Agfa DR 800

Rad rooms get more complex while detectors lighten up

November 19, 2018
by Lisa Chamoff, Contributing Reporter
While the fluoroscopy market has continued to remain flat, some manufacturers in the radiography space are doubling down – in the sense that they’re focusing on multipurpose radiography and fluoroscopy systems that allow facilities to increase room utilization in the era of value-based care.

On the flip side, OEMs are also focusing on the growing urgent care market, with products that bridge the gap between portable systems and fixed rooms.

In the detector market, the newer releases are consistently wireless, lighter and easy to grip while ensuring the highest-quality images.

Here’s a look at what’s new.

Agfa HealthCare
Agfa HealthCare has started installation of the new multipurpose DR 800 X-ray room that received FDA clearance in April of this year. The system combines radiography and fluoroscopy and uses Agfa’s Dynamic MUSICA (Multi-Scale Image Contrast Amplification) software, the first time the software has been used for fluoroscopy.

The company continued doing research and development and delayed the release “until we were confident we could meet customer needs,” said George Curley, director of marketing and communications for Agfa HealthCare’s North American imaging business.

The DR 800 also has a new workstation with tools to help increase efficiency before, during and after exams, including personalized dose settings, intelligent collimation control, intelligent automated exposure control and automated positioning. Automated image rotation and alert triggering are works-in-progress.

At this year’s RSNA, the company will be introducing digital X-ray tomosynthesis as a future option for the DR 800.

“Some sites demand it,” Curley said. “Tomosynthesis gives you a volume rendering of a skeletal structure or organ. It’s not going to replace CT, but I think it’s going to help ER physicians further evaluate fractures.”

In May, Agfa began the release of a complete product line of X-ray detectors for the retrofit market.

The 17-inch-by-17-inch detector and 14-inch-by-17-inch detectors were released in May and a 10-inch-by-12-inch detector is expected to be released in the first quarter of next year.

The detectors themselves are rugged and operate either wirelessly or tethered, Curley said.

The detectors are cleared to work with Agfa’s entire portfolio.

“Initially we came out with the 14-by-17 and realized the demand is there,” Curley said. “This year we focused on the new sizes as well as getting everything validated to work with the entire portfolio except for the DR 800. I think it has wider appeal for customers.”

Canon Medical Systems
At this year’s RSNA, Canon Medical Systems is planning to announce an improved workflow for its Ultimax-i multipurpose X-ray and fluoroscopy room.

Canon XR Ultimax-i
The workflow enhancements are designed to allow procedures to be done faster, with a lower radiation dose and image enhancements, said Jay Aboudjaoude, director for the X-ray business for Canon Medical Systems, which, up until a year ago, was part of the company’s vascular unit.

“The new enhancements we’re introducing are going to improve workflow compared to what is offered in the marketplace,” Aboudjaoude said. “We will continue to develop new enhancements to the system to make it easier to use.”

In July, Fujifilm released its FDR D-EVO Suite II with Auto-Stitching configuration. This mid-tier room is designed for use in radiology departments, the ED, and for trauma cases. It has the ability to acquire up to three images and combine them into one long-length image up to 48 inches long.

“This configuration is in high demand because of a combination of just the right mix of automated and manual features,” said Rob Fabrizio, director of strategic marketing, digital radiography and women’s health at FUJIFILM Medical Systems U.S.A. Inc.

Fujifilm FDR D-EVO Suite II X-ray Room
Fabrizio noted that 70 percent of hospitals routinely perform long-length imaging, including for scoliosis and long-leg imaging exams.

“It is very common for hospitals to want that combination,” Fabrizio said. “Most of the time it’s only available in a more sophisticated room, a fully automated room. Our FDR D-EVO Suite is a more affordable high-volume general use room with this capability.”

In August, Fujifilm released its FDR ES detectors, which replaces the company’s previous generation of the original D-EVO detector it was selling for X-ray room retrofits.

The detector includes new configurations which lowers the cost for converting an X-ray room to DR, said Fabrizio.

“The detectors include our high-sensitivity technologies of the D-EVO II and are compatible with Fujifilm’s Dynamic Visualization II and Virtual Grid image processing software,” Fabrizio said.

The detectors also feature a new mini power box option, which the company says simplifies installation and costs. The power box maintains battery charging for extended use by providing plug-in power while in the bucky tray.

The retrofit market is slowing down, but there are still a lot of hospitals that haven’t completely converted to DR yet.

“There’s a lot of pent-up demand for this,” Fabrizio said, “mostly due to its being more affordable for environments that don’t need all the bells and whistles of a premium detector.”

GE Healthcare
GE Healthcare recently announced the release of its Discovery XR656 HD, a fixed radiography room powered by its new Helix advanced image processing software, and also its Optima XR240amx for mobile radiography. Both use GE’s new Flashpad HD wireless digital detector.

The detector has a resolution of 100 microns, which the company says is the highest available on the market.

GE Optima XR240amx - with Carestation Incubator
“With 100 microns, you get four times the resolution,” said Chiranjiv Singh, chief marketing officer for X-ray at GE Healthcare.

The company is also launching the Discovery RF180, a remote combination X-ray and fluoroscopy room.

“Traditionally, the classical rooms have the technologist or interventional radiologist leading the procedures being next to the table,” Singh said. “In a remote system, it operates more like a cath lab or a surgical suite, where they’re behind a lead-lined wall.”

Singh said the major advantage of a remote room is less dose for the operator and the ability to use it as a multipurpose room for all exams.

“The younger radiologists are more concerned about their exposure to the radiation dose and prefer a remote system,” Singh said.

While the overall fluoroscopy market is stagnant, Singh said the market for digital fluoroscopy is growing by double digits.

Konica Minolta Healthcare
In early May, the company launched REALISM, image processing software that optimizes bone and overlapping soft tissue image data independently within the same image, which the company says can reduce the need for post processing.

“REALISM delivers a new level of clarity and detail in X-ray imaging that improves the sharpness of fine details, enhances visibility of hard to penetrate structures, and delivers excellent visibility of high contrast images,” said Steven Eisner, senior product manager for Konica Minolta Healthcare. “This translates to the ability to generate more information with fewer exposures per exam as well as avoid the need to retake images due to poor image quality.”

Eisner said the approach also reveals subtle details in even the most demanding views.

“Initial results demonstrate that REALISM provides better detail in all vertebrae, including C7 in a lateral C-spine exam, greater tissue detail in abdominal views, sharper trabecular patterns and bony cortex, and improved representation of orthopedic implants with clearer bone interfaces,” Eisner said. “There is also significant improvement in the visualization of small parts with REALISM.”

REALISM can also help reduce overall patient dose by enabling fewer retakes and views, Eisner said. Hospitals are seeking to lower a patient’s overall exposure to radiation, not just in CT imaging but also for X-ray and angiography.

Konica Minolta AeroRemote Insights
Dr. Pradeep Albert, a radiologist with Medical Arts Radiology on Long Island, N.Y., said he notices better signal-to-noise ratio with REALISM and said the images processed faster than they did previously.

“REALISM has become an integral part of our practice,” Albert said. “We’ve really seen the impact in cervical spine, abdomen, smaller bones and fine bony detail, such as the fingers and toes. … We are experiencing fewer retakes and repeat views, which means less X-ray exposure to the patient. This also improves workflow significantly, with patients waiting less and completing their exams quicker.”

At the end of May, Konica Minolta released AeroRemote Insights, a cloud-based business intelligence tool available with Konica Minolta AeroDR Digital Radiography Systems, designed to help radiology managers and others responsible for the productivity of the radiology department.

The product provides analytics on things including procedure volume, staff performance, dose metrics and the overall health of the AeroDR system, in an effort to improve department performance, enhance personnel productivity and improve the patient experience.

Managers are notified immediately about critical events related to the system, such as if an X-ray detector is dropped.

“These simple visualizations of often complex data enable users to make valuable decisions at a glance and deliver a better experience for patients,” Eisner said.

20/⁠20 Imaging, a division of Konica Minolta Healthcare Americas Inc., recently introduced MOMENTUM DR, a wireless DR flat panel detector designed for nursing homes and other non-⁠hospital or non-clinic sites.

MOMENTUM DR uses Konica Minolta’s AeroDR technology, with a built-⁠in lithium ion capacitor power cell that provides up to 4.1 hours of use on a 13-⁠minute charge, providing the ability to capture up to 150 digital X-rays, according to the company.

Because it doesn’t use batteries, the detector has a water-⁠resistant seal that the company says improves durability and lowers the cost.

The panel can be used for imaging patients up to 661 pounds while they are sitting, lying down or standing.

“Mobile X-⁠ray is a demanding imaging environment that requires durable and reliable solutions to deliver the high-⁠quality images that clinicians need to make better decisions, sooner,” said Susan Ott, sales administrator for mobile DR sales at 20/⁠20 Imaging, in a statement. “MOMENTUM DR is the ideal detector designed to withstand the rigor of daily use in a mobile imaging environment with a high capacity to help maximize patient outcomes, productivity and return on investment. As a hospital-⁠grade, durable panel that doesn't require battery rotation and replacement, longer charge times and warrantied for three years, MOMENTUM DR can increase uptime and help users image more patients in less time.”

Philips DXR ProxiDiagnost N90
Philips Healthcare
Philips received FDA clearance in March 2018 for its ProxiDiagnost N90 combination radiography and fluoroscopy system.

The system’s two-in-one capability optimizes room utilization and patient throughput, and is enabled by Philips low-dose grid-controlled fluoroscopy (GCF) and Dynamic UNIQUE image processing, said Stefan Mintert, senior portfolio manager for DXR at Philips. For pediatric examinations, for example, Philips GCF enables a dose rate reduction of up to 68 percent compared to pulse-controlled fluoroscopy (PCF), depending on patient type and clinical application.

Mintert said the system follows the trend of combination rooms in the era of value-based care and acknowledges the continued use of fluoroscopy.

“Now, more than ever, hospitals are looking to improve outcomes and reduce costs as a part of the shift to value-based care, and combination rooms enable space to be better utilized at a lower cost,” Mintert said. “Today, fluoroscopy is still a must-have in hospitals, and an aging population and increase in chronic conditions means the number of stroke patients will continue to grow. Fluoroscopy is seen as the gold standard of care for these patients and related research, playing a key role in stroke swallow studies, speech pathology studies, and endoscopic retrograde cholangio-pancreatography procedures. Additionally, the dose levels associated with modern fluoroscopy units are much lower and are often preferred over CT for pediatrics.”

ProxiDiagnost N90 also allows radiologists to work close to the patient, making them more comfortable in an effort to improve the patient experience, Mintert said.

Additionally, a user interface that is identical to other Philips systems and the ability to share mobile detectors makes training and the rotation of staff easier, Mintert said.

Rayence flat panel wireless detectors
Last summer, Rayence released its Rayence 1417 Wireless Series Detector, a 14-inch-by-17-inch cesium ion flat panel detector. Earlier this year, it also debuted the Rayence 1012 Wireless Series Detector, a 10-inch-by-12-inch detector for extremity imaging, and the Rayence 1717 Wireless Series Detector, a 17-inch-by-17-inch detector for wide-angle imaging.

“The majority of hospitals like a larger detector,” said Stalin Calvache, marketing manager for Rayence.

Calvache said the Rayence stands out among its competitors for being the manufacturer of its detectors, with resolution of 140 and 127 microns.

“The majority of our competition is buying from other vendors,” said Calvache, who notes they have sold more than 25,000 detectors worldwide.

Shimadzu RADspeed fit
Shimadzu is in the process of launching the RadSpeed Fit, a small fixed room designed for the high-end urgent care market.

The patient table of the RadSpeed Fit has an integrated tube arm and generator, and there is a wall stand for upright exams. A small console mounts to the wall or floor stand to control the exposures and the system uses a 14-inch-by-17-inch flat panel detector.

“You don’t have to do anything special to the room,” said Frank Serrao, marketing manager for Shimadzu.

The system comes with either a 32-kilowat generator with single phase power or a 56-kilowat generator with three-phase power.

Siemens Healthineers
Based on changes in the healthcare market and in response to concerns over cybersecurity and the 2017 WannaCry ransomware attack that impacted healthcare organizations, Siemens Healthineers recently released new VF 10 software for the company’s Luminos Agile Max and Luminos dRF Max fluoroscopy systems, its Multitom Rax twin robotic X-ray system and the Ysio Max digital radiography system.

“Any of these systems leaving the factory are at a software level hardened for cyber security,” said Joe D’Antonio, director of radiography, fluoroscopy, mobile and twin robotic X-ray products for Siemens Healthineers in the United States.

The upgrade brings the operating system from Windows 7 to Windows 10 and includes whitelisting, the ability for the system to check for approved software that is allowed to run on the device. Updates to the whitelist are done regularly.

“Anything not on the list is unable to run on the systems,” D’Antonio explained. “For example, if someone connects a USB drive and tries to install software, it is blocked.”

There is also hard drive encryption allowing only authorized users to access data and locking down the system if someone were to take the device or attempt to hack into it.

“Siemens Healthineers is taking a substantial step forward related to enabling our systems, wherever possible, to support our customers’ strategies toward safeguarding patient health information, and to fix potential vulnerabilities on their equipment,” D’Antonio said.

Source-Ray is also targeting the urgent care market with its UC-5000, a new high-frequency mobile digital X-Ray system specifically designed for the segment.

Source-Ray UC5000
“While the system is not portable, it is mobile,” said John Schaumburg, director of business development for Source-Ray. “This allows it to be moved from room to room without requiring a high-voltage outlet and the dedicated lead-lined X-Ray room necessary with a fixed system. The system was designed to be utilized in an existing patient exam room, eliminating this dedicated X-Ray room, thereby significantly reducing overhead.”

The UC-5000 has 5-kilowatt power versus the 3-kilowatt of a standard portable system, along with a “true uniform wave form” allowing for high-quality spine and hip exams, according to Schaumburg.

The company has seen additional applications in the weight-loss market, specifically with the Obalon balloon system, which is a pill that the patient swallows that requires a high-resolution X-Ray before it is inflated in the patient’s stomach, where it takes up space, resulting in the patient eating less.

Dr. David Cohen, the founder and medical director of Teleradiology Specialists, said in a testimonial, after reviewing chest, lumbar spine, shoulder and extremity exams from the UC-5000, that the images were “of the highest diagnostic quality. … I find the quality remarkable considering the images were produced by a lower-power unit.”

The company has had more than 50 installations of the UC-5000 since its FDA approval and release last summer.