Smart Look
By Keith Loria
Radiology Today
Vol. 20 No. 9 P. 18

AI is one of the most significant trends shaping DR’s future.

The move to DR from CR and conventional analog X-ray systems continues, but the industry is nearing the end of the transition cycle. The image quality and workflow advantages of DR are now benefiting most patients in both mature and emerging markets.

“The most significant new trend in the industry in this context is artificial intelligence applications that promise to improve clinical confidence and efficiency, and there is a lot of AI innovation happening specifically in the X-ray modality,” says Katelyn Nye, GE Healthcare’s global product manager, artificial intelligence & analytics, X-ray. “Coupled with that, we see patient experience becoming a much higher priority than before. This is driving vendors to provide more automation and ergonomic design in the X-ray room.”

Guillermo Sander, director of marketing, digital radiography for Konica Minolta Healthcare, says as DR matures, there’s been an increase in demand for better image quality and more information from the X-ray system. This drive underscores the need for AI in X-ray.

“As image quality increases, the volume of information contained in an X-ray will also increase,” Sander says. “Better image quality means radiologists can see more and do more with DR. Radiologists will be able to use advanced image processing and AI algorithms to further interrogate the digital X-ray image and see things in ways they’ve never seen before when using radiography.” Therefore, AI will give clinicians the extra information from X-ray images they need to make accurate diagnoses and therapeutic decisions.

Sarah Verna, Carestream’s worldwide marketing manager for Global X-ray Solutions, says the aging population will drive greater demand for medical imaging, and diagnostic medical imaging is moving from hospitals to outpatient centers.

“Manufacturers need to establish a larger distribution channel to reach customers outside the traditional hospital environment,” Verna says. “Today, patients are more empowered. As medical consumerism grows, manufacturers must produce equipment that incorporates leading-edge technology and prioritizes patient satisfaction.”

Additionally, Verna sees the imaging industry moving toward a simplified look and feel for X-ray rooms with an eye on industrial design. “More features and functionality are moving into mid- and low-tier systems, similar to the car industry where end users are expecting capabilities that were once a premium feature,” she says. “Additional enhancements to mobile units include larger display screens as well as collapsible columns that allow full line of sight while driving and positioning these systems.”

Here’s a look at the latest DR systems:

GE Healthcare
GE Healthcare’s newest DR equipment features the new Helix advanced image processing and the high-resolution FlashPad HD detectors.

“We’ve quadrupled the amount of information our detectors capture—reaching 100-micron pixel resolution,” Nye says. “The Helix image processing delivers up to a 40% increase in detection of fine structures. This matters, for example, in the detection of subtle wrist fractures that can be missed. And while increasing the resolution, we refuse to compromise on dose, delivering as little as half the dose of CR or alternative flat-panel detectors of lower [detective quantum efficiency].”

Helix and FlashPad HD are powering GE’s Discovery XR656 HD, Optima XR646 HD DR systems, as well as the Optima XR240amx portable X-ray. Additionally, at RSNA 2018, the company announced the Critical Care Suite, an AI application embedded in a mobile X-ray device designed to identify critical conditions such as pneumothorax and enable PACS worklist notifications for the radiologist.

“The AI algorithm runs on the X-ray device, our Optima XR240amx portable, and does not need cloud access to run. It automatically runs within seconds at the bedside of the patient and sends an image flag and secondary [DICOM image file] to PACS when a pneumothorax is detected,” Nye says. “Critical Care Suite is 510k pending at US FDA.”

Critical Care Suite is the result of GE Healthcare’s collaboration with four different research partners across three countries, from concept development to the annotation of images that were used to train its deep learning algorithms.

Konica Minolta Healthcare
Konica Minolta’s new Dynamic Digital Radiography (DDR) technology lets clinicians use a conventional digital X-ray system to capture motion so they can view anatomical structures relative to physiological changes and time.

“In thoracic and pulmonary imaging, DDR provides a full view of chest, lung, and organ movement during the respiratory cycle,” Sander says. “With X-ray that captures motion, clinicians can visualize diaphragmatic, heart, and lung motion during successive respiratory and cardiac cycles. This is the foundation upon which we will apply advanced analytics and AI to provide a greater level of diagnostic information.”

The company has also introduced the AeroDR HD Wireless Flat Panel Detector, which has rapid acquisition capabilities and combines high sensitivity and smaller pixel size in a lightweight and waterproof enclosure.

“This high-definition detector delivers four times more than standard resolution, giving clinicians more insight for precise imaging in extremities, pediatrics, and other specialties where subtle details are critical for accurate diagnosis,” Sander says. “Designed for portability with a protective waterproof enclosure and a new ergonomic design, it absorbs impacts from bumps and drops and has higher drop resistance, higher load resistance, and higher bend resistance.”

Konica Minolta recently partnered with the Icahn School of Medicine at Mount Sinai in New York to study the impact of DDR on thoracic imaging and concluded that DDR may be a clinically relevant option to assess COPD severity in the acute setting as well as for patients unable to perform pulmonary function tests.

“DDR has the potential to help both the pulmonologist and the radiologist to more clearly identify newly recognized pathophysiologic abnormalities and better understand the context of the underlying disease,” Sander says.

A poster presentation by Mary M. O’Sullivan, MD, an assistant professor of medicine at the Icahn School of Medicine, at the American Thoracic Society 2019 International Conference demonstrated that DDR may allow for earlier discovery and a clearer understanding of the etiology of dyspnea in patients by enabling direct visualization of the kinesiology of the respiratory system, helping clinicians to streamline tests and reduce the time from evaluation to diagnosis.

Philips Healthcare
The latest innovation for Philips Healthcare is DigitalDiagnost C90, a DR system that features an industry first: a live camera image shown directly at the tube head.

“We developed this in collaboration with customers to counter retakes due to false positioning and patient movement,” says Sandra Burghardt, the company’s marketing director for diagnostic X-ray. “In the examination room, the camera assists the technologist with positioning and finding the right collimation area—a not-so-trivial task, particularly when dealing with bariatric patients.”

Additionally, in the control room, the live camera image is displayed on the workstation monitor. In this way, technologists can remotely double check whether the patient is in the right position or needs readjustment, something that is especially important for patients, such as the elderly or children, who have difficulties holding certain positions. This double-check is done before taking the exposure and allows technologists to avoid retakes as well as unnecessary doses.

“The Eleva tube head of the DigitalDiagnost C90 can speed up workflow by 28 seconds per examination on average—16.9% faster than the previous release of DigitalDiagnost,” Burghardt says. “In our clinical study, 94% of users stated that the live camera images at the workstation help to avoid retakes.”

The DigitalDiagnost C90 also features a mechanism—which includes a patient-facing welcome screen—that allows technologists to see all relevant patient data before starting an examination and address patients personally.

“This is not only a safety feature to avoid patient mix-ups, but it also creates a personal atmosphere and allows the technologist to spend more time with the patient,” Burghardt says. “For the development of the DigitalDiagnost C90, we invited clinicians from several hospitals to our development site in Hamburg and performed ongoing user experience testing on our prototypes. After the launch of the new system, we’re very keen to continuously collect customer feedback, as there are increasing demands on the performance and quality of health care to address with our future innovations.”

Carestream’s DRX-Evolution Plus includes a table with higher weight capacity, enhanced pediatric capabilities, extended tube-column range for sites with high ceilings, plus a design that can accommodate new advanced applications as they’re released. The company’s strategic planning process involves working closely with regional leaders to review trends and gather feedback from its medical imaging customers. With that in mind, Verna says Carestream’s DR equipment portfolio includes DR room-based and mobile imaging systems that address imaging needs for small, medium, and large facilities.

“In addition to LED lighting, room-based systems can provide music selections to help customers relax during an exam,” Verna says. “These systems can also be implemented in satellite locations that are more convenient for patients. Mobile systems improve a patient’s comfort and experience and can provide imaging data to help clinicians enhance the overall quality of care.”

Siemens Healthineers North America
Siemens Healthineers North America’s latest development in DR is the Mobilett Elara Max portable X-ray system, which was cleared by the FDA in March, with features that enable comprehensive IT security as well as secure system integration into the hospital’s IT environment for anytime access to patient data.

“It’s all about workflow and improving efficiency, decreasing the time working with the equipment, and increasing the time working with the patient,” says Joseph D’Antonio, the company’s senior director of X-ray products. “When you look at portable X-ray, most hospitals have more than one unit, which are utilized when patients can’t be taken to the radiology department, so they bring the radiology department up to them.”

The Mobilett Elara Max is built on a Windows 10 workstation; key features include an option for a virtual workstation and antimicrobial coating for better cleaning. “Our integrated cable design and antimicrobial coating is unique to our system,” D’Antonio says.

DR of the Future
The industry is at the start of an exciting journey in medical imaging—especially in X-ray, Nye says. “We anticipate more applications of AI and analytics in the future,” she says. “The combination of deep learning, computing power, and access to big clinical data will touch all stakeholders, helping the technologists, radiologists, and administrators be more effective at their job and improve patient care.”

Burghardt says Philips’ future direction for digital X-ray engagement will likely focus on more adaptive intelligence and workflow. “We believe helping to improve operational excellence through smart and autonomous-acting modalities may add the most significant value to X-ray imaging,” she says. “Furthermore, technologies providing more user-independent outcomes on a consistently high quality level help caregivers stay on the clinical edge at manageable costs.”

Konica Minolta personnel believe that DDR and X-ray that moves is the key to the future, especially when quantifiable data are added through the use of AI, according to Sander.

“Within a few years, we will start to see how AI will guide the radiologist through their diagnosis,” Sander says. “In the future, we believe AI will help radiologists quickly identify normal scans, becoming more efficient in their diagnoses, so that they can spend more time diagnosing abnormal pathology and focus on the complex patient cases.”

— Keith Loria is a freelance writer based in Oakton, Virginia.