April 2014

Techology Update: CT
By Keith Loria
Radiology Today
Vol. 15 No. 4 P. 26

Dose reduction remains in the spotlight, but scanner manufacturers see other needs driving CT purchase decisions.

Talk to physicians about CT scanners, and the conversation usually will turn toward radiation dose, but that’s not the only topic on the mind of specialists who work with CT on a daily basis. Spectral imaging, the ability to obtain more information from images, advanced iterative reconstruction techniques, and technologies to improve workflow also are important to evolving CT technology.

Jakub Mochon, Siemens Healthcare’s director of marketing and operations for CT, says dose reduction talk still is everywhere, but just as important is creating a better imaging experience for both patients and users. When it comes to the latest advancements and technology upgrades, the core theme from original equipment manufacturers (OEMs) seems to stem from the challenge of making CT systems that are fast, easy to use, and accurate.

Looking around the industry, recently released or announced CT scanners are designed to address new clinical pathways to personalized medicine and improve speed, ease of use, and accuracy. Today’s CT scanners provide clinicians with more information in the hope of helping physicians make earlier, more definitive diagnoses and improve patient care.

Doug Ryan, group vice president for Samsung’s health and medical equipment business unit, says that in addition to dose reduction, one trend he’s noticed in the industry is an increased focus on research and development on reconstruction technology. “The newest introduction is the idea of using a multilayer detector vs. a dual-energy [detector] for quantification,” he says. “I think that’s an area we will see expand in the next four or five years.”

Streamline Workflow, Reduce Cost
Andy Mack, Philips Healthcare’s senior director of product management for CT, says innovation has been reinvigorated regarding Philips CT offerings, and he sees this same trend throughout the industry.

“The surge of our CT innovation is motivated by the needs expressed by our customers,” Mack says. “We are working to support our customers in providing the shortest path to the best care at the lowest cost. As a result, we continue to invent new tools and provide new levels of information so clinicians are enabled to make a more confident diagnosis without increasing complexity in their routines and at low dose.”

Each of the major OEMs has been working to take advantage of new technology and provide the CT scanner solutions that their customers seek. “We are developing CT innovation in the areas of advanced iterative reconstruction, detector technology, workflow, and advanced visualization technologies,” Mack says. “Our continued focus is the impact these innovations have on enriching the realm of clinical information and improving the care being delivered to the patient.”

For example, Philips’ IQon Spectral CT is a spectral-detector CT system designed for simultaneous acquisition of different X-ray energies. “In the same way that white light is made up of a spectrum of colors, the X-ray beam used in CT scanners also consists of a spectrum of X-ray energies,” Mack says. “With the development of a fundamentally new spectral detector that can discriminate between X-ray photons of multiple high and low energies simultaneously, it adds a new dimension to CT imaging, delivering not only anatomical information, but also the ability to characterize structures based on their material makeup within a single scan.”

The company also touts iPatient, a platform designed to facilitate patient-centered workflow and the production of high-quality images at low dose levels. According to Mack, this platform will increase users’ ability to efficiently perform complex and advanced procedures and to handle future innovation, such as Philips’ IQon Spectral CT.

Steve Gray, president and CEO of molecular imaging CT and Advantage Workstation for GE Healthcare, sees a race involving strategy among the OEMs, with each company going in a different direction with technology trends and not just worrying about who’s fastest and who’s first. He believes GE’s focus on providing the best possible images with lowest possible doses with its Revolution CT has become the talk of the industry, as the technology enables clinicians to noninvasively visualize the human heart more clearly than ever before and diagnose more patients with erratic or high heart rates. The system, which is awaiting 510(k) approval, can capture a motion-free image of the human heart in just one beat.

“This will be the first CT scanner that’s right for everybody in every clinical specialty,” Gray says. “Revolution CT is able to scan even the most challenging patients, day in and day out, with remarkably clear images. And we made sure that using it is productive, logical, and intuitive.”

According to Gray, another step in low-dose technology is the introduction of the latest adaptive statistical iterative reconstruction (ASiR) technique, ASiR-V, which is part of Revolution CT. The technique combines the speed of ASiR with more of the capabilities of GE’s Veo full model–based iterative reconstruction. ASiR has been installed on more than 3,600 CT systems worldwide and has been involved in more than 31 million scans to date.

GE’s Discovery GSI, announced during RSNA 2013, is designed to reduce CT dose and deliver seamless workflow. Its purpose is to provide clinicians with patient care improvements such as virtual unenhanced imaging, and the first high heart rate coronary and stress perfusion protocol with integrated GSI Cardiac and SnapShot Freeze.

Tim Nicholson, senior manager of market development for Toshiba’s CT business unit, says his company has worked on ways not only to make its scanners faster but to find new ways to improve workflow and diagnosis. “In the last 12 months, we’ve really redefined our platform and redefined our outpatient safety and dose reduction on all our scanners,” he says. “We aim to provide the right technology for the right customers to fit their needs. We have a product line for every segment.”

Since Toshiba introduced its first Aquilion ONE in 2007, it’s been making modifications that have reduced radiation exposure up to 90%. Its Aquilion ONE ViSION utilizes an alternating focal spot that allows 16-cm z-axis coverage to be sampled twice, thus generating 640 slices in one rotation. Its innovative adaptive iterative dose reduction technology can acquire anatomical and functional data simultaneously to change and improve clinical pathways.

Portable CT
Samsung’s NeuroLogica series transforms fixed CT technologies into portable platforms, allowing physicians to utilize mobile devices, which Ryan says helps with safety and changes the whole point-of-care paradigm.

Last year, Samsung introduced its NeuroLogica BodyTom, the first portable, 32-slice full-body CT scanner. With an 85-cm gantry and 60-cm field of view, BodyTom enables surgeons to capture high-resolution 3D images intraoperatively and immediately verify surgical results before the patient leaves the operating room.

“BodyTom can be combined with surgical navigation, also known as image-guided surgery, to facilitate the guidance of surgical instruments relative to a patient’s anatomy, improving visualization and precision during minimally invasive surgical interventions,” Ryan says. “I believe we are the only company offering mobile CT in the market today, and we are looking to expand the mobile offerings in the future.”

Siemens’ FAST CARE platform of CT scanners helps enable faster, more efficient scans and as-low-as-possible patient radiation doses. CARE kV is one aspect of FAST CARE and automatically can suggest the correct tube voltage, depending on a patient’s anatomy and the organ to be scanned. “People that switched to CARE kV basically do 60% to 70% of imaging at lower than 120 [kV], so it’s an automatic gain in dose reduction,” Mochon says. “That has tremendous impact on the care provided to the patient.”

Improving patient experience also was behind the company’s 128-slice SOMATOM Perspective CT system, which, according to Mochon, was designed with the community hospital in mind and includes an illumination mood-light feature. Meanwhile, the company’s Force CT machine eliminates the need for patients to hold their breath to obtain chest or abdominal images.

Gray says customers across the board are looking for fast, definitive diagnoses. “Patient safety and being able to get outstanding clinical results at the lowest dose practical is still a big driver for our customers,” he says. “CT has always done an excellent job with [negative] predictive value. If a CT scanner tells you you’re healthy, 99% of the time you are healthy. But if a CT scanner tells you you are sick, and you go on to the cath lab, 40% of the time that you get there, you can leave. I think there’s a lot coming that will help get a more definitive answer and help it grow [CT’s] role.”

“Our goal at Philips is to deliver meaningful innovations that matter to our clinicians and their patients,” Mack says. “We continue to launch and provide solutions that help clinicians provide a confident diagnosis, deliver the best care to their patients, and help them do more with less.

Patients and Technologists
Mochon says Siemens talks with technologists to understand their needs and work on making technology that’s better for both them and their patients. “We want the patient to see a smile on the technologist’s face and be more relaxed, and for the technologist to be part of the solution,” he says. “We don’t want them to see that frustration and think it has something to do with their condition. If we can cut the amount of time that the technologist spends with the machine, then there will be more time to spend with the patient. That’s the philosophy behind our FAST [CARE] approach.”

Ryan believes that health care now requires more cost-effective solutions thanks to government reimbursement cutbacks, resulting in hospitals using a mixture of high-end CT scanners and general systems for body imaging and contrast study.

As a result of accountable care and reimbursement reductions, Mack says hospitals are looking for ways to do more with less. “We recognize their challenges and are diligently innovating solutions that can help them to get to their diagnosis faster while at the same time providing the best care at the lowest cost,” he says.

CT is the backbone of diagnosis in health care organizations because it delivers high image quality, low dose, and speed to help clinicians manage challenging and diverse clinical scenarios.

Looking into a hypothetical crystal ball, Ryan believes the future of CT will be scanners that are faster, more automated, and easier to use, with the goal of transitioning from a good interpretation tool to something with more quantification and a speedy and direct diagnosis.

— Keith Loria is a freelance writer based in northern Virginia.