Industry leaders offer insight into what is available now, as well as what to expect in the future.
By Chris Hayhurst
Ronald Layne has been an imaging technician for the better part of 30 years—all of that time with the biomedical engineering department at Dallas VA Medical Center in Texas. Early on in his career, Layne recalls, “I saw tubes kind of going out, and solid-state electronics and microprocessors kind of making their way in.”
Today, he says, he still tends to think “like an old-school component repair person,” and fondly remembers the days when imaging technologies were expected to be serviced and worked on by hand. It wasn’t so long ago, Layne recalls, when he and his colleagues could “just replace a diode, transistor, IC chip, capacitor, or even a resistor on a board.”
With current technology, though, he’s no longer able to swap out discrete components; so instead of replacing the silicon-controlled rectifiers (SCRs) in a high-voltage generator, for example, he now has to replace the entire inverter assembly. Circuit boards, meanwhile, are now multi-layered, “and the construction of the wafer inside integrated circuit chips contain multiple components that make up an entire circuit or circuits.”
And because diodes are now “microscopic and encased,” it’s impossible to troubleshoot, which one might be bad in a circuit, “so now you’re left with replacing the entire module,” Layne says. The same can be said for imaging systems, as they’re “continuing to become more and more compact,” Layne notes.
Previous systems would have separate modules or multiple circuit boards to perform individual processes, he explains. In the new systems, however, those modules and circuit boards are being combined into smaller, single modules capable of performing multiple functions; and each system contains multiple computers that are networked together to produce patient images.
If someone entering the field today were to ask him what they might do to prepare, he’d tell them it’s a different world than when he started out, he says. “Now, instead of manually having to go slide a wire along a ceramic wirewound resistor, you just go in and sit there in front of a computer and change a digital value. There’s a lot less of removing covers and going into the equipment to get to a potentiometer, and a lot more reading of scripts that say ‘do this and do this until you get this value.’”
Now, Layne says, it’s essential for imaging techs to have IT skills. “And all of the technologies are changing so fast, it’s hard to predict what might come next.”
RSNA 2018…and Beyond
One way you can predict what’s next is by attending the annual meeting of the Radiological Society of America (RSNA), which this year will be held in Chicago over six days at the end of November.
Among the demonstrations, talks, and exhibits on the RSNA 2018 docket: a showcase on machine learning and its applications in radiology; a lecture titled “Artificial Intelligence, Analytics, and Informatics: The Future Is Here”; and vendor displays showing off new devices employing everything from 3D printing to virtual reality. (And if you can’t make it to the conference in person, you can attend it “virtually” here.) To get a sense of what we can expect at RSNA, we spoke to two major imaging-device manufacturers that plan to be there: Canon Medical Systems USA (formerly Toshiba America Medical Systems) and GE Healthcare.
We also contacted Irvine, California-based Ampronix Medical Imaging Technology, which develops, distributes, and services imaging solutions used by healthcare organizations in the United States and internationally. We asked representatives at all three companies for their take on the current state of imaging technology, and for their thoughts on what’s to come. What follows is just a snapshot of what they had to say.
Overcoming Imaging Challenges
The engineers at GE Healthcare, according to Mark Phillips, the organization’s imaging chief marketing and commercial officer, are currently focused on developing technologies that address and alleviate some of radiology’s biggest challenges. Radiologists, Phillips notes, are experiencing high rates of “burnout,” in no small part because of their ever-increasing workloads.
Second, he says, “there is a lot of opportunity to improve reject-repeat rates” and thereby improve efficiency. “If a patient has to come back in later to retake the scan, that slows down throughput; utilization of the machine goes down; and it increases cost to the healthcare provider.”
And finally, there’s the related issue of patient satisfaction, which Phillips describes as “very important” to GE Healthcare’s customers. The company’s role in that area involves the exam process, he says, “including the patient’s experience during the exam, the accuracy of the exam, and how long it takes to get results.”
With those needs and challenges in mind, GE Healthcare has been leveraging advancements in data science, artificial intelligence, and GPU processing power to develop new offerings its leaders believe will make every aspect of radiology a little bit easier, Phillips says. The company’s Centricity Universal Viewer, for example, which will be on display at RSNA, allows radiologists to locate, review, and analyze images from multiple modalities in a single application. “So, they waste less time searching for data, and can spend more time making diagnostic decisions,” he explains.
Another new product, called Imaging Insights, pulls data from across an organization’s imaging fleet and displays it in a dashboard-like format so it can be analyzed and used to improve operational efficiency. “You can look and see how you’re doing with dose management, with protocol adherence, as well as with things like throughput and error rates,” Phillips explains.
The company has already deployed the vendor-neutral technology at nine sites in Germany, he says, and across the board has seen “increased imaging technology utilization, a sharp reduction in patient wait times, and significant increases in revenue as a result.” Numerous other new GE Healthcare technologies will also be shown at RSNA, Phillips says, including some that promise to affect HTM professionals directly.
An offering called “Tube Watch,” for example, uses predictive analytics to forecast two to three weeks in advance when a CT tube will fail. “It lets us reach out to the customer—usually the HTM leader managing the CT fleet—and say, ‘Hey, this tube is headed for failure, let’s take the machine down at a time when it isn’t going to inconvenience your radiologists or your patients.’”
Looking ahead, Phillips says, GE Healthcare will devote much of its attention to developing tools that use artificial intelligence to improve workflow for its customers. (One new imaging product, called “Liver Assist,” uses AI to identify the blood vessels feeding a patient’s liver tumor.) “We’re looking for ways to save radiologists time, so they can spend more time doing the work that they love to do. And we’re working to enable precision healthcare, which we think is critical to achieving better clinical outcomes,” Phillips says.
Focus on Collaboration
Artificial intelligence is also top of mind for the product development team at Canon Medical Systems USA, says Satrajit Misra, the company’s vice president of marketing and strategic development. At RSNA, Misra says, Canon will have a “huge focus” on collaborative medicine and collaborative imaging, “where we’re putting technologies together using best-of-breed modalities, using cutting-edge clinical applications, and embedding AI every step of the way.”
Two products they plan to showcase, Misra says, are their Infinix-i 4D CT, a unit that incorporates angiography and CT capabilities into a single system; and a “robust suite” of quantitative tools for assessing liver disease on their Aplio i800 ultrasound system. The first device, he explains, can improve workflow by reducing or eliminating the need for patient transfer between devices.
“If a patient comes in with symptoms of stroke, for example, and you have this near your emergency department, it can shorten the time between triage and intervention.” Similarly, he says, their Liver Analysis Suite is a “unified approach for all kinds of liver triage.”
The HTM community, Misra notes, should appreciate Canon Medical’s continued emphasis on cybersecurity and risk management—another strength they plan to highlight at RSNA. “We believe we are ahead of every other imaging vendor in making sure that our products are cyber-secure, and we have processes in place to continuously update our customers with security improvements.”
At this year’s conference, he adds, Canon Medical will have a number of new applications on display that may be of interest to imaging techs and others in HTM, including analytics tools that track equipment utilization and help biomeds identify and remediate risks.
Building Bridges in Medical Imaging
Ampronix, which won’t be at RSNA, is different than most players in the medical imaging industry—a company that specializes in developing imaging solutions that “bridge gaps” between technologies produced by other manufacturers.
“A lot of the OEMS out there,” says Cesar Mairena, the company’s global sales and customer service director, “they’re coming up with new and innovative products, but everything is moving so fast that they’re not able to interface” with what their customers already have in place.
To remedy that problem, Mairena explains, Ampronix offers products like their Scanmaxx 4KSC45P 4K medical video scaler, which it has billed as “the premier auto-sync medical video converter to upscale images for 8-megapixel technology.” The device was designed for use with the Sony HVO-4000MT recorder, a technology that permits recording of 4K video and still images from either endoscopic or laparoscopic camera systems.
“Our 4K Scanmaxx scaler acts like a ‘bridge’ so those different systems can work together, especially with the ability to connect via HDMI single-plug, SDI (X4), or via DisplayPort,” Mairena says. A significant portion of Ampronix’s annual revenue comes from its service business, Mairena notes. “And what we’re seeing, and our technicians are seeing, is that a lot of the service calls are for issues with displays.” Often, the problem involves merely cosmetic damage, he explains.
“Maybe the doctor was pointing at the screen with a scalpel, and he scratched or cut the protective panel or even the LCD display itself.” Another common issue involves bad power adapters on low-voltage surgical displays. “We thought at one point that they’d last a lot longer than the built-in power supplies, but now we’re seeing a lot that are failing.”
To stem the tide of damaged displays, some manufacturers are now using anti-scratch/anti-fracture Gorilla Glass, while others are offering “enhanced” glass, or protective panels facilities can place on top of their displays. And to minimize problems with AC-to-DC adapters, some companies “are starting to put redundant power supplies inside the units themselves,” Mairena says.
As far as other innovations the Ampronix team is seeing, a lot of manufacturers are streamlining their products to be more efficient, Mairena says, “and to be up-and-ready right away.” They’re also seeing higher-resolution units—up to 12-megapixel for PACS displays. In addition, he says, there’s more wireless technology on surgical displays. “Wireless hasn’t taken off just yet, but it may gain ground [soon].”
On to the Next Service Call
Although Layne won’t be able to make RSNA this year—“I’m pretty much stuck in the here and now; I get the next service call, and that’s where I go,” he quipped—he knows what is unveiled at the conference may have strong implications on the medical imaging sector. Digital detectors are particularly impressive to him, Layne reaveals.
“The detail they can pick up, and how they’re using algorithms now to process data—the physics involved, and the engineering principles, it really is amazing,” he says. Nevertheless, when he thinks about what he’d like to see in the future, he can’t help but focus on the basics.
“I know our techs here are busy and equipment gets accidentally broken, [such as] portable detectors. They get dropped, stepped on, or [someone uses] sharp implements to turn them on and off…” He’d like to see the cost of such equipment come down. He’d also like greater access to remote monitoring technologies, which would allow HTM professionals like him to “see into these systems and see what they’re reporting back.”
And finally, Layne says, he’d like to see more imaging devices built with solid-state drives, instead of what in his experience tend to be “high-failure” hard drives. “Durability, longer life expectancy. In my job, those are the things we look for—the things that we deal with every day.”
Chris Hayhurst is a contributing writer for 24×7 Magazine. Questions and comments can be directed to firstname.lastname@example.org.