Diagnostic Reading: Five Must-Read Articles from the Past Week

This week’s Diagnostic Readings include a look at the history of the RSNA conference, healthcare technology updates, industry accomplishments and more. Check out our weekly series, “Diagnostic Reading,” for news and updates in healthcare IT and radiology.rsna_afiche

1) Constant Change Characterizes RSNA’s First 100 Years

As we prepare for the 100th annual RSNA conference on November 30, take a look at the development that the field has made since the first RSNA conference. This article examines current market trends and discusses how radiology has grown over the past century.

2) Health IT Enabled Quality Improvement: A Vision for Better Health and Health Care

According to the ONC, this paper “describes ONC’s vision for advancing the use of health IT to support transformational improvement in health care quality and value.  It invites health IT stakeholders – clinicians, consumers, hospitals, public health, technology developers, payers, researchers, policymakers and many others – to join ONC in shaping the future with a renewed focus on health and care quality as the ‘why’ that aligns with the ‘what’ of interoperable health information systems.”

3) DeSalvo Discusses Future of Health IT, Growing Pains

Karen DeSalvo, Acting Assistant Secretary for Health to the Obama administration, gives an overview of the adoption of health IT. She discusses the primary challenges that the healthcare industry is facing when it comes to technology. Furthermore, DeSalvo is encouraged that electronic health records can be implemented and facilitate the meaningful use process.

4) Emory Healthcare Shares Imaging Processes for Ebola Patients

Emory University Hospital was responsible for curing all four Ebola patients that went to their facility this fall. One of the most important factors in this success was the use of radiology. This article summary explains the importance of portable computed radiology to obtain chest x-rays from patients with dangerous infections such as Ebola.

5) Quality and Contract Negotiations: Putting a Price on Quality

Healthcare is facing a time where quality of patient care is as important as any other aspect healthcare. This article discusses how radiologists are not judged by the same criteria as primary care physicians (availability of parking, waiting time, etc.). Quality in radiology is judged by the ‘fast and accurate diagnostic imaging results and superior patient outcomes’—standards that are difficult to quantify. Read how the radiology field can add quality to the care of each patient that is encountered.

Top Trends to Expect at RSNA 2014

PrintThis year marks the 100th annual RSNA conference, with the theme “A Century of Transforming Medicine.” Over the last century, we have achieved the unthinkable. Never would we have thought that we can capture a 3D image with such clarity and accuracy, or that we could transfer high-quality digital radiology images instantly through powerful wireless technology. After continuous progressive advancement in medical imaging technology, radiology has become one of the most integral parts of the healthcare continuum. Radiology will constantly evolve and improve, and here we list a few of the top trends you can expect to hear about at RSNA 2014:

Adoption of Big Data

Big Data is a highly sophisticated topic to discuss. Simply put, it is a collection of billions of bytes of data that is collected, mined and analyzed. Software is then used to create reports and prediction algorithms based on findings from the data. Dr. Daniel Rubin, an assistant professor of radiology & medicine at Stanford University, said that in the future big data will be utilized to pull information harvested from historical data in patients’ archives in order to guide clinicians in the decision-making process by pursuing ‘evidence-based’ care. He added that imaging will be a crucial component in the future if we are to embrace the adoption of big data.

New Premium CT-Scanners & MRI Systems

With the ever-advancing technology in the medical imaging profession, companies are racing against each other to build the most advanced and reliable CT-Scanner and/or MRI Systems. In a research article by Greg Freihrerr, the assertion is the market will demand much faster CT-Scans but with more accuracy and more flexibility that allows the CT-Scan to perform exams amidst clinical difficulties. More importantly, the market will demand a significant decrease in radiation dose.

Decreasing Dose

This subject continues to be an important topic of conversation and debate. Many companies are driven to and strive for lowering dose in their medical imaging systems. In relation to X-ray systems however, when analyzing how to lower dose, companies do not necessarily have to redesign these technologies. Dan Harvey wrote in Radiology Today that “DR detector enhancements have led to improve dose efficiency.” Detectors convert X-ray into signals, which are then translated into an image. The more efficient the detector is, the lower the dose needed for an X-ray exam. Improving the DR detectors not only lead to decreasing dose, but also ultimately improving the images captured as well.

Improving productivity

In Radiology Today, Amit Dedhia and Shujah Das Gupta believed that healthcare costs are constantly rising, pushing radiology to become more “outcome-based and value-driven.” Many companies have developed products and software that help increase the productivity of radiologists. The idea is to improve the efficiency of work flow and increase productivity, but at the same time making the experience more patient-centric. For instance, Carestream has developed software to remove the ribs from a chest X-ray image in order for radiologists to see soft tissue more clearly and help them better visualize lung nodules and other pathology. This can add value for radiologists and can be a helpful diagnostic tool for clinicians in determining the best treatment for each individual patient. Dedhia and Gupta wrote that by using analytics, radiologists can pull actionable insights from a large pool of data. By doing that, workflow becomes much more efficient as machines can make better and accurate assessment based on patterns derived from the data.

Many challenges stand between a greater improvement in image quality, dose reduction, and lowering costs. With these trends in mind, we can see that radiology is moving towards value-based customer-centric system. Radiology will advance beyond what it is today towards the future.

What top trends do you expect in RSNA 2014?

Carestream CMONorman Yung is the CMO of Carestream Health. He will be attending RSNA 2014, come and meet him at our booth at McCormick Place in Chicago,  South Hall Booth #4735.


Infographic: The Evolution of Radiology Reporting

Cristine Kao, Healthcare IT, Carestream

Cristine Kao, Global Marketing Manager, Healthcare Information Solutions, Carestream

We have come a long way since the days of handwritten radiology reports. What was once difficult to read and understand has evolved into a narrative history of a patient’s medical imaging experiences.

Radiology has now reached its pinnacle with multimedia reporting. An interactive, complete report full of graphs, charts, high-res images, hyperlinks, and videos can provide the radiologists with a patient’s complete history.

We live in an era where visuals are needed to tell the story and complement the written report. By combining these features in multimedia reporting, radiologists can ensure that they truly understand their patients and that the information is easily accessible at a moment’s notice.

The infographic below takes you through the history of radiology reporting, and how it has gotten to where it is today, along with the pros and cons of each evolutionary stage.

Additionally, at RSNA 2014, scientists from Emory University and Carestream will present a scientific poster entitled “Traditional Text vs. Image and Interactive Data Embedded Multimedia Enhanced Radiology Reporting: Referring Physicians’ Perceptions about Value,” on Wednesday, Dec. 3, from 12:15-12:45 pm in Learning Center, Hall D.

Evolution of Radiology Infographic

Radiology and Macro Healthcare Trends Part III: Quality Care

On-site or cloud-based teleradiology can provide effective patient care.

An on-site or cloud-based teleradiology system can connect radiologists to reports, images, and patient history to provide efficient and effective care.

Part II of this series explored how radiology can impact cost effectiveness at healthcare facilities.  In this final post, we will look at delivering quality care in our new healthcare environment.

New regulations, controlled costs for facilities and patients, and technological innovations have given healthcare providers the ability to more easily provide patients a high-quality level of care. Particularly in radiology, we see significant advances in the products and software that support the capture and delivery of images.

Patients expect that the care they receive will be of the highest quality.  To contribute to this, radiologists should think about the following:

  • Streamlining Communication
    • Making sure that getting to images and results is easy for technologists, doctors and patients. One way to do this is leverage new technology that provides a platform from which this is possible.  Doctor and patient portals are becoming more and more popular – and standard functionality – across many types of healthcare facilities.
  • Playing a Role in Patient Communication
    • Instead of seeing radiology outside of the healthcare continuum, facilities and radiology professionals can work to see how imaging has a direct impact on the quality of patient care. This understanding must be facility-wide so that radiologists have the support they need to become part of the continuum and to be educated on how to communicate with patients.

Technological advances such as reporting platforms that offer native voice recognition, RIS or PACS integration, and advanced reporting, support internal and patient communication.  Having a strong, integrated reporting system contributes to reducing delays in processing and produces better, more contextual reporting.

One area in which streamlining communication and patient communication is having a greater impact is in the area of telemedicine.

Telemedicine, and to be more specific, teleradiology, has not entirely come to fruition because of laws and payment systems that are more encouraging for face-to-face doctor-patient visits. In the U.S., doctors are licensed by states, but the rules follow where the patients live, so doctors must also be registered in their patients’ states too. In the European Union, doctors are licensed by country and have the free reign to practice throughout the union, no matter where their patient lives.

While the U.S. may seem more conservative with telemedicine laws, telemedicine practiced within a state has its advantages. It can be difficult for those living in rural areas to have access to quality care. With a broadband connection, telemedicine can provide rural populations with high-quality care that many in more populous areas have access to. This is certainly the case in China, where it is spending billions on healthcare reform with an emphasis on teleradiology.

What do you think? Are you seeing radiology become an integrated, vital component of quality healthcare? Are there other trends to keep an eye on? 

Carestream CMONorman Yung is the CMO for Carestream. His series about macro trends in healthcare is being published in three parts. Part I was posted in September and Part II was published in October.


Diagnostic Reading: Five Must-Read Articles from the Past Week


On-site or cloud-based teleradiology can provide effective patient care.

An on-site or cloud-based teleradiology system can connect radiologists to reports, images, and patient history to provide efficient and effective care.

This week’s Diagnostic Readings include updates on meaningful use, analysis of telemedicine growth, tips about dose management and more. Check out our weekly series, “Diagnostic Reading,” for news and updates in healthcare IT and radiology.

1) Survey Indicates Telemedicine Adoption Growth among Healthcare Executives

This post presents the results of a survey taken by 57 healthcare executives. The findings explore the extent to which health care systems are adopting telemedicine and electronic health records (EHR). The author explores the the channels of telemedicine that are the most popular among this sample group.

2) Enterprise Imaging—Walking the tightrope: Optimizing radiation dose management 

Since the 1980s, the annual per-capita radiation dose from medical exposure has risen from 0.53 mSv to 3.1 mSv. This article from the November edition of Applied Radiology explores the challenges and solutions of moderating dose. The author discusses how the balance of radiation dose management can be optimized.

3) AMA Urges CMS to Drop Meaningful Use Penalties

This article addresses the existing meaningful use criteria and the difficulties that some medical centers may encounter. This piece discusses that reasons outside of a physician’s control may be the reason for their lack of interoperability. Due to these difficulties, the American Medical Association has asked the Centers for Medicare & Medicaid Services to “suspend all penalties to physicians and healthcare facilities for failure to meet meaningful use criteria.”

4)  It’s Time for Radiology to Take Peer Review Seriously

This post discusses the importance of knowing your diagnostic accuracy rate in radiography. The author writes about comparing accuracy rates to bench marks and national standards. These ideas could lead to more accurate readings and more industry-wide credibility.

5) To Improve Mammography Reading Accuracy, Follow Through with Workups

This article discusses the correlation between reading high volumes of mammography readings and accuracy rates. The study conducted at the Group Health Research Institute in Seattle found that radiologists with higher numbers of annual workups had higher screening sensitivity and cancer-detection.

Webinar: The Future on Displays


Click the image to go to the sign-up page for the webinar, “The Future on Displays.”

On Tuesday, November 18, I will be presenting a webinar titled, “The Future of Displays.” The goal of this presentation is to provide attendees with an idea of what they can expect to see in the evolution of medical-grade monitors they work with on a routine basis, and how they differ from conventional displays.

Multi-modality hybrid diagnostic displays are essentially the future of image viewing in radiology. The image quality and versatility these monitors offer for facilities have been able to improve efficiency and allow for remote access to images from a central point, which also allows the execution of remote calibration and performance monitoring.

After the webinar, it is my goal that attendees can take away the following information:

1) Why medical monitors are needed over conventional monitors. This is especially true for telemedicine. We must ensure that radiologists conducting the readings have the same set up and same calibration as the technologies at the physical imaging center, so that they are both viewing the same image.

2) Screen elements that have an impact on image quality. Luminance, sharpness, brightness, contrast, gamma, uniformity, grayscale, and panel technology are elements that will be discussed. These image technologies, in addition to panel size customization, are what contribute to high-quality images on a medical monitor.

3) Quality control is vital for medical-grade monitors and certain standards must be followed. Standards define the condition, how monitor should be checked and controlled, and that this should be done every quarter. There are many countries that buy medical equipment and do not understand why one image looks different between two different screens. I will cover the different quality control standards facilities need to adhere to in order to ensure high image quality, as well as how these standards change among different regions and modalities.

4) Thorough understanding of the required type of display. Everyone understands the workflow, but when it comes to the image quality for different modalities—ultrasound, mammography, MRI, CT—how should the colors/greyscale be displayed? What happens when the monitor is not calibrated?

You can click the following link to the sign up for the webinar, “The Future on Displays.” It will be taking place on Tuesday, November 18, at 10 AM EST.

Juergen HeckelIng. Juergen Heckel currently serves as EIZO’s worldwide VP of Medical Business Sales and Marketing. With over 13 years in the medical industry, he has worked with a large network of key hospital decision- makers and radiologists – making him an authority on market trends and needs regarding display solutions.

Radiology in the First World War

World War I Radiology

Radiology a hundred years ago was still a heroic endeavor not just for the patients but also for the personnel. Concepts such as protection against the danger of ionizing radiation were largely unknown or ignored.

The horrors of war stimulated a remarkable period of technological development in the then embryonic field of medical imaging.

At the eleventh hour of the eleventh day of the eleventh month in 1918 the armistice was declared to bring to the end one of the most murderous of all conflicts, with an estimated grand total of some 37 million soldiers reported as killed, wounded or missing. The armistice ceremonies, still celebrated in most countries with appropriate solemnity on the 11th of November are always very poignant, but this year, exactly one hundred years after the onset of the First World War they are particularly so.

In the face of the overwhelmingly bleak immensity of the casualty statistics, it is very difficult to unearth any positive aspects but, as so often happens, the sheer force and immediacy of military imperatives actually resulted in positive developments which far outlasted the war itself. Such a situation occurred in the First World War where the overwhelming need for better and more immediate care of the huge numbers of wounded soldiers brought about a step-change in radiology. There was of course a ruthless logic to the need for improved treatment of military wounded in the First World War — the quicker a soldier could be treated, the higher the chance that he would survive and be able to be sent back to the front again.

It was difficult and time-consuming to evacuate the thousands of wounded soldiers from the trenches to traditional military hospitals located far behind the lines. The solution was to develop mobile radiology units which could get closer to the battlefields. The French in particular were active in this aspect, which required considerable ingenuity to overcome problems such as those caused by the then fragility of the radiology equipment. Image visualization techniques have changed in the hundred years since the First World War.

It was difficult and time-consuming to evacuate the thousands of wounded soldiers from the trenches to traditional military hospitals located far behind the lines. The solution was to develop mobile radiology units which could get closer to the battlefields. The French in particular were active in this aspect, which required considerable ingenuity to overcome problems such as those caused by the then fragility of the radiology equipment. Image visualization techniques have changed in the hundred years since the First World War.

Firstly, let’s put things in context. As every modern radiologist knows the birth of radiology occurred in 1895 — so not even twenty years before the First World War — with the discovery in 1895 by WC Röntgen of X-rays and their then  mysterious power of being able to visualize the interior of living tissue and organs. By the standard of the time, the news of the invention spread very rapidly thanks to the use of the latest newfangled invention the telegraph (of course at a snail’s pace as compared to modern communication methods of phone internet, Facebook and Twitter, etc.). Interestingly, the military was one of the first to realize the potential of the new X-ray technique. Thus only one year after Röntgen’s ground-breaking discovery, there were already reports of the use of radiology by military surgeons in the Kaiser Wilhelm Academy in Berlin.

Thus, by the time of the onset of the First World War, the potential of radiology for the examination of soldier’s wounds was well recognized by the military authorities. The principal application was brutally simple. With a wounded soldier of a hundred years ago, no one would bother looking for suspicious probably cancerous soft tissue lesions. Instead the primary objective of radiology was to identify the location of metallic foreign bodies such as shrapnel, projectiles etc. lodged within the soldier’s body so that the surgeon could extricate them as quickly as possible.  Such metallic foreign bodies are a potential source of infection. The early radiology systems were actually quite good for this purpose — apart from the obvious disadvantage that a radiograph is a two-dimensional projection of a three dimensional volume. Recognizing this, several ingenious solutions were proposed, including the wartime invention by the Frenchman A. Bocage of a rudimentary tomographic system, using the principle of two images of the same patient but taken from different angles, with of course no computer to reassemble the images. The CT scanner as we know it nowadays was still many years off.

The sheer number of casualties was the stimulus for remarkable technological development. By the end of the war, there even existed air-borne mobile radiology units. Here a converted bomber carries in its under-wing pods a complete radiology station which could be rapidly set up in an inflatable tent also carried in the plane.

The sheer number of casualties was the stimulus for remarkable technological development. By the end of the war, there even existed air-borne mobile radiology units. Here a converted bomber carries in its under-wing pods a complete radiology station which could be rapidly set up in an inflatable tent also carried in the plane.

In fact as the sheer numbers of wounded soldiers increased dramatically in the early war years, the problems were not so much the basic technique itself, but rather the organization and structure of the military medical services responsible for radiology. The standard model was to have fully equipped military hospitals located far behind the lines. However the difficulty and time taken to evacuate so many wounded soldiers from the front lines to the hospitals meant that by the time they arrived their situation had deteriorated so seriously that medically there was almost nothing to be done.

Hence a huge effort was expended into making mobile radiology systems to be able to positioned wherever were the biggest needs. There were however huge problems to be overcome in the development of early mobile radiology units, principally due to the fragility of the early radiology equipment and the need for a supply of electrical power. The abandonment of the traditional horse-drawn cart in favour of the then new technology of automobiles had the advantage of being able to rig up special dynamos run off the motor engine. The French in particular were very active during the first world war in the development of motor driven mobile radiology units. Even Marie Curie and her daughter Irène were actively involved.

The speed at which solutions were introduced to previous problems was quite remarkable and indicative of the urgency of the situation. For example, one problem of mobile radiology units was that under the conditions of war the glass photographic plates used at the time frequently broke. This explains how avidly the invention by Eastman of cellulose-based films coated with photographic emulsions was seized by military radiologists. Likewise the invention of the hot cathode X-ray tube finally solved the short life time of the cold tube. By the end of the war the inventive process reached its peak with the introduction of a Franco-American project of an air-borne radiology unit, where a converted Voisin bomber carried all the equipment necessary to set up a radiology surgical room quickly installed under an inflatable tent.

Despite these advances, one mustn’t become misty – eyed or nostalgic about radiology of the time. Compared to today’s equipment and performance, radiology during the First World War was still a heroic and relatively primitive undertaking. In particular the concept of protection against the dangerous side effects of radiation was effectively non-existent.

Of course the remarkable developments occurring in radiology during the First World War go nowhere near to justifying the carnage which was the underlying impetus for the developments. At best it is a meagre consolation that, in the midst of the colossal human tragedy, a little spark of benefit was found in an embryonic technology that has since grown into today’s indispensable profession.

Alan BarclayAlan Barclay, PhD., is the editor of Diagnostic Imaging Europe.



Mobile Radiology: Accessible to All in the Future

Carestream DRX-1 System

La versión española de este post se puede leer aquí.

We know that technology can work miracles, but does it really matter when such technology is only available to a few, and not all?

In relation to today’s world, Roentgen certainly could not have imagined that capturing X-rays would contribute to the birth of one of the most important inventions in radiology.

The most useful of medical specialties. 

Today, medical students worldwide are taught to provide a majority of their patients with a radiological examination because of how critical a role the images play in the diagnosis and treatment of diseases. The unfortunate reality is that many patients live in rural areas, far away from hospitals or imaging clinics where they can receive such exams.

Therefore, it is important to develop and scale mobile digital diagnostic equipment to ensure accessibility for people living in rural, isolated or under-developed geographic areas.

Development is to provide care to the majority of the population. 

The World Health Organization (WHO) estimates that more than 2/3 of the world population has no access to radiological tests. Today, one of the primary goals of WHO is to ensure accessibility, because any acute pathology requires emergency radiographs.

It is necessary to leave the hospital environment and bring radiology to where the patient is located. For example, portable digital detectors, apart from being mobile, have low power consumption, and are provided with a longer range. Being digital allows for the capability of sending the image to be viewed by other doctors for a second diagnosis.

Equipment capable of cruising the world’s environments to meet the patients.

A portable X-ray detector can bring medical technology to unimaginable places and thereby bring care to impervious areas of the world for use in various humanitarian missions. The issue of time is important in medical imaging, and early diagnosis makes a difference in fractures or in detecting metallic foreign bodies caused by external trauma. This method of radiology gives access to faster information and delivers it with a speed that is often not available.

The use of mobile and transportable radiology systems has not only proven useful in military and humanitarian missions, but also in expeditions and athletics. In his quest across the Antarctic, Ranulph Fiennes’s team brought a portable scanner, and the technology is also used in professional sports to diagnose player injuries quickly.

Mobile and transportable systems have also expanded into public hospitals with X-ray rooms, because this equipment becomes necessary when a patient cannot be transported safely to the room due to illness, possible infection or because of a patient quarantine.

The technology, as it is used more often, is proving to be a success in radiology field. Radiologists believe in the efficiency of the technology, and by improving efficiency without compromising image quality, imaging professionals can be sure they are providing the best care to the patients.

FernandezRafael Fernández Navarro is the Iberia X-ray Solutions Business Manager & Iberia Service Sales Specialist for Carestream


Radiología portátil, Accesible Para Todos en el Futuro

Carestream DRX-1 System

The English version of this post can be read here.

Sabemos que la tecnología hace milagros, pero ¿qué importa todo eso cuando esta solo al alcance de unos pocos?, Seguramente  Roentgen  no podría  ni imaginar  que  al descubrir los   “rayos x”  estaba contribuyendo al  nacimiento de una de las ramas más importantes de la medicina.


Hoy en día a los estudiantes de medicina de todo el mundo se les enseña que habrá que someter a la mayoría de sus futuros pacientes a exámenes radiológicos, porque se ha convertido en algo crucial  en el diagnostico y tratamiento de  enfermedades.  Pero  la triste  realidad es que cuando ejerzan  a menudo tendrán que hacerlo en medios rurales, lejos de hospitales donde pueden recibir los exámenes radiológicos.

Por ello es importante el desarrollo  y la envergadura de losequipos de diagnostico portátiles digitales  para asegurar la accesibilidad de los habitantes que viven en zonas rurales, desprovistas o aisladas por cuestiones geográficas.


La OMS calcula  que más de 2/3 de la población mundial no tiene acceso a pruebas radiológicas.Hoy, Uno de los objetivos principales de la OMS es asegurar  la accesibilidad, ya que cualquier patología aguda requiere un estudio radiológico de urgencias.

Por ello es necesario salir del ámbito hospitalario y llevar la radiología allí donde se encuentran los paciente., por ejemplo, detectores digitales portátiles , aparte de ser móvil, tener un bajo consumo, y estar provisto de larga autonomía.Al ser digital, cuenta con la ventaja  de poder enviar la imagen para que sea vista por otros médicos y que puedan dar un segundo diagnóstico, supone entrar de lleno en el concepto de la telerradiología llevando la sanidad  donde sea necesario.


Un aparato portátil con un detector de rayos X permite llevar la tecnología médica a lugares inimaginables y con ello poder llevar la salud a zonas impenetrables del mundo para utilizarlo en diferentes misiones humanitarias.La cuestión del tiempo es importante en el diagnóstico por la imagen, y un diagnostico precoz marca la diferencia en  fracturas o en la  detección de  cuerpos extraños metálicos provocado por traumatismos externos. La radiología es el acceso a la información  de la manera más rápida y proporciona la velocidad que a veces no se dispone.

Esta tendencia necesaria y vital  no solo ha llegado a uso militar, o a misiones humanitarias , también a expediciones. En la expedición atraves del Antártico, el equipo de Ranulph Fiennes llevó un escáner portátily esta tecnología se usa en el  deporte de elite, diagnosticando las lesiones de los jugadores rápidamente.

Los equipos portátiles  se han expandido  en hospitales públicos dotados de sala de rayos, ya que  a veces son necesarios equipos portátiles cuando un paciente no se puede trasportar de forma segura a la sala, debido a una enfermedad, por posibles contagios o porque este se encuentra en cuarentena.

La tecnología, como se utiliza más frecuentemente, está demostrando ser todo un éxito en el campo de la radiología. Los radiólogos creen en la eficacia de la tecnología, y en la mejora eficiente sin comprometer la calidad de imagen, los profesionales del diagnostico por la imagen pueden asegurarse de que están proporcionando el mejor cuidado a los pacientes.

FernandezRafael Fernández Navarro es el especialista de Iberia de rayos X Soluciones de Business Manager Iberia y Servicio de Ventas de Carestream


Key Imaging Technology Trends to Watch for at RSNA 2014

RSNA 2014 logoAll major technology advances in the world of radiology and imaging are unveiled or highlighted at the Radiological Society of North America (RSNA) annual meeting in Chicago. This makes it the ideal place to see how the vendors are responding to legislative mandates, economic factors and how new advances in technology that are likely to impact how healthcare is conducted in the coming years.

Based on trends and new product releases Imaging Technology News (ITN) magazine monitors throughout the year, here is a list of some of the items I expect to be the hot topics at RSNA 2014.

1) Women’s Health

Breast imaging has seen a lot of increased interest in the past year. A lot of this has to do with the rapid expansion of 3-D mammography, also known as digital breast tomosynthesis (DBT). The second part of this is due to new legislation in several states and pending in Congress to require clinicians to inform women if they have dense breasts, which can greatly limit diagnostic accuracy in traditional mammography. Until recently, there was not much that could be done for women with dense breasts, but advances in breast MRI, automated breast ultrasound (ABUS) and tomosynthesis now offer options to better screen these patients. Of these, tomosynthesis will likely become the primary modality, since it is substantially similar to current mammography workflows. It also offers the ability to view slices of the breast to better differentiate real lesions from areas of overlapping dense tissue. Imaging centers across the country are leveraging their new tomosynthesis machines in public ad campaigns to attract new patients.

2) Radiation Dose Reduction

Well publicized overdoses of ionizing radiation from CT scans have inspired legislation in Texas and California to force hospitals and imaging centers to now record and monitor patient dose exposures. Other states are expected to follow suit with their own legislation. Additionally, earlier this year the Joint Commission changed its rules for credentialing facilities by now requiring dose-recording software so facilities can get a handle on doses used and how to reign in high-dose outliers. Congress also passed H.R. 4302 earlier this year, which delays the large cuts in Medicaid called for by the Sustainable Growth Rate (SGR) if imaging facilities meet new requirements for stricter patient radiation dose safety controls in efforts to lower dose.  Expect to see many new software options on the show floor that record the dose from each exam from multiple X-ray and nuclear imaging modalities. These systems often package that data into dashboard management apps to monitor doses based on specific machines, protocols, departments and technologists. Some software will also help interface data for easier upload to the American College of Radiology (ACR) Dose Index Registry.

3) Enterprise Imaging

“Enterprise” recently has become a major buzz work in imaging and this year many vendors will feature solutions that enable image and report access anywhere in a hospital or healthcare system without the need for dedicated workstations. Enterprise imaging also is likely the next evolutionary step in image storage and management, which will take the responsibility for imaging management away from radiology and place it into the hands of IT. This makes sense from the standpoint that today, reports and images collected from all departments in actually just computer data. Also, as imaging expands to include digital files from all hospital departments (pathology, orthopedics, cardiology, radiology, OB/GYN, internal medicine, etc.) access to images will no longer need to be routed through the radiology PACS or dozens of potentially incompatible image storage systems.  Enterprise imaging is often tied to Web-based software systems and a vendor neutral archive (VNA). These usually use Web-based cloud computing vendors that offer virtually unlimited storage capacity, while at the same time often offering a disaster recovery solution. Use of vendor neutral platforms is supposed to enable easier integration of data from disparate systems throughout the hospital so it can be made available in one place via the electronic medical record (EMR). Interoperability has greatly improved in recent years, but buyers should be watchful, as some systems interface better than others, and all will have some technical hiccups.

4) Less Expensive and More Efficient Imaging Systems

Due to the economic downturn, stagnation in healthcare capital spending due the uncertainties involved with the Affordable Care Act (ACA) and declining reimbursements, vendors now offer a variety of more affordable imaging systems than in the past. Additionally, all imaging systems and software are now graded of workflow efficiency and patient throughput, where speed and automation to save staff time are key.

5) Concentration of IT, Not Imaging Hardware

While PET/MR and state-of-the-art high-slice CT scanners are innovative and have a certain wow factor, the RSNA show floor and has largely transitioned to being an imaging software market place. Note above I only briefly mentioned actual imaging systems under the first subhead, the rest is IT related. You are hard-pressed to find anything regarding the gasping corpse of analog imaging on the show floor, since everything imaging today is digital. This includes the image files, the reports, how that data is stored, attached to EMRs and transferred to referring physicians.

The ACA pushes healthcare reform almost entirely through IT innovations and the digitalization of healthcare in an effort to make data more accessible and efficient. As Stage 2 meaningful use criteria begins to creep into specialties such as radiology and all others that rely on imaging, greater emphasis will be placed on some key new technologies on the show floor. This includes computerized physician order entry (CPOE) for imaging orders. Patient engagement is a key element, which I suspect will center on easy to use patient portals that are smart phone friendly to access their medical images, test results, etc. Another biggie for Stage 2 is remote viewing systems that allow easy image access to anyone who needs to see them who are not connected to the PACS. There has been an explosion of these remote image viewing systems over the past couple years. The new normal for most of these apps is to be tablet and smart-phone friendly to allow image and report access anywhere a physician happens to be.

DDavid_Fornell_ITNave Fornell is the editor of Imaging Technology News (ITN) and Diagnostic and Interventional Cardiology (DAIC) magazines, which both cover the latest technology trends. He reports on technology advances at several key imaging, healthcare IT and cardiology meetings each year.