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CAD Widens its Mark(et)     By Lisa Fratt Select a vendor below for a complete line-up of product announcements at RSNA. CAD Carestream Health iCAD Riverain Medical Confirma Median Technologies Siemens Medical Solutions EDDA Technology Medipattern Corporation   EDDA IQQA-Liver CAD       Computer-assisted detection software has moved beyond its initial applications in mammography imaging and is becoming an essential tool in the diagnosis and management of various types of cancer. At RSNA, vendors are showing systems for film and digital mammography, but the real news extends into other applications. There are new systems for chest and abdominal CT images that not only facilitate lesion detection, but also support workflow by automatically generating measurements of lung and liver lesions. RSNA-goers also can check out a prostate MRI CAD application. Similar to breast MRI CAD, the system helps users efficiently sort through the volume of MRI data to more efficiently diagnose prostate disease. Carestream Health (Booth 2513) is debuting CAD for chest and digital mammography at RSNA 2007. In addition to CAD for film-based mammography, Carestream Health is showing CAD software for its CR-based mammography platforms and CAD for other vendors’ full-field digital mammography (FFDM) systems. The CAD for CR and FFDM solutions are available outside of the United States. The company also is demonstrating chest CAD and bone mineral density testing on its Kodak Directview DR 3000 platform. These applications are currently only available in China. Confirma (Booth 7950) is unveiling the next generation of CADstream for breast MRI enhancements, CADstream for prostate MRI and the Access Breast Coil. Other booth highlights include CADalog and SureLoc console. CADstream for breast MRI includes a new customizable BI-RADS-centric user interface that accommodates a variety of user experience levels. Additional CADstream enhancements include improved 3D renderings and volume summaries and morphology reporting tools. CADstream Prostate is designed to improve quality, standardization and efficiency in MRI studies of the prostate. Confirma’s application-specific product provides image registration, image alignment between contrast series and T2 images and uptake and washout maps. The system also features multiplanar reformatting with subtractions, MIPs and prostate-specific lesion reporting. Confirma’s Access Breast Coil provides the optimal balance of high-quality diagnostic capability (high signal-to-noise ratio) with optimized access and patient comfort. Its open design provides flexibility when performing interventional procedures, with both lateral and medial access, the company says. Confirma’s CADalog study library system instantly retrieves prior studies for on-demand comparison. The SureLoc Console for MR-guided interventional procedures is compatible with all interventional guidance methods and equipment. EDDA Technology (Booth 6534) is introducing the IQQA Enterprise Engine technology and highlighting the IQQA-Chest and IQQA-Liver. The EDDA universal enterprise solution enables fast delivery and easy access of 2D/3D/4D advanced clinical applications on existing PACS workstations in any hospital PACS environment without code-level integration. The IQQA Enterprise Engine is available with IQQA-Chest for digital x-ray lung nodule CAD and IQQA-Liver for contrast MDCT of liver. The IQQA Enterprise Engine also can accommodate third-party imaging applications. IQQA-Chest offers real-time, interactive diagnostic analysis of digital chest x-rays using a comprehensive set of tools to support physicians in the identification, confirmation and quantification of lung nodules. The system is powered by intelligent tools with real-time interaction to seamlessly integrate advanced diagnostic analysis technologies into physicians’ softcopy reading process for improved workflow and clinical decision-making. Published clinical studies suggest IQQA-Chest may help physicians identify small lesions and reduce inter-observer variation, according to the company. The immediacy provided by IQQA-Chest Enterprise allows for expanded use of chest CAD tools on a routine basis with the prospect of enhancing diagnostic quality on a broad scale. IQQA-Liver Enterprise addresses the clinical challenge faced by physicians in efficiently dealing with tremendous data volume from contrast MDCT images of liver. Combining advanced image analysis algorithms and visualization tools, the software supports physicians to quickly and effectively distill critical diagnostic information. It performs automatic anatomy-based phase registration to allow simultaneous visualization and cross-referencing of lesion location and characteristics across different phases. IQQA-Liver Enterprise provides 3D segmentation and measurement tools for visualization and analysis of liver, liver lesions and vascular structures. This volumetric analysis provides physicians with a visualization aid and offers quantification tools to support clinical decision-making and patient care management. iCAD (Booth 3507) is showing enhancements to its SecondLook Digital mammography CAD product. SecondLook Digital CAD is designed for digital-based mammography facilities to assist in the early detection of cancer. Based on an open-system architecture, SecondLook Digital is optimized for digital mammography systems including GE Healthcare, Siemens Medical Solutions, FujiFilm Medical Systems USA (which is pending FDA approval), Hologic—and both IMS Giotto and Agfa HealthCare which are available outside of the U.S. only. In addition, iCAD’s SecondLook Digital provides a flexible DICOM connectivity solution enabling universal compatibility with PACS and review workstations.  Median Technologies (Booth 8548) is showcasing its complete portfolio of Lesion Management Solutions, including LMS-Lung/Track and LMS-Liver CAD systems. LMS-Lung/Track and LMS-Liver are designed to efficiently assist radiologists managing oncology patients in all steps from lesion measurement and follow-up to report generation for referring physicians. The applications segment user-identified lesions and measure key characteristics such as volume and longest axial diameters. They also pair lesions in follow-up exams, compute growth and doubling time and generate reports according to the RECIST criteria to assess the response to treatment of solid tumors. LMS-Lung/Track and LMS-Liver perform automatically tasks that radiologists would normally carry out manually. This contributes to improving the workflow and reducing intra- and inter-observer variability, Median says. LMS-Lung/Track and LMS-Liver support images acquired on any multidetector CT scanner and can be integrated with modality or PACS/RIS workstations. Medipattern Corporation (Booth 5515) is announcing new B-CAD products: multiple versions of B-CAD for breast ultrasound imaging and one version for breast MRI. Medipattern crosses the modality boundary, creating CAD products for breast ultrasound imaging and breast MRI from the same algorithm platform technology. Its B-CAD solutions save time, increase consistency in reading and document information in greater detail, providing a better record for tracking patients. B-CAD 1.2.1 for breast ultrasound imaging is available in a wide range of formats. The solution includes a DICOM-network-ready PC with a B-CAD viewer and CAD reporting system, ideal for facilities just entering a PACS environment. For those facilities that have invested in a large number of workstations, 1.2.1 is available in a software format for existing equipment. Two software plug-in modules for PACS partners Cedara and Sectra can plug into new or existing PACS viewers. B-CAD 1.2.1 delivers ease of workflow, enabling radiologist-customizable methods that easily integrate into the natural reading process, the company says. B-CAD 1.2.1 analyzes multiple lesions in multiple views for unilateral or bilateral cases, organizing the information into a complete, unified natural language report, according to the company. Medipattern is showing its morphology CAD for breast MRI as part of Confirma’s Version 5 CADstream product. It performs detection and characterization of features based on physical shapes or morphology within a breast MRI. Medipattern’s morphology CAD, joined with Confirma’s kinetic CAD, form a complete approach to reviewing MRI images, detecting lesions via both physical characteristics and dynamic flow characteristics. Medipattern also is showing works in progress for CAD on whole-breast ultrasound. CAD is key to effectively reading the multiple images acquired during whole-breast ultrasound, the company says. Next-generation B-CAD reads the images in cine loops, automatically detecting and characterizing lesions. CAD results are reviewed by the radiologist for editing and then B-CAD automatically enters all of the evidence and findings into a natural language report. Riverain Medical (Booth 8503) is highlighting its OnGuard Chest X-ray CAD system. OnGuard works in conjunction with the reading of original standard AP/PA digital chest x-rays. It provides practical early detection by quickly identifying solitary pulmonary nodules between 9mm and 30mm in diameter that may be early stage lung cancer. The OnGuard system supports efforts to proactively detect lung cancer when it is most treatable. It also integrates with any PACS workstation to provide a solution to finding subtle suspicious nodules that may warrant further examination. Siemens Medical Solutions (Booth 7713) is showcasing syngo Lung CAD, syngo PE Detection, syngo Colonography PEV, syngo MammoCAD, syngo CXR CAD and syngo TrueD. syngo Lung CAD offers automated detection of solid lung nodules in thoracic CT studies. A large multi-case, multi-reader study showed that the use of syngo Lung CAD as a second reader helps to significantly increase the detection accuracy for clinically relevant lung nodules, according to Siemens. syngo Lung CAD is based on proprietary image processing and pattern recognition algorithms that have been trained on a large database of thoracic CT studies, according to Siemens. It is designed to detect a range of nodule sizes, starting at 3mm in diameter. syngo Lung CAD integrates into the syngo CT Oncology application to provide a comprehensive solution for the detection, evaluation and follow-up of lung nodules. It is available on syngo MultiModality Workplace, syngo CT Workplace and syngo CAD Manager for viewing CAD results on PACS. Siemens is showing a work-in-progress, next-generation version of syngo Lung CAD that provides with improved detection performance for solid nodules. syngo PE Detection is a second-reader tool for the detection of segmental and sub-segmental filling defects in CT angiography studies of the thorax and supports commonly applied CT acquisition protocols for detection of pulmonary embolism. It is integrated with the syngo Circulation application to enable efficient reading and reporting process. The system provides automated vessel-aligned viewing for optimal visualization and interpretation of potential emboli via the syngo Circulation application. syngo PE detection is available for sale only outside the U.S. syngo Colonography PEV is an automated second-reader tool to support the user with a special workflow for the identification of possible lesions. It also provides an automatic size measurement tool for accurate polyp measurement. syngo Colonography PEV can be used with both clean-prepped and solid-liquid tagged protocols and is optimized for the visualization of polyp-shaped objects between 6mm and 25mm in size. The PEV tool is seamlessly integrated into the syngo Colonography CT application. Siemens is showing a next-generation, work-in-progress version with improved performance including visualization of flat polyps. syngo MammoCAD is a CAD solution for full-field digital mammography. It facilitates detection of masses and microcalcifications to help radiologists detect breast cancer in its earliest and most treatable form. It is integrated with syngo CAD Manager and validated on Mammomat Novation full-field digital mammography system and syngo MammoReport softcopy reading and reporting workstation. syngo MammoCAD is not approved for the U.S. market; it is available for sale outside of the U.S. syngo CXR CAD is a second-reader tool for the detection of lung nodules in digital chest x-ray studies. It is integrated with the syngo CAD Manager for viewing CAD results on PACS workstations. The system is validated for use with images from the Siemens AXIOM Aristos digital x-ray system and provides processing of posterior-anterior view for the detection of lung nodules. It is optimized for the detection of nodules from 8mm to 30mm in size. syngo CXR CAD is integrated with syngo CAD Manager. The system is not cleared for the U.S. market. It is planned to be available outside the U.S. market by the end of the year. syngo TrueD is a multi-modality application for oncology supporting PET/CT, SPECT/CT as well as CT or MR fused with PET or SPECT. It enables physicians to efficiently compare patient scans from different time points (e.g. pre- and post-therapy) and provides advanced image analysis and comparison, including a suite of change detection tools, to help make more informed diagnosis, therapy and follow-up decisions. It is available on the syngo MultiModality Workplace with additional deployments planned on syngo Imaging and syngo RT Oncologist. syngo TrueD has received 510(k) clearance and is available in the U.S. market and throughout the world.