One-Stop Cardiac CT

A new Radiology Journal study found that combining Triple-rule-out CT (TRO CT) with Late Contrast Enhancement CT (LCE CT) significantly improves acute chest pain diagnosis.

Background – It’s traditionally been challenging to diagnose patients with acute chest pain and mild troponin rise, as TRO CT is effective for several key diagnoses (coronary artery disease, acute aortic syndrome, pulmonary embolism) but can’t identify nonvascular causes of myocardial injury.

The Study – The researchers examined 84 troponin-positive patients with acute chest pain using TRO CT, and then performed LCE CT exams on the 42 patients who had negative/inconclusive results. 

The Results – The added LCE CT exams revealed positive/conclusive findings in 34 of the 42 previously-negative/inconclusive patients (including 22 w/ myocarditis), improving overall diagnostic rates from 50% to 90% (from 42/84 to 76/84).

The Takeaway – This new TRO CT + LCE CT protocol could make cardiac CT a “one-stop shop” for diagnosing acute chest pain, eliminating the need for follow-up MRI exams and allowing faster diagnoses. That’s especially notable considering that CT is already recommended for patients with low-risk acute chest pain (to exclude CAD) and was recently proposed as a gatekeeper for invasive coronary angiography.

Canon’s Big Virtual RSNA

Canon Medical was among the first companies to decide to virtually exhibit at RSNA 2021, but the OEM still had quite a presence, prominently placing Canon signage throughout the convention center and announcing a range of new products and technologies. 

Vantage Fortian – Canon expanded its open bore MRI lineup, launching the Vantage Fortian 1.5T system. The FDA-cleared MRI debuts with a range of productivity enhancements, including new patient monitoring and positioning tools and planning tools for liver, prostate, and whole spine imaging. The Vantage Fortian also adopts Canon’s prioritized AiCE deep learning image reconstruction technology.

MRI Solution Expansion – The Vantage Fortian’s new automation tools will soon expand to Canon’s Vantage Orian 1.5T MR and later go into the Vantage Galan 3T system (pending regulatory approval). Canon will also make Resoundant Inc.’s advanced Magnetic Resonance Elastography (MRE) technology available with its latest MRIs.

Premium Ultrasound Overhaul – Canon Medical introduced the Aplio i-series / Prism Edition, completely redesigning its premium ultrasound family. The Aplio i-series / Prism Edition ultrasounds launch with a new interface and ergonomics, higher processing power, added image enhancement applications (microvascular, ultra wide view), and new AI-based workflow automations.

Aquilion ONE / PRISM CT Enhancements – Canon continued to enhance its Aquilion ONE / PRISM Edition CT scanner, adding its new Precise IQ Engine (PIQE, a new DLIR solution for cardiac CT image enhancement) and SilverBeam X-ray filter (reduces lung cancer CT radiation dosage close to CXRs). These FDA-pending enhancements come one year after the Aquilion ONE / PRISM Edition added Deep Learning Spectral CT scanning (allowing one-beat cardiac scans).

Hi-Def Interventional Detector – Canon also launched a new 12×16 Hi-Def detector for its range of Alphenix interventional systems (Sky +, 4D CT with Sky +, Biplane, and Core+), joining its existing 12×12 detector. The hybrid detector has the highest resolution on the market (76 micron resolution, up to 6.6 lp/mm), while achieving 2-times greater spatial resolution than conventional flat panels.

Winners Announced for 2021 Imaging Wire Awards

The Imaging Wire is thrilled to announce the winners of the 2021 Imaging Wire Awards, honoring this year’s most outstanding contributors to radiology.

The following Imaging Wire Award winners were nominated by their peers and selected by a panel of judges for their efforts to evolve radiology and improve the lives of clinicians and patients:


COVID Hero: Lt Col Giovanni Lorenz, DO; Deputy Radiology Product Line Leader, San Antonio Military Health System (SAMHS)

Lt Col Dr. Giovanni Lorenz distinguished himself and the San Antonio Military Health System during the COVID pandemic, developing new remote diagnostic programs that improved SAMHS’ cardiac imaging operations, while also leading several National military COVID-19 working groups.


Diagnostic Humanitarian: Arlene Richardson, MD; Radiology Department Chair, Jackson Park Hospital

Dr. Richardson serves as Radiology Chair for Jackson Park Hospital and Medical Center, where she upholds equitable care for the hospital’s traditionally underserved patient population, and is deeply involved in RAD-AID International, where she currently serves as Director of RAD-AID Tanzania.


AI Activator: Greg Zaharchuk, MD, PhD; Professor of Radiology, Stanford University, Founder of Subtle Medical

In addition to his clinical and academic achievements at Stanford, the image enhancement solutions that Dr. Zaharchuk developed with Subtle Medical have significantly improved hospitals and imaging centers’ productivity and their patients’ experiences. 


Insights to Action: Richard Duszak, MD; Professor and Vice Chair of Radiology, Emory University

Dr. Duszak founded the Neiman Health Policy Institute and currently leads radiology health policy and practice efforts at both Emory University and the JACR, where he and colleagues have expanded awareness of imaging overuse and volume growth.


Burnout Fighter: Chris Mattern, MD; Practice President, Greensboro Radiology

Dr. Mattern created and leads many of Radiology Partners’ mental health and burnout prevention programs, combining education, mentorship, and communication to improve the organization’s cultural wellness.


Cornerstone: Elad Walach; CEO, Aidoc Medical

Elad Walach and his teams have developed seven FDA-cleared AI products and brought AI into clinical use across 600 global sites, improving medical imaging efficiencies and quality of care.


Tech Trailblazer: Sheela Agarwal, MBA, MD; Chief Medical Information Officer, Nuance Communications

Through her work with the ACR Data Science Institute and Nuance Communications, Dr. Agarwal has championed radiology professionals’ role in bringing AI into clinical care, while providing much needed tools and frameworks to support AI adoption.


The 2021 Imaging Wire Award judges include: Bill Algee of Columbus Regional Hospital, Dr. Jared D. Christensen of Duke University Health, Dr. Keith J. Dreyer of Mass General Brigham, Dr. Allan Hoffman of Commonwealth Radiology Associates, Dr. Saurabh Jha of Penn Medicine, Dr. Ryan K. Lee of Einstein Healthcare Network, Dr. Marla B.K. Sammer of Texas Children’s Hospital, and Dr. Irena Tocino of Yale New Haven Hospital.

Congratulations to this year’s Imaging Wire Award winners and nominees, who’s efforts to elevate radiology is truly inspiring. Also, thanks to this year’s amazing judges and everyone who nominated these very deserving imaging professionals!

RSNA 2021 Reflections

The first in-person RSNA since COVID is officially a wrap. Hope you had a blast if you made it to Chicago and a productive week if you stayed home. We also hope you enjoy The Imaging Wire’s big takeaways from what might have been both the most special and most subdued RSNA ever.

Crowds & Conversations – We were already expecting 50% lower attendance than RSNA 2019, but the exhibit hall and cab lines looked more like 70% below 2019’s crowds (even less on Sunday & Wednesday). That said, most of the stronger companies had steady booth traffic and nearly every exhibitor emphasized that the attendees who did show up were ready to have high-quality conversations.

Focus on Productivity – Just about every product message at RSNA focused on productivity and efficiency, often with greater emphasis than clinical effectiveness. The modality-based efficiency enhancements seemed to be the most impactful, which is good news for technologist bandwidth and patient throughput, but might be bad news for rad burnout unless informatics/AI efficiency can catch up (it doesn’t seem like that happened this year).

Modality Milestones – The major OEMs did a good job making modalities cool again, debuting milestone innovations across both their MR (low-helium, low-field, reconstruction, coils) and CT (photon-counting, spectral, upgradability) lineups. We also saw the latest scanners take big strides in operator efficiency and patient experience. There weren’t many breakthroughs with X-ray or ultrasound, and most point-of-care ultrasound OEMs stayed home (rads aren’t their market anyway), but attendees seemed okay with that.

AI Showcase – The RSNA AI Showcase had solid traffic and high energy (especially on Mon & Tues), helped by continued AI buzz and the fact that RSNA finally let AI vendors out of the basement. The AI Showcase highlighted many of the trends we’ve been seeing all year, including larger vendors transitioning to AI platform strategies, an increased focus on workflow integration and care coordination, and a greater emphasis on radiologist efficiency. There were also far fewer brand-new AI tools than previous years, as many vendors focused on improving their current products and/or expanding their portfolio via partnerships. 

PACS Cloud Focus – PACS vendors continued to place a major emphasis on their respective cloud advantages, and there was a widespread consensus that cloud is on every imaging IT roadmap. The PACS vendors seemed to talk less about multi-ology enterprise imaging than previous years, and expanding EI beyond radiology/cardiology still seemed pretty futuristic for most players. It was also quite clear that most of the PACS players’ AI marketplaces/platforms haven’t been as prioritized as earlier announcements might have suggested.

Best RSNA Since… 2019 – We’ve heard some folks saying this was the “best RSNA ever” because it was easy to get around and it was great to see everyone, but those seem more like pandemic silver linings than “best ever” qualifications. Still, the imaging industry made the most of RSNA 2021, and everyone seemed truly happy to be together again after two long years of working from home. As long as COVID cooperates, we should be set up for an excellent RSNA 2022.

GE’s Productive RSNA

GE Healthcare had another busy RSNA, highlighted by several major modality launches and an overarching focus on helping imaging teams be more productive. 

Return to MR Hardware – After focusing on AIR Recon DL during the last two RSNAs, GE Healthcare’s MR team made sure to roll-out new hardware at this year’s show. 

  • GE’s MR section was headlined by its new SIGNA Hero 3T MR, which brings a wide range of improvements (image quality, workflows, productivity, comfort, reconstruction, helium & energy), and a major focus on operator efficiency.  
  • GE also unveiled the SIGNA Artist Evo, which allows health systems / imaging centers to upgrade their existing 1.5T 60cm-bore MRs with 70cm bore systems (w/ AIR Recon DL & AIR Coils), without the construction and downtime typically required when upgrading to a net new MR system.

GE’s Scalable CT Platform – GE unveiled the unique Revolution Apex platform, which offers the modularity and scalability to cover a wide range of current and future needs, and represents GE’s biggest CT launch since 2014. 

  • The FDA-cleared Revolution Apex CT is available with multiple detector coverage configurations (40mm, 80mm, 160mm, upgradable w/o replacing gantry) and is offered with GE’s new Smart Subscription service (allows software upgrades/downgrades, plus auto updates). 
  • True to GE’s productivity focus, the Revolution Apex also includes a range of features to improve technologist efficiency and/or expand clinical applications (e.g. “Effortless Workflow,” patient positioning camera, TrueFidelity DLIR, motion correction for cardiac).

Much More – GE Healthcare has been busy throughout 2021, so although the other products in its RSNA booth were still quite new, they’ve already been detailed in previous Imaging Wire issues. Some of these other highlights include its in-development Photon Counting CT, it’s now FDA-approved Endotracheal Tube X-ray AI tool, its StarGuide SPECT/CT scanner, and its recent alliance with Optellum.

Arterys’ Platform Expansion

At a time when many major AI companies are trying to become AI platform companies, Arterys announced a trio of 3rd party AI alliances that showed how a mature AI platform might work.

Arterys Expands Neuro AI – Arterys launched neuroradiology AI alliances with Combinostics and Cercare Medical, expanding Arterys’ already-comprehensive Neuro AI suite (also includes MRI brain tumor diagnostics, CT stroke & ICH detection, 2D/4D Flow brain MRI). Combinostics’ cNeuro cMRI supports multiple neurological disorder assessments (specifically dementia and multiple sclerosis), while Cercare Perfusion automates brain CT and MRI perfusion map generation and stoke treatment decision making. 

Arterys Adds Breast AI – Arterys launched a global distribution agreement with iCAD, making iCAD’s full suite of breast health solutions available in Arterys’ new Breast AI suite. iCAD’s portfolio is certainly broad enough to deserve its own “suite,” ranging from 2D and 3D mammography detection, personalized risk screening and decision support, and density assessments. The Arterys Breast AI suite also makes iCAD available as a cloud-based SaaS solution for the first time (previously only on-premise).

Arterys Platform Impact – Arterys’ integration of multiple complementary AI tools within curated AI Suites is unique and makes a lot of sense. It seems to be far more helpful to provide neurorads with integrated access to a suite of neuro AI tools, than to provide them with one or two tools for every subspecialty.

The Takeaway – Arterys’ new alliances reveal a far more subspecialist-targeted approach than we usually see from AI platforms or marketplaces. It also shows that Arterys is committed to its vendor neutral strategy, effectively doubling its number of active AI partners (previously: Imaging Biometrics & Avicenna.AI in Neuro suite, MILVUE in Chest MSK Suite), while highlighting the value of its cloud-native structure for integrating new partners within the same user interface.

Visage Adds Videos

Visage Imaging now allows radiologists to create and distribute video reports from the Visage 7 platform, representing an interesting milestone for radiology patient engagement and multimedia reporting.

About Visage Videos – The latest Visage 7 version (7.1.17) allows radiologists to quickly create and edit one minute multimedia video reports (video, audio, 2D/3D manipulations) at their workstations (same setup & dictation system), and use these videos to explain key findings to patients. Visage developed its new Video Reports feature with NYU Langone Health, which already had over 70 rads create more than 1k video reports, and found it to be valuable for both patients and referring physicians.

Patient Readiness – We’ve covered plenty of studies detailing how patients want to review their radiology reports, but struggle to understand them. We’ve also seen video communication and patient portals gain increasingly prominent roles in patient care. Based on those factors, Visage’s new Video Reports seem to have a solid product-market fit… if only patients were the decision makers.

Radiologist Adjustments – Visage’s Video Reports will expand radiologists’ reporting audience to patients for the first time, which would require mindset changes (simple language, referrer etiquette) and add workflow steps (rads would have to create two reports). These adjustments might initially make video reports a better fit for the most patient-centric radiology teams, but that could change over time. Plus, the Video Reports tool comes standard with Visage 7, so it will be available if/when the other groups change their mind.

The Video Trend – Given the telehealth and patient engagement revolutions taking place, it’s a solid bet that all types of clinicians will be expected to increase their digital / virtual patient interactions in the future. For radiologists, this might come in the form of Visage-style recorded videos or real-time primary care teleconsultations like MGH piloted earlier this year, but more patient-centric communications are coming.

The Takeaway – Visage’s new Video Reporting feature might be a small part of the overall Visage 7 platform, and its initial adoption might also be relatively small given most rad groups’ focus on productivity. However, this “small” video feature could prove to be part of a very big change in how radiologists engage with their patients.

Philips’ RSNA MRIs

After two straight solution-centric RSNAs, Philips’ RSNA 2021 booth will be headlined by a pair of new MR systems (plus some MR solutions) and a major focus on operational efficiency.

MR 5300 – The FDA-cleared MR 5300 (1.5T) is Philips’ second helium-free BlueSeal MR scanner, arriving three years after the Ingenia Ambition X, and launching with new AI-powered features intended to automate clinical and operational tasks. Philips also emphasized the image quality advantages of the MR 5300’s 55cm field-of-view and dStream Breeze coils.

MR 7700 – Philips’ forthcoming MR 7700 system (3T) is positioned for both clinical and research use, although its features and messaging largely emphasize its value to researchers. The MR 7700 boasts new multinuclear clinical capabilities, including diffusion imaging and advanced neuroscience sequences, while its XP gradients (65 mT/m) support neuroscience.

MR Workspace – Philips’ new MR Workspace is intended to support technologist productivity, providing a dashboard that automates the planning and execution of many routine scans and supports decision making by suggesting the most suitable Exam Card for each patient. MR Workspace will be included with all new and installed Philips MR scanners. 

Philips SmartSpeed – The SmartSpeed image reconstruction platform is designed to speed up image acquisition and enhance image quality, leveraging Philips’ Compressed SENSE acquisition technique and AI to reconstruct full images from under-sampled data, “while maintaining virtually equivalent image quality.”

The Takeaway – Philips’ MR lineup has been relatively quiet during the last few years, while its main MR competitors made some solid progress (particularly w/ reconstruction, operability, comfort, and low-helium tech). It seems like that won’t be the case at RSNA 2021.

Viz.ai’s Care Coordination Expansion

Viz.ai advanced its care coordination strategy last week, launching new Pulmonary Embolism and Aortic Disease modules, and unveiling its forthcoming Viz ANX cerebral aneurysm module.

PE & Aortic Modules – The new PE and Aortic modules use AI to quickly detect pulmonary embolisms and aortic dissection in CTA scans, and then coordinate care using Viz.ai’s 3D mobile viewer and clinical communications workflows. It appears that Viz.ai partnered with Avicenna.AI to create these modules, representing a logical way for Viz.ai to quickly expand its portfolio.

Viz ANX Module – The forthcoming Viz ANX module will use the 510k-pending Viz ANX algorithm to automatically detect suspected cerebral aneurysms in CTAs, and then leverage the Viz Platform for care coordination.

Viz.ai’s Care Coordination Strategy – Viz.ai called itself “the leader in AI-powered care coordination” a total of six times in these two announcements, and the company has definitely earned this title for stroke detection/coordination. Adding new modules to the Viz Platform is how Viz.ai could earn “leadership” status across all other imaging-detected emergent conditions.

The Takeaway – Viz.ai’s stroke detection/coordination platform has been among the biggest imaging AI success stories, making its efforts to expand to new AI-based detection and care coordination areas notable (and pretty smart). These module launches are also an example of diagnostic AI’s growing role throughout care pathways, showing how AI can add clinical value beyond the reading room.

Siemens’ Healthineers Hardware Evolution

Siemens Healthineers’ Shape 22 pre-RSNA event featured a pair of ambitious hardware announcements that stand to expand what can be done with CT exams and where MRIs can be performed.

NAEOTOM Alpha PCCT – Siemens Healthineers confirmed its pole position in the Photon-Counting CT race, officially launching its NAEOTOM Alpha scanner. Although the NAEOTOM Alpha already received a rare marketing head-start from the FDA, this week’s launch begins its official 2022 rollout, and provides new details about this milestone product:

  • Far higher image quality than CT
  • Provides much more imaging data and new levels of CT-based insights
  • Expands CT to new cardiac, oncology, and pulmonology use cases
  • Allows 50% lower radiation dosage, could shift exams to non-contrast
  • Supports Siemens’ core solutions, including operability and AI-based diagnosis
  • Cleared in US and Europe, 20 systems already installed, 8k patients scanned
  • PCCT expected to become the main CT technology within 10 years
  • Siemens is holding another NAEOTOM Alpha event today (Nov. 18)
  • Siemens might be first, but we’re seeing more PCCT activity from GE Healthcare, and Canon and Philips aren’t far behind

MAGNETOM Free.Star MRI – One year after introducing the MRI-expanding MAGNETOM Free.Max, Siemens continued its MRI accessibility push, revealing the “disruptively simple” MAGNETOM Free.Star. The new Free.Star MRI will inherit much of the MAGNETOM Free.Max’s accessibility-friendly qualities (0.55T, small/light, low helium & installation requirements), and will have the ambitious goal of supporting the half of the world’s population that doesn’t have MRI access. The MAGNETOM Free.Star is still early-stage (it hasn’t begun the FDA process), but it’s massive healthcare ambitions make it worth keeping an eye on.

The Takeaway – The NAEOTOM Alpha is expected to be the start of a major shift towards Photon-Counting CT, while the new MAGNETOM Free.Max and Free.Star could expand where MRIs are used. That makes these extremely significant products.

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-- The Imaging Wire team