ECR 2013: R&D Trends and Dose Reduction in Pediatric Imaging

Sam Richard, PhD, Senior Research Scientist, Carestream

Sam Richard, PhD, Senior Research Scientist, Carestream

I recently had the pleasure of presenting research that addressed two key topics in medical imaging at ECR 2013: pediatric imaging and dose reduction. More specifically, reducing dose when capturing pediatric images.

The research I took part in focused on optimizing image quality across a wide range of pediatric patient sizes. It looked at the thickness of the patient and sought to answer which kVp is best for each body size. The study concluded that in order to get the best image quality and lowest dose, pediatric patient size should be taken into account when selecting the kVp. Specifically, we found that the optimal kVp setting should be around 50 kVp for neonate, 60 kVp for young children and around 70 kVp for adolescents (assuming average patient size for each age group).

The second area of research that the team looked into focused on rib suppression in chest imaging. The key point here is that image quality can be improved by removing the ribs. Physics tell us that we get the best contrast if we go to lower kVp, but we use higher kVp to remove rib contrast. By reducing rib contrast, we can then reduce the kVp and improve lesion conspicuity while reducing the radiation dose to the patient.

It’s a fascinating time in the medical imaging space, and the research and technologies that are being released are proving this on a consistent basis. You can watch my complete interview from ECR 2013 below to hear more about the research, and what innovations we’re focusing on here at Carestream.


Three More Reasons to Visit Carestream at ECR 2013

Robert Ashby, Carestream

Robert Ashby, European Communications Manager, Carestream Health

Only one more day to go until the start of ECR 2013.  As you finalize your agenda at the show here are three final reasons to visit stand 211, Expo B:

  1. Streamlined Mammography Workflow – See our new module that displays digital breast tomosynthesis (DBT) exams from DICOM-compliant acquisition devices on the CARESTREAM Vue Mammo Workstation, where radiologists can also view traditional mammograms, breast ultrasound, breast MRI and general radiology exams from a single desktop. The module streamlines workflow by allowing healthcare providers to store, route, display and query/retrieve DBT exams from DICOM-compliant acquisition devices. Comparison tools enable radiologists to use personalised hanging protocols for DBT exams along with other procedures.


  1. Efficient, Quality Printing – The new DRYVIEW 5950 Laser Imaging System produces 508 pixels-per-inch output for general radiology and mammography images. The new imager uses time-saving film cartridges and offers an enhanced quality control system for mammography images. Its built-in densitometer will produce test prints and display data needed to support mammography quality control charting— eliminating the need for an external densitometer and greatly reducing the time required for mammography quality control.


  1. Cone Beam CT Advancements –  A must-see at ECR 2013, the CS 9300 System – a high-quality cone beam CT and true panoramic imaging system for a variety of ear, nose and throat and dental applications – including sinus, temporal bone and maxillofacial exams; dental implantology; oral surgery; orthodontics; periodontics and endodontics. The CS 9300 delivers up to 94% less radiation dose than conventional CT units, and images at a much higher resolution. The optional, one-shot cephalometric module captures images in less than a second. It delivers best-in-class image quality, a one-of-a-kind 30 cm x 30 cm full skull exam and automatic cephalometric landmarking software, further enhancing radiology and referring dentist workflows.

Join our Twitter and Facebook communities now and tell us what you’re most looking forward to seeing at the congress.


Top Healthcare Trends to Discuss at ECR 2013: #2 – Digital Capture

Anton Graule, Carestream Sales and Business Development Manager, Europe

Anton Graule, Carestream Sales and Business Development Manager, Europe

We’re going to focus on digital capture as being the second important topic that will be a strong focal point at ERC 2013. From mobile DR, to detectors focused on pediatric patients, the field is only growing more diverse and more impressive with each new piece of technology that is released.

At RSNA 2012, pediatric patients were a key point of interest because there are so many vital components to consider when working with these patients such as, various patient sizes, radiation dose, and even the mobility of the technology to be able to capture images outside of the traditional X-ray room. This focus is only going to become more important as more radiologists and vendors learn more about the importance of dose efficiency and reduction when it comes to the smallest of patients.

Below you can find some of the Carestream X-ray solutions that we will be featuring at ECR 2013. Stop by our booth to chat with us about these topics and the solutions available to meet facility needs. You can find us at stand 211, Expo B.

Carestream’s Digital Capture Story at ECR 2013:

  • Extending our leadership in the wireless digital radiography market, we’re demonstrating a work-in-progress, smaller-format 25 cm x 30 cm CARESTREAM DRX 2530C Detector.*  The new cesium iodide detector is intended to offer high efficiency for dose sensitive paediatric, orthopaedic and general radiology exams. Use it with CARESTREAM DRX-Revolution or CARESTREAM DRX-Mobile Retrofit Kits for mobile imaging of neonatal or paediatric patients
  • Come and see the new non-motorised option for the CARESTREAM DRX-EVOLUTION. The new DRX-EVOLUTION Standard-Q offers efficient upgrade to DR capability at an affordable cost. The ergonomically designed wall stand makes standing exams easier and the extra-wide Standard-Q elevating float-top table offers increased patient weight capacity and lowers easily for stretcher and wheelchair patients.

* 510(k) pending

Three Ways to Get Involved with Social Media at ECR 2013

This time last year we posted on social media at ECR with lots of hints and tips about how to interact and make the most of the experience online as well as in person. Lots of that information stands up today and if you’re a relative newbie to the social media scene it’s worth having a read.

ECR 2013At #ECR2013 we’re doing lots more to create an interactive experience and we’re looking forward to you getting involved. Here’s how!

1. Like us on Facebook – join the Carestream community. We’ll be posting our album of images from the stand so look out for those and tag yourself, and why not take part in our online #QuizECR2013 – one question a day for every day that the show runs.

2. Join the conversation on Twitter –  follow us and use the hashtag #ECR2013 to get involved. At the show we’ll be asking the questions below – tweet us your answers using the hashtags provided and we’ll retweet them to our followers:

  • What are the biggest issues in Healthcare today? #RADChallenge
  •  How will the healthcare horizon have evolved by 2020? #2020vision
  • Which single piece of kit has had the most radical effect on radiology in practice? #RADical

3. Come and meet us on the stand to tell us about your experiences as a Carestream customer. Our production team is ready and waiting to capture your   thoughts on the products and technology on the #CarestreamCam to appear on the Carestream YouTube channel.

Most importantly – enjoy your #ECR2013 experience and come and say hello to us in Expo B, booth 211!

ECR 2013: Q&A with Dr. Les Folio, Radiologist at the National Institutes of Health Clinical Center

Dr. Les Folio, Radiologist, NIH and Adjunct Clinical Professor, Radiology, George Washington University Hospital

Dr. Les Folio, Radiologist, NIH and Adjunct Clinical Professor, Radiology, George Washington University Hospital

Dr. Les Folio is a radiologist at the National Institutes of Health Clinical Center and an adjunct Clinical Professor, Radiology, George Washington University Hospital has recently completed research titled, “Automated Registration, Segmentation, and Measurement of Metastatic Melanoma Tumors in Serial CT Scans,” which will be published in Academic Radiology in the next few months. Dr Folio will be presenting at ECR2013 and we’ll be interviewing him at the show following this presentation – we caught up with him this week to gauge what he thinks he can expect at the show.

What will be the first reaction from radiologists when they see this research? How will you respond?

Judging from the US and local presentations I’ve already given, I’d expect them to be mixed.

General radiologists that do not do oncology regularly may be excited that the segmentation capabilities are now within PACS to save time assessing volumes across serial images. Some will wonder if there will be more expectations from radiologists with this capability, a genuine concern, at the same time; perhaps radiologists should be more quantitative in reports; beyond the scope of my presenting the current research.

Just to clarify this point: Are you suggesting that radiologists ought to be producing more quantitative reports, or that they might think they should be producing more quantitative reports?

Simply put, I believe radiology departments will be producing more quantitative reporting; in addition to the current qualitative reports we traditionally provide. Some radiologists, like myself, will include in the report; most will likely depend on radiologist extenders that many cancer centers now have. Of note, there has been initial success in providing an additional charge for the quantitative report; since it is often a separate event, but another radiologist (for example). Ability to obtain RVU’s should provide a funding source to provide these additional reports.

Radiologists that perform staging exams in metastatic cancer should be glad to see PACS providers are moving towards image post processing self-sufficiency. Specifically lesion measurements, which will now include volumes and volumetric density, exporting of bookmark annotations in organized tables associated with organs and tumor trajectory plots.

One common reaction I experience is the surprise that we will be assessing all lesions rather than a select few as all other criteria currently do. Especially in the disease we are currently studying: ASPS (Aveolar Soft Parts Sarcoma), where some patients have nearly 100 metastatic lesions. It is undoubtedly a monumental effort and I do not expect all lesions to be successfully segmented, at least in the initial years. But this could well be a trend – I believe this may be the direction the oncology community goes, Of course nobody can say that for sure, but what better tumor burden assessment than to look at all lesions volumes and densities, at least in targeted therapy cancers?

How will the automation of this process eventually work into the radiologist’s workflow? What benefits will this ultimately have?

I can only speak for those radiologists such as myself aiming toward providing more comprehensive tumor burden reporting. National surveys confirm most radiologists provide select tumor measurements, providing image-series number in reports. However, most in the US do not provide RECIST reports, and many for good reasons. Unless one knows the history, baseline, and to what exam to compare, tumor assessments are left to radiologist extenders, nurse managers or the oncology teams themselves. Also, there is a lack of agreed-upon standards as to how to report, tabulate, save annotations and what format to save in.

At NIH and many other cancer centers, we are providing more comprehensive reports by working with individual teams on the way they assess tumors since there are assessment modifications depending on cancer type (mesothelioma, GIST and ovarian cancer each have specific ways of assessing, for example). We provide the unique criteria, with teams providing specific histories and constant feedback through emails, calls and meetings. We have a radiologist dedicated to tumor assessment, with other radiologists working with individual teams through investigation associations (for example).

I can speak best for myself in that the registration and key image capability has saved me many hours over the last few years. With the one-button lesion-tracking tool we co-developed, the time savings will save at least half the time (as we showed in a study accepted for publication in AJR). I am looking forward to the next version where we have the ability to segment baseline and fully automatic serial exams. The survey I mentioned earlier said that 86% of radiologists would provide tumor measurements if it were possible to do it with one mouse click; that is what we created.

 What is a “steeper tumor trajectory” and what does this capability mean for patients and for cancer treatment as a whole?

The tumor trajectory is the direction and magnitude that metastatic lesions decrease or increase in size; and in our case how necrotic they get as they sometimes disappear now with targeted therapy. Of course we hope that the direction for steep trajectories is to disappear (indicating cancer therapy is working), however, it is just as important to demonstrate when tumors are growing, or not responding to therapy. This will save on patients getting unnecessary treatments (and side effects) and save money by discontinuing medications earlier.

Taking density into account may help make the trajectory steeper in that some tumors (like sarcomas) do not decrease in size as much as they do become necrotic (less density). Our TVVT is a product of density (throughout every lesion) and volumetric size (of all lesions). We cannot think of a more comprehensive way of assessing metastatic cancer.

How will this affect the relationship between the radiologist and  oncologist?

It could mean a stronger, more cooperative relationship. I believe that improved automatic segmentation within PACS that allows radiologists to instantly compare and import measurements and comparisons into reports will bring oncologists to radiology more often for guidance such as more complete histories and what exams to compare with. The ultimate result being improved patient care.

The views expressed here are of Dr. Folio and are not necessarily of the NIH or the U.S. government. Also, Dr. Folio is a member of Carestream’s advisory board.

UPDATE – March 14, 2013:

Below is an interview with Dr. Folio about his research that was conducted in Vienna at ECR 2013. You can click on the link to read more about Carestream’s lesion management assessment technology.


Top Healthcare Trends to Discuss at ECR 2013

Massimo Angileri, WW General Manager, Healthcare Information Solutions, Carestream

Massimo Angileri, WW General Manager, Healthcare Information Solutions, Carestream

We’re excited to meet with our European colleagues to discuss industry trends, and what their health IT and radiology needs are in 2013.  On account of the rapidly changing climate of the healthcare industry across Europe, we’re more inspired than ever to learn what people are seeing and experiencing in the field. These discussions are sure to bring up invigorating conversations at the event. Based on what has been seen after RSNA 2012 and early into 2013, over the next few weeks we’re going to feature the top five healthcare trends that we’ll be exploring at our booth—stand 211, Expo B.

First up: healthcare IT.

#1 Healthcare IT

According to Aunt Minnie Europe, the radiology PACS and RIS markets in Western Europe is maturing and inviting a new set of products in the form of cloud-based services and software-as-a-service offerings. It is these new technologies that are improving costs for organizations and allowing the easier transportation of data between facilities.

Mobile capabilities have never been more important or requested more often from patients. The ability to access medical records via mobile devices such as an iPad is changing the way that patients use healthcare information, as well as the patient-doctor relationship since these patient portals are able to provide better access to providers.

Carestream’s Healthcare IT Presence at ECR 2013:

The MyVue patient portal is our patient-empowering platform that enables electronic access and management of X-ray exams. Patients can then share that data with specialists and other healthcare professionals. Easy to use, it reduces the time and cost of outputting medical exams onto DVD/CDs or other physical storage formats for medical records.

Our new lesion management tools (see video demo) enhance accuracy in assessing changes in cancerous lesions as part of diagnosis and treatment for oncology patients.

You’ll see enhancements to Carestream’s RIS including the storage and tracking of radiation dose information and other capabilities that lay the groundwork to support cumulative dose tracking – an important global patient care initiative.

ECR 2013: The Conflicting Demands of Patient Needs and Business Efficiencies

Christian Marolt, Secretary General and Editor-in-Chief, European Association of Healthcare IT Managers

Christian Marolt, Secretary General and Editor-in-Chief, European Association of Healthcare IT Managers

With about a month to go before we congregate in Vienna for ECR 2013, we invited Christian Marolt, Secretary General and Editor-in-Chief of the European Association of Healthcare IT Managers, to write for us about healthcare in a changing world.

The European Association of Healthcare IT Managers is the largest interest representation for CIOs and IT Managers in Europe.

Is it always about the patient or is technology sometimes one step ahead? With the growth of patient choice and patient power on the one side, and huge advances in technology on the other, it is sometimes hard to know what are the key drivers in healthcare today.

What is clear is that many countries are facing cuts in healthcare budgets as governments tackle recession and low growth. How can technology enable the sometimes conflicting demands of more patient contact and higher visibility for the radiologist while coping with the demands of productivity and cost-effectiveness?

Management of Technologies within Healthcare Organisations

Excellent management would be an option. But as there are still key jobs filled not upon skill-set but political affiliation this might not always work. What else? Vendors in radiology have adapted to these times. Upgrades to existing installations are easily available, and interoperability is almost a given. At least “Integrating the Healthcare Enterprise” (IHE) is trying very hard to achieve this goal. Vendor-neutral applications are being further developed.  Along with a nod to economic hard times and increasing competition from Asia (in particular China), vendors are also acknowledging the focus on increasing user friendliness and lowering radiation doses. Dose measurement software is rapidly evolving, as both radiologists and patients want to minimise radiation exposure.

Empowering Patients with Access to Medical Information

Patient access to images and medical records is a great development for patient empowerment. However, many countries have a rapidly aging population. We cannot generalise about who uses what technology, however the over-50s are the fastest growing demographic for Facebook. It is necessary to respect what media the patient is comfortable with and that alternative formats are available to meet different needs.

Accessible options make things easier for all of us, but sometimes not. It’s often asked, “Why can’t we get the levels of service from imaging that we get from airlines?” Being able to book yourself the time you want for your imaging exam at the facility most convenient to you should be possible. Patients expect access from their smartphones and tablets, they want to go to punctual appointments, and they are right in making these demands. Here we could once again learn an important lesson from the airline industry, thus compensating patients waiting for an unacceptable time period. I am sure that this would speed up efficiency swiftly. Making money by going to the doctor? Fab!

Medical imaging advancements are vital but still have a long way to go.

Medical imaging was pronounced by the New England Journal of Medicine as one of the “eleven developments that has changed the face of clinical medicine” during the last millennium. A decade on, and the statement still holds true.  For example, PET/MR is an exciting new technology that is still evolving. While the technology offers advantages, adoption has been quite slow so far. Clinical studies are continuing to assess its benefit.  What is clear is its application for oncologic imaging, with the benefit of low levels of radiation.

What else? Intelligent image searching is another area that is evolving rapidly. Being able to match and retrieve images is vital for assisting in computer-aided diagnosis, and in education and training.  Linking radiology with pathology will be another mega trend; cross-departmental understanding and retuning from micro-medicine to a holistic view will help.

Often consumer adoption of a technology flows into the healthcare setting. Mobile, especially smartphones and tablets, is becoming increasingly popular, hence the devices will change along with the healthcare world. Health systems are now looking at their applications in radiology while keeping concerns about data privacy and protection in mind. Good old data privacy—too often misused as an excuse for people failing to deliver. Empowering patients has to go together with one’s own decision on how to treat personal health data.

Health and safety in healthcare settings tends to concentrate on infection control, and the risk of trips and falls. While this is important, with the many hours healthcare staff spend using computer technology, more thought should be given to the design and ergonomics of radiology equipment. To pile on, the future in hospital is wireless (during RSNA there was the world’s first wireless ultrasound scanner presented), and this is sure to bring even more issues to think about in the future.

The contribution is the personal opinion of the author and is not the opinion of HITM or Carestream.

ECR 2013: Challenges Facing Radiologists and Solution Providers in Europe

Ludovic d’Apréa, Carestream Manager, France-Belgium-Luxembourg Region

Ludovic d’Apréa, Carestream Manager, France-Belgium-Luxembourg Region

With the European Congress of Radiology (ECR) in Vienna, Austria, approaching fast in March 2013, it’s appropriate to take a look at the issues and challenges the industry faces, as well as what attendees can expect from Carestream at the show.

Pressing challenges facing radiologists and radiology solution providers in Europe today.

The situation is very difficult at the moment for many of our customers. The UK has recently decided to decrease healthcare expenditure by £20 billion within 5 years. The Italian government has implemented a law that forces hospitals to save EUR 8.5 billion over the next few years. With very few exceptions, unemployment in the Euro 15 zone is high. Many countries are running huge deficits. We’ll see all these healthcare-related austerity programmes gain momentum in 2013.

Parallel to that, a longer-lasting trend, the demographic change, is becoming more serious, which means, for radiology, that the demand for high quality imaging is in fact increasing. But healthcare providers cannot simply invest in imaging in order to meet demand. In countries like the UK, France, Italy and Spain, there are strong regulations in place now that make investments difficult. We have national purchase organisations in many European countries that negotiate prices. All this makes it far from easy for healthcare IT providers in general, be it in imaging or in other fields.

Ways in which Carestream can respond to these challenges.

One of our biggest strengths is our ability to understand the radiology market. The needs of customers and their financial situations are very diverse in Europe. For a company like Carestream, this means that we have to understand diversity and be able to provide solutions that are adaptable to individual needs. On a macro level, we will certainly see a bigger demand for financing through the vendor and for cloud-based services. But on a micro level, we will have to be able to tailor our solutions to all radiologists in all countries, whether they have mature markets or not.

Carestream solutions being presented at the ECR 2013.

A showstopper in the segment of digital capture will be our new DRX 2530C detector*, which will be demonstrated as a work-in-progress. The new caesium iodide detector is being designed to offer high efficiency for dose-sensitive paediatric, orthopaedic and general radiology exams. All part of the DRX-1 system that allows for the easy conversion of existing analogue rooms to digital radiology.

The DRX 2530C will be a wireless, cassette-sized detector that allows fast and easy positioning in paediatric incubator trays and offers higher DQE (detective quantum efficiency), which can lead to lower dose requirements than CR cassettes or gadolinium scintillator detectors. It is also ideal for orthopaedic tabletop imaging, because handling is easy and positioning is highly flexible, aiding exams such as knee, elbow, skull and other exams that require a patient to hold the detector or that require a smaller field of view. Through the whole DRX-1 system we utilise existing equipment and give the customer a chance to go digital without forcing any investment in really big solutions.

Overall, the market will evolve towards cloud-based solutions, especially in the field of picture archiving. With the Vue portfolio, we are well positioned to meet these needs. In Europe, we are certainly one of the leaders in this technology. But again, we don’t force any customer into cloud-based services. It is an option.

At ECR 2013, we will focus on our new MyVue portal that allows Vue customers to securely share images with patients. Through the portal, patients are given the opportunity to download to PCs, laptops, or iPads and share their images with whomever they like. There is no longer any need to burn to a CD. This makes it easier for the patient, and at the same time it means less work for the radiologist.

MyVue is currently available as an option for Vue PACS and Vue Archive users and is now available for order as a Vue Cloud Service. The Vue Cloud Service offers the flexibility of a monthly fee and can accommodate rapid expansion without the need for healthcare facilities to fund and manage network expansions to accommodate additional patient users.

What are you most looking forward to seeing at the ECR 2013? Are there specific products or services that are on your radar this year?

Based on an article originally produced for HealthTechWire.

*Not commercially available


Visit us at booth #211 at ECR 2013 to see the medical imaging and healthcare information technology systems that are at work in 90 percent of hospitals worldwide. We’ll be holding demonstrations of our DRX-Revolution, Mobile X-ray System, Vue Cloud Services and MyVue patient engagement portal.