By Dr. Michael Friebe

My last years report was titled "BEYOND IMAGING: Radiology is Changing! Big Data / Machine and Deep Learning / Artificial Intelligence is everywhere!“ — well that was just the beginning and the title this year definitely deserves to be...

Machine Learning in the center of Radiology Innovation

There were about 30 smaller company showings in a dedicated Machine Learning (ML) section of one of the main exhibition halls ... with their own presentation stage and demo program. I was there 3 times and it was always quite crowded. Canon (Toshiba), Philips, and Siemens also presented their ML expertise and often saw surprised radiologist that were not aware that the big ones already invested quite heavily in this technology approach for many years now. In the East Hall there was a seminar area run by NVIDIA introducing ML to anyone who was interested. I attended that too and was quite excited to see what is available already and even programmable from an iPAD. IBM Watson (last year only a small exhibition area) and GOOGLE also had booth space occupied and are very likely to stay and grow in presence and importance in the coming years.

General impression — not verified though — less visitors and even less radiologists. RSNA is slowly changing from a science to a business conference. For the first time I only stayed 2.5 days and do not feel that I missed a lot ... actually on my way to San Francisco now attending an Exponential Innovation Seminar at Singularity University (www.su.org) ... fits well with the growing importance of Artificial Intelligence, Machine Learning, Robotics, and 3D printing (was also highlighted in a separate section of the East Hall with own program and presentation stage).

In the last years I have always integrated a small section on physical activities and even some food info... very short this time: average 10km walking per day, swam around 1km every morning, and I actually ate three meals a day... on Sunday with my friends from the 'MIM-Club‘. Never heard of that? Good, we want to keep it that way, but if you are willing to pay for next year's dinner at Harry Caray we may give you some insight details :-)

By the way, the weather was excellent again — at least on Monday and Tuesday no coat needed even at night. After 26 years of RSNA attendance I for sure am convinced that the weather has changed in Chicago and a global warming effect is undeniable — saying that for the very few people left that still believe President T.

The big OEMs were actually asked - as every year - about their single most important product highlight — you will find them in the next paragraphs — but I am of course aware that depending on who you ask from Philips/Siemens/ Canon(Toshiba)/GE you will get different answers, eg the MRI product manager will see the most important innovation in MRI. For that reason I tried to stay with the corporate or sales management. And of course — even though they do have very similarly specified products — every OEM is better than the others. Surprise, surprise! I will list some of these, but my personal opinion is that there was nothing groundbreaking, disruptive or game-changing — but decide and judge for yourself.

It was the last RSNA with Toshiba being present with their own name ... from January on they will be Canon Medical. I also worked for Toshiba as MRI Systems Engineer early in my career (1990–1992 in San Francisco) and am a little sad ... but hey at least they won in their last year the price for the largest RSNA booth beating all the other OEMs.
OEM Booth Designs
I actually checked my report from last year and dug out the pictures. No or very little changes this year. I think that most of them recycled their booth ... nothing wrong with that ... they all still looked good. I was missing the fancy look-through screens though ... don’t know what happened to them. Some impressions are shown in the enclosed pictures above. Look at the right one from BAYER — the dropping logo is water!

I would say that Orange/Red - on average - was the most dominant color followed by Blue. Again, not very scientific and very subjective.

Ever heard of and know what CHANGE Healthare is all about? Completely new to me with a large booth. There were several relatively generous booth layouts of companies that were new to me ... actually surprising for someone like me who reads just about every blog on radiology / imaging related business news.

Which brings me to mention DOTMED ... I am on their editorial advisory board for many years now and every RSNA Monday they have a breakfast meeting with the newest “radiology predictions” for the coming year from their President Phil Jacobus. Check out their online business news and you will be able to read them yourself - very much in line with mine.

Exciting Imaging Products
I may repeat myself (from last year's reports), but there were nice improvements in workflow, acquisition time, image resolution and quality - no groundbreakingly new RSNA offerings however (this was the exact wording from last years report ... true for 2017 as well and therefore recycled).

As mentioned already the OEMs are ready and prepared for ML and AI, but did not highlight that on their booth showings, which were focusing on the necessary incremental improvements. All showed new fully digital 3T systems with lots and lots of channels. The MR LINAC (Philips/Elekta) was shown on Elekta’s booth and presented in a lunch symposium that I attended. I cannot believe that this is the way forward considering the cost constraints and the already existing inequalities in health care provision. The companies need to think more in terms of making processes and procedures easier, cheaper and that come with a smaller footprint. That may then really lead to disruption. I actually know that the OEMs are actively thinking about that and they may already have some great product ideas, but not a clear business concept yet. Will be exciting to see their reaction if a medium size vendor introduces such a system.

Siemens Healthineers showed a new CT / Angio combination and a clever new camera concept with the potential to reduce user positioning errors and decrease X-ray dose. They use an infrared stereo camera system over the CT patient bed that measures the patient volume and distance to the X-ray tube. I can see many potential additional applications for that including tool tracking, automated patient classification and protocol selection.

Toshiba highlighted a new CT with 0.25mm detector dimension that increased the resolution dramatically ... unfortunately, but not surprisingly, the price also increases dramatically. And Philips was presenting the new fully digital PET/CT and an improved spectral CT.

GE combined high-end ultrasound with the Fibroscan method for liver diagnosis that I believe will be successful within that dedicated market segment, as it provides valuable additional diagnostic information also for screening.

Disruption? What is on the horizon?
Machine learning is the hottest and most promising development - no, promising is actually not the right word anymore, because it is clear that ML and AI will improve the diagnostic quality significantly and will definetely stay. So lets call it “emerging” and for many it is also rather frightening, as it will come with workflow changes, will change reimbursement and delivery, and most importantly will change the role of the radiologist. It will most likely not be “bye, bye radiologist”, but possibly lead to an empathetic disease management role for the radiologist on behalf of the patient. From a patient's point of view that sounds awesome.
And let me mention in that context some of the cool companies that I am working with and/ or that I like and that were present at this years show — check them out: CONTEXTFLOW (AI, ML from Vienna), PIUR IMAGING (Ultrasound Tomography), INTERVENTIONAL SYSTEMS (Surgical Assistance), SMART REPORTING (the name says it all), SURGICEYE (Surgical Nukmed); MR:COMP (MRI compatibility), and of course VISUS.

Since this October my research group (engineering innovations for new image guided therapy devices including a machine learning and signal analysis group) in Magdeburg is additionally running an INNOVATION LAB directly at the university clinic and we - together with our clinical partners - would like to work with you on the exciting RSNA product highlights for 2018 and beyond — www.inka-md.de