RADIOLOGY Technology Trends and Their Impact on American Healthcare Monte Clinton, CRA Director of Radiology Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire USA Kodak Healthcare Advisory Board Shanghai

American Healthcare Academic Medical Centers (not for profit) Hospitals (both for and not for profit) Rural hospitals (both for and not for profit) Imaging Centers (for profit) Private office (for profit)

Radiology Trends and Opportunities Routine Radiography Mammography Ultrasound Magnetic Resonance Imaging Computed Tomography Vascular Interventional Nuclear Medicine PACS and IT What is Needed Now The Future

Routine Radiography The Trends Volume will continue to fall Film-based imaging will remain in small facilities The Opportunities Digital radiography (DR) increasing DR required for PACS and increased productivity Chest radiography with CAD Dedicated trauma and pediatric DR equipment

Technologist Work Components

Upright DR Eastman Kodak Company

Mammography The Trends: Digital becoming standard in large centers Film will continue to be used in small centers The Opportunities: Digital equipment with CAD Breast MR for dense and high risk patients Tomosythesis shows great promise Breast biopsy in Radiology will be standard

Tomosythesis Hologic Corporation

Ultrasound The Trend: Volume of referrals will continue to increase The Opportunities: 4D in OB ultrasound Ultrasound guided biopsy Molecular imaging and therapy coming New contrast agents for characterizing lesions Gene therapy delivery Musculoskeletal imaging – sports medicine

3D Ultrasound Philips Medical Systems

Magnetic Resonance Imaging The Trend: Volume will increase with new developments The Opportunities: Huge potential in cardiac imaging 1.5T – 3T – 7T migration Molecular imaging will develop quickly New applications: Perfusion Imaging, Functional Imaging, Diffusion Tensor Imaging, Peripheral Angiography, MR Spectroscopy Site specific contrast agents

3T MRI General Electric Company

CAD Breast MR – Volume Summary Seattle Cancer Care Alliance – CADstream Confirma

CAD Breast MR – Angiomap Seattle Cancer Care Alliance – CADstream - Confirma

Cardiac MR – Scar Mapping Justin Pearlman, MD, PhD

Computed Tomography The Trends: The volume will increase with new techniques Huge number of images requires PACS Multi detector migration – 32, 64 and beyond The Opportunities: Cardiac CT Angiography Coronary calcification scoring Virtual Colonoscopy Lung screening

Volume CT (64 Slice) General Electric Company

Volume CT Heart

Vascular Interventional The Trend: Steady volume increase as more procedures are developed with Cardiology, Oncology and Vascular Surgery The Opportunities: CT/Interventional equipment will be standard Cancer therapy collaboration with Oncology Gene therapy delivery – pancreas and liver Chemoembolization Radio frequency ablation

Nuclear Medicine The Trend: Volume will continue to increase - 35% Cardiac New PET techniques The Opportunities: PET cardiac and Alzheimer’s screening shows great potential PET/CT becoming the standard equipment Functional imaging

3D PET/CT University of Texas, MD Anderson Cancer Center, PET Center General Electric PET/CT

PACS Picture Archive and Communication Systems The Trends: Major hospitals are adopting PACS Small hospitals are hampered by high cost The Opportunities: Low cost (turn key) PACS for small facilities Integration within the hospital’s electronic record Wireless transmission of images directly to the referring clinician

Radiology’s PACS and IT The Trends: All American hospitals to have EMR in 10 years Billing standardization required Portability of medical record is essential Radiology PACS images imbedded in EMR Radiology – IT collaboration required The Opportunities: Single RIS-PACS source solutions DR/CR – RIS – PACS – HIS Other clinical areas - Vascular - Cardiology

Patient Summary Access

Radiology Reports

Viewing Images via CIS

What is Needed Now? Lower cost DR and PACS equipment Integrated DR and PACS equipment Image transmission to central interpretation hub Equipment that enhances productivity Well built equipment that is easy to use and maintain Better use of mobile imaging equipment – CT, MR, PET/CT, VIR, Cardiac Catherization, Mammography, Radiography and Ultrasound

The Future Robotic imaging Automated CAD with interpretation and reporting Integrated RIS-PACS-HIS through I.T. Portable medical records – perhaps imbedded in patient Molecular Imaging Image guided chemotherapy and gene therapy

Questions? Monte Clinton, CRA Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire USA