By Gus Iversen, Lauren Dubinsky, and John W. Mitchell

Kicking off on Sunday and gaining steam through the early part of the week, RSNA attendees have by now gotten more than a taste of what's happening in the world of radiology — and the HCB News team was alongside them taking notes.

First off, it's necessary — if not a little sobering — to acknowledge that this year's meeting has not turned the industry on its head. Health reform remains the key catalyst for hospital decision makers, and it's been that way for several years now.

But what draws over 50,000 radiology professionals (last year it was 56,026 to be exact) to Chicago in the early stages of the winter season is not a desire to reacquaint themselves with what remains the same. It's an opportunity to find out about the latest technology and research taking place in the industry, to form new partnerships, and to discuss the problems and solutions that are shaping radiology.

We divided and conquered the main attractions (announcements, presentations, and exhibition booths) and have come up with the HCB News top 10 takeaways from RSNA 2015:

10) Tomosynthesis — No longer just for breast imaging

While tomography has largely been displaced by CT for many indications, X-ray tomosynthesis, in turn, is poised to raise the bar on many of those CT exams. GE Healthcare is among the OEMs getting an early jump on this technology with an application called VolumeRAD which is proving to be very useful in the orthopedic segment. Shimadzu has also arrived early on the scene, and other companies (including Canon USA) mentioned big-picture plans to get involved eventually.

Once the reimbursement is there for X-ray tomosynthesis we expect this trend to gain greater momentum and have a big impact on some of the more common exams, like chest X-ray.

9) Ethics, computer-learning, and the FDA

Computer learning has massive potential for health care, but it presents regulatory challenges. How will the FDA, and other agencies, be able to validate systems to ensure they are learning correctly? And what would correct learning look like, anyway?

It's an abstract concept for an agency that has traditionally dealt in comparatively finite terms.

The partnership between IBM Watson and Merge Healthcare is a perfect example of the promise computer learning holds — but to what extent can you give artificial intelligence a license to make medical decisions? The thought alone may be enough to make you want to never watch The Matrix again.

8) On the road again

We address this in our December magazine, but we witnessed it up close and in person at RSNA: After several years of decline, the mobile imaging industry is enjoying a resurgence.

Acquisitions are reshaping the landscape for the flagship modalities while newer modalities are finding their wheels for the first time. Gamma Medica's LumaGEM molecular breast imaging system for dense breast secondary screening is a prime example, and it's already gained the attention of the Marshfield Clinic, which is using the system to reach its rural patient population.

The mobile imaging industry was initially hit hard by the ACA, but as the value proposition of limited downtime, shared services, and increased patient access find their footing in the new legislative climate, that business model is showing new signs of life. Advanced Mobility's acquisition by Kentucky Trailer is a testament to this.

7) A call for breast density standardization

In the U.S. there are 24 states that have already implemented breast density laws and a handful of others will follow suit shortly. Historically, radiologists have determine density based on their opinion, but that leads to inconsistent scoring.

The industry is in need of a standardized approach for breast density scoring both because many states require that women be notified of their score, and breast density is associated with a higher risk of cancer.

Volpara and iCAD showcased new automated breast density assessment technologies this year. Volpara released its VolparaDensity Version 3.1 and iCAD released its iReveal and both include ACR's BI-RADS 5th edition.

The difference is that VolparaDensity uses a volumetric approach to measure the breast and iReveal uses an area-based approach. But regardless of what approach is used, both standardize the measurement of breast density so that facilities can get more reproducible results each time.

6) Watch out stethoscope, ultrasound is on your tail

For years people have speculated about the possibility of ultrasound replacing the stethoscope. It's a powerful thing to wonder about, after all, the stethoscope has been a key part of the physician's toolkit for 200 years.

You don't have to be a health care professional to recognize the incredible potential of app-based ultrasound systems, and while the market is likely to become more crowded over time, Philips currently leads the charge with its Lumify software.

Randy Hamlin, vice president and business segment leader of ultra mobile at Philips, told HCB News that the system is currently only available for Android because it satisfies output requirements pertaining to the charge port.

5) There's no substitute for usability

It's part of that top-level trend toward making the most of what you've already got. More than ever, hospitals are looking for systems that will compliment the training their technicians and assistants have already received. A system with endless capabilities is of little use to an end user who doesn't know how to operate it.

The goal is to bundle these advanced features into systems that make accessing and using them an intuitive process, (yes, like a smart device). Incidentally, this trend also coincides with the rise of tablet technology, touch screen systems with intuitive UX, and all the other gadgetry that has already saturated the commercial market.

For DR panels, FUJI unveiled the world's first long-length DR detector with a 17 inch by 49 inch field of view. The FDR D-EVO GL detector was designed to simplify the imaging process for pediatric patients with scoliosis, wider patients and patients requiring spinal exams.

4) XR-29 and stretching the dollar

Regular hospitals no longer have the budget for a new MR or CT, and yet many of them are facing greater reductions in their payments if they don't upgrade. An estimated 1/3rd of the current CT scanner install base stands to lose money if they don't figure out how to meet the four qualifications of the standard.

Medic Vision and BC Technical are two companies that have turned this dilemma into a business opportunity. According to Eyal Aharon, CEO of Medic Vision, CMS has clarified its stance on third-party compliance. If the FDA approves a third-party tool, then it's good enough for full reimbursement by Medicare and Medicaid.

Medic Vision is currently seeking FDA approval of its SafeCT-29 solution.

This is significant because if an OEM does not have a software upgrade pathway to make an older CT system record and monitor dose, (the most decisive aspects of the standard) there may still be options for that end user in the third-party market.

3) 3-D printing is getting down to business

"3-D printing is a completely disruptive technology in general and in medicine," Dr. Frank Rybicki, professor and chair of the department of radiology at the University of Ottawa Faculty of Medicine, said in a session on Sunday.

Surgeons at Texas Children's Hospital successfully used CT images to create a 3-D model of a pair of conjoined twin's anatomy to assist in surgically separating them. That was the first time conjoined twins with that degree of complexity were separated.

However, Rybicki explained in his session, there is still an unmet need for radiologists to render DICOM images as 3-D printed models that provide tactile feedback and tangible depth information of anatomic and pathologic states. Radiologists are traditionally used to diagnosing with 2-D images from CT and MR.

The hurdles in the way of widespread adoption of 3-D printing include cost, training, materials, equipment, guidelines, a lack of consensus in terminology, and reimbursement. However, a lot of vendors at RSNA have introduced 3-D printing software and hardware, which Rybicki said will drive down costs over time.

2) Big ticket modalities can wait

It's no longer about the latest widget, instead it's now about helping the hospitals become more efficient with what they have, David Pacitti, the new president of Siemens Medical Solutions USA, Inc., said at a meeting with the press.

The decision-making process is much more complex now that more stakeholders including providers, payors, policymakers, patients, employees and suppliers are involved. The population is aging and putting a strain on the health care system and reimbursements are continuing to decline.

All of these factors are converging on a volatile health care landscape in which hospitals need to ask themselves what services make them most valuable.

1) You cannot say interoperability enough

That's it. Interoperability. Every year companies chip away a little more at realizing those eight magical syllables. The word deserves a place right next to better outcomes, faster, and for less money in the Tenets of Health Reform hall of mottoes.

This year Health IT companies, the ones that might make someone think of the HIMSS conference, were drawing major crowds at RSNA. Enterprise imaging is at a tipping point and radiologists may finally be starting to slip out of their silos.

More than anything, this has been the theme of RSNA. How do we get the entire hospital to play nice together? How do we simplify radiology while adding massive loads of information and cross-channels? How do we accomplish this securely while letting the data sing its snowflake song?

The overwhelming focus on this issue suggests that the industry is in earnest pursuit of answers. Many of the educational sessions offered a front row glimpse into such particulars as: new hospital and physician compensation models; population wellness management; security and privacy of health care data in response to social media and portable devices; and integrating process improvement to engage employees in efforts to meet new patient consumer demands.

It's no secret that we aren't there yet, but the progress being made is massive and by most accounts it overshadows the developments taking place with imaging itself. It isn't because people don't want revolutionary imaging capabilities, they do, but in order to stay in business they need to streamline their entire workflow and create harmony where once was chaos.

Some slightly less momentous observations

A Twitter hashtag picked up momentum this year, in which attendees post pictures of their feet with the tag #RSNAshoes. The HCB News team makes no claim to understanding this phenomenon. #RSNAmanpurse and #RSNAsocks were less successful derivatives.

On the subject of fashion, Medical Ties, a company selling neckties (and bowties) with medical themes such as "Psychedelic Wrist MRI", was also somewhat remarkable at the show. The ties were $35 each or four for $100. On its website, the company describes itself as "a small Wisconsin company that, in between eating cheese sandwiches and watching the Packers, designs and makes medical ties."

Finally, is it possible that USB flash drives are passed their prime? In the past, exhibitors have provided the press with increasingly unique flash drives containing all of their RSNA media announcements. This year the creativity seemed to have gone down, as did the total number of drives being provided. Perhaps this is evidence of an industry truly embracing the cloud.

Did we miss anything? If you attended RSNA we would love for you to share your reflections with us.