By Tom Watson, clinical analyst with MD Buyline

There is no doubt that new hardware and software solutions unveiled at the 2017 RSNA will have a growing impact on the future of imaging and radiology. But a somewhat different and intriguing perspective was advanced by Dr. Elias Zerhouni, a keynote presenter at the opening of the conference.

Zerhouni is president of Global Research and Development, a member of the executive committee at Sanofi, and the former director of the National Institutes for Health (NIH). His presentation, “Imaging Innovation in 21st Century Biomedicine — Challenges and Opportunities,” posed the intriguing proposition that “What will be is already here.”



This statement seems to suggest that the future is already here, and what we will achieve in the coming years is more about how we integrate and utilize information that we can already acquire than it is about developing totally new data and technology. But I do not believe Zerhouni is suggesting there will be no further innovation in technology or advancement in evolutionary – if not revolutionary – imaging.

“The speed at which things will happen tends to be overestimated,” Zerhouni continued. “We have to participate, not just peripherally, but in the core scientific challenges of today, which are summarized by the tension between the complexity of biological systems and the precision medicine needed in the individual patient population. Imaging innovation is, by its very nature, interdisciplinary.”

While there are many horizons yet to be explored in biomarkers and related areas, the principle that resonated with me was the first, “What will be is already here.” I believe a “works-in-progress” on display at the Philips Healthcare exhibit is a perfect example of that principle being developed in practice.

Dr. Atul Gupta, Philips’ chief medical officer as well as an interventional and diagnostic radiologist practicing in Philadelphia, is a key developer and researcher working with Philips on an Augmented Reality (AR) solution. This offers a potential improvement in the workflow and logistics of accessing and integrating the multiple aspects of patient imaging, such as biological results, 3-D image modeling, image fusion of MR, CT and/or ultrasound with interventional x-ray, and even the ability to control the angiography system with a “floating” virtual control board. This latter innovation was available for RSNA attendees to “test fly”.

The combination of Image-Guided Therapy with Augmented Reality (AR) transports the test “pilot” into a data-centric and patient-centric world. With the AR headset on, and in the midst of a virtual patient procedure, the physician could, by using hand gestures, finger movements, and body position, bring up and see virtual representations of CT images, MR images, IVUS, lab results, ultrasound imaging, and hemodynamic monitoring parameters, all in a virtual floating cockpit within his field of view. The result was access to all or many of these parameters without having to turn away from the patient or move to see hardware monitors or other traditional display technologies.

The system can recognize the device specs being considered for use, such as balloons or stents, then virtually overlay the device on the virtual angiographic image of the vessel for proper sizing in both length and diameter. The demo allowed the user to bring up a holographic image of a 3-D model of the vasculature, which one could then rotate to see the X, Y, and Z axis perspectives without ever moving away from the table or breaking the sterile field.

I believe that the ability to consider all the imaging, monitoring, device data, and 3-D modeling, as well as live procedure imaging – not just from memory, but seen in the virtually augmented presentation – offers physicians and patients the information and images to more efficiently and accurately make decisions in “real time”.

Philips most decidedly is not the only vendor aggressively pursuing the integration of Artificial Intelligence (AI), Machine Learning (ML), and/or Deep Learning (DL). These terms are somewhat synonymous, or certainly overlap, in the realm of virtual reality. They were a major focus of many vendors and presentations during RSNA. It is important to note that I use Philips only as a working demonstration as to what is possible, and not as an endorsement of its technology over that of any other vendors. Philips simply had a functional display that demonstrated the tremendous potential of AI/ML/DL in a manner that, I believe, supports Dr. Zerhouni’s first principle: “What will be is already here.”

The use of augmented reality is taking what is already here and possible with MRI, CT, IVUS, biological testing, 3-D reconstruction and modeling, ultrasound, and ultrasound-based guidance, and presenting the information, data, and imaging in “real time” for the physician to remain focused on the patient procedure in progress. With this information the physician can make decisions based on a wide array of other procedures and imaging to optimize decisions and patient care.

I believe my initial question, “A New View or Just a Different View?” is answered, as it is both!


About the author: Tom Watson joined MD Buyline in 1986 and has over 40 years of experience in the field of cardiovascular medicine. He started his career as a staff technologist at West Jefferson Medical Center in Marrero, La. He spent two of those years as a staff technologist and the remainder as administrative and technical director of cardiology. His clinical experience and training include all diagnostic noninvasive cardiac modalities, including echocardiography, stress-testing Holter and ECG. His invasive experience encompasses diagnostic cardiac catheterization, PTCA and electrophysiology. He also has experience with critical care and intensive care monitoring, as well as cardiac rehabilitation applications. As a senior clinical analyst at MD Buyline, Watson is the primary analyst for cardiology, which includes interventional angiography (cardiac, vascular and neurological), electrophysiology imaging and monitoring and cardiology PACS and information systems. He provides secondary support for noninvasive cardiology. He also provides cross-coverage to related areas of radiology.