Portability, automation, and standardization are set to drive demand

By Elaine Sanchez Wilson

The CT systems market was valued at $4.9 billion last year, and there are no signs of it slowing down, according to a recent report from Kalorama Information. Contributing to the modality’s demand, Kalorama Information officials say, are an increasing number of clinical applications, an aging population, and the rising incidence of chronic disease.

24×7 reached out to a panel of experts to discuss key trends on their radar. Participants included Matt Dedman, director of strategic corporate accounts for CT at Malvern, Pa.-based Siemens Healthineers; Mike Ghazal, president and CEO of Zetta Medical Technologies LLC in Lake Zurich, Ill.; Maarten Leertouwer, senior director of customer support, CT and nuclear medicine for the Netherlands-based Philips; Tim Nicholson, senior manager of market development for the CT business unit at Toshiba America Medical Systems in Tustin, Calif.; and Helen Titus, worldwide ultrasound and CT marketing director at Rochester, N.Y.-based Carestream Health.

24×7: What’s propelling growth in CT technologies?

Dedman: There are a couple key reasons why facilities are upgrading their CT scanners today—first and foremost being able to improve patient care, for example, through reduced radiation dose. Plus, now with some emerging technologies, we are able to reduce the contrast volume dosage, which reduces the risk of complications with the patient’s kidneys.

New CT scanners offer the ability to improve consistency of the outcomes of those CT studies. Primarily, automation technologies are standardizing the way CT is performed in terms of the scan range and reconstruction, and that automation is driving the increased standardization of CT outcomes, reducing the variability within those outcomes as well.

Ghazal: The current driving interest is in dose reduction and [the National Electrical Manufacturers Association’s] XR-29 compliance. Many end users are being forced to either upgrade their current systems or even replace them to stay current with regulations and patient safety. As a service provider, Zetta has created solutions for both of these main focuses that are driving this growth.

Leertouwer: In previous years, there was a trend toward multislice scanners, especially in cardiac applications. But today we’re seeing customers base their scanner purchase decisions on not just how the CT scanner performs, but also on how it may help to reduce costs while improving patient care. Clinicians want a definitive answer the first time without having to rescan a patient.

It is in this area of helping clinicians build confidence in their diagnosis where Philips continues to make strides. Features such as Philips’ iDose, our iterative model reconstruction, or Philips’ metal artifact reduction application, are important to improving image quality while minimizing dose. Spectral technology is also a buzzworthy innovation within the CT industry. Philips’ spectral technology is unique in the fact that the IQon Spectral CT is always on, so clinicians don’t have to think about whether they want to use it upfront.

Nicholson: The CT market is more than a billion-dollar market, and it is expected to continue to grow with better access to healthcare and more patients visiting emergency departments across the nation. CT is usually the most prominently used imaging modality in emergency departments because it is fast, high resolution, and now offers less radiation dose than ever before. And Toshiba Medical’s big advantage in this growing market is that we have a scanner that fits every customer’s needs.

24×7: What insight or feedback did you receive from attendees at November’s Radiological Society of North America (RSNA) meeting, with regard to their CT needs?

Titus: Managers of imaging centers, orthopedic clinics, urgent care centers, and hospitals were all interested in Carestream’s OnSight 3D Extremity system because this compact system provides high-quality, lower-dose 3D imaging studies. RSNA attendees who want the ability to provide 3D weight-bearing extremity exams appreciate that this system meets that need and is affordable and easy to install.

Nicholson: At RSNA 2016, attendees let us know that they want technology that fits their operational and capital budget needs today and in the future. The CT scanners that they are looking for have to fit financial, clinical, and operational needs.

Leertouwer: Attendees were interested in understanding new advances in CT, and how these solutions can help them diagnose patients more accurately and improve outcomes. They wanted to know how they can utilize new technologies in their practice, as well as how those technologies will fit into their workflow.

At Philips, we provide results in a way that allows routine use (i.e., results on PACS, results that can be brought up in exam cards). The normal way of scanning is kept intact, but the new advances are added to help improve diagnosis, image quality, and efficiency.

Dedman: The biggest feedback we received from healthcare providers is: ‘How can they reduce variability within their practices?’ ‘How can they increase standardization on the CT images they’re acquiring across their healthcare system?’ ‘How can they improve the reproducibility of the CT results and outcomes?’ That was the biggest theme we received from customers—as their CT provider: ‘Help us reduce the variability and, really, reduce the unnecessary variability within our CT service.’

Ghazal: In Zetta Medical’s market, attendees seek out Zetta to discuss keeping and extending the life of their current CT/MRI equipment. Some of those solutions include using our software to become XR-29 compliant or upgrading software to enable low-dose scanning to stay consistent or ahead of their market without being forced to purchase high-cost upgrades or even a completely new scanner.

24×7: What are the biggest challenges that hospital biomeds encounter in the servicing and maintenance of CT equipment? In what ways does your technology and/or company respond to these issues?

Ghazal: Some of the current challenges with servicing and maintaining CT equipment are that proprietary tubes and the OEM parts pricing are considered inflated. Zetta responds to these issues by carrying a large selection of system-specific tubes and replacement parts to help our customers have access to hard-to-find parts at reasonable prices.

Leertouwer: In most facilities, CT is a ‘mission-critical‘ asset, making system availability paramount to patient care. With as much as 30% of CT imaging done in the emergency department, unscheduled downtime has become one of the biggest concerns for care providers—especially when facilities have only one scanner. At Philips, we are investing in advanced data analytics and remote service technologies to support our ambition of zero unplanned downtime.

Predictive maintenance is on the rise. By means of data analytics and algorithms, machine and service data are constantly analyzed to identify patterns and trends. These notifications are predictive in nature, enabling service action to be scheduled in advance without interrupting normal clinical workflow. We envision that by 2018, one in five systems service events will be triggered by careful analysis of system data, and will therefore be identified before any major issues arise.

Titus: Servicing and maintaining the OnSight 3D Extremity system will be much easier than a conventional CT system and similar to a standard x-ray room. Installing the system takes only one day. We recommend one preventative maintenance call per year, which is included in our warranty and extended maintenance agreement. Most key components are field-replaceable units so they can be easily swapped out if a problem occurs.

Nicholson: Operational costs are a huge challenge for any provider and are a part of the total cost of ownership for any CT system. At Toshiba Medical, if a customer has an in-house biomed team, they are offered in-person training with full access to our machines, just like we would train our own Toshiba engineers.

Dedman: The largest challenge we see from a biomed perspective—particularly talking about a modality CT—is maintaining uptime of this equipment. CT really is the front-line modality—especially for emergency department patients. And as a result, it’s mission-critical for a hospital to have their CT scanner up and operational.

For hospitals that only own one CT scanner, if that CT scanner is down, it is not uncommon for that hospital to have to put their emergency department on diversion until their CT scanner is repaired and brought back up to operational status.

So as a result, there’s a lot of pressure on the biomed department to ensure the uptime on that CT scanner because of how critical that imaging modality is to overall hospital operations. To assist healthcare providers with overcoming that challenge, we’ve invested significantly in remote diagnostic and remote monitoring technologies—technologies that give us the ability to identify issues before they occur, or to remotely diagnose and fix issues, as opposed to having to send an engineer onsite.

24×7: How does your company hope to differentiate its CT offerings from those of competitors in the marketplace?

Nicholson: Toshiba Medical’s CT systems are differentiated from competitive systems because our technology is offered across the entire platform of systems with no-compromise, with high-end features like dose reduction technologies and 0.5 mm slices for high-resolution detector technology and patient-centric designs that are standard on all systems.

Dedman: We introduced a brand-new CT platform called the SOMATOM go., which is currently 510(k)-pending. This platform—which includes two CT systems, the SOMATOM go.Now and the SOMATOM go.Up—offers a workflow concept where for the first time in the history of CT, a CT scanner can be remotely operated via a tablet. It allows the technologist to remain much closer to the patient throughout the CT exam process.

A majority of the tasks a technologist would have typically had to perform in the control room behind the CT console can now be done via the tablet in the exam room closer to the patient, really creating a much more patient-centric workflow for the CT technologist.

Leertouwer: Philips’ Magic Glass on PACS app, which is available on the IQon Spectral CT, is an application that allows the availability of spectral results anywhere within a PACS environment. Another example is our detector technology, also on our IQon Spectral CT, which enables the CT scanner to operate as a normal CT scanner but offers spectral results on demand every time a patient is scanned. That’s something unique to Philips.

Further, Philips’ PerformanceBridge is a new, flexible suite of continuous improvement solutions that provides a pathway to identifying and optimizing improvement opportunities. PerformanceBridge connects expertise and actionable data to inform everyday decisions, from managing assets to improving quality of care for patients—all in a secure and compliant manner.

Ghazal: Zetta is a national, independent service organization that provides direct service on CT, MRI, and PET/CT for GE, Siemens, Philips, and Toshiba. With Zetta’s experienced engineers and dedication backed by the proper service tools and parts, Zetta can achieve consistent service delivery and reasonable pricing to our customers. In addition to service, our suite of software solutions enables dose reduction, XR-29 compliance, remote monitoring and diagnostics, etc.

Titus: Carestream’s OnSight 3D Extremity system is designed to represent a new class of CT systems. It utilizes cone-beam CT technology to deliver high-quality 3D images with a compact, affordable system that can be used by a variety of healthcare providers.

This 3D extremity imaging system can help with the diagnosis and treatment of orthopedic conditions that affect the biomechanical behavior of the joints such as arthritis, meniscus loss, instability, and malalignment syndromes. This system equips healthcare providers to capture and process a 3D exam in about 10 minutes and conduct the patient consultation in a single visit.

24×7: Looking ahead, what innovations can we expect to see in the next-generation of CT scanners, and what trends are you responding to?

Dedman: I think the SOMATOM.go platform is a great example of where we’re headed as a CT vendor. We’re really focused on how we can develop technologies that assist our customers in reducing unnecessary variability within their health system and providing more standardized, reproducible results.

From the service and the biomed perspective, we will continue to focus on technology that improves the uptime and reliability of our platforms, and we’ll further expand our remote monitoring and remote diagnostic capabilities to be able to perform more of our service fixes and repairs remotely, versus having to have an engineer sent onsite.

Titus: Carestream’s OnSight 3D system addresses a need within the healthcare market for compact, affordable 3D imaging of extremities, including weight-bearing exams. Orthopedic imaging is a major focus for Carestream because of the prevalence of musculoskeletal conditions among people of all ages. Youth and adults often suffer sports-related injuries to their knees, ankles, and feet while older adults experience arthritis, joint instability, meniscus loss, and other conditions.

Ghazal: With the advancements of detectors and collimators, image quality and details are a top priority. Zetta stays committed to training our engineers on the latest and greatest in software and hardware developments. Another trend we’re watching is portable CT scanners; scanners are being moved to where the patient is. Zetta is monitoring this technology to see if we can add value to our customers in this area.

Leertouwer: Trends continue to show that customers want a definitive diagnosis with the first scan. If they choose CT as the imaging modality, they want that modality to be able to tell them what the next steps in the patient’s treatment should be.

The difficulty is when there are indeterminate findings. If we can continue to reduce indeterminate findings and make CT the first and final imaging modality needed, it can help reduce costs while facilitating improved outcomes and greater patient satisfaction. I think we’ll see continuous improvements in CT reconstruction techniques, which will continually improve image quality at low doses. Future trends will be adherence to making spectral results a standard of care.

Nicholson: Looking forward, improved resolution and new clinical applications that can help physicians to diagnose and stage disease even earlier will continue to be very big trends. With higher resolution and new clinical applications, clinicians can continue to improve their quality of care and provide better outcomes for patients.