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There have been some major announcements throughout the year that may have somewhat robbed RSNA of its thunder. From Philips launching its latest flagship spectral CT scanner in May, to Siemens revealing its photon-counting CT system, and a new whole-body, low-field MRI system over the past months. Other factors could also have put a dampener on the radiology conference. As has been widely reported attendance at the event was far lower than it was in previous years, while a few high-profile vendors also were unable to attend due to coronavirus restrictions in their countries and companies.
However, despite all this, the vendors, radiologists and providers in attendance were generally very positive about the conference. This was perhaps in part the result of meeting in person again for the first time in two years, but also no doubt down to the solutions being shown to providers.
Tools for a Job
One of the themes that united these different products from different vendors was their focus on straightforward, practical utility. Vendors did, of course, show off their latest feature-rich flagship systems, but they were also keen to promote the mid-tier ‘workhorses’ of their ranges. This is in large part due to the situation providers find themselves in. With large backlogs of patients, which had elective procedures and examinations postponed because of Covid restrictions, providers are looking for cost effective and efficient systems across the modalities, which will allow them to address this backlog most effectively. In most cases vendors were looking to meet this need with existent products, often with new features and software applications, rather than showing new products specifically catering for this product tier.
A corollary of this pattern saw vendors exhibiting products that had feature sets which enabled providers to attend to patients more efficiently and increase patient footfall. This was particularly true in MRI and CT, which have higher scan times, as opposed to X-ray and ultrasound. Imaging vendors were increasingly drawing attention to tools such as embedded cameras to enable technicians to more easily assess a patient’s position before the image is taken and ensure that the scanner will be able to capture the required image.
These hardware developments were also tied to software improvements, with technologies such as smart protocolling being demonstrated at the conference. These technologies offer numerous benefits. They will improve the broader departmental efficiency by improving the number of ‘right-first-time’ scans, and therefore saving radiology departments from having to conduct rescans and reducing the preparation time needed for scans. They will also help make the process of scanning individual patients more efficient and minimise a system’s set-up time. Another benefit is that it makes the systems easier to use, allowing providers to maximise the utility they can gain from the systems, despite potential limitations caused by shortages of technicians or inexperienced technicians.
Although there were fewer product announcements for ultrasound, the technologies on show and vendor positioning were also primarily focussed on workflow efficiency. That said, there was also a strong focus on the ever-improving imaging capabilities of ultrasound as an alternative to advanced modalities in certain applications, with continued focus on contrast-enhanced ultrasound imaging, elastography and micro-vascularization assessment. Other key trends were the increased focus on liver imaging, with Siemens Healthineers and Philips launching new liver analysis capabilities, and the increasing infiltration of AI-based features, not only for clinical decision support but also to assist the user during image capture through probe placement guidance, organ detection and automated labelling.
Modality vendors at RSNA 2021 were also looking to aid users through hardware improvements. Some technicians suffer from ailments or injuries caused or worsened by their repetitive use of imaging equipment. To this end, vendors have also been focusing on both the ergonomics and useability of systems to address the technician’s as well as the provider’s and patient’s requirements.
Another manifestation of this drive for efficiency materialised in launches of on-scanner AI solutions which helped improve the acquisition of medical images from the advanced modalities. These deep learning-based image reconstruction techniques can dramatically cut the time it takes to acquire MR images. This reduces both the effective cost of utilising the modality and the time required, diminishing some of the barriers stopping MRI being more broadly used in clinical practice. The higher scanning efficiency also improves the patient experience and enables providers to scan more patients per day. Similar tools for CT imaging also offer the added benefit of reducing the radiation dose patients are exposed to, whilst improving imaging quality, an increasingly important consideration given the growing interest in CT-based screening programmes in some countries.
Among the broader themes in terms of modalities at RSNA was the fact that innovation and developments are increasingly focused around 3D imaging. There are multiple reasons for this, but in essence, these modalities have greater clinical potential, and with the greater level of precision imaging they provide, enable radiologists to make better diagnoses. This is being illustrated with investment being promoted in these modalities. In China, for example CT is forecast to grow significantly over the coming years, with the Chinese government actively prioritising the modality. This prioritisation means that in some markets CT looks set to increasingly take market share away from high-end radiography systems as the cost of CT becomes more affordable.
This will also be facilitated in part by developments such as those seen at RSNA. The major barriers stalling the adoption of MRI and CT are the investment required both in terms of upfront cost and the time investment required to capture and read the images. Advances in software to expedite image capture and analysis will help diminish these barriers, and enable providers to consider MR and CT systems, where they wouldn’t have previously. For vendors, this also represents opportunity. The maturity of the X-ray market in developed countries means that most sales will be on a replacement basis. CT and MRI on the other hand are markets in which growth for new installations is still possible, through systems which are less expensive and resource intensive to purchase, and therefore enable providers to choose the modalities for the first time. This trend is being catered for further by the likes of Siemens and Hyperfine, for example, who are both marketing smaller and lighter systems, that require less extensive infrastructure for them to be installed within smaller hospitals, clinical departments (e.g., orthopaedic, emergency and intensive care) and outpatient centres.
Efficiency Above All
Ultimately, the factor that united the majority of the developments at RSNA was efficiency and allowing providers to do more with less. Whether that meant less expenditure, less infrastructure, less time or less expertise, most of the new developments at the show opened up increased possibilities for providers. In many instances, instead of demonstrating new high-end clinical tools, vendors were showing providers how they could address the incoming backlog of scans within their budget and time limitations.
This, at times, happened in unexpected places. In many instances, the use of AI in medical imaging was expected to aid image analysis. While this is a developing trend and such tools look set to have a dramatic impact in the future, at present AI has had the most success on the scanner rather than in the reading room. One of the reasons for this is that in many instances, it is easier to demonstrate a return on investment for AI based on scanners compared to image analysis systems. Vendors can demonstrate that AI-enhanced systems can reduce scan times, which directly translates to the ability to conduct more scans for providers. On-scanner workflow tools, such as positioning support, intelligent protocolling and automatic image accept and reject meanwhile can offer a clear route to the necessity of fewer rescans, again clearly enabling radiology departments to operate more efficiently.
More broadly RSNA 2021 will have been a successful show for most vendors. While there were less attendees, and some initial consternation at the reduced footfall, in the end, the consensus was that it had actually enabled vendors to have more focused conversations. There were fewer conversations to be had, but those that vendors did have with providers would have been with qualified buyers and focused around solving providers’ specific problems of the moment. These problems would have, in many cases, revolved around dealing with the enormous backlog of patients, and attending to them effectively and efficiently. This focus would have allowed vendors to directly address this problem. Vendors’ displays at RSNA showed that they weren’t resting on their laurels, and have been continuously innovating, with, once again, a great deal of focus on the clinical workflow and efficiency that providers need at present.
This year’s conference will have no doubt benefited from the ‘buzz’ that a return to Chicago will have caused, and with providers’ purchasing disrupted over the last two years and an unprecedented volume of patients to be seen in the coming months and years, RSNA 2021 was always going to represent a golden opportunity for vendors. By giving providers what they need, both in terms of the hardware itself and its integration into the workflow, this opportunity has been seized.
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