that facilities have aging equipment that has to be replaced. Oftentimes, trying to stretch the useful life of systems can cost a facility more money in the areas of support and service, and because of the extended age of this equipment, there is a decrease in the ability to get new parts to replace older or broken components. This should be considered highly when making the decision to put off purchasing new equipment. We expect health care organizations will continue to be prudent and purchase on an as-needed basis. HOT TOPICS AND TRENDS IN TECHNOLOGY The pace of new medical technological advances is faster than most people realize, with some changes more important than others in the radiology domain: Use of Portable Mobile Tablets The 2012 RSNA showcased a few products using portable radiography tablets, but there is debate about whether the cost of the tablets is worth the time and effort to keep them from being dropped, lost or taken. According to a HealthImaging article, “SIIM: Pros and Cons of In-hospital Tablets,” “Radiologists could use tablets to enhance consultations and to educate clinicians and patients on rounds, which is an opportunity for imaging professionals to become more embedded in the clinical care setting.” In addition, “iPads® could improve efficiency for radiologists and referring physicians by reducing wasted wait time for consultation.”1 Mobile devices do have limitations, though. The iPad and iPhone® screens are smaller than workstation monitors, and currently users can neither dictate reports nor look at comparison films side by side2. In addition, health care mobile apps are needed for portable tablets and smart phones. 4 DIAGNOSTIC IMAGING WATCH - SPRING 2013 Mobile Apps in Radiology Mobile apps in health care are gaining popularity. The Mobile Health Market Report 2011-2016 expected that mobile health care would add to $1.3 billion in 2012, up from $718 million in 2011.3 According to the U.S. Food and Drug Administration, a growing number of software applications are being developed for health care providers to use on mobile platforms, including smart phones, tablet computers and personal digital assistants. In addition, many apps are being geared to the patients to assist in their own health and wellness management. As these mobile platforms become more user friendly, powerful and readily available, innovators have begun to develop mobile apps of increasing complexity to leverage the portability mobile platforms can offer.4 Introduced in spring 2012, Apple’s iPad 3 has made it easier for radiologists to review images, potentially moving medical imaging closer to using mobile devices for diagnostic purposes. Multi-modality Imaging Software™ was one of the first apps for diagnostic radiology approved by the FDA, opening the way for other companies.5 Challenges remain in the mobile app world and radiologists aren’t likely to abandon traditional workstations overnight, but experts say the industry is definitely moving in that direction. 1 Cloud Imaging According to Nadim Daher at Frost and Sullivan, the health care industry tends to lag behind many others when it comes to investing in, or even simply experimenting with, new models of information technology deployment, including cloud-based technology and its two major health care applications: cloud storage and cloud computing. The cloud computing market for medical imaging in the United States, valued at an estimated $56.5 million in 2010, is expected to grow at a compounded annual rate of 27 percent through 2018.6 As diagnostic imaging extends across medical specialties, imaging data will account for 35 percent of all medical data by 2015, compared with 28 percent in 2010.7 Despite concerns about data security and regulatory compliance, the use of the cloud to store and share medical images across health care providers continues to gain interest. Cloud archiving and cloud-based picture archiving and communication systems offer the ability to remove upfront software licensing fees, mitigate maintenance costs, overcome departmental silos, improve collaboration and data sharing with referring physicians, and enable upgrades with minimal downtime that health care providers find appealing. 1 Fratt, L. (2012, June 10). Clinical Innovation and Technology. Retrieved Dec. 17, 2012, from http://www.clinical-innovation.com/topics/imaging-informatics/siim-pros-cons-hospital-tablets. Bonner, L. (2012, November). Radiography (and Fluoroscopy) Keep Pace with Market Demands. DOTmed, pp. 66-69. Jahns, R.-G. (2012, January 25). Research 2 Guidance. The mobile research specialists. Retrieved Dec. 21, 2012, from http://www.research2guidance.com/us-1.3-billion-the-market-for-mhealth-applications-in-2012/. 4 U.S. Food and Drug Administration. (2011, July 21). U.S. Department of Health and Human Service. Retrieved December 2012, from http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments UCM263366.pdf. 5 RSNA. (2012, August 1). Radiological Society of North America. Retrieved Dec. 17, 2012, from http://www.rsna.org/NewsDetail.aspx?id=5953. 2 3 6 Medical Device Network. (Jan. 5, 2012). The US cloud computing market for medical imaging. Retrieved Dec. 27, 2012, from http://www.medicaldevice-network.com/features/featuresnapshot-the-us-cloud-computing-market-for-medical-imaging/. 7 (Medical Device Network, Jan. 5, 2012) DIAGNOSTIC IMAGING WATCH - SPRING 2013 5 DOSE MANAGEMENT As policy makers and the general public have become more aware of the hazards of radiation, there has been an increased emphasis on radiation safety, particularly in the United States, which has created the need for better dose tracking and monitoring tools. In California, legislation passed July 1, 2012, with new requirements for computed tomography scanners. A facility using CT scanners now must track dose metrics, and these metrics must be included in the radiology report for all patients undergoing diagnostic CT scans. Suppliers of radiology equipment are now offering dose tracking functionality within their workstations. The Medical Imaging and Technology Alliance and the FDA have been working on an initiative to ensure that necessary dose and patient information, like age and weight, for X-ray imaging procedures are recorded in digital imaging and communications in medicine radiation dose-structured reports, which then can be easily transferred to a dose registry.8 More recently, the FDA has bolstered its efforts to reduce and control radiation doses for pediatric patients. The FDA is working on final guidance rules for a proposal, Pediatric Information for X-ray Imaging Device Premarket Notifications, which will recommend that new X-ray imaging devices be manufactured with protocols and instructions that address use on pediatric patients.9 The FDA initiative, along with the continued efforts of radiologists, radiographers, medical physicists and health care organizations, should further ensure that patients are receiving optimal benefits from medical imaging exams while minimizing potential risk. CARE BILL UPDATE The American Society of Radiologic Technologists announced on June 26, 2012, that the Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy Bill, S. 3338, was introduced in the U.S. Senate by Sen. Mike Enzi, R-Wyo., and Sen. Tom Harkin, D-Iowa. The CARE bill would ensure that basic minimum education and certification standards are established as part of the Medicare program for all medical imaging and radiation therapy personnel. As of July 13, 2012, there were 130 bipartisan cosponsors of the CARE bill.10 With the passage of proposed federal legislation and state licensure laws, the public will benefit from being cared for by properly educated and certified radiologic personnel. 2 A GLIMPSE AT REIMBURSEMENT FOR CENTERS FOR MEDICARE & MEDICAID SERVICES IN 2013 The 2013 calendar year is going to be a challenging one for health care. The one good note from a doctor’s perspective is the recent fiscal deal reached on New Year’s Day. The deal produced a patch that fixes the Centers for Medicare and Medicaid Services Sustainable Growth Rate through Dec. 31, 2013. The fix keeps reimbursements stable for physicians and avoids the 27 percent reimbursement cut that was set to take effect Jan. 1 based on the SBG formula. Unfortunately, the fiscal deal did not stop any cuts coming to imaging and health care, in general. 8 9 10 (Bonner, 2012) (Bonner, 2012) The ASRT. (2012, June 26). American Society of Radiologic Technologists. Retrieved Dec. 21, 2012, from http://www.asrt.org/main/standards-regulations/regulatory-legislative-news/2012/06/27/care-bill-introduced-in-theu.s.-senate. 6 DIAGNOSTIC IMAGING WATCH - SPRING 2013 Imaging will face more cuts in 2013. What makes this more difficult is that the cuts in 2013 will be in addition to the $1 billion in cuts in imaging and radiation therapy services in 2012. Based on the Physician Practice Information Survey adopted by CMS in 2010, radiation therapy centers will see an overall reimbursement decrease of 9 percent and radiation oncology providers will see a 7 percent decrease, according to AuntMinnie. com associate editor, Kate Yee. CMS will also expand the multiple procedure payment reduction to include a 25 percent reduction in reimbursement for interpretations made on CT, magnetic resonance imaging and ultrasound subsequent scans, provided to the same patient on the same day. While the news was not good for imaging in 2013, hospitals did not fare any better. Although the fiscal deal on Jan. 1 delayed the CMS physician reimbursement cuts for at least a year, the cost for that patch was about $25 billion. The majority of that $25 billion was found through coding and reimbursement adjustments for hospitals. CMS made adjustments to recover overpayments for inpatients through MS-DRGs, which should produce about $10 billion in savings during the next years. Also, the statute of limitations was changed from three years to five years to recover Medicare overpayments. This adjustment could bring in about $500 million. CMS made changes to bundled payments for dialysis care, which could save CMS about $5 billion. CMS also will save close to $6 billion by implementing cuts to Medicaid disproportionate-share hospitals and reducing reimbursements for subsequent therapies when performed on the same day. All of these measures will affect hospitals’ bottom line and probably be felt by each department of a hospital system. The next 10 years will be challenging for health care, and doctors and hospital administrators will have to work together to find more savings and become more efficient. CONTRAST MEDIA AGENTS 2013-2014 DRUG PRICE FORECAST Period Projected Inflation Rate: 0 percent Portion of Drug Spend: 1.28 percent Year in Review Despite the absence of generic equivalents in the United States, the contrast media market basket, especially X-ray, is displaying behaviors of a mature product line with significant pricing erosion and consolidation of tiers. With pricing in 2012 hitting a new low for most contrast media manufacturers, many of the perceived clinical differences in the types of contrast media are diminishing. Opportunities for standardization to the most costeffective agent, proper administration and appropriate patient management are becoming more relevant than ever. With implementation of health care reform and the emergence of accountable care organizations looming, health care professionals can begin to reexamine how, when and why contrast media are being administered, focus on real clinical significance rather than perceived adverse reactions, and concentrate on the relative effect of the choice of agents on patient outcomes, and the efficiency and profitability of the imaging suite. While many clinicians understand the indications for the use of contrast media, such as computed tomography, interventional procedures and cardiac caths, many clinicians have historically focused solely on contrastinduced nephropathy as being the primary reason for choosing a particular X-ray contrast media agent. As a result, manufacturers have done an excellent job marketing the features and benefits of their high-osmolar, low-osmolar and iso-osmolar products to prevent adverse patient events such as contrast induced nephropathy through premedication and strict protocols. DIAGNOSTIC IMAGING WATCH - SPRING 2013 7 During the past few years, a few papers were published to determine the differences in the nephrotoxicity of iso-osmolar agents with that of low-osmolar contrast media and for the management of patients with unstable angina/non–ST-elevation myocardial infarction. The expert panels responsible for authoring the guidelines state that the strength and consistency of relationships between specific iso-osmolar or low-osmolar agents and CIN or renal failure are not sufficient to enable a guideline statement on selection among commonly used lowosmolar and iso-osmolar media. Instead, the group recommends focusing on operator conduct issues shown to be important to protect patients, via proper patient preparation with hydration, and adjustment of maximal contrast dose to each patient’s renal function and other clinical characteristics. Furthermore, the authors take the same approach as in 2007 of not recommending any contrast agent (low-osmolar or iso-osmolar) over another. In September 2012, Novation’s Clinical Pharmacy Advisory Group found there were no clinically meaningful differences in the various types of common injectable X-ray contrast media agents (LOCM and IOCM agents). Likewise, the group confirmed that CIN could be minimized with adequate patient hydration and adjustment of dosing protocols to each patient’s individual renal function and/or other clinical characteristics. Election 2012: The practice of radiology, going forward There is still a great deal of uncertainty about the impact of health care reform on the various imaging procedures. Based on a Regents Health Resources report, by 2014 CT and magnetic resonance procedures could increase by an average of 13 percent, ranging from 3 to 22 percent, depending on location and modality. www.imagingbiz.com/images/site/pdf/apr_may12_market_file.pdf Myocardial Perfusion Imaging Used 50 Times More Than Cardiac Computed Tomography Angiography In November 2012, a study presented at the RSNA meeting showed that coronary CT angiography is vastly underutilized when compared with single-photon emission computed tomography myocardial perfusion imaging in patients with suspected coronary artery disease, despite its status as a competitive test. In fact, between 2007 and 2010, cardiac computed tomography angiography utilization began a steady decline, reducing the probability of any incremental use of iodinated contrast media. www.auntminnie.com/index.aspx?sec=rca&sub=rsna_2012&pag=dis&ItemID=101647 References on Marketplace|Procure Drug Monographs w Non-ionic Iodinated Radiocontrast Agents w Gadolinium-Based Radiocontrast Agents Additional Resources 2011 ACCF/AHA Focused Update of the Guidelines for the Management of Patients with Unstable Angina/ Non– ST-Elevation Myocardial Infarction (Updating the 2007 Guidelines) 8 DIAGNOSTIC IMAGING WATCH - SPRING 2013 Technology Summaries The following technology summaries represent an overview highlighting the latest technologies and key existing offerings of interest to members. A brief overview of the imaging modality or related technology gives a foundational education for those who may not be fully engaged in diagnostic imaging. An emphasis has been placed on Novation contracted suppliers. Not all suppliers in the market have been addressed. For additional information, links to supplier websites have been included whenever possible. ANGIOGRAPHY/CARDIOVASCULAR SUITES Cardiovascular systems constitute some of the most sophisticated and expensive X-ray systems on the market. Angiography is a fluoroscopic technique enabling clinicians to obtain images in real-time as radiopaque contrast material is infused into the blood vessels of interest. These systems generally come in configurations which include a single or dual c-arm with an X-ray tube that may be either floor or ceiling mounted. A complete system will be equipped with an automated positioning table, computer workstations and high-resolution viewing monitors. Images may be captured in monoplane or biplane fashion, which may include features such as realtime digital subtraction angiography, bolus chase angiography and three-dimensional reconstruction. The key to this imaging modality is the ability to provide clinicians faster access to critical information and increased accuracy in diagnosing and treating cardiovascular disease. SUPPLIERS TECHNOLOGY SUMMARY GE FlightPlan for Liver http://www3.gehealthcare. com/en/Products/Categories/ Advanced_Visualization/Applications/FlightPlan_for_Liver FlightPlan for Liver helps interventionalists plan their liver embolization procedures. The liver’s complex vasculature can make precise identification of tumor-feeding vessels a challenge that often requires significant time, radiation and contrast media. FlightPlan for Liver automatically highlights vessels, travelling from the catheter tip to the vicinity of a hypervascular lesion in just three easy steps. Then, these vessels are used as threedimensional roadmaps to help guide the catheter with Innova™ Vision. Innova™ IGS 540* The Innova™ IGS 540 provides excellent image quality, exceptional dose efficiency and tools that help health care professionals work with confidence. It offers the following features: w a large field of view for vascular and interventional imaging, and built-in protocols for a range of procedures w exquisite detail in excellent images at any angle w coverage of anatomy with fewer runs for efficient use of contrast and dose w multi-modality images to view more information in real time DIAGNOSTIC IMAGING WATCH - SPRING 2013 9 w clinically relevant applications like Innova three-dimensional reconstruction of cardiac and vascular images, Innova CT for CT-like soft-tissue imaging in the lab and digital subtraction angiography for outstanding images at a low radiation dose Innova™ IGS 630 Innova™ IGS 630 is a biplane interventional imaging system that helps health care professionals meet their most challenging clinical needs with enhanced image quality and advanced reconstruction at a low dose. The system offers the following features: w a design that provides consistent, excellent imaging in a full range of procedures: cardiac, general vascular diagnosis and intervention, electrophysiology, neuro and a variety of non-vascular interventions w clinical tools that integrate with the user interface in the control room and at tableside for optimized workflow w a robust design that combines a floor-mounted three-axis C-arm and a ceiling-suspended C-arm with GE’s Innova solid-state digital detectors and that is 31 cm x 31 cm w dose efficiency and customization, remote connectivity and fluoroscopic uninterrupted power supply backup *In clinical use, the results of the application of dose reduction techniques will vary depending on the clinical task, patient size, anatomical location and clinical practice. The intended operator (for example, interventional radiologist), assisted by a physicist as necessary, has to determine the appropriate settings for each specific clinical task. Philips Healthcare http://www.healthcare.philips.com/us_en/clinicalspecialities/Cardiology/index.wpd 10 The Allura Xper FD20 The Allura Xper FD20 offers an open architecture and focus on integration. This flexible flat detector system can handle the full spectrum of interventional radiology procedures. The system also offers the following features: w ability to expand a practice via unique, live three-dimensional guidance tools that support challenging cases, including interventional oncology w multi-modality interventional suite that allows for the ability to integrate multi-modality capabilities, combining existing MR/CT information as well as on-the-fly ultrasound w ability to reduce X-ray dose for patients and staff via DoseWise and DoseAware Personal Dose Meter System that provides instant feedback in the examination room, enabling staff to immediately adjust working habits to minimize radiation exposure DIAGNOSTIC IMAGING WATCH - SPRING 2013 w Siemens http://www.medical.siemens. com hybrid operating room suite FlexMove option for Allura Xper FD that moves the X-ray imaging system more freely in the treatment area and can be parked in standby position near the table; provides more room around the table and gives access to other equipment Artis Q* Artis Q product line for interventional imaging is a breakthrough in X-ray generation and detection that takes performance and precision to the next level. Features include the following: w unparalleled performance with the new powerful GIGALIX X-ray tube based on flat-emitter technology for a clearer visualization of small devices and vessels w high dynamic range detector that enables enhanced image quality in advanced three-dimensional imaging *Artis Q is pending 510(k ) clearance and is not yet commercially available in the U.S. Artis Q.zen* Artis Q.zen product line for interventional imaging is a breakthrough in X-ray detection with unique sensitivity enabling ultra-low dose imaging. It also takes performance in X-ray generation and precision to the next level. Features include the following: w a groundbreaking new detector technology based on crystalline silicon w reduction in electronic noise and imaging at ultra-low dose levels *Artis Q.zen is pending 510(k ) clearance, and are not yet commercially available in the U.S. The Artis zen family includes the following: w floor-mounted system, ceiling-mounted systems for cardiology, angiography or hybrid O.R. with a dynamic flat detector w bi-plane flat detector system for cardiology or angiography with two dynamic flat detectors or frontal plane and a lateral plane w floor-mounted system for electro physiology to be used in conjunction with Stereotaxis Magnetic Navigation System (with magnet system purchased separately from Stereotaxis) with a dynamic flat detector w Artis zee multi-purpose for interventional radiology with a dynamic flat detector DIAGNOSTIC IMAGING WATCH - SPRING 2013 11 w Artis zeego robotic system for hybrid O.R. and multi-use interventional radiography and interventional cardiology applications w improved visualization by intelligent noise reduction, advanced temporal filtration and better visualization of coronary stents w highly precise three-dimensional diagnostic imaging tool to quantify and visualize lesions with accuracy w intuitive workflow with improved ergonomic tableside control panel and flexible detector /collimator positioning w standard with all Artis zee and zeego systems: combined applications to reduce radiation exposure that provides optimal image quality while minimizing radiation exposure to the patient, physician and staff w AXIOM Sensis XP and EP with bidirectional communication and functions of integrated recording solutions, accessible via tableside touchscreen w straight view that supports radial approach and allows patients to leave the hospital sooner w improved workflow for cardiology w help in reducing complications New features that are not applicable for all applications: w Neuro PBV SW that provides structural and functional imaging in one location to assist in examinations like stroke management, tumor biopsy and embolization or intracranial aneurysm procedures w aortic valve guide software that supports TAVR examinations, provides automatic segmentation, helps select the proper angle for valve introduction and positioning, and provides improved guidance with overlay w IC stent that offers better stent visualization w CAREMonitor that allows visual display for staff to see accumulated dose per angle or position to better manage dose to patient during procedure, and is saved and stored vis DICOM SR for reporting purposes Artis zeego robotic system specific features include the following: 12 w robotic technology for unique positioning flexibility for both clinical and parking w Artis zeego with 360-degree acquisition capability in six seconds and esocentric acquisition capability for DynaCT w improved image quality DIAGNOSTIC IMAGING WATCH - SPRING 2013 Toshiba http://medical.toshiba.com/ products/cv/index.php w reduction in amount of dose and contrast to patient w fewer motion artifacts w capability to do a 360-degree full-body DynaCT acquisition, which is unique to Siemens with the flat detector Toshiba’s Infinix-i Angiographic Systems Toshiba’s Infinix-i Angiographic Systems are shipping with DICOM Dose Structured Reporting data output as a standard offering. Another new capability for Infinix-i systems equipped with the threedimensional angiography option is compatibility with Vital Images’ Vitrea Enterprise Suite, a thin-client solution providing three-dimensional image display and manipulation throughout the enterprise and beyond. VES adapters can access the three-dimensional data from where they are at the moment, rather than the historical need to go to the standalone Vitrea workstation for access. Economic Impact: Advanced imaging techniques continue to evolve with improvements in image quality, dose reduction techniques and efficiencies in workflow. Keeping up with the latest technology available is important when attempting to attract physicians. Capital purchase of this equipment tends to outpace leasing based on the financial models for this type of equipment. The cost for a single-plane angiographic system will range from $750,000 to $1.5 million, with bi-plane systems costing $1.4 million to $2.8 million, depending on the configuration. C-ARMS (SURGICAL AND MINI) Surgical mobile X-ray systems are generally configured with a C-arm platform for maximum flexibility when it comes to patient positioning and access to the field of interest. These systems can be simple units to highly sophisticated digital units with multiple high-resolution displays. Systems now offer volumetric imaging with three-dimensional reconstruction and interfacing with intraoperative navigation systems. The C-arm market should begin to see more integration of flat-panel technology. Flat-panel technology provides better image quality, and the newest models have become more reliable because they have less chance of overheating, which can result in shutdowns during procedures. The standard size C-arm generally has a larger footprint and higher cost than the mini C-arm. The mini C-arm market has been growing steadily. These systems are often used in the orthopedics, emergency rooms and even physician offices. They are preferred over the standard size C-arm when doing fluoroscopic imaging of extremities. DIAGNOSTIC IMAGING WATCH - SPRING 2013 13 SUPPLIERS TECHNOLOGY SUMMARY Philips Healthcare Veradius Neo Mobile C-arm http://www.healthcare. philips.com/us_en/products/ xray/products/c_arms/index. wpd Siemens The Veradius Neo Mobile C-arm provides the user the clarity, space and convenience to carry out cardiac, vascular and orthopedic surgeries, and the most challenging minimally invasive procedures. Features include the following: w excellent contrast for the most demanding cardiac, vascular and orthopedic surgery w fast startup time that streamlines workflow in the O.R. w consistent high image quality through unique automatic calibration w 1.6 k x 1.4 k image matrix that provides high resolution in a mobile C-arm w large field of view that is unaffected by geometrical distortions and that supports wide range of applications w flat detector that is not affected by magnetic distortions so the system can be freely positioned ARCADIS® Avantic ARCADIS® Avantic is a multipurpose high-end C-arm for a vast range of applications, including cardiac surgery, vascular surgery, gastroenterology, orthopedics and many other fields of practice where high power and a large field of view are required. It has the following features: w powerful performance with up to 25 kW w large field of view by industry-leading 33-centimeter (13-inch) image intensifier w optimized clinical workflow ARCADIS® Orbic The three-dimensional functionality of the ARCADIS® Orbic is best-suited for intraoperative use in orthopedics and trauma surgery, such as threedimensional imaging of bones and joints of the lower and upper extremities, entire spine and hips, as well as maxillofacial applications. ARCADIS Orbic can be equipped with NaviLink™ 3D, the direct threedimensional navigation interface, or NaviVision® 3D, the integrated optical navigation platform. ARCADIS Orbic allows with its isocentric design and 190-degree orbital movement for unlimited projection flexibility, which eliminates the need for C-arm repositioning. It is best-suited for intraoperative use in orthopedic, trauma, pain management and spine surgery. It has the following features: 14 DIAGNOSTIC IMAGING WATCH - SPRING 2013 w truly isocentric design that enables time and dose savings w syngo®-based for a unique software platform w comprehensive connectivity and specialized interfaces ARCADIS® Varic Focused on improving everyday practice and solely led by needs, ARCADIS® Varic incorporates numerous unique to-the-point solutions. From image quality to operability, from versatility to efficiency, the ARCADIS Varic features set new benchmarks – with outstanding functionalities that make excellent imaging a snap and an overall ergonomic concept that redefines clinical workflow in many fields of practice. Features include the following: w brilliant 1K2 image quality w user-friendly operation w optimized clinical workflow w syngo-based for a unique software platform SIREMOBIL® Compact L SIREMOBIL® Compact L supports the spectrum of X-ray-based applications in the operating room, including in orthopedics, trauma surgery and general surgery. Features include the following: Ziehm http://www.ziehm.com/us/ w optimized clinical workflow and connectivity w high-quality imaging w user-friendly operation w dose savings Ziehm Imaging Mobile C-arms Ziehm Imaging Mobile C-arms represent the forefront of X-ray, video and digital imaging technology, as well as mechanical excellence. Ziehm offers a wide range of products from compact systems to systems that are well-suited for interventional cardiology and radiology. Ziehm Vision RFD Ziehm Vision RFD offers flexibility of a mobile C-arm combined with fixedroom imaging capabilities and the following other features: w increased clinical confidence thanks to distortion-free image quality from flat-panel technology DIAGNOSTIC IMAGING WATCH - SPRING 2013 15 w expanded anatomical visualization with a 30 cm x 30 cm panel compared with conventional 12-inch image intensifier w extended performance in demanding procedures with advanced active cooling w optimal anatomic penetration with minimal dose thanks to a high-power pulsed fluoroscopy monoblock generator w substantial cost savings eliminating expensive installations w well-suited for demanding procedures in cardiovascular surgery, endovascular surgery, interventional cardiology, interventional radiology, and neuro and spine surgery The Ziehm Vision FD Vario 3D The Ziehm Vision FD Vario 3D combines excellent two-dimensional image quality with a highly efficient intraoperative three-dimensional imaging module. Intraoperative three-dimensional imaging plays a vital role, especially in bone surgery, such as traumatology and orthopedic surgery, and in neurosurgery, as well as in oral and maxillofacial surgery. Ziehm Vision FD’s fully-digital, distortion-free image acquisition and processing technology increases accuracy and image quality to a previously unknown level, especially when combined with navigation systems or computer-assisted surgery. The C-arm’s intelligent and compact design, and its unmatched ease of use benefit surgeons and operation staff. Ziehm also offers a wide portfolio of II based systems. OrthoScan http://www.orthoscan.com/ OrthoScan is a privately held medical device company founded in 2002 with the intent to bring to market a state of the art mini C-arm and to provide innovative product solutions in orthopedic imaging. OrthoScan HD The OrthoScan HD with flat detector is the new standard in mini C-arm imaging. Fine details of relevant anatomy are visible due to the increased gray scale and contrast capability of flat detector technology. The OrthoScan HD with flat detector reduces the distortion inherent with image intensifier technology, improving diagnostic accuracy. The OrthoScan HD with flat detector opens valuable space in the work area. The small, thin design affords maximum maneuverability, resulting in ease of movement. A greater arc depth of 19.2 inches provides the surgeon with space to work more comfortably. The slim profile of the flat detector provides additional positioning options for better patient access. 16 DIAGNOSTIC IMAGING WATCH - SPRING 2013 COMPUTED TOMOGRAPHY Computed tomography is a noninvasive, radiographic technique that utilizes computers to evaluate data and convert them into a tomography plane (virtual slice). Individual image slices can also be combined or reconstructed to produce a three-dimensional image of body structures (for example, bones, organs) that can be virtually rotated to allow viewing from any perspective. CT imaging is used to image virtually every organ or area in the body and serves various clinical practices, including radiology, cardiology, oncology and other clinical areas. Discussions on radiation dose reduction continue to be at the forefront and remain a key initiative of many radiology administrators. Following the “as low as reasonably achievable” principle that reduces radiation doses to the lowest possible level, suppliers are making significant efforts to reduce patient radiation exposure. These include proactive warnings to equipment operators when chosen imaging protocols would exceed dose standards and iterative image reconstruction technology for CT scanners. Iterative reconstruction is a software algorithm which can lead to a significant reduction in dose without sacrificing image quality. Dose monitoring and reporting standards developed by the Medical Imaging Technology Alliance are being integrated into most new CT systems. SUPPLIERS TECHNOLOGY SUMMARY GE Optima™ CT540 http://www3.gehealthcare. com/en/Products/Categories/ Computed_Tomography/Optima_Series/Optima_CT540 Optima™ CT540 is a daily partner in the CT department, helping to manage a busy workplace with its updated user interface, enhanced workflow features and innovative dose reduction technology. This intelligent 16-slice CT scanner is designed for clinical excellence and diagnostic versatility. With its clinical breadth, Optima CT540 is a partner in a large panel of applications and environments, from oncology to computed tomography angiography to emergency room to dedicated CT to interventional procedures. http://www3.gehealthcare. com/en/Products/Categories/ Computed_Tomography/Optima_Series/Optima_CT660_ FREEdom_Edition Optima™ CT660 FREEdom The Optima™ CT660 FREEdom is a new generation, intelligent volume CT scanner that brings together diagnostic power and workflow efficiency, enabling fast, high-quality acquisitions at an optimized dose for exceptional patient care and operational excellence. It features full capabilities in advanced applications such as cardiac, oncology, angiography and dynamic imaging. Streamlined workflow helps make it simple for less focus on the buttons and more on the patient, while using 60 percent less energy than previous GE CT systems. DIAGNOSTIC IMAGING WATCH - SPRING 2013 17 http://www3.gehealthcare. com/en/Products/Categories/Computed_Tomography/ Discovery_CT750_HD/Cardiac_CT Discovery™ CT750 HD FREEdom Edition Philips Healthcare Ingenuity CT http://www.healthcare.philips.com/us_en/products/ct/ index.wpd The FREEdom edition of the Discovery™ CT750 HD is a breakthrough in cardiac CT that provides clarity and confidence for the clinician. Built on GE’s exclusive HD technologies, it offers high image quality with low dose and is able to correct for coronary motion for an unprecedented level of detail. With GE’s Gemstone™ Spectral Imaging, the CT750 HD can perform quantitative lesion characterization and separate materials like calcium and iodine to generate a virtual non-contrast-like image. Its high-resolution, low-contrast detectability, noise reduction and artifact reduction raise the bar in diagnostic imaging to address the foremost challenges in cardiac CT, such as dose, calcium blooming, high heart rates, plaque composition and myocardial perfusion. The Ingenuity CT is a 128-slice scanner that has a new gantry design with a wider patient aperture, new user interface and a faster image reconstruction engine. RapidView IR is 137 percent faster than the first-generation reconstructor used by Brilliance scanners. Ingenuity offers improved image quality (spatial resolution by 33 percent), with up to 80 percent less dose and up to 15 percent less contrast. iDose Philips’ iDose iterative reconstruction technique is a solution for radiation management. iDose is designed to provide equivalent diagnostic image quality with the same look as full-dose images at a fraction of the dose. iDose works in concert with other DoseWise tools, including filters, detectors, collimators and automatic current selection, which adapts tube current to patient size, and dose modulation tools. Philips iDose can reduce doses up to 80 percent while maintaining diagnostic image quality and fast reconstruction times. When used in combination with the advanced technologies of the iCT, Ingenuity and Brilliance scanner families, this provides a unique approach to managing important risk factors in patient care for low-energy, low-dose and lowinjected contrast imaging. Brilliance iCT TVI The Brilliance iCT TVI is a new approach to total vascular imaging, using a unique combination of low-kVp scanning and an iterative reconstruction technique to improve low-contrast sensitivity. 18 DIAGNOSTIC IMAGING WATCH - SPRING 2013 Siemens SOMATOM® Perspective ® http://www.usa.siemens.com/ The SOMATOM Perspective is designed so budget-conscious community hospitals, critical access hospitals and outpatient centers can extend the ct range of available examinations to their communities at reduced radiation doses. With fully assisting scanner technologies, such as FAST Planning and FAST Cardio Wizard, to help simplify and automate time-consuming procedures, the 128-slice SOMATOM Perspective features a slim gantry design and a footprint of 194 square feet. At this year’s RSNA, Siemens unveiled a 64-slice version of the SOMATOM Perspective. SOMATOM® Definition Edge The SOMATOM® Definition Edge single-source CT solution offers high image quality, dose reduction and dual-energy acquisition in clinical settings, including the emergency department. The SOMATOM Definition Edge features the unique Stellar Detector, which for the first time fully integrates the detector’s miniaturized electronics within the photodiode. The recent KLAS “How Stellar Can a Detector Be?” report featured interviews with several early adopter sites of the SOMATOM Definition Flash and Edge with the new Stellar Detector. Recurring themes in the interviews were the lower dose, improved image quality and an associated higher confidence to deliver diagnostic-quality exams. Spine and bariatric exams stand out as well as pediatric imaging benefits. More information: www.klasresearch.com/ reports www.siemens.com/care-right CARE Right CARE Right is a holistic approach based on the belief that after the recent innovations in radiation reduction, a singular focus on low dose-only is not sufficient anymore. Efforts must now be targeted at a comprehensive understanding of the right dose, a balance between applied radiation and image quality. Thus, CARE Right encompasses three key areas: w right-dose technology w right-dose levels w right-dose management Introduced at RSNA 2012, Optimized CARE is a consultancy program designed to guide users toward optimizing the use of radiation in order to lower dose, enhance workflow and optimize contrast usage. Optimized CARE will be available in spring 2013. DIAGNOSTIC IMAGING WATCH - SPRING 2013 19 Toshiba Aquilion™ ONE http://www.medical.toshiba. com/products/ct/dynamicvolume/index.php Aquilion™ ONE and Premium scanners provide an adaptive iterative dose reduction algorithm as standard. AIDR reduces noise in the image, while maintaining image texture, significantly reducing dose. http://www.medical.toshiba. com/products/ct/multidetector/index.php AIDR joins a full lineup of Toshiba dose reduction technologies, including SUREExposure™, SUREExposure™ Pediatric, QDS and Boost3D®, providing patients with safer CT exams without sacrificing the diagnostic confidence. http://www.medical.toshiba. com/products/index.php VeloCT* VeloCT on Toshiba’s Aquilion 64 and 32 scanners provides adaptive iterative dose reduction algorithm as standard and includes 128- and 64-slice reconstruction, respectively. Current Aquilion 64 and 32 CT scanners can be upgraded with the VeloCT console to provide AIDR technology. *VeloCT upgrade is currently pending 510(k) clearance in the United States. Aquilion™ PRIME* Aquilion™ PRIME is the industry’s first 160-slice CT scanner that includes an AIDR as standard. Aquilion PRIME incorporates a variety of dose management tools based on technologies developed for Aquilion ONE that can significantly reduce patient exposure dose during helical scanning, including active collimator, AIDR, SUREExposure™ 3D Adaptive and Boost3D™. *Aquilion™ PRIME CT is currently pending 510(k) clearance in the United States. Economic Impact: The exceptional speed of 64-slice scanners enables detailed tomographic images of the entire body in sub-30-second scan times. With 256- and 320-slice CTs, clinicians can image an entire organ in a single rotation of the gantry. Given the rapid pace of this technology, many facilities are faced with whether to purchase or lease. Configurations can vary widely, depending on add-ons and software packages included in the purchase. Plan to spend between $800,000 and $1.8 million for a 64-slice scanner and from $1.3 million to more than $3 million for a 160-slice or higher scanner. As with most technologies that have price erosion with age, a lower-end CT Scanner (32-slice or less) can be purchased for much less. DIGITAL RADIOGRAPHY AND COMPUTED RADIOGRAPHY General radiography and fluoroscopy systems are used for a variety of imaging needs, including chest X-rays, intravenous pyelography, and upper and lower gastrointestinal tract radiography. Conventional X-ray is commonly used due to its simplicity, price point and low operational cost. According to a recent market report published by Transparency Market Research, “Digital Radiology Market – Global Industry Size, Market Share, Trends, Analysis and Forecast, 2012 – 2018,” the global radiology systems market is estimated at $9.7 billion in 2012 and is expected to reach $13.3 billion by 2018 at a CAGR of 5.4 percent from 2012 to 2018. Globally, the North American region is expected to maintain its lead in revenue until 2018. North America held about 41.9 percent of the global digital radiology market revenue share in 2012 followed by Europe. In terms of volume, the global digital radiology market is expected to reach 158.2 thousand units by 2018. 20 DIAGNOSTIC IMAGING WATCH - SPRING 2013 Conventional radiography images may be produced in analog or digital formats. The use of medical film to capture images in analog format has been declining significantly year-over-year due to adoption of picture archiving and communication systems. Digital technology eliminates hardcopy film and enables electronic distribution. Two types of digital image acquisition are computed radiography and digital radiography. Computed radiography uses very similar equipment to film-based radiography, except that in place of a film to create the image, an imaging plate made of photostimulable phosphor is used. Digital radiography technology was first introduced in about 1997. DR typically captures the image directly onto a flat-panel detector without the use of a traditional cassette. This technology has matured and is more efficient and affordable than ever. Portable flat-panel DR detectors are proving to be extremely versatile, providing more flexibility to meet imaging needs. This presents an option for the cost-conscious because a conventional X-ray room can be retrofitted with a digital solution without a complete overhaul. This same methodology also applies to portable X-ray units. Secure wireless image transmission is also available, which adds to the geographic independence. DIGITAL RADIOGRAPHY SUPPLIERS TECHNOLOGY SUMMARY GE Discovery™ XR656 with FlashPad http://www.gehealthcare. com/usen/promo/campaigns. html?CampaignID= GPONO5SM2012JAN This GE next-generation digital radiographic system streamlines exams with auto-positioning and auto field of view, and adds flexibility with the FlashPad™ wireless digital detector. Quality is enhanced with advanced applications that help provide diagnostic confidence. VolumeRAD™ acquires volumetric patient data with up to 60 low-dose exposures from one sweep across the patient. It displays anatomy at various depths, removes overlying structures and enhances tissue separation. Auto Image Paste images long anatomy, stitching up to five images to form one single, seamless image. Dual Energy Subtraction separates X-ray data into a soft-tissue image and a bone image, helping visualize abnormalities and to see whether they are calcified. Philips Healthcare DigitalDiagnost http://www.healthcare. philips.com/us_en/products/ xray/products/radiography/ index.wpd http://www.healthcare. philips.com/us_en/products/ xray/products/fluoroscopy/ index.wpd This high-end digital radiography features exceptional performance and flexible rooms, including a cutting-edge emergency setup. MobileDiagnost wDR Access all areas with the premium DR room-to-go, with a flexible and easyto-maneuver mobile X-ray system. DIAGNOSTIC IMAGING WATCH - SPRING 2013 21 Juno DRF The Juno DRF digital system for both radiography and fluoroscopy examinations allows users to increase workflow and patient throughput, while at the same time enhancing room utilization. This is a two-in-one system with a range of applications. Juno DRF is designed to conveniently carry out exams on obese patients. With a very high table weight capacity, the large table-top size and ample distance between table and tube make the system especially suitable to virtually all patient sizes. EasyDiagnost Eleva with DRF Room Solution The EasyDiagnost Eleva delivers exceptional image quality with excellent X-ray dose efficiency. Combine it with other devices to perform a comprehensive range of fluoroscopy and digital radiography procedures swiftly and easily. Siemens Fluoroscopy http://www.medical.siemens. com/webapp/wcs/stores/ servlet/CategoryDisplay~q_ catalogId~e_-1~a_ categoryId~e_12753~a_ca tTree~e_100010,1007660, 12753~a_langId~e_-1~a_ storeId~e_10001.htm Fixed Radiography http://www.medical.siemens. com/webapp/wcs/stores/ servlet/CategoryDisplay~q_ catalogId~e_-1~a_ categoryId~e_12759~a_ca tTree~e_100010,1007660, 12759~a_langId~e_-1~a_ storeId~e_10001.htm http://www.medical.siemens. com/webapp/wcs/stores/ servlet/CategoryDisplay~q_ catalogId~e_-1~a_ categoryId~e_14334~a_cat Tree~e_100010,1007660,127 59,14334~a_langId~e_-1~a_ storeId~e_10001.htm 22 Siemens’ fluoroscopy systems provide the capability for a wide range of applications, from fluoroscopy, including gastrointestinal and genitourinary exams, to special procedures to routine radiographic work. The product selection also provides a choice of under-table or over-table systems, depending on the member’s preference. In addition, Siemens offers a product spectrum, from fully digital, to cassette analog systems, to fit every budget. Siemens’ radiography systems are designed together with users to optimize workflow and improve efficiency and convenience in the radiography department. To provide a unique and optimal approach to your daily routine, the product spectrum fits every budget and includes fully digital with flat detector technology to analog cassette to mobile X-ray systems. Mobilett Mira The wireless X-ray system combines digital mobility with wireless technology, taking mobile X-ray to the next level. As a fully integrated system, Mobilett Mira provides the answers to everyday challenges with wireless freedom and flexibility: w transfer of images wirelessly to and from the PACS w high image output of up to 35 kW w counter-balanced rotating swivel arm with integrated cables DIAGNOSTIC IMAGING WATCH - SPRING 2013 MOBILETT XP Digital MOBILETT XP Digital (30 kW) is a digital mobile X-ray imaging system with flat-panel detector technology and instantaneous digital image display, which can be seamlessly integrated into standard clinical processes. Features include the following: w compact design, outstanding imaging power, easy maneuverability and positioning w ease of cleaning due to the hidden cable design MOBILETT XP Hybrid MOBILETT XP Hybrid (30 kW) can easily be positioned for X-ray imaging in virtually all conceivable projections with the patient recumbent, sitting or any position in between. The self-calibrating high-power X-ray generator enables short exposure times down to 1 ms, virtually eliminating motion blurring. Features include the following: Carestream http://www.carestream.com/ drmain.html w lightweight and compact mobile X-ray system with industry-leading arm range w two power sources: long-life rechargeable batteries and a conventional power outlet CARESTREAM DRX-1 System The CARESTREAM DRX-1 System offers a quick, easy and affordable way to transition to digital radiography. Based on the unique X-Factor platform, a wireless DR detector simply slides into existing X-ray equipment and can be used with imaging systems throughout a facility. The detector is also the center point of the DRX line – a complete line of innovative DR systems, including full radiology rooms and mobile X-ray systems. CARESTREAM DRX-Mobile Retrofit Kits Carestream’s mobile retrofit kits use a single wireless detector to convert existing mobile X-ray equipment, regardless of supplier, to a DR system fast and cost effectively. Maximize current investment and upgrade to digital radiography productivity with three easy-to-install, easy-to-use retrofit kits. CARESTREAM DRX-Revolution The CARESTREAM DRX-Revolution is the industry’s only mobile X-ray system with a fully automatic collapsible column. Powered by a wireless DRX detector, this X-ray room-on-wheels is easy to drive and gives fast, highquality images. DIAGNOSTIC IMAGING WATCH - SPRING 2013 23 CARESTREAM DRX-Evolution DR Room The CARESTREAM DRX-Evolution DR Room is a versatile digital radiography system with configurable, modular components that combine to fit space, workflow and budget. It performs a variety of general radiographic exams with remarkable convenience, productivity and patient comfort, and it is powered by portable, wireless DRX detectors. X-ray rooms can be upgraded with three configurations: automated, hybrid and standard-Q that can expand to fit increased needs. CARESTREAM DRX-Ascend System The CARESTREAM DRX-Ascend delivers high-end DR system features at an affordable price for imaging centers, orthopedic facilities, urgent care clinics and hospital radiology departments. http://www.carestream.com/ cs-9300.html NEW CS 9300 System FUJIFILM Medical Systems FDR AcSelerate Suite™ http://www.fujimed.com Combining true panoramic imaging, cone beam CT technology and optional cephalometric capabilities, the CS 9300 will make expanding your ears nose and throat and dental imaging services easy and affordable. The FDR AcSelerate Suite™ is a fully integrated dual-detector DR system designed to be a complete radiographic room replacement solution. FDR AcSelerate offers improved workflow and superior image quality. In as little as three easy steps, complete a patient exam and see the image displayed in two seconds. FDR D-EVO™ The FDR D-EVO™ is a six-pound, 14-inch x 17-inch flat-panel detector that is the lightest weight FPD in its category, and its thin size presents an easy retrofit to existing analog rooms, making D-EVO ideal for all types of diagnostic environments. The FDR D-EVO wireless flat-panel detector was created to enhance workflow and meet needs. FDR GO™ The new portable FDR Go™ features a sleek new design, quiet and smooth drive, large display, two-second image previews, low dose and high-quality images FUJIFILM is known for. 24 DIAGNOSTIC IMAGING WATCH - SPRING 2013 AGFA http://www.agfahealthcare. com/usa/en/main/products_ services/direct_radiography/ mobile_system/dx_d_100.jsp DX-D 100 The AGFA next-generation wireless digital detector with the DXD 100 portable enables lower dose and facilitates higher visualization of anatomic details. The DX-D 100 can handle a broad range of general radiography X-ray studies, even for less mobile patients. Available with cesium-based DR panels, the improved DQE delivers improved image quality and potential dose reduction for patients and operators. The DX-D 100 offers a very short exposure time, so images are available for validation immediately. The combination of greater productivity and image quality translates into lower cost per exam and higher diagnostic efficiency. With excellent handling capabilities, patient waiting times are reduced and diagnostic confidence increased. Overall, the DX-D 100 helps meet the need to constantly enhance patient comfort and performance in the radiology department. Shimadzu http://www.shimadzu.com/ SONIALVISION G4 RF System The SONIALVISION G4 is a best-in-class multi-functional universal RF system that is useful in a variety of examinations and examination environments. It provides high image quality minimizing X-ray dose levels and is easy to operate. The system has been designed for a diversity of users in a diversity of situations, making it ideal for a variety of examinations, such as orthopedics, general radiography studies, barium studies, endoscopy, urology and angiography. Long imaging chain’s movement capability and 17-inch x 17-inch wide field FPD will provide more than 2 meter? long patient coverage without moving a patient, which enables you to perform all kinds of examinations in very safe conditions. RADspeed Series Digital Radiography System The RADspeed series has been awarded Best in KLAS for four consecutive years and has been highly evaluated for its efficient preparation of examinations, including the auto-positioning feature interlocked with the anatomical programmed radiography. This function moves the ceilingmounted X-ray tube support to any desired position at the press of a single button and can automatically set the X-ray tube angle. Also highly evaluated was the collimator with a filter that is switched in accordance with the region being imaged or the imaging menu, enabling appropriate and efficient imaging while minimizing unnecessary exposure. DIAGNOSTIC IMAGING WATCH - SPRING 2013 25 MobileDaRt Evolution and MobileArt Evolution The MobileDaRt Evolution digital mobile X-ray system lineup features dual wireless flat panel detectors FPD. The new thinner large-view-field FPD has a thickness close to a conventional film cassette and is lighter than previous FPDs. Carrying and position the FPD is extremely simple. The 32kW high output of the system permits radiography in a short time. It offers images with little motion blur for children and other patients who find it difficult to hold a posture and in emergency situations where a stationary state cannot be maintained. Swissray ddRFormula® Plus ® http://www.swissray.com/for- The ddRFormula Plus performs direct digital radiographic examinations on recumbent, seated and upright patients. All movements are fully automatic mulaplus.html and can be operated by remote control or push buttons on the system. It includes the eXpert™ 5000 control and communication center, which provides utmost positioning convenience and highest patient throughput. The eXpert View feature is an integrated video camera that monitors the patient’s position so the technologist can ensure that correct positioning has been maintained from the control room. The ddRFormula Plus also has off-center and offdetector imaging capabilities. The ddRFormula Plus also has an Automated Positioning System™ – which enables full programmable user functions, including automatic positioning from the eXpert 5000 for every body part as well as from existing images on SwissVision® XG, and is capable of performing the same workload as four conventional cassette-based radiography systems. http://www.swissray.com/ element.html ddRElement™ The ddRElement™ was designed based on more than a decade of feedback received from consumers. Without sacrificing image quality and functionality, Swissray offers a space-efficient, multifunctional, affordable DR system. The ddRElement delivers the highest quality radiographic images in just seconds and is the perfect system for all general radiography examinations. All system positions are achieved manually using the push buttons on the control handle to patient positioning, and it offers variable source to image-receptor distance and allows off-center and off-detector imaging. It features the new FP-6000™ amorphous silicon flat-panel detector and the latest cesium iodide detector technology, which delivers excellent image quality at low radiation dose. The ddRElement utilizes eXpert/SwissVision® XG workstation which simplifies and organizes every aspect of the radiographic procedure. The software is designed for simple, fast and intuitive use, and provides the most optimized workflow and productivity. 26 DIAGNOSTIC IMAGING WATCH - SPRING 2013 http://www.swissray.com/ combiplusfp.html ddRCombi® Plus FP Toshiba RADREX-i http://medical.toshiba.com/ products/xr/kalare/index.php The ddRCombi® Plus FP performs direct digital radiographic examinations with efficiency and versatility. It consists of a floor-mounted positioning device and a vertically motor-driven ceiling suspension system. It performs automatic tube/detector centering with its Follow-Me function and offers preprogrammed system positions for fast and convenient positioning. All detector movements can be controlled by remote control or push buttons on the system, and because of its automated detector rotation, the patients can be examined for anterior-posterior and lateral views without repositioning. It includes the eXpert 5000 control and communication center which provides utmost patient throughput. The 14-inch x 17-inch wireless REXPanel™ detector performs a range of procedures, and the RexSpeed auto-features include auto-mapping, autocenter stop, auto-collimation, auto-tracking and auto-park. T.RAD Plus The T.RAD Plus radiographic systems for general purpose radiography are available with multiple prepackaged configurations and more standard features to provide high-quality imaging, exam efficiency and excellent patient care. The T.RAD Plus systems have been designed to provide members with a modular family approach to meet a variety of clinical, budgetary and space requirements, while providing application versatility and configuration flexibility, including: w floor-mounted and ceiling-suspended X-ray tube support w manual, motorized and automatic continuous collimator w 50, 65 or 80 kW generator w elevator Bucky table and vertical Bucky wall stand w barless tomography with no mechanical coupling for free access to patient and reliable operation DIAGNOSTIC IMAGING WATCH - SPRING 2013 27 COMPUTED RADIOGRAPHY Computed radiography is applied to an imaging system that includes a photosimulable storage phosphor plate, a computed radiography reader and digital electronics to convert signals into a digital form. CR is largely driven by its low-end system prices, its ease of integration into existing X-ray systems and the proven reliability of its technology, which has undergone very little change since its introduction in the mid-1980s. According to Frost and Sullivan, CR unit shipments are expected to grow to 4,811 in 2016, at a CAGR of 2.2 percent from 2009 to 2016, and CR revenues are expected to grow at a CAGR of 0.8 percent during the same period, reaching $242 million in 2016. Low-end systems include only single-plate CR systems with basic functionality. These systems are more typical in decentralized work environments, where facilities have chosen to purchase several low-cost CR units that can be placed near each of their imaging locations rather than purchasing a single, high-capacity multi-plate reader that requires transferring cassettes to a centralized area. High-end systems include single-plate CR systems with enhanced functionality (e.g., high-resolution scanning) and all multi-plate CR systems. Multi-plate systems are more typical in centralized work environments, where cassettes from several locations in a department are taken to a central area for processing. SUPPLIERS TECHNOLOGY SUMMARY AGFA DX-G http://www.agfahealthcare. com/global/en/main/products_services/computed_radiography/index.jsp The DX-G digitizer unites superb image quality with a drop-and-go buffer based workflow. The combination of needle-based detectors and standard phosphor plates with specific cassettes and image resolution mode makes the DX-G ideal for a broad range of applications, including general radiography, orthopedics/extremities, dental, pediatrics/neonatal and full leg/full spine. When used with the exclusive DirectriX needle-based detectors, the DX-G provides superb image quality with a much higher detective quantum efficiency, offering the potential for a significant patient dose reduction. CR 10-X CR 10-X is an affordable computed radiography solution. The table-top CR 10-X digitizer is based on tried-and-tested AGFA HealthCare technology, with a modular, yet robust design, offering affordability without compromising on image quality. Versatile, this CR digitizer can handle general radiography, orthopedic, chiropractic, full-leg/full-spine and dental applications. The total cost of ownership remains low, thanks to its ease of installation, maintenance and use, making it an affordable way to move from analog to digital. With the CR 10-X, lower volume practices, rural hospitals and private practices can take advantage of the convenient and fast workflow offered by digital radiography. 28 DIAGNOSTIC IMAGING WATCH - SPRING 2013 Carestream http://www.carestream.com/ cr-main.html DIRECTVIEW CR The DIRECTVIEW CR systems offer a variety of CR solutions, from flexible point-of-care CR options to a central system with multiple workstations. Carestream provides an affordable entry to digital mammography when coupled with DIRECTVIEW CR mammography cassettes and EHR-M screens. These solutions scale to meet the specific needs of the facility and can integrate seamlessly with existing equipment. Offerings include the following: DIRECTVIEW Classic CR System The compact, single-cassette DIRECTVIEW Classic CR system, which handles up to 69 plates per hour, improves workflow and boosts productivity. DIRECTVIEW Elite CR System The DIRECTVIEW Elite CR System accommodates up to 90 plates per hour. This single-cassette system is designed for distributed and central CR applications where image quality, rapid image availability, lower costs and high departmental productivity are paramount. DIRECTVIEW Max CR System The DIRECTVIEW Max CR System multiple-cassette performance maximizes throughput, productivity and patient satisfaction. This system “drop-and-go” workflow can process up to 101 cassettes an hour and handles 16 cassettes at one time. It is an ideal solution for even the highest volume imaging facilities. FUJIFILM FCR Systems: FCR XG5000, XG2000 & Carbon http://www.fujimed.com The FCR Carbon is small and powerful, with all the productivity and image quality of a full-size CR system in a size that fits in every imaging environment. The XG5000 is fast, efficient and reliable, With four independent cassette insertion drivers, this high-performance system is perfect for centralized imaging, multiple exam rooms or any busy environment. Throughput speeds of up to 165 images per hour and image previews in as little as 23 seconds put the XG5000 at the top of its class. The XG200 is the fastest dual-cassette drive reader available today. Konica REGIUS MODEL 210 http://www.konicaminolta. com/medicalusa/products/ cr_solutions REGIUS MODEL 210 is an all-around system that achieves maximum productivity in various environments, succeeding the “super distribution system” concept from REGIUS Model 170. The system offers a 43.75 μm* read function for mammography, with new, enhanced console features. The C-PLATE series cassette with columnar crystal phosphor is ideal for mammography and pediatric use. *Optional license DIAGNOSTIC IMAGING WATCH - SPRING 2013 29 ImagePilot Sigma ImagePilot Sigma delivers a compact and affordable imaging solution that maintains the superior image quality and reliability expected from REGIUS products. Combined with the redesigned ImagePilot software, the Sigma provides simple operation and smooth workflow to a range of medical practitioners. REGIUS Nano CR The REGIUS Nano CR is a high-performance single-bay CR system that can process up to 76 plates an hour (14-inch x 17-inch) for fast patient turnaround time and improved workflow. Its touchscreen control station provides intuitive software tools for generating superior image quality with a few easy steps. This compact reader is designed with dependable, high-quality components to ensure system reliability. Nano CR will satisfy a range of needs from those of a large hospital or imaging center to that of a standalone clinic or surgery center. Whether it is networked with another Nano CR, an Xpress CR or the REGIUS DR system, Nano CR delivers speed, workflow and redundancy. ImagePilot ImagePilot is the newest technology in CR imaging. AutoPilot image processing completely automates the image optimization process for consistently superb images with every exposure. In addition, ImagePilot pioneers the true meaning of an integrated CR system. It combines patient registration, CR acquisition, image viewing and storage in one system that is easy to use and maintain. These advanced features eliminate the need for a separate PACS. Economic Impact: The CR and DR market is highly competitive with no shortage of suppliers. The use of traditional film-based imaging has dropped to less than 5 percent and is expected to all but disappear within the next few years. The installation of analog-based imaging equipment simply continues to diminish because of the combination of DR and CR. With that, DR is becoming the technology of choice largely due to increased efficiencies. The expectation is that DR system purchases will outpace CR system purchases by a ratio of about three to one in the coming year. But the cost of CR is still less expensive than DR and continues to drop, making it an economical solution for facilities that cannot afford DR. Single-plate CR readers can range from $30,000 to $75,000, with multi-plate readers costing from $55,000 to $150,000. CR mammo can range from $65,000 to $85,000 for single-plate readers, and multi-plate readers start at about $125,000. For DR, the cost starts at about $120,000 for a single wireless detector system to dual-detector rooms ranging from $200,000 to $800,000. Given the healthy competition in these areas, costs are expected to continue to be driven down. 30 DIAGNOSTIC IMAGING WATCH - SPRING 2013 INFORMATICS Informatics is an integral part of diagnostic imaging operations. The primary components include the radiology and cardiovascular information systems, picture archiving and communication systems, voice recognition and advanced visualization tool sets. These systems must also communicate and/or integrate with the hospital information system and electronic medical record. The lines between all of these systems continue to become less and less delineated as most IT suppliers are offering integrated solutions and the ability to seamlessly share information. The notion of an enterprise-based image management system appears more prevalent. SUPPLIERS TECHNOLOGY SUMMARY AGFA IMPAX http://www.agfahealthcare. com/usa/en/main/products_ services/ris_pacs_reporting/ index.jsp Carestream http://www.carestream.com/ vue-healthIT.html The system features the following: w a design that streamlines the enterprise workflow and delivers increased efficiency and productivity to the hospital or care facility w fast-and-easy access to information, images and reporting tools from a single desktop w convenient access to all relevant information residing in both AGFA’s RIS and PACS w a complete workflow solution that supports the diagnostic process effectively and efficiently, resulting in improved interpretation and report turnaround times CARESTREAM Vue for Radiology Complex radiology workflow requires intuitive solutions for all end-users. Carestream has adapted a “one workstation” philosophy when designing the next generation RIS+PACS+Reporting. The Web-enabled Vue for Radiology that is accessible anywhere with many native advanced tools optimizes productivity and maximizes investment. CARESTREAM Vue PACS CARESTREAM Vue PACS provides one workspace for the clinical tools and applications physicians and radiologists need for convenient local and remote reporting. Web-enabled Vue PACS has integrated advanced visualization, threedimensional post processing, lesion management, dictation, critical results notification and a mammography module that eliminates the need for dedicated workstations. DIAGNOSTIC IMAGING WATCH - SPRING 2013 31 CARESTREAM Vue RIS CARESTREAM Vue RIS improves radiology workflow by automating the patient’s diagnostic journey from order entry to results distribution, reducing errors and improving patient care. The Web-based radiology information system is accessible from anywhere, adapts to the needs of multi-site enterprises or hospitals and integrates mammography workflows, peer review and reporting to eliminate disparate systems. CARESTREAM Vue Connect Vue Connect, powered by Carestream’s unique SuperPACS™ architecture, lets health care providers manage patient information regardless of location by synchronizing multi-vendor and multi-site RIS+PACS. CARESTREAM Vue for Vendor Neutral Archive Enabling the clinical community to have access to a complete patient record requires a patient-centric vendor-neutral archive with a universal viewer. Carestream’s Vue Archive, seamlessly consolidates disparate imaging systems into one repository using the latest interoperability standards. Combined with Vue Motion – a zero-footprint universal image viewer – it provides secure, real-time imaging access across the health care enterprise. CARESTREAM Vue for Cloud-Based Services Vue Cloud is a software-as-a-service innovative approach to imaging information on a predictable, pay-as-you-go basis. FUJIFILM Medical Systems http://www.fujimed.com Synapse® PACS This advanced visualization solution seamlessly integrates with Synapse® PACS, was fully designed and developed by FUJIFILM and is the most costeffective choice. Synapse was the first PACS to accomplish this extraordinary degree of functionality for single- or multi-site PACS. The same exact Synapse code that a runs 30,000-exam-per-year outpatient imaging center can run a multi-server, multi-site configuration with greater than a million exams a year. Synapse® RIS Synapse® RIS is the most advanced, most comprehensive Web-based radiology management solution available. Synapse RIS offers a full-featured, Web-based radiology management system that is fully integrated with Synapse PACS and has complete electronic health record certification for meaningful use in radiology. Synapse® Cardiovascular Synapse® Cardiovascular offers an integrated image and information system that has been clinically proven to deliver the results that cardiologists require. The Web-based, virtualized platform fits into a facility’s infrastructure to cover all bases when it comes to today’s cath lab. 32 DIAGNOSTIC IMAGING WATCH - SPRING 2013 Philips http://www.usa.philips.com/ Workflow Layer Philips recently introduced Workflow Layer on its popular iSite PACS solution. iSite PACS combines relevant patient data with clinical applications to deliver images anywhere in the hospital enterprise in three seconds, regardless of how old the study is. The new Workflow Layer offers several applications that facilitate ACR reporting, improve productivity and interdepartmental collaboration, and enhance the delivery of patient care. Three-Dimensional Viewing Philips now offers multi-modality three-dimensional viewing with the latest release of iSite PACS by having volume vision standard on board. Volume vision adds three-dimensional hanging protocols, collaborative threedimensional workflow tools, three-dimensional exam comparison, and threedimensional measurement and segmentation tools. BRIT Systems http://www.brit.com/ (New contract starts May 1, 2013.) PACS/RIS BRIT Systems provides turnkey solutions for PACS/RIS that include patient portals, teleradiology, critical results reporting, radiology reporting, peer review, CD burners and importers, DICOM workstations, and crossenterprise/universal viewers. BRIT provides a free five gigabyte server for Roentgen Work’s zero footprint viewer and image sharing platform at cloud. brit.com. Servers are built on Unix. INFINITT North America INFINITT, rated Best in KLAS for four consecutive years in products and services, offers a complete selection of imaging and information products for Inc. http://www.infinittna.com/ the most flexible, scalable and customizable solution on the market. Features include the following: (New contract starts May 1, 2013.) w single database RIS/PACS/cardiology w PACS /mammo PACS; three-dimensional w central, consolidated archive for all w departments: DICOM and non-DICOM w Web-based anywhere, anytime access w mobile access to images and reports w painless data migration and integration w unified worklist for multi-vendor, multi-site PACS, creating one global work list and a completely virtual reading environment w virtualization option for the ultimate in flexibility, scalability and uptime w proven technology with more than 2,700 installations globally DIAGNOSTIC IMAGING WATCH - SPRING 2013 33 Economic Impact: Information technology suppliers, especially in the PACS arena, continue to offer both a capital lease (capital and operating) and fee-per-study purchase model. As an application service provider, suppliers often offer to manage image data and information remotely. The PACS and information systems markets are saturated, however, and continue to expand their offerings. Managed storage options are becoming more popular, well-refined and cost-effective. Because this is a replacement market, it is important to consider the cost of the data conversion, retraining staff, and upgrading or expanding hardware. MAGNETIC RESONANCE Magnetic resonance imaging uses strong magnetic fields and radiofrequency radiation to translate hydrogen nuclei distribution in body tissue into computer-generated images of anatomic structures. The primary advantage of MRI over other radiographic imaging methods, such as computed tomography, is improved soft tissue contrast. MRI also does not use ionizing radiation and produces no known side-effects. This imaging modality is used to identify diseases of the central nervous system, brain and spine, and to detect musculoskeletal disorders. It is also used to diagnose infectious diseases, detect metastatic liver disease, display heart-wall structures, and to stage prostate, bladder and uterine cancers. Breast MRI is utilized frequently to determine the nature of lesions discovered by conventional mammography and to detect cancer in high-risk patient groups. Breast MRI applications are growing faster than all other types of MRI procedures. MRI equipment is generally classified by the type and strength of the magnet. MRI equipment is available in four general configurations. w closed-magnet with (standard) closed-bore design w closed-magnet with (larger) open-bore design w high- and low-field open magnet w dedicated extremity Wide-bore magnets and enhancements for both 1.5 and 3 T magnets remain at the forefront. Magnets which are 7T in strength are considered ultra-high field and thus far have been implemented in research only. These systems promise a world of unmatched resolution, enabling researchers to visualize functional detail never before experienced. High-strength, 3 T MRI systems can provide much better image quality and reduce the time needed for scanning when compared with lower-strength systems. Multi-transmit body coils are offered to reduce artifact. There is also a focus on increasing the signal-to-noise ratio in order to improve image quality. This equates to higher resolution, allowing the clinician to better view smaller anatomical structures and lesions. As new scanners are brought to market with intuitive patient setup, protocol automation and faster scan time, MR throughput is expected to increase. The number of annual MRI procedures performed in the United States is expected to exceed 33 million by end of 2013. 34 DIAGNOSTIC IMAGING WATCH - SPRING 2013 SUPPLIERS TECHNOLOGY SUMMARY GE Discovery™ MR750w 3 T http://www.gehealthcare. com/usen/promo/campaigns ml?CampaignID=GPONO6SM 2012JAN The Discovery™ MR750w 3 T wide-bore system includes a compact superconducting magnet and delivers a full field of view at 50 cm x 50 cm x 50 cm, well-suited for large FOV imaging, as well as off-center imaging. With a 70 cm patient bore diameter and the Geometry Embracing Method Suite of lightweight flexible coils with anatomy-optimized element geometry, the system accommodates virtually all patient sizes and shapes, providing excellent RF and signal homogeneity to make the most of your FOV. Philips Healthcare Ingenia http://www.healthcare.philips.com/us_en/products/mri/ index.wpd The Ingenia, at 1.5 T and 3 T, feature Philips-exclusive DirectDigital RF. This system brings MR signal digitization to the RF coil and sends the signal to the reconstructor via fiber optic cable. The result is up to 40 percent higher signal-to-noise ratio. Ingenia also offers a 55 cm field of view and an embedded body coil, which allows for 60 percent of routine exams to be performed without any coil handling, channel independent architecture and a 70 cm bore for increased patient comfort. Philips Ingenuity TF PET/MR is a hybrid modality that offers Astonish TF Time-of-Flight technology combined with the exceptional soft tissue imaging of Achieva 3 T MRI in a whole body footprint. Ingenuity TF PET/MR offers clinically validated advanced applications in neurology, oncology and cardiology. Siemens Biograph mMR http://www.usa.siemens.com/ The Biograph mMR is a fully integrated state-of-the-art 3 T MRI and cuttingedge PET molecular imaging system. Having MR and PET in a single scanner mr means a need for only one exam and one room. Simultaneous PET-MR imaging provides for the highest level of precise assessment, planning and intervention. MAGNETOM® Aera and MAGNETOM® Skyra at 3 T Siemens offers two Tim4G open-bore systems – the MAGNETOM® Aera at 1.5 T and MAGNETOM® Skyra at 3 T. The features include the following: w the Aera 1.5 T and Skyra 3 T that both have a 70 cm aperture w total imaging matrix fourth generation that provides flexibility, accuracy and speed by combining coils in any way; technology that helps reduce examination times by up to 50 percent; newly designed ultra high-density coils combined with 48 RF channels DIAGNOSTIC IMAGING WATCH - SPRING 2013 35 w day optimizing throughput that helps to take away the complexity inherent in MR scanning that can slow down technologists; dot-optimized scanning that allows for customizable patient examinations, reduction in exam times and improved clinical outcomes w both systems that feature the first-ever integration of Siemens Tim 4G+Dot system w DirectRF with optical links for improved signal purity and RF stability with integration of digital transmit/receive in its new magnet housing and local coil design w new Tim dockable table that allows patients to be prepped anywhere for faster exam setup and patient throughput, allowing for a greater number of MR exams per day MAGNETOM® Avanto at 1.5 T and MAGNETOM® Verio at 3 T Siemens offers two Tim+Dot open-bore systems – the MAGNETOM® Avanto at 1.5 T and MAGNETOM® Verio at 3 T. The features include the following: w Avanto1.5 T with 60cm aperture and Verio 3 T with 70 cm aperture w the Siemens Tim +Dot system w total imaging matrix that provides flexibility, accuracy and speed by combining coils in any way w day optimizing throughput that helps to take away the complexity inherent in MR scanning that can slow down technologists, allowing for customizable patient examinations, reduction in exam times and improved clinical outcomes Siemens also provides the MAGNETOM® ESSENZA 1.5 T and MAGNETOM® Spectra 3 T. Hitachi http://www.hitachimed.com/ products/mri/index.html The Oasis™ 1.2 T The Oasis™ 1.2 T magnet includes a gantry design that offers patient access from all sides. The open architecture also helps eliminate claustrophobia for patient comfort and increased throughput. Oasis XP Workflow Enhancement takes high field open MR to new levels of efficiency and capability. The Oasis XP platform with the Vertex II computer and Origin 4.0 MR operating software provides computing and processing power enhancements that streamline the entire imaging process from patient registration, through scan planning, scanning, image processing and image management. The Echelon™ The Echelon™ provides a high performance 1.5 T magnet, ultra-fast 150T/m/ sec slew rate gradient system, eight-channel RF receiver (with a 16-channel XLS option) and wide range of multi-channel receiver coils. 36 DIAGNOSTIC IMAGING WATCH - SPRING 2013 Echelon™ Oval Echelon™ Oval is designed around the shape of the human body, allowing for an optimal patient experience with outstanding comfort, space and efficiency. The game-changing 74 cm oval bore is the widest 1.5 T MR system available. Enhanced patient accessibility combined with Hitachi’s Workflow Integrated Technology, advanced imaging capabilities and UltraPlus Customer Support, makes Echelon Oval an ideal solution for-improved workflow, greater diagnostic confidence and increased cost efficiencies. Toshiba http://medical.toshiba.com/ products/mr/3t/index.php Titan™ Series 3 T Large Bore Scanner The Titan™ Series 3 T large bore scanner is scalable from 16 ch to 32 ch RF and 30/203 gradient strengths to accommodate any members’ imaging requirements. This is the first 3 T system on the market with the patented Pianissimo™ technology, which results in up to a 30 db reduction in gradient noise. It also comes with Toshiba’s industry-leading non-contrast MRA techniques which are in their fourth generation. Titan™ Series 1.5 T Large Bore Scanner The new Titan™ Series 1.5 T large bore scanner is scalable from 8 ch to 16 ch to 32 ch RF and 33/148 or 34/203 gradient strengths to accommodate any member imaging requirements. It is pending FDA approval. M-Power, Toshiba’s new user interface, makes it easy starting a procedure to advancing post-processing procedures, with many new automated features. Sixteen element flexible coils will be offered, pending FDA approval, and will come in three sizes accommodating all MSK imaging needs. These 16 element coils provide superior imaging quality, while also making placement of the coils easier and ultimately helping to reduce coil costs by reducing the number of coils needed. Invivo http://www.invivocorp.com Expression MRI Patient Monitoring System The Invivo Expression MRI patient monitoring system is built from the ground up to withstand the rigorous demands of the MRI suite. Designed specifically for ultra-high magnetic field environments, the Expression MRI patient monitor operates at the 5,000 Gauss field line and 4 W/Kg SAR regardless of configuration, without compromising patient safety. This level of performance and reliability simply can’t be achieved by monitors that have been adapted from other, less-demanding applications. Smart features help make more informed, confident decisions about a patient’s condition. Expression is simple to use, too, with a host of productivity-boosting innovations. Invivo’s industry-exclusive wireless technology makes it easy to move the patient from room to room, expediting patient management and workflow in the MRI suite. The Expression monitor also is the only device on the market that evolves with needs and offers unrivaled uptime. DIAGNOSTIC IMAGING WATCH - SPRING 2013 37 Expression IP5 Information Portal The Expression IP5 information portal is a convenient way to take MR patient monitoring from the suite level across the enterprise. With the Expression IP5, integrate the MR patient safety strategy with overall information strategy. It works with a host of integration engines and EMR systems, making it easier to customize the integration of the MR patient monitoring information with your hospital information systems or EMR. On its 19-inch widescreen display, access, view and track vital signs in the MR control room without the need for extensive – and expensive – wireless router networks. The Expression IP5 blends smart decision-making support with robust casemanagement capabilities, evolving to become intelligent and tailorable to the needs of health care professionals and their patients. Its advanced platform gives more opportunities to gain deeper insights into a patient’s condition – and helps in satisfying the never-ending quest for better decision support. Essential MRI Patient Monitor The portable Invivo Essential SpO2 monitor moves with patients from sedation to imaging suite and into recovery. Essential helps create a more satisfying patient experience, introduces new opportunities in patient monitoring and makes better use of your human and financial resources. Lightweight and easy to transport, with a unique wireless design, Essential features digital technology for exceptional performance on SpO2 values, low and high perfusion and motion. Artifact suppression also helps enhance study quality. And with its unrestricted gauss rating, Essential can be used virtually anywhere. Economic Impact: Although 3 T MRI is an attractive option, due to the economic climate some facilities have been forced to purchase a 1.5 T MRI system. When making the decision to lease or purchase, consider the complexities associated with installing and uninstalling this modality which is much different technically from computed tomography. Facilities that have adequate capital are installing the 3 T MR and preparing the site to accommodate the future technology which is expected to include 7 T MR systems for clinical use. Configurations can vary widely, depending on the number of channels and software packages included in the purchase. The cost of a 1.5 T MRI system can vary greatly from $600,000 to more than $1.5 million. A 3 T MRI system will range from $1.8 million to $3 million, while dedicated systems for extremities will be closer to $400,000 to $600,000. MOLECULAR IMAGING – NUCLEAR MEDICINE, PET/CT AND PET/MR Molecular imaging is a modality that utilizes single photon or positron emission from a locally administered radiopharmaceutical agent. Unlike many other imaging techniques that are used to survey the anatomy, this imaging method is used to visualize the functional and physiologic activities of various tissues and organs. Molecular imaging is well-suited for cardiovascular and oncology applications. Gamma camera imaging is used extensively in myocardial and cerebral perfusion studies. Positron emission tomography imaging enables clinicians to detect chemical and physiologic changes in targeted tissues early. Hybrid positron emission tomography/computed tomography allows for the fusion of images and is used extensively in radiosurgery planning. This technology enables clinicians to plan with unprecedented accuracy the best orientation of radiation beams for the treatment of disease. The birth of hybrid PET/MR systems has taken things to the next level. This is an area that shows much promise but the full impact is unknown. 38 DIAGNOSTIC IMAGING WATCH - SPRING 2013 SUPPLIERS TECHNOLOGY SUMMARY GE Trimodality PET/CT + MR http://www3.gehealthcare. com/en/Products/Categories/ PET-CT/PET_CT_and_MR_ Trimodality_Imaging w exquisite soft-tissue-contrast of 3 T MR w exceptional metabolic insight of PET imaging w precise anatomical reference of CT The Trimodality PET/CT + MR allows technicians to scan with PET/CT, transfer the patient on an air-hover tabletop, scan on an advanced MR – then fuse the images with integrated registration software and use, offering: Fusing these three powerful modalities is not only financially responsible, it holds tremendous clinical promise. Once the PET/CT and MR images are acquired, integrated registration software on the Advantage Workstation produces high-quality fused images with a single click of a mouse. This opens up exciting new possibilities in the management of cancer, and neurodegenerative and cardiac diseases. Philips Healthcare http://www.healthcare. philips.com/us_en/products/ nuclearmedicine/index.wpd BrightView XCT BrightView XCT is Philips’ SPECT/CT system designed entirely for nuclear medicine. CoPlanar FP uniquely integrates Philips’ BrightView SPECT in a co-planar design with advanced Philips’ flat-detector X-ray CT technology. The BrightView XCT uses advanced algorithms for the truest picture possible. Astonish TF TOF PET State-of-the-art Astonish TF TOF PET technology is now standard across the family of PET/CT systems. Astonish TF improves the signal-to-noise ratio, resulting in high image quality and improved accuracy. The proprietary reconstruction design used full-fidelity list mode reconstruction to improve image quality and SUV accuracy in seconds. TruFlight Select PET/CT The TruFlight Select PET/CT provides members with enhanced image quality and speed. Diagnostic CT capabilities allow the system to be used not only for PET/CT scans, but also for standalone CT scans, thereby serving a dual purpose. DIAGNOSTIC IMAGING WATCH - SPRING 2013 39 Siemens www.usa.siemens.com/MI Biograph® mCT The Biograph® mCT brings accurate and reproducible quantification to molecular imaging, giving the ability to make unprecedented progress in diagnosing and treating some of the greatest challenges facing health care, such as cancer, neurodegenerative disorders and cardiovascular disease. By incorporating daily system normalization with Quanti•QC, precise PET and CT alignment with SMART innovations, and intelligent software with syngo.via, the new Biograph mCT overcomes inherent variability faced by conventional PET/CT systems. The Biograph mCT’s OptisoHD detection system optimizes all components of the imaging chain. With isotropic detector elements, industry-best 400 x 400 reconstruction matrix* and high-definition PET technology, Biograph mCT delivers the industry’s finest* volumetric resolution of 87 mm3. Siemens Biograph mCT is the leader in dose reduction technologies for PET injection combining ultraHD•PET and TrueV to increase scan sensitivity, allowing members the choice of a 50 percent decrease in radioactive injected dose. Biograph mCT is the only PET•CT that combines the large bore of 78 cm with a 224 kg (500-pound) table limit to accommodate most patients. Equipped with a high-end CT, Biograph mCT provides a true dual-use workflow solution that enables increased utilization. Biograph mCT helps to achieve results that are more accurate and reproducible for greater diagnostic confidence, more accurate therapy monitoring and more informed treatment decisions. * Based on competitive literature available at time of publication; data on file. Symbia® T Symbia® T is an advanced and highly integrated diagnostic SPECT•CT solution. Offered with 2-, 6- or 16-slice diagnostic CT, Symbia T expands the role of nuclear medicine into routine surgical planning, orthopedics, advanced cardiology and much more. Whether it’s heart or brain imaging, renal exams or bone scans, the Symbia T series of nuclear medicine imaging equipment performs a complete range of studies. And it offers the broad spectrum of configurations and options to meet each price point and need. Symbia SPECT•CT offers minimum dose and maximum speed at the same time. For example, IQ•SPECT on Symbia SPECT•CT enables four-minute routine cardiac perfusion imaging, or half-dose and half-time imaging at the same time. The innovative scanners offer the highest NEMA resolution in the market and unique productivity features. 40 DIAGNOSTIC IMAGING WATCH - SPRING 2013 Symbia ensures this clarity through its advanced HD detector, innovative bed design, BiCORE™ collimators with AUTOFORM® technology, Flash reconstruction and full diagnostic multi-slice CT capability. Supported by automated quality control, automated collimator changer and fast spiral CT, Symbia’s automation helps achieve imaging speeds that were previously unattainable, leading to faster patient diagnosis and treatment, and the ability to support increased patient volumes. Symbia® S Siemens bestselling imaging platform, Symbia® S, is a premium multipurpose SPECT system that can be upgraded to diagnostic SPECT•CT at any time. Unique features such as automated quality control make Symbia S perfect for hospitals and clinics looking for top performance, flexibility and investment protection. To help further expand SPECT clinical utilization, IQ•SPECT on Symbia S enables four-minute routine cardiac perfusion imaging or both half-dose and half-time imaging. Symbia S offers minimum dose and maximum speed at the same time, and it delivers the highest NEMA resolution* in the market and is equipped with unique productivity features. *Based on competitive literature available at time of publication; data on file. Comprehensive Amyloid Imaging Solution* The comprehensive amyloid imaging solution for evaluating Alzheimer’s disease and other causes of cognitive decline combines reliable radiopharmaceutical manufacturing and distribution with innovative PET CT hardware and software for the detection of amyloid plaques — one of the necessary pathological features of Alzheimer’s disease1, 2, 3 — in the living brain. The system includes three unique elements — the new Biograph mCT PET•CT scanner, syngo.PET Amyloid Plaque neurology quantification software, and the manufacturing and distribution of amyloid imaging biomarkers. 1 Hyman BT, Phelps CH, Beach TG, et al. National Institute on Aging –Alzheimer’s Association guidelines for the neuropathologic assessment of Alzheimer’s disease. Alzheimer’s Dement. 2012; 8 (1): 1-13. 2 Mira SS, Heyman A, McKeel D, et al. and participating CERAD neuropathologists. The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD): Part II Standardization of Neuropathologic Assessment of Alzheimer’s Disease. Neurology. 1991; 41 (4): 479-486. 3 Thies W, Bleiler L; Alzheimer’s Association. Alzheimer’s Association Report: 2012 Alzheimer’s Disease Facts and Figures. Alzheimer’s Dement. 2012. DIAGNOSTIC IMAGING WATCH - SPRING 2013 41 www.usa.siemens.com/mMR Biograph® mMR Biograph® mMR fully integrates state-of-the-art 3 T MR and cutting-edge PET molecular imaging that is precisely aligned for accurate imaging. It features simultaneous acquisition of morphology, function and metabolism with wholebody MR and PET integration. This results in new insights into the progress of disease, new paths to treatment, new areas of research and, ultimately, an expansion of the understanding of life. Having MR and PET in a single scanner means a need for only one exam and one room. Simultaneous PET-MR imaging provides for the highest level of precise assessment, planning and intervention. Economic Impact: Molecular imaging, especially in the cardiac segment, is expected to grow with the continued attention that cardiac disease prevention and treatment are receiving. It will be important to keep up with the latest technology in order to remain competitive in this market. More and more cardiologists are offering dedicated SPECT units in order to perform cardiac studies in their offices. A single-head gamma camera averages about $200,000, with dual-head cameras costing about $300,000 to $400,000. SPECT/CT systems range from $400,000 to $600,000 on average. In the area of PET/CT, image fusion software continues to be refined and expanded. Many facilities have already replaced their outdated dedicated PET-only models. A PET/CT (64-slice) can easily cost between $2 million and $3 million. POWER INJECTION SYSTEMS Power injection systems enable contrast agents to be injected into the vessels. The contrast agents in turn circulate through the bloodstream, enhancing the tissue structure of the vessels and organs. These devices are utilized in computed tomography, cardiovascular, positron emission tomography/computed tomography and magnetic resonance imaging. Advances with these systems continue to prove their efficacy when it comes to image quality, safety and dose reduction. Development efforts continue on power injector technologies with features such as dual-syringe, adjustable flow rates, body weight protocol, personalized patient protocol technology, radiofrequency identification technology and extravasations detection. These advances make it safer and improve image quality for the patient during the procedures. The power injector market is growing due to the increase sales of MR, CT, ultrasound and cardiovascular systems. GE Healthcare and Covidien offer power injection systems, however, these were not fully evaluated as part of this publication. 42 DIAGNOSTIC IMAGING WATCH - SPRING 2013 SUPPLIERS TECHNOLOGY SUMMARY MEDRAD The Mark 7 Arterion™ Injection System http://www.medrad.com/ en-us/info/products/Pages/ Arterion.aspx The latest in the MEDRAD Mark series of angiographic injectors, the Mar & Arterion™ Injection System is unique to the market: The front load system simplifies setup and makes for a cleaner tear down. The clear syringe provides a higher level of confidence about injection readiness. With a smaller base, lighter head and a flexible articulating arm, the injector can go where it needs to go – even around corners. eXposure™ The eXposure™ is a comprehensive approach to monitoring and managing patient radiation dose and offers these features: w tracks absorbed dose by organ/region w ICRP 60 effective dose w ICRP 103 effective dose w DLP, CTDIvol, and SSDE w size-adjusted estimates for effective dose w incorporation of protocol management to ensure end-to-end compliance w generation of alerts according to protocol-specific thresholds that are based on patient age, gender, size and clinical context to minimize unnecessary interruptions w incorporation of a flexible reporting system with customizable dashboards to deliver easy-to-assimilate visual data whenever or wherever they are needed w utilization of vendor-neutral independent dose assessment w simplified ACR Dose Index Registry integration with built-in RadLex™ mapping DIAGNOSTIC IMAGING WATCH - SPRING 2013 43 ACIST http://acist.com/us/ EmpowerCTA PREPARE w arming at injector head w eGFR calculator w pendant-switch-empowered saline advance w more control at the injector head; goes beyond stop/start w intuitive air purge and fill process w built-in tilt sensor that reduces the risk of air embolisms w automated initialization, fill-and-line purging of contrast and saline INJECT w modular flow rate adjustment in real time w real-time pressure monitoring at the injector head and remote w saline advance w saline jump w voice prompts w IRiSCT® Viewer that provides continual contrast tracking w unique patented extravasation detection technology CAPTURE w high--capacity protocol storage and customization w capture and transfer of data for more informed decision-making w Windows-based operating system Economic Impact: The purchase of injection systems is largely driven by growth in several different imaging modality markets. This would include computed tomography, magnetic resonance imaging, angiography and cardiovascular suites, and molecular imaging. There are a relatively low number of competitors in this market along with a high level of market saturation in the area of CT. Potential for growth remains in the area of MRI and molecular imaging, especially with infusion systems available for radiopharmaceuticals. In a large majority of cases, facilities will bundle the purchase of the injector with the purchase of a new imaging modality. The capital cost of injectors, depending on the type, will range from $20,000 to $90,000. The long-term cost of consumables must be taken into consideration, especially when the cost of capital is being operationalized as part of the purchase. 44 DIAGNOSTIC IMAGING WATCH - SPRING 2013 ULTRASOUND An increase in the number of chronic diseases that are detected early by sonography will help drive growth in the global ultrasound market during the next five years, according to a new study by Transparency Market Research. The report estimates that the worldwide ultrasound market will total $4.82 billion in revenues this year and advance to $6.11 billion in sales by 2017, with a compound annual growth rate of 5 percent. Ultrasound is a non-invasive technology used to obtain real-time, dynamic images of the most major soft tissues and organs. Defined bursts of ultrasound waves are transmitted and received from a transducer. Generalpurpose ultrasonic scanning systems provide two-dimensional and sometimes three-dimensional images of most soft tissues without subjecting patients to ionizing radiation. Four-dimensional ultrasound imaging is also available and often used in fetal imaging. These advanced images can also be applied to cardiovascular ultrasound in assessing treatment and therapies for heart failure management. In addition to general-purpose systems, specialized systems are available that are optimized for specific scanning applications: Cardiac ultrasound systems (echo machines) are designed specifically for real-time, noninvasive imaging of cardiac structures and functions. A specialized procedure called transesophageal echocardiography uses an ultrasound probe inserted into the esophagus to detect myocardial ischemia and assess cardiac output. Intravascular ultrasound systems use a miniature transducer mounted on the end of a flexible catheter that is inserted into an artery to facilitate internal imaging of the vessel walls. This is used as an adjunct to angiography to view and assess atherosclerotic plaque. Portable ultrasound systems are a convenient way to perform point-of-care image capture. Depending on the probe and software calculation packages available, portable systems may be used for abdominal, OB/GYN, urologic, small-parts, cardiac, vascular and other examinations. Development efforts continue on ultrasound technologies to reduce size, increase transducer versatility and expand the roll of ultrasound in the clinical setting. Diagnostic medical sonography is often associated with a significant risk for work-related musculoskeletal disorders. Several manufacturers have implemented equipment-related ergonomic features. Many conventional ultrasound scanners incorporate position-adjustable display monitors, control panels and keyboards that provide more options for the operator. DIAGNOSTIC IMAGING WATCH - SPRING 2013 45 SUPPLIERS TECHNOLOGY SUMMARY GE LOGIQ™ E9 with XDclear The LOGIQ™ E9 with XDclear gives extraordinary images and expert tools to http://www3.gehealthcare. com/en/Products/Categories/ help manage the changing ultrasound environment: Ultrasound/LOGIQ/LOGIQ_E9 w stunning penetration and resolution with innovative XDclear transducer technology w direct hemodynamic visualization with the innovative B-Flow™ technology w new workflow tools and productivity packages w auto-registration for CT fusion w platform enhancements for a fast, powerful computer, easy speed of sound adjustment and new fully adjustable monitor w volume navigation that combines the advantages of volume ultrasound with an onboard advanced navigation system somo•v™ Automated Breast Ultrasound System Using proprietary technology to automate the ultrasound imaging process, the somo•v™ ABUS system was developed specifically for the high-volume, breast cancer screening environment and is clinically proven to increase cancer detection (sensitivity) by 31 percent. The somo•v ABUS system is an ultrasound device approved for breast cancer screening in the United States and licensed in Canada as an adjunct to mammography for asymptomatic women with dense breast tissue. More than 40 percent of women have dense breast tissue in the United States. Images generated from the somo•v ABUS are sent to the somo•VIEWer Advanced 3D Workstation for interpretation, enabling fast review and archiving of patient exams to optimize breast ultrasound screening workflow. Hitachi Aloka http://www.hitachimed.com/ ProSound Alpha 6 The ProSound Alpha 6 incorporates the benefits of the high-end ProSound Alpha series. It offers superior performance in one compact, easy-to-use, economic and environmental system. The ProSound Alpha 6 addresses all diagnostic applications in one system that supports a full range of applicationspecific probes and software, designed to target all specialist diagnostic areas in general imaging, cardiovascular, women’s health care and internal medicine. The ProSound Alpha 6 high-power processor allows a number of different imaging modes previously seen only in high-end systems, without compromise on image quality and color Doppler sensitivity. The compact, ergonomic design of the ProSound Alpha 6 features a large, programmable touchscreen panel for quick access to frequently used controls. A height-adjustable operation panel and swivel LCD monitor provide ease of use. Its lightweight small footprint offers outstanding mobility. 46 DIAGNOSTIC IMAGING WATCH - SPRING 2013 ProSound Alpha 7 The ProSound Alpha 7 is a diagnostic ultrasound system that inherits the proven technologies and functions of Hitachi Aloka’s high-end product, yet offers outstanding mobility thanks to being one of the smallest units in its class. The system is easily transported to deliver high performance throughout the hospital. The Broadband Harmonics™ realizes high sensitivity that is comparable to fundamental imaging even with harmonic echo imaging. Directional eFLOW™ features enhanced spatial resolution for greater detail of blood flow information. The three-dimensional automated volume measurement requires no manual tracing for accurate three-dimensional volume calculation. With these versatile functions, the ProSound Alpha 7 is the ideal choice for expert analyses in a wide range of applications with the best features: Broadband Harmonics, high-quality imaging with high-performance HST+ probes, analysis functions, and real-time threedimensional/four-dimensional in a very small console. Hitachi Aloka’s extensive collection of probes offers a variety of imaging capabilities to meet all imaging needs and the ProSound Alpha 7, following the design concept of the higher-end models, provides images of excellent contrast and spatial resolution, making the diagnosis easier. HI VISION™ Preirus The HI VISION™ Preirus is a new generation ultrasound platform with advanced ergonomic architectural design, the latest broadband beamforming technology and ultra-high speed processing capability. The unique design of the HI VISION Preirus platform allows precise adjustment to facilitate the performance of any examination by any operator. With its super slim-line footprint and operator console with large digital LCD monitor moving together in a rotational arc, positioning at the bedside can be optimized to make diagnosis a more comfortable experience for operator and patient. Customized scanning parameters are combined with high-speed image processing for improved diagnostic confidence. Proven innovative technologies confer superior penetration, temporal, spatial and contrast resolution, giving high-quality images for every patient every time. Avius SE® Inspired by experience, the Avius SE® is an ultrasound system that is small in stature but big in performance. With the same imaging performance and attractive system design of our HI VISION ultrasound platform range, Hitachi’s new system architecture incorporates the latest broadband beamforming technology and ultra-high speed processing capability. DIAGNOSTIC IMAGING WATCH - SPRING 2013 47 The Avius SE supports all mainstream ultrasound applications and is compatible with Hitachi Aloka’s full range of standard and dedicated specialist transducers. With premium-level technologies such as Hitachi Aloka’s Realtime Tissue Elastography, four-dimensional and dynamic contrast harmonic imaging, the Avius SE is an attractive and affordable compact ultrasound system that can be customized to individual requirements. ProSound Alpha 7cv The ProSound Alpha 7cv is a diagnostic cardiovascular ultrasound system that inherits the proven technologies and functions of Hitachi Aloka’s highend product, yet offers outstanding mobility thanks to being the smallest size in its class. The system is easily transported to deliver high performance throughout the hospital. The Broadband Harmonics realize high sensitivity that is comparable to fundamental imaging even with harmonic echo imaging. Directional eFLOW features enhanced spatial resolution for greater detail of blood flow information. It features Adaptive Image Processing, a revolutionary feature for speckle noise reduction. AIP clearly displays differences in tissues, reducing speckle noise while maintaining the frame rate, which is an unparalleled function in this product range. It offers a visualization of the cardiac cavities’ borders or vessels edges with a new level of image quality previously not seen in this level system. The ProSound Alpha 7cv offers comprehensive cardiovascular examination functions and highly specialized analysis capabilities useful from prevention to treatment. These functions and capabilities include eTRACKING for evaluating early atherosclerosis, A-SMA and strain/strain rate for evaluating ischemic cascade, and various asynchrony evaluation functions for cardiac resynchronization therapy. Philips Healthcare http://www.healthcare. philips.com/us_en/products/ ultrasound/index.wpd ClearVue 550 – Pending FDA Approval The new, versatile ClearVue 550 ultrasound system offers an elegant design and Active Array technology that integrates key imaging technologies into the transducer for superb images in a lightweight system. The ClearVue 550 is energy efficient for lower energy costs. iU22 xMATRIX The iU22 xMATRIX ultrasound system provides excellent image quality for improved diagnostic confidence, integrated image fusion and navigation technology, and enhanced ergonomics. The iU22 xMATRIX ultrasound system features the new X6-1 xMATRIX transducer and 35 times more active elements than conventional transducers, allowing for better uniformity, fewer artifacts and finer anatomical detail. 48 DIAGNOSTIC IMAGING WATCH - SPRING 2013 The iU22 xMATRIX also provides live xPlane imaging for simultaneous, highresolution real-time scanning in two planes without moving the transducer, the ability to perform high-quality two-dimensional and three-dimensional imaging with the same transducer, and PercuNav image fusion and instrument navigation capabilities. CompactXtreme CompactXtreme is a portable ultrasound that offers a high level of clinical performance, image quality and versatility. SonoSite Edge™ http://www.sonosite.com/ products/edge The Edge™ is SonoSite’s fifth generation portable ultrasound system. It features a 12.1 inch LCD monitor, splash-resistant silicone keyboard weighting 8.5 pounds in a “clamshell” design and a five-year standard warranty. http://www.sonosite.com/ products/s-series S Series™ http://www.sonosite.com/ products/m-turbo http://www.sonosite.com/ products/nanomaxx The S-Nerve™ is a high-resolution, all-digital, 9.25-pound (4.2 kg) ultrasound system with 10.4-inch digital display. The system is optimized specifically for the needs of the anesthesiology, ER, ICU, cath lab and MSK. It features the “tablet-style” zero footprint design for stand, wall or ceiling mounting, and a five-year standard warranty. M-Turbo® The M-Turbo® is a high-resolution, all-digital, 7.5-pound (3 kg) ultrasound system with 10.4-inch digital display. The clamshell design shares service applications, and offers a five-year standard warranty. NanoMaxx® The NanoMaxx® is a high-resolution, all-digital, 6-pound (2.72 kg) ultrasound system with 8.4-inch diagonal digital display. The NanoMaxx combines high performance with the ease-of-use, speed, flexibility and durability of a handcarried ultrasound, and a five-year standard warranty. Siemens ACUSON S3000™ Ultrasound System http://www.usa.siemens.com/ The ACUSON S3000™ delivers pioneering technologies for general imaging and interventional radiology. This ultra-premium platform enables workflow ultrasound excellence and provides investment protection with upgradeability and interchangeable software, transducers and accessories across the ACUSON S systems. ACUSON S2000™ Ultrasound System Superior image quality, knowledge-based workflow, adaptive ergonomics, and innovative applications extend diagnostic reach to address a broad range of clinical applications. DIAGNOSTIC IMAGING WATCH - SPRING 2013 49 ACUSON S2000™ Automated Breast Volume Scanner The ACUSON S2000™ is the first multi-use ultrasound system that automatically, quickly and comfortably acquires full-field sonographic volumes of the breast. ACUSON SC2000™ Volume Imaging Ultrasound System This ultra-premium cardiovascular ultrasound system for two-dimensional and three-dimensional volume imaging streamlines exams. Innovative applications enable fast, accurate and reproducible measurements. It improves diagnostic confidence with quantification tools and single-beat full volume acquisition. ACUSON S1000™ Ultrasound System The ACUSON S1000™ provides premium image quality to achieve diagnostic confidence in all body types. This premium imaging platform has unmatched investment protection, where one system can be used for multiple specialties with its complete suite of transducers and exam types. The ACUSON X700™ Ultrasound System The ACUSON X700™ system is built around the latest imaging technologies, equipped with a rich set of standard features and designed for the ultimate in comfort and usability. It redefines the ultrasound experience providing performance and value. ACUSON X300™ Ultrasound System This portable system offers a broad range of solutions: comprehensive cardiology, general imaging and OB/GYN applications. ACUSON X150™ Ultrasound System This small, lightweight system delivers top performance and clinical scalability at an outstanding value. ACUSON P300™ Ultrasound System This complete, portable patient care solution is a compact unit with two builtin transducer ports, is battery operable and offers high-frequency imaging up to 18 MHz. Advanced technologies are standard: speckle reduction, spatial compounding and panoramic imaging. Toshiba http://medical.toshiba.com/ products/ul/aplio-500/advanced-applications.php 50 Aplio™ 500 Every aspect of Aplio™ 500 has been optimized to facilitate superior workflow. The system offers customizable, ergonomic features that improve efficiency and throughput, along with unsurpassed service and support that helps minimize downtime and maximize clinical utilization. DIAGNOSTIC IMAGING WATCH - SPRING 2013 Also available on the new Aplio 500 ultrasound system is the industry’s first Fly Thru® technology, a three-dimensional volume rendering technique that allows the operator to soar through cavities, ducts and vessels from the inside. Features include the following: similar to virtual endoscopy, allows automatic and manual navigation through any fluid-filled structure w a revolutionary tool for exploring lesions and masses, and planning interventional procedures w available during or post exam Esaote MyLab™Twice http://www.esaote.com/ modules/core/page. asp?p=MYLABTWICE&t=SPE w satellite ultrasound system wirelessly connected to the main cart-based unit w convex, linear and phased array transducer technology from 1 to 22 MHz bandwidth; applications: abdominal, small parts, MSK, breast, cardiac, vascular, obstetric, gynecology and urology w Tissue Enhancement Imaging™, real-time adaptive imaging user configurable processing (X-View), multi-angle electronic beam steering (M-View), extended linear format (TP-View), panoramic viewing imaging (V-Pan) (optional) and B & Doppler auto adjustment algorithm w advanced cardiac package including Stress Echo SW (optional) and Miocardial 2d-Base Quantification SW (XStrain) (optional) w tissue characterization application packages including tissue elasticity algorithm (ElaXto) (optional), contrast technology imaging (CnTI) (optional) and radio frequency signal processing analysis http://www.esaote.com/ modules/core/page. asp?p=MYLABCLASSC &t=SPE w MyLab™Twice offers fully digital architecture for general imaging ultrasound applications supporting the following technologies and features: MyLab™ClassC MyLab™ClassC features a premium digital architecture multimodality ultrasound system and 1 to 22 MHz bandwidth for cardiac, vascular, abdominal, small parts, MSK, breast, obstetric, gynecology and urology. Fully digital architecture supports the following technologies and features: w TEI, real-time adaptive imaging user configurable processing (X-View), multi-angle electronic beam steering (M-View), extended linear format (TP-View) and B & Doppler auto adjustment algorithm w advanced cardiac package including coronary flow imaging, compass M-mode (optional), tissue velocity/tissue velocity mapping (optional), Stress Echo SW (optional) contrast technology imaging CnTI (optional) and Miocardial 2D-Base Quantification SW (XStrain) (optional) w tissue characterization application packages, including tissue elasticity algorithm (ElaXto) (optional) DIAGNOSTIC IMAGING WATCH - SPRING 2013 51 http://www.esaote.com/ modules/core/page. asp?p=MYLABALPHA&t=SPE http://www.esaote.com/ modules/core/page. asp?p=MYLABSEVEN&t=SPE 52 w advanced vascular package w complete connectivity package MyLab™Alpha The system offers a premium portable multimodality productivity-oriented ultrasound system, and a fully digital architecture, supporting the following technologies and features: w high-resolution rotating LCD color monitor, high-resolution touch LC interactive display w intelligent configuration capability, including applications, measurements and reports enabled for the user through one of the more specific application licenses w image processing algorithms: speckle noise reduction and compound exclusive productivity-oriented tools: e-Touch, SmarTouch w two electronic high-density probe ports available (new-generation ZIF type) w modern and ergonomic design for user comfort, user-friendly and efficient keyboard layout, including keys, knobs and sliders w complete connectivity package MyLab™Seven The system offers multimodality digital productivity-oriented ultrasound platform, and fully digital architecture, supporting the following technologies and features: w high-resolution LCD 16/10 color monitor, high-resolution touch LC interactive display w image processing algorithms: speckle noise reduction (X-view – standard) and compound (M-view – optional) w exclusive productivity-oriented tools: e-Touch, SmarTouch w four electronic high-density probe ports available (three ZIF and one standard) w modern and ergonomic design for user comfort, including rotating and height-adjustable keyboard, articulated-arm monitor, alphanumeric QWERTY keyboard (HW and SW) for patient identification and annotation, user-friendly and efficient keyboard layout, including keys, knobs and sliders w battery backup that allows the system to be moved room to room without a full shutdown DIAGNOSTIC IMAGING WATCH - SPRING 2013 http://www.esaote.com/ modules/core/page. asp?p=MYLABONE&t=SPE Mindray http://www.mindray. com/na/products/ m7.html?backUrl=pro_line2_ col.html http://www.mindray. com/na/products/ m5.html?backUrl=pro_line2_ col.html MyLab™One MyLab™One is an application-specific tablet ultrasound system suited for all general imaging, regional anesthesia, emergency, MSK, vascular and interventional applications. It is a high-performance and lightweight system with a 12-inch sterile-friendly touchscreen display, long battery life and wireless connectivity. It provides the following features: w 2 to 22 MHz bandwidth w linear, convex and phased array technology w user customizable buttons available on some of the probes w exclusive onboard dedicated application-specific tutorials w operating modes: B, M, CFM, Power Doppler, PW w battery (three hours) and mains operated w completely touchscreen operation w Focus Touch technology w biometry measurements M7 The M7 epitomizes the optimal combination of advanced imaging technologies and miniaturization technologies. Mindray research and development engineers employ the System On Chip design within the M7 ultrasound system. SOC enables complex technologies to be built into the M7’s compact laptop-style chassis. Medical devices built around SOC designs are energy efficient and highly reliable. The M7’s exceptional image quality, user experience and versatility have expanded the performance and flexibility envelope for hand-carried ultrasound imaging systems. M5 M5 is a full-featured, high-quality color Doppler ultrasound tool that performs imaging across an extensive range of clinical settings and applications. The laptop-style M5 delivers uncompromising two-dimensional performance and exceptional value in a compact, yet durable package. The portable, simplistic nature of the M5 makes it ideal for a variety of hospital and office environments, including emergency medicine, breast surgery, anesthesia, vascular, interventional radiology, critical care, PICC line placements, MSK, obstetrics, gynecology and urology. DIAGNOSTIC IMAGING WATCH - SPRING 2013 53 Mediwatch USA http://www.mediwatch.com/ index.php Portascan+ The Portascan+ is unique with a large real-time screen, a patient database and the ability to combine ultrasound scans with uroflow data wirelessly by Bluetooth®. Simple point-and-freeze operation makes the Portascan+ the scanner of choice for the busy clinical environment. The Portascan+ calculates the bladder volume automatically from an ultrasound image. An in-built thermal printer provides a permanent hardcopy printout of results for accurate record keeping and archiving. Features include: w real-time ultrasound scanning and image capture w simple, intuitive software with touchscreen input w 3.5 to 5.0 MHz abdominal probe for adults and children w automatic bladder volume calculation Multiscan PVR The Multiscan PVR has been designed for use by health care workers in a variety of specialties and includes these features: Medline Industries http://www.medline.com/ category/Diagnostic-Testing/ Monitoring/cat500089 54 w ideal for point-of-care use where immediate and reliable imaging of the bladder is required w designed for bladder volume scanning w simple point-and-freeze operation w touchscreen controls for ease of use w on-screen virtual keyboard for data input w USB port for data output w large database for image storage w variety of mounting options for mobility BioCon CUBEscan 700 Bladder Scanner Compact and portable, the three-dimensional ultrasound device provides quick, safe and non-invasive measurements of bladder volume and postvoid urinary retention. Real-time pre-scan helps improve accuracy, reduces improper scans and saves time by viewing the bladder before performing the test. Built-in printer facilitates immediate documentation in the chart. Features include the following: w child, male and female modes w voice recording w high storage capacity: up to 700 scans DIAGNOSTIC IMAGING WATCH - SPRING 2013 w w w w seven-inch TFT-LCD (WVGA) full-color touchscreen easy transfer of images and data to a PC and the EMR via an SD card or USB cable durable, encapsulated and protected probe one-year warranty BioCon 500 Bladder Scanner As part of a urinary continence program, the portable, three-dimensional BioCon-500 Bladder Scanner with pre-scan feature allows caregivers to scan the resident’s bladder to determine if catheterization or toileting is necessary. Residents are shown the results so they can actually see how much fluid is in their bladder; this helps them re-learn the sensation of needing to urinate. As a result, develop individualized toileting schedules based on each resident’s bladder function pattern rather than at fixed times, such as every two hours; this will save staff valuable time. Also, more accurately determine if a resident’s bladder volume, and voided amounts are consistently low, prompting an increase in their fluid intake. The scanner promotes staff efficiency and requires little training. Meets Tag F315 requirements, helps manage effective incontinence and helps minimize unnecessary catheterization. It is a quick, safe and non-invasive way to measure bladder volume and post-void urinary retention, and the scanner helps benefit the residents by preserving dignity and reducing discomfort. The portable unit is wheeled to the resident’s bedside, and the clinician applies clear gel to the patient’s lower abdomen. The device’s wand is then positioned over the bladder area. An image of the bladder appears on the screen, and the device calculates the bladder volume in less than five minutes. Onsite printing with PC transfer helps the caregiver quickly and easily document and track the resident’s progress. It benefits the facility by helping to improve care, reducing the frequency of catheterization, saving staff time, decreasing total expense and reducing training time. Samsung Medison America http://www.samsungmedisonusa.com/ultrasound/ General Imaging General-purpose ultrasound diagnosis systems with sophisticated image processing technology include Accuvix, SonoAce and MySono. Accuvix® A30 Accuvix® A30 establishes a new benchmark for state-of-the-art imaging, offering the world’s first 21.5-inch full HD LED monitor, enriched threedimensional performance, increased detection rates, unparalleled automation, a sensitive interface and a forward-looking ergonomic design. DIAGNOSTIC IMAGING WATCH - SPRING 2013 55 MySono® U6 MySono® U6 provides the ultimate in content optimization for a portable system. Vastly improved resolution provides the most accurate clinical outcomes. OB/GYN Innovative ultrasound diagnosis systems leading the new standard for OB/ GYN diagnosis include the Accuvix®, MySono and SonoAce®. SonoAce X8 The SonoAce X8 blends high-end ultrasound technologies and compact design, providing superb value, and the best image quality and performance. Accuvix V20 The Accuvix V20’s ultrasound imaging system represents more than a decade of technology advancement in three-dimensional/four-dimensional ultrasound imaging at Samsung Medison. Economic Impact: Ultrasound is a very popular imaging modality that has relatively more market competition than other technology, such as CT and MRI. These procedures are typically a lower-cost alternative to other imaging procedures. There appears to be extensive growth in portable and hand-carried units. Entry-level portable units can start at less than $30,000 with premium departmental system prices ranging from less than $100,000 to $300,000, depending on the number of software applications and transducers purchased. WOMEN’S IMAGING PRODUCTS Women’s imaging products span multiple modalities, including digital radiography, computed radiography, ultrasound, molecular imaging and magnetic resonance imaging. These imaging solutions generally reside within the broader categories listed above. The market for breast imaging devices is expected to recover and continue growing at compound annual growth rate of 10 percent, reaching more than $1 billion by 2017, a market analysis shows. The report prepared by iData Research observes that a strong trend for faster, higher-quality imaging has resulted in an almost entire replacement of older analog mammography with more advanced systems. In addition, emergence of breastspecific gamma imaging as a supplement to mammography and ultrasound is the fastest growing segment of the breast imaging market. Together they form the basis of a projected double-digit growth of the market. 56 DIAGNOSTIC IMAGING WATCH - SPRING 2013 SUPPLIERS TECHNOLOGY SUMMARY AGFA DX-M http://www.agfahealthcare. com/global/en/main/products_services/computed_radiography/digitizers/dx_m.jsp AGFA’s DX-M is the only CR mammography to offer high-resolution cesium iodide needle IP for both gen rad and mammography applications. In addition, AGFA is the only CR mammography supplier to carry both FDA and EUREF designations. By supporting both standard phosphor plates and needle-based detectors, the DX-M unites complete convenience with top image quality, while leveraging a radiography department’s existing investments. With standard phosphor plates, the DX-M delivers excellent image quality. When used with DirectriX needle-based detectors, the DX-M provides excellent image quality with a much higher detective quantum efficiency. The DX-M digitizer unites the superb image quality necessary for mammography, with high throughput, delivered by a drop-and-go bufferbased workflow. Carestream http://www.carestream.com/ womenshealthcare.html DIRECTVIEW CR Systems DIRECTVIEW CR systems provide an affordable entry to digital mammography when coupled with DIRECTVIEW CR mammography cassettes and EHR-M screens. There are also solutions to improve workflow and productivity, and verify and report required image quality. CARESTREAM Vue Mammo Ranging from a standalone workstation through a comprehensive RIS/PACSviewing and reporting solution, Vue Mammo offers flexible configurations and productivity tools to suit unique digital breast imaging workflow demands. Film Solutions for Mammography Carestream’s mammography films offer an integrated approach with products, service and support. FUJIFILM http://fujifilmusa.com/products/medical/digital-mammography/information Aspire™ HD Plus Aspire™ HD Plus combines FUJIFILM’s groundbreaking Direct Optical Switching technology with single-touch positioning and ergonomic design to enhance the experience for patients, technologists and radiologists. Aspire HD Plus is a fully-featured system that not only provides brilliant images and ease of use for screening but also can be used with FUJIFILM’s stereotactic biopsy system. DIAGNOSTIC IMAGING WATCH - SPRING 2013 57 GE SensorySuite Mammography exams can be perceived as uncomfortable, unnerving and http://www3.gehealthcare. com/en/Products/Categories/ intimidating. One-fourth of women avoid mammograms because of worry Mammography/SensorySuite or fear. SensorySuite re-invents the experience, designed to help distract her from the perceived anxiety by surrounding patient’s senses in an allencompassing interactive event. By letting the patient choose the ambiance she prefers, the mammography exam can be less intimidating – addressing many of the reasons why women avoid a mammogram. SensorySuite is designed to: w improve the mammography experience for every woman w encourage patient compliance with mammography screening w promote a high level of patient care w differentiate a facility from others in the area A comprehensive marketing toolkit is included for promotion of the SensorySuite with patients and referring physicians, including pictures, a short video, sample letters and press releases, a patient reminder card and even an interactive patient presentation for facility’s Web page. Hitachi Aloka http://www.hitachimed.com/ The ProSound F75 The ProSound F75 is the latest addition to the Aloka ProSound high-end color series. The ProSound F75 is a multi-purpose diagnostic ultrasound system which provides unprecedented performance in a variety of clinical applications and is comfortable and easy to use. The ProSound F75 system has been designed with the new Hitachi Aloka “FIT” ethos (Facilitate workflow; Investment return; True diagnostic) at its heart and each system can be tailored to the needs of any clinician. The ProSound F75 reduces burden on the examiners and patients, maintains versatility at a high dimension, reduces patient dependency by increasing the level of diagnostic ability, and improves productivity of routine examinations with accuracy and efficiency. The ProSound F75 supports various scan methods, and a diversified lineup of specialty probes gives a variety of imaging capabilities to meet all imaging needs. The system’s new high-efficiency SmartProbes™ are very lightweight and designed to be high in energy conversion to transmit high-quality ultrasound beams without raising the temperature on the probe surface. 58 DIAGNOSTIC IMAGING WATCH - SPRING 2013 The ProSound F75 The ProSound Alpha 6 enables outstanding OB/GYN imaging even on the most technically difficult patients. Features include the following: w exceptional image quality and penetration capabilities thanks to tissue harmonic echo, Broadband Harmonics, AIP speckle reduction and spatial compound imaging technologies w color Doppler, power flow and new high definition eFLOW wfree angular M-mode for fetal heart exams at any angle Philips Healthcare http://www.healthcare.philips.com/us_en/clinicalspecialities/WomensHealthCare/ index.wpd MicroDose The MicroDose full-field digital mammography system uses a unique photoncounting detector technology that allows for outstanding image quality at a dramatically reduced dose. The MicroDose system addresses busy case volume by helping perform as many as 15 four-image examinations per hour and can cut radiation by up to 50 percent. Image resolution is 25 megapixels, enabling visualization of fine detailed structures in the breast, such as microcalcifications and spiculations. Siemens MAMMOMAT® Inspiration http://www.medical.siemens. com/webapp/wcs/stores/ servlet/ProductDisplay~q_ catalogId~e_-1~a_catTre e~e_100010,1007660,1275 5,1003504~a_langId~e_1~a_productId~e_182741~a_ storeId~e_10001.htm Digital mammography presents a unique opportunity to optimize the entire clinical workflow. The digital MAMMOMAT system offers shorter examination times, easy storage and transmission of images, as well as increased utilization of computer-aided detection and the improved capability to diagnose dense breasts. The MAMMOMAT® Inspiration platform for screening, diagnostics and stereotactic biopsy allows for one or all applications on a modular basis. The Opdose® feature of MAMMOMAT Inspiration is designed to minimize a patient’s radiation dose and exposure time. The intelligent Opcomp® function applies compression only as long as the patient’s breast is soft and pliable – stopping at the point of optimal compression. MAMMOMAT Inspiration allows screening of 15 or more patients per hour* and provides a smooth upgrade path – from the standard configuration needed for screening purposes to stereotactic biopsy. * Results may vary. Data is on file. DIAGNOSTIC IMAGING WATCH - SPRING 2013 59 Toshiba http://www.medical.toshiba. com/products/mr/breastimaging.php Bard http://www.bardbiopsy.com/ products/enspire.php Incorporating productivity-enhancing, patient-friendly Atlas technology, Toshiba’s innovative 1.5 T MR and 3 T MR systems are optimized for breast MR with the Radiance Plus Breast Imaging Package, featuring the eight-element Sentinelle Breast SPEEDER Coil. Features include the following: w performing breast exams feet first, reducing the high volume of patient exams cancelled due to patient discomfort and claustrophobia w dedicated, multi-element SPEEDER breast coil that is designed to provide high-resolution images of breasts and auxiliary tissues w CAD compatibility that offers the ability to reduce time required to interpret images and make biopsy planning easier for clinicians by automating data analysis ENCOR ENSPIRE™ Bard introduced ENCOR ENSPIRE™, the first smart biopsy system intended to provide breast tissue for histologic examination with partial or complete removal of the imaged abnormality. The system offers the simplicity of an intuitive touchscreen user interface, the ability to adapt to challenging lesions while in the breast and real-time visual confirmation of needle activity. ENCOR ENSPIRE has versatile performance in ultrasound, stereotactic and MRI imaging modalities. http://bardbiopsy.com/products/finesse.php FINESSE® ULTRA The FINESSE® ULTRA breast biopsy system is the only self-contained, vacuum-assisted, ultrasound-guided breast biopsy system with the ability to acquire multiple samples with a single probe insertion. With sample cycling time just 10 seconds, the FINESSE ULTRA acquires large, high-quality, contiguous tissue samples rapidly from a single insertion. Its sharp cutting tip and optional piercing mode penetrate dense breast tissue and lesions without displacing the lesion. http://bardbiopsy.com/products/max-core.php http://bardbiopsy.com/products/ultraclip_dual.php MAX-CORE® The MAX-CORE® disposable core biopsy instrument is a single-patient use, core biopsy device intended for use in obtaining biopsies from soft tissue, such as liver, kidney, prostate, breast, spleen, lymph nodes and various soft tissue tumors. The instrument is fully disposable and is available in various gauge sizes and lengths. UltraClip® The UltraClip® breast tissue marker is intended for use to attach to soft breast tissue at the surgical site during an open surgical breast biopsy or a percutaneous breast biopsy to radiographically mark the location of the biopsy procedure. The marker is designed for precision and ease of use. There are various shapes available for marking multiple sites within the same breast. 60 DIAGNOSTIC IMAGING WATCH - SPRING 2013 Mammotome http://www.mammotome. com/ revolve™ The only device to offer advanced tissue management technology, the revolve™ is designed to empower clinical decision-making, increase procedural efficiency and provide optimized sample reliability. Economic Impact: Women’s imaging products span multiple modalities, including digital radiography, computed radiography, ultrasound, molecular imaging and magnetic resonance imaging. As such, the cost to implement will vary based on the imaging technique(s) employed. Please refer to the appropriate section of the technology summary for guidance on the cost for a specific imaging modality associated with women’s imaging. Advancements in technology will continue to move at a fast pace to meet diagnostic and treatment needs in the areas of cardiology, osteoporosis, and breast and colorectal cancers. As new technology is developed, it will likely come with a higher initial price tag; however, existing technology that continues to be improved will tend to experience the same price erosion as others within the same modality. This document has been compiled based on information gathered from many primary and secondary sources, which Novation believes to be accurate to the best of its knowledge. It is intended as general information only and is provided as an accommodation to the members, however, and not as an authoritative basis for specific clinical decisions. Use of this data is at your sole risk. This information is presented “AS IS” and without any warranty or guarantee, expressed or implied, as to completeness or accuracy, or otherwise. As always, clinical decisions on behalf of any individual patient should be made by the attending physician. DIAGNOSTIC IMAGING WATCH - SPRING 2013 61 62 DIAGNOSTIC IMAGING WATCH - SPRING 2013 DIAGNOSTIC IMAGING WATCH - SPRING 2013 63 125 E. John Carpenter Freeway Irving, Texas 75062-2324 888/7-NOVATE novationco.com Mailing address: P.O. Box 140909 Irving, Texas 75014-0909 ©2013 Novation LLC. Novation is a registered trademark of Novation LLC. 04/13