RSNA attendees who stopped by KA Imaging’s booth last week got a first look at chest X-rays from a clinical trial that incorporated dual energy to enable greater detection of pneumonia.

The study is a world first, according to the company, and is based around its Reveal 35C, a portable detector that utilizes dual energy to create three images in a single exposure: a standard chest X-ray, a soft tissue image without bone, and a bone image without soft tissue. The technique eliminates motion artifacts and helps capture images in which the bone and soft tissue do not overlap with one another, all at the same dose as a standard chest X-ray. The separate images enable radiologists to assess the lungs and soft tissue without bones obstructing their view and vice versa, and make it easier to determine the location of lesions or signs of a disease.

The solution allowed radiologists to identify 25% more cases of pneumonia, including COVID-19, than a standard X-ray in immunocompromised cancer patients at a cancer center in Toronto. Additionally, because Reveal 35C is portable and retrofittable, it can be used with any existing X-ray system, including point-of-care units at the patient’s bedside.
“Radiologists with the dual-energy images were able in the portable case usage to find 25% more cases of pneumonia that are there in the other population. They are there but are not able to be seen because they are either too small at the time, still developing, or there is too much overlapping anatomy for the radiologist to see it,” Jay Potipcoe, applications specialist for KA Imaging, told HCB News.

Unlike other dual-energy systems, Reveal 35C does not rely on a fixed room and does not require lots of equipment or result in high costs and large amounts of downtime that interfere with workflow. Additionally, dual-energy rooms and CT both require higher dosage, and the rooms still run the chance of producing images with motion artifacts.

With all three images, radiologists can differentiate between various lesions and signs of other conditions. For instance, if a radiologist sees a spot on a patient's chest X-ray, the system can help them pinpoint where exactly, within a patient’s anatomy, it is located. “If that spot does not appear on the soft tissue but does appear on the bone image, you know it must be calcified, because only calcified bone anatomy is going to show up on that bone image. So then you can say it’s a calcified lesion. It’s not lung cancer,” Potipcoe told HCB News.

The detector in its current form is FDA-cleared and also approved for use in Canada and in Australia.

Additionally, the company is currently working on a project that will incorporate the detector's dual-energy capabilities into tomosynthesis. Doing so would enable the solution to help capture different exposures at different angles for clearer images that provide more information about shape and orientation. The approach would be similar to CT, but the image would be a regular X-ray captured at a lower dose. “This is the value of dual-energy tomo,” said Amol Karnick, president and CEO of KA Imaging, told HCB News.

In addition to chest X-rays, the detector can image extremities such as the arms, legs and ankles. It is applicable in a range of facilities, from big hospitals to private community centers.

The trial is currently ongoing.

EDIT: A previous version of this story said that tomosynthesis was incorporated into the trial. This is incorrect and we apologize for the error.

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