An Op-Ed by Michael Friebe, Editorial Advisor and Contributing Reporter

RSNA's first year of the second century (101st meeting) ... brought some changes for my 24th attendance ... after 10+ years at the Intercontinental I stayed for the first time at the UNION LEAGUE CLUB and HOTEL - a very good choice and probably the only hotel in Chicago with an official dress code (e.g. no jeans during the weekdays!) that is handed out to you during the check-in. But also a very beautiful pool on the 21st floor which opens at 5am on weekdays - ideal time for jet-lagged Europeans ;-)

Another first for me was the fact that I only stayed till Tuesday evening giving me a full three days of RSNA ... I believe I will leave it at that for the future, met probably just about everyone and saw most likely just about everything.

A lot of people asked me on whether I would provide the walking statistics again ... yes, of course ... and you will get even more statistics this time including the personally walked booth size of some of the major vendors and a short statement on the booth appearance.

RSNA is still in two halls and probably will not need an extension in the coming years - I saw a lot of open spaces and expansion potential. My feeling was that the Sunday had a very low attendance, Monday picked up a bit and Tuesday was already down again. Maybe RSNA should eventually consider to shorten by one day. While I did not see any numbers I would estimate a low double digit drop in attendance compared to last year.

Weather was OK, never below freezing and only light rain on one day (Monday). This year I even spent quite a bit of time at the educational exhibits. Hundreds of e-presentations and posters including some interesting review works that I bookmarked and will download once I am back in Germany.

Have I seen many great new things and disruptive innovations? No! Some new products I will mention in the latter part of this report, but in general the show was focussed on incremental innovations and on software for collaboration, data and image exchange, improved efficiency and of course on image enhancement.

Worth to mention a quote from Jeffrey Immelt (CEO GE) at this point, who gave the NEW HORIZONS lecture "NO MATTER WHERE YOU ARE AROUND THE WORLD OF HEALTHCARE, IF YOU ARE LOOKING FOR THINGS TO BE STABLE OR IF YOUR ARE LOOKING FOR THINGS TO BE CERTAIN, YOU ARE GOING TO BE WAITING FOR A LONG TIME". How true and how frustrating at the same time especially for someone like the author of this report, who regularly invests (and believes) in new technologies and then has to realise that it always takes a lot longer and requires a lot more money than initially anticipated. But then, if everyone is hesitant no new innovations and technologies would be developed and subsequently commercialised. Please note the subtitle of this years RSNA -- INNOVATION IS THE KEY TO OUR FUTURE.

Now down to the promised personal statistics: Walked an average of 11km (7 miles) a day (left: Sunday / Monday / Tuesday - Schritte = Steps, Strecke = Distance). Also swam close to 5km and all in all lost about 0.5 kg, which means that with all the exercise I must have invested also heavily in food and beverages :-)

Ate steak on Sunday at Harry Caray Restaurant, as always with 3 close friends, a mix of appetizers on Monday and Airline food on Tuesday. Breakfast is always a problem for me in Chicago, as I am a rather frugal person and am not willing to spend US $25 or more for a buffet style breakfast. However, a Cappuccino and a Muffin at a Starbucks (or similar) is also almost US $10.

Which brings me to the incredible cost of staying in Chicago for Europeans (and probably everyone else outside the USA) these days. The exchange ratio to the EURO is very unfavorable (I purchased an iPad without checking the price in Germany beforehand and now had to find out that it would have been cheaper there), the state/federal/city tax has increased to almost 10% and the restaurant prices are very hefty. But then again, it is a beautiful town, you meet a lot of people and you generally have a very good time. And, the exchange ratio has been in our favor before in the recent past.

Lets talk about the vendor booth size / setup and general impressions.

Winner in size this year (probably for the last 50 years): GE, with a size of 28 x 125 MFS (MFS = Michael Friebe Steps - I personally walked every booth mentioned. 1 MFS is probably around 3 feet or 0.9m).

Runner-Ups: PHILIPS with 28x105 MFS and SIEMENS with 28x96 MFS.

Winner of the best booth setup and design (remember, that this is a subjective and personal report): PHILIPS, with a colorful, innovative setup

Runner-Ups: SIEMENS, which is a little to bright for me, but came with a clean and easy structure, but with possible improvements on the location and placement of the meeting rooms. GE, which is always a little too packed for me, but they had a pathway in the middle of the booth that made it easy to "navigate and look". Why they had to use such a thick carpet for that ... I do not know. I really liked TOSHIBA this year because of their clear corporate design and good layout (by the way 28 x 75 MFS plus 18 x 24 MFS for VITAL IMAGES).

Further booth comments (all numbers in MFS): HOLOGIC 28 x 60, much smaller and less prominent than last year, but quite a nice look that may have been a little too dark though. HITACHI 28 x 60, very open and inviting design. CARESTREAM 28 x 60 + 3x7, which was a little too bright for me and also too confusing in their product offerings. SAMSUNG 17 x 48, which must be a lot smaller than last year. AGFA 18 x 44, FUJI 28 x 44 + 4 x 7, and the GERMAN PAVILLION 18 x 25.

Many of you will now say "so what". The content and the offering is important. And, you are of course right about that. I usually go to the individual vendor representative (thanks to all, who showed me around and discussed new products / services) and ask about the new INNOVATIONS. And while I am generally excited about everything that is new in diagnostic imaging, I am particularly interested in image guided surgeries and easy and less expensive solutions to clinical and technical problems.

In that respect I was a little disappointed, maybe with the exception of the new MULTITOM RAX from SIEMENS, that has XR tube and Detector on individual ceiling mounted arms that can move inside the Rad room in all kinds of distances and angles to each other and with that can even create 3D XR images of a standing patient. GE, as well as SIEMENS (and probably PHILIPS too) were heavily promoting integrated software solutions that connect all systems, allow for remote downloading of imaging protocols, management of resources, and bookkeeping of time and materials spend.

Clearly, radiology operations and system management will be of utmost importance in the future and could very much benefit from these offerings. In the last years the innovation focus has been more and more on the software for imaging manipulation / handling / fusion and now additionally on the people and systems management side as well as on image / report distribution. Efficiency boosters with the imaging systems as enablers. The major vendors are trying to get even more prominent in the imaging practices, diagnostic departments, and hospitals / healthcare providers. I think that this strategy is a smart move, but that will also increase the users dependency on that one vendor and increase the switching cost to another vendor.

What else? SAMSUNG showed their own 128 slice CT (NExCT 7), with quite a small footprint and an appealing design. I also liked the new PET/CT of PHILIPS, size reduced and with significantly improved image quality.

TOSHIBA presented a combined CT / FLAT PANEL ANGIO because some of their customers apparently "... move their patients a lot between imaging and intervention." I am not sure that I can follow that and while I always think that it is cool to combine imaging modalities I have a hard time believing that there will be too many customers actually buying this system for the reasons mentioned. So, don't get me wrong ... that is cool, but possibly overkill ... and I have also been wrong quite often in the past with my predictions!

I saw a new breast biopsy table presented by HOLOGIC. The TomoBiopsy (I like that word combination) system AFFIRM comes with something like a C-ARM mounted vacuum biopsy system and allows access to otherwise difficult to reach areas.

GIOTTO had a different setup with the mammograhy system and attached biopsy device tilted 90 degrees towards the bed - also an idea! I checked my reports from the last three / four years about the Chinese/Asian vendor presence. The companies that are largely unknown to US or European customers have not increased their presence and I also did not see lots of new products. Exceptions are MINDRAY, that presented a range of well designed US and XR products and NEUSOFT with a new CT and even a PET/CT scanner on display.

3D printing of organs, vascular structures, phantoms ... based on imaging data was on display by at least 4 smaller vendors and additionally was presented in a special exhibit as part of the education exhibit in the lakeside hall. With new biomaterials that will be available for 3D printing there will possibly/probably be an economic business model behind that service, once we have found the clinical need ... but for the time being it looks a little bit like " ... we do things because we can do things." While it looks nice, it was unclear to me what the real value of it is at the moment.

I could actually write a little more and even share some predictions for the coming years with you, but I think this is quite enough.

Also, please come and visit the MEDICAL RESEARCH CAMPUS STIMULATE in Magdeburg, Germany and my labs for CATHETER TECHNOLOGIES + IMAGE GUIDED PROCEDURES ... you are always welcome with some prior notice :-)

We would like to work with you in developing new tools and systems for unmet clinical imaging and therapy needs and discuss and present the outcomes at one of the next RSNA meetings -- my official retirement is 2031 (unofficially I intend to go till at least 2064 - my friend Ed Adams from MEDICAL COACHES staffed the booth again this year with 92! Keep going Ed!), so we still have some time!!