Health Imaging & IT - October 2007 - (Page 43) CardIaC CT and Mr: wHaT’s In THe pIpelIne T he major vendors in CT and MR are working fast and furious to improve the technologies for the burgeoning cardiovascular imaging demand. From reducing dose in CT to factoring in data management, companies are addressing virtually every concern. Before the advent of coronary CT, MRI was growing pretty rapidly within the cardiology segment, says nancy gillen, zone general manager for Siemens Medical Solutions’ northeast region. MR is coming back into prominence, she says, but CT is still the dominant modality. That may change because MR can do perfusion and certain other diagnostic tests better and with no radiation. Within MR, there is a constant push to see whether there are new applications in cardiology and to improve ease of use, says gillen. “MR is more complex so there needs to be a greater understanding of the technology.” Adrian knowles, MR clinical development leader for gE Healthcare, echoes gillen on MR’s need to improve ease of use. “ultimately, MR is a more complex procedure but we’re really trying to get close to the simplicity of CT.” Right now, he sees 1.5T MR as the mainstream technology, but 3T “will grow rapidly over the next few years,” he predicts. New apps, simplification Philips is working on whole-organ coverage, lower radiation dose, low temporal resolution and high signal-to-noise ratio, says Reed. “You need to have something so simple to use that anybody, any technologist or physician, can access that information. That’s what Philips is driving toward.” The drive for lower radiation led gE to bring its SnapShot Pulse technology to market earlier this year, says DeAnn Haas, global CT product marketing manager. users can switch from helical to gated imaging, which reduces radiation by 70 percent. Less than four months after its release, more than 150 customers have installed SnapShot Pulse, she says. “It’s very exciting in the world of CT because dose is a lot lower than it ever has been before,” says Haas. Looking forward, gE is focusing on developing ways to see more, know more and reduce dose. For example, today clinicians can determine whether a patient has greater or less than 50 percent stenosis or less than 50 percent. The goal is to get a more specific idea of the extent of stenosis. 3D volume rendered coronary CTA using 0.5mm x 256 row detector from Toshiba. Calcified lesions along the RCA are clearly demonstrated and lung field in blue has been automatically rendered in a transparent view over the myocardium. Image courtesy of Joao Lima, MD, and Richard George, MD, Johns Hopkins University. MR beats CT in its multiplanar reformatting capabilities. It also can utilize multiparametric information acquired from different mechanisms which isn’t possible with CT, says knowles. MR lets users study morphology, tissue characterization and viability, which has a big impact on cardiac applications, says Piero ghedin, MR advanced applications specialist for gE Healthcare. Those are unique features of MR—the ability to quantify blood flow.” gillen points out that the IT aspect of cardiovascular imaging is critical in diagnosing and managing patients. “All of this information is great but we need to bring it together in one place to look at over time.” knowles, too, looks to improvements in workflow for cardiac MR reporting and post-processing. “That’s where we see the bottleneck moving,” he says. “Away from acquisition and to review of images.” There’s been lots of talk over the past couple of years about the 256-slice CT scanner in development by Toshiba America Medical Systems. After a successful beta trial at Johns Hopkins earlier this year, Robb Young, senior manager of the company’s CT business unit, says efforts are underway to have the system in production by next summer. 256 is coming CT in the crystal ball On the cardiac CT front, Don Reed, product manager of cardiac CT for Philips Medical Systems, says that the market isn’t growing as fast as it was in 2005 and 2006, but he still anticipates growth— probably by early 2009. Reimbursement issues played a role in that slowdown. “As a payor, the government is looking at CT as such a diverse and easy diagnostic tool, that it’s concerned there will be overuse,” says Reed. Hopefully, outcome studies due out soon will show that CT is cheaper and more accurate than other tools, thereby driving better reimbursement. 256-slice CT can capture the whole heart in a single heartbeat for a much lower dose of radiation. That could reduce the number of tests patients require for better control of costs. “If you can get your answer without going to nuclear medicine and MR and everything else, it’s better for the patient and for the hospital,” says Young. “Buyers also have to consider investing in capital equipment that can do a myriad of applications. As hospitals and businesses are looking at investing in technology, they’ve got invest in systems that give the widest range of applications to maximize their return on investment.” new study results will give a better algorithm of which patients can benefit the most and should help with reimbursement, he says. The Core 64 study at nine centers blindly compared 64-slice coronary CTA to cath lab results; results are expected shortly. Stay tuned With this year’s annual RSnA meeting coming up soon, CT and MR vendors are sure to offer new features and enhancements for both technologies. 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