Vendors showcase the latest medical imaging technological advances each year during the annual Radiological Society of North America (RSNA) meeting in Chicago, always held the week following Thanksgiving. After spending a week walking the show floor and meeting with scores of vendors, the following are some of ITN Editor Dave Fornell's choices for the most innovative new radiology technologies introduced in 2011.

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IBA ProteusONE offers uncompromised treatment solutions enabling physicians to leverage the clinical effectiveness of proton beam therapy. While Pencil Beam Scanning enables the delivery of Intensity Modulated Proton Therapy (IMPT) treatment plans, the latest imaging techniques make Image Guided Proton Therapy (IGPT) possible. ProteusONE has been inspired by everyday clinical practice. Its design enhances the patient experience by fostering a soothing environment while making the medical staff's daily practice safer and easier. Finally ProteusONE is IBA's response to making protons affordable. It is a proton therapy system that is smaller, more affordable, easier to install, easier to operate and ultimately easier to finance. With ProteusONE, protons are possible for more patients worldwide.

For more information: www.iba-worldwide.com

IBA showcased its noninvasive radiation oncology treatment systems during the American Association of Physicists in Medicine (AAPM) 2011 annual meeting. This included its new Proteus One proton therapy system, advanced dose management and the addition of cone-beam computed tomography (CT) to help guide therapy.

For more information: www.IBA-protontherapy.com

The American Association of Physicists in Medicine (AAPM) is taking steps to help guide the future of its specialty, said AAPM President Tony Seibert, Ph.D. During the group's 2011 meeting, Seibert explained there is a shift in healthcare priorities from research to a more clinical emphasis. AAPM is encouraging younger members to get involved and keep research as an important part of medical physics, so advances can be made to eventually improve patient care.

Imaging is expanding its role in radiotherapy systems, which will require additional medical physics in that area, he said. In addition, AAPM is working with both government agencies and industry in efforts to push forward new protocols, and technology.

For more information: www.aapm.org

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Eliot Siegel, M.D., FSIIM, FACR, who is on the Board of Directors of the Society for Imaging Informatics in Medicine (SIIM), gives an overview of several programs that are part of the 2011 SIIM annual meeting and exoplains the benefits of the society. Siegel is professor and vice chair radiology for the University of Maryland School of Medicine Department of Diagnostic Radiology and chief of imaging for the VA Maryland Healthcare System.

Among the programs Siegel describes are the opening session on meaningful use rules; the "Ghost of Radiology Future," a look at the future challenge of regulations on the industry, and "Mind the Gap," about managing healthcare reform with informatics. The meeting also includes several new learning tracks, including ones on image sharing, improving efficiency in the reading room and imaging department, and new archival and storage models. There also will be round table sessions and a Sunday morning hands-on "Tools of the Trade" series.

For more information: www.siim.org

This podcast explains how syngo Dynamics can be used to integrate cardiac imaging picture archiving and communication (PACS) and cardiology reporting systems into one platform.

The 2011 National Consortium of Breast Centers (NCoBC) annual meeting broke all attendance records, according to Yuri Parisky, M.D., vice president of NCoBC. He said the event highlighted the biggest trends in breast cancer imaging and treatment from specialties including radiology, radiation therapy, oncology, pharmaceuticals and plastic surgery. Parisky said digital mammography, which makes up about 75 percent of the U.S. market, continues to grow. In addition, tomosynthesis and molecular breast imaging are gaining ground. Three major trends in breast imaging and oncology include attempts to lower imaging radiation dose exposure, earlier detection of cancer and more minimally invasive interventions to both preserve breast tissue and reduce scarring.

IBA introduced its new Proteus One proton treatment system during ASTRO 2010. It is about one-third the size of current proton treatment systems, taking up about the same amount of space as two linac rooms side-by-side. The Proteus One is designed to offer more patient access to proton therapy by making the treatment system easier to install. It is also designed to be used as a single treatment room installation, rather than sharing a larger cyclotron and beam with several treatment rooms. For more information: www.iba-worldwide.com

American Association of Physicists in Medicine (AAPM) President Mike Herman, Ph.D., radiation oncology medical physicist, Mayo Clinic, explains the role of the society and its goal to improve patient care. Activities include sharing the latest scientific research, developing best practices, education, setting guidelines for certification and the roles of various staff under mediacl physicists, and how physicists can better serve their hospitals. The main focus in sessions at the AAPM annual meeting include patient safety concerning radiation dose and how to lower these doses in practice. Herman said AAPM is also calling for a national patient safety event recording process to make it easier to see where there are mistakes so they can be addressed. The society is also Herman said the process needs to be easy to access and use. He spoke to ITN at the some 2010, 52nd annual AAPM meeting 

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An interview with Peter Herscovitch, M.D., chief of the positron emission tomography (PET) department, senior attending physician, National Institutes of Health (NIH) Clinical Center, who explains why it is important to develop comparative effectiveness trials of PET.  He was the chair of the 2010 committee on scientific program at Society of Nuclear Medicine (SNM - SNMMI) annual meeting. 

"Most people have no idea what a tremendous impact radiology and telemedicine have on poor and remote regions of the world," said Rebecca Cornelius, M.D., professor of radiology, neuroradiology, department of radiology, University Hospital, University of Cincinnati, College of Medicine. Cornelius was one of the physicians on the panel and video presentation "Zero Footprint Radiology and Telemedicine Build a Platform for Sustainable Care," which Imaging Technology News (ITN) hosted at the SIIM 2010 annual meeting.

The panelists described how physicians based in the United States used teleradiology and telemedicine technology to treat patients located in a remote clinic in Honduras. The panelists made the case that this technology suite is the basis for sustainable health care outreach programs in the future. ITN Editor Cristen Bolan then presented a video illustrating how physicians and technicians equipped The Roy and Melanie Sanders Frontera Medical Center in Honduras with the digital imaging and informatics infrastructure.

Several providers donated the suite of imaging technology. The equipment included a telemedicine system and ultrasound probe from Global Media, the VirtualPACS Web-based picture archiving and communication system (PACS) from MedWeb, a portable digital x-ray system from MinXray and a computed radiography (CR) unit from iCRco.

In this video, Dr. Juan Vasquez gives a live demonstration of how the imaging suite quickly and seamlessly operates. Vasquez started by taking an X-ray image, processing and reviewing it on the CR, and uploading the data set to the PACS in under 10 minutes. The guest of honor, Honduran Minister of Health Arturo Bendaña, himself a trained physician, easily toggled through the streamlined digital workflow. Vasquez explained how the transition from film to digital x-ray would save the clinic on significant costs incurred from developing film. Vasquez then examined a patient's thyroid gland with the ultrasound probe connected to a laptop computer. Next, he used a high-definition telemedicine camera to capture superficial anatomical images. Finally, he uploaded the images and consulted with physicians over Global Media's video-conferencing system. Jeffrey E. Heck, M.D., executive director and founder of Shoulder to Shoulder, explained to onlookers this was a model for delivering high-tech care, including expert specialty consultations, to some of the most remote and isolated areas of the developing world.

"With the addition of this technology, poor people have access to the same set of services that any well-equipped health center in the United States has access to," Heck said.

The panelists included: - Rebecca Cornelius, M.D., professor of radiology, neuroradiology (Clin Geo), University Hospital; University of Cincinnati, College of Medicine; Department of Radiology - Phillip Silberberg, M.D., head of Shoulder-to-Shoulder Radiology, pediatric radiologist, Kosair Childrenâ??s Hospital, - Roland Talanow, M.D., Ph.D., department of radiology, The Cleveland Clinic - Hayley Holland, MPH, director of grants and projects, Shoulder-to-Shoulder - Kim Guevara, corporate philanthropy officer and director of emergency management, Medweb. For more information: www.shouldertoshoulder.org

Related Radiology and Telemedicine in Honduras:

Radiologists Without Borders: The Heart of Radiology

ACS, Teleradiology Deliver Modern Healthcare to Honduras

Digital Imaging Delivers Modern Medicine to the Developing World

Digital Imaging Transforms a Nation

Radiology IT Explores New Frontiers

Computed Radiography Delivers Modern Medicine to Remote Regions

Radiology Delivers Modern Medicine to Rural Honduras

Michael Ringold, M.D., interventional radiologist, St. Luke's Hospital and Health Network, Bethlehem, Pa., explains how GEâ??s Innova system is used to perform embolization of hepatic tumors.

Musculoskeletal injuries are of concern to many interventional radiologists due to the constant positioning, twisting and turning to see the fluoro monitors. Kenneth Chin, M.D., of the San Fernando Valley Interventional Radiology and Imaging Center, explains how GEâ??s Innova imaging system helps to avoid these injuries.

Prashant Patel, M.D., St. Luke's Hospital and Health Network, Bethleham, Pa., explains a case where he uses GE's Innova for an arteriogram, embolization and cystography in a single session for a trauma case.

Dr. Thierry DeBaere, head of surgical radiology at the Institut Gustave Roussy in Villejuif, France explains how he uses the GE Heathcare Innova Vision to perform a portal vein embolization on a patient with liver cancer.

There is no doubt that medical imaging procedures save lives. However, one size does not fit all. Because children are three to five times more sensitive to radiation than adults, and cumulative radiation exposure can have adverse effects, it is critical for doctors to lower radiation levels when imaging a child. That is why in 2007, the Society for Pediatric Radiology (SPR) initiated the Alliance for Radiation Safety in Pediatric Imaging. Not long after, the American College of Radiology (ACR), the American Society of Radiologic Technologists (ASRT), and the American Association of Physicists in Medicine (AAPM) joined the Alliance.

The Image Gently campaign is the Alliance's initiative to raise awareness for lowering radiation dose used in pediatric imaging. The aliance is actively working with imaging manufacturers to standardize dose assessment and display for children. Although disagreements about the accuracy of the risk models or the degree to which the risks of radiation are emphasized are ongoing within the medical community, the message of the Image Gently campaign is clear: Reduce or "child-size" the amount of radiation used when obtaining a CT scan in children. To child-size the amount of radiation used, Image Gently encourages doctors to ask their medical physicist to determine the baseline radiation dose for an adult for that site's equipment and compare that dose with the ACR Standards.

While these guidelines are clear, it is not certain how widely doctors have implemented these radiation-reducing measures to date. To gage the impact Image Gently on medical imaging practices, Imaging Technology News (ITN) spoke with Marilyn Goske, M.D., chair of the Alliance, and Neil Johnson, M.D., president of the Society for Pediatric Imaging, both practice at Cincinnati Children's Hospital.

ITN: How serious a risk does radiation imaging pose to children?

Dr. Goske: One of the first things we need to remember is when children have imaging it is being done for an indicated medical condition and for a benefit for that patient. That is really what the Image Gently campaign revolves around. Once a study if medically indicated it behooves all of us in pediatric imaging to promote radiation protection and try to lower the dose and still maintain the quality of the exam so that we get the diagnostic information that we need. We know from studies, particularly from the atomic bomb survivors in Japan, that if children receive radiation from a bomb blast such as that one, they are more sensitive to radiation. Now medical imaging is different as it's a different form of energy and quite diffrent in how it's given for the imaging test, but it's the best we have. The data from that tells us that we need to be overly cautious and conservative, and that if we are going to use this technology, we want to use it in the safest way possible.

ITN: How exactly is the Alliance standardizing dose assessment and display for children?

Dr. Goske: We are working together under the direction of Keith Straus, who is the medical physicist at Boston Children's Hospital, Mr. Tom Toth, who is the former chief physicist at GE Healthcare, and Stephen Vastaghat the Medical Imaging Technology Alliance (MITA). The four major CT vendors have signed on to come up with more standardized dose displays so that when we complete a CT scan and we look at the images on task and that we have the information we need to interpret the information more accurately. Under the current system the CT dose that is displayed, which is the CT dye volume and the DLC are based on 32-centimeter adult-size phantoms. So if the patient is on the table and is exactly the same size as the phantom, the dose display is reasonably accurate. But in our patient population where you have an infant who weighs 5 lbs., for example, the younger they are, the smaller they are compared to the size of the phantom, and the more discrepant the dose display is. According Mr. Strauss in a paper that he published, the dose display can be off by a factor of three. So we are actually underestimating radiation dose for those small patients. We are working with numbers to get those displays more accurate so that radiologists, radiologic technologists and medical physicists have a better idea of what our smaller patients are really getting in terms of radiation dose during CT scans and other imaging procedures. Dr. Johnson: It's a very simplistic but important idea that we give our patients the right dose. We use the analogy of flying. We all fly in a commercial aircrafts, so we take risks. But there is a huge benefit when we minimize the risk. What we are trying to do is minimize the dose of radiation to children. We are not trying to stop these scans when they are needed medically. We are trying to do them with the minimum dose possible.