“After two challenging years, our attendees were ready to return to Chicago for the world’s leading imaging forum and to engage with the state-of-the-art technical exhibition.”

Mary Mahoney M.D., President, Radiological Society of North America

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It’s Thanksgiving week. And medical imaging professionals know that generally means a terrific dinner with family, a short day of relaxation following all that food, and a Saturday trip to the Windy City to prepare for the opening of the world’s biggest medical imaging conference, the Annual Meeting and Exhibition of the Radiological Society of North America (RSNA).

In the past, that was my usual Thanksgiving routine throughout my time as a company representative and provider of imaging services. In all, I’ve attended 43 RSNA conferences. And it’s was both a grueling and fun experience. I know I don’t have the stamina today to handle a week of booth duty, customer meetings, presentations, and walking the halls of McCormick Place (for miles and miles) to scope out the competitive landscape. But, that doesn’t mean I’m not interested in what technology will be shown and what techniques will be discussed. So, I thought I’d dust off my crystal ball and take a shot at forecasting what this year’s conference will be like – for attendees and exhibitors. Here goes:

Attendance will be down considerably from pre-COVID-19 levels – An industry reporter acquaintance emailed me this week saying that his contacts told him that Professional registration is now at 9,200. This is approx. 50% of in-person professional registration from the same time in 2019. 31% of the professional, in-person registrants are from outside of N. America. This ratio is similar to 2019. There are 7,800 virtual RSNA meeting registrants, 56% of which have opted for both the in-person and virtual event (we’ll have to watch out for double-counting in the reported numbers), so they can access the RSNA educational program until April 30th, 2022. On Monday of this week, Aunt Minnie published an article that stated that the Society is expecting about 19,000 in-person attendees and about 4,000 virtual attendees. Pre-pandemic attendance was usually between 51,000 and 60,000 total attendees.

Exhibitor numbers and total exhibitor square footage is down – The number of exhibitors is down approximately 33% vs. 2019, with 495 in-person technical exhibits occupying 296,000 square feet (versus 740 technical exhibits occupying 452,000 square feet in 2019). I would expect that companies will send fewer staff to the conference this year. Some exhibitors have opted only to do virtual booths. Most major exhibitors will have a robust online component to their marketing efforts for 2021 – mirroring what they did last year – 52 virtual exhibits, including 32 virtual-only exhibits. (Numbers accurate as of 10/30/2021)

A.I. will be a significant focus again this year – As usual, AI research will be the focus of a variety of dedicated scientific sessions, as well as sprinkled throughout the scientific program at RSNA 2021. AI is increasingly being investigated for its potential utility in predicting patient outcomes and guiding treatment. The conference will also include an A.I. Showcase which will be located in the South Hall of McCormick Place this year. As of early November, 93 vendors were scheduled to showcase their wares in this dedicated area on the exhibit floor. Those visiting the AI Showcase in person will also have the opportunity to visit the RSNA’s Imaging AI in Practice interactive exhibit, which will feature 22 vendors demonstrating AI technologies and the integration standards needed to embed AI into the diagnostic radiology workflow. Featuring 32 different products, the interactive exhibit will showcase the use of AI and health IT standards throughout the radiology workflow in real-world scenarios.

Photon-Counting CT will be the talk of the exhibition – Just this past week, Siemens Healthineers’ Shape 22 pre-RSNA event featured an ambitious hardware announcement that stands to expand what can be done with CT exams. The new scanner has received clearance from the U.S. Food and Drug Administration (FDA), a move the FDA said was the “first major imaging device advancement” in CT in nearly a decade. Naeotom Alpha uses the emerging technology of photon-counting CT, in which each individual x-ray photon is measured as it passes through the patient’s body. This differs from existing CT instrumentation, in which the scanner’s detectors measure the total energy in many x-rays at once. Proponents of photon-counting CT believe the scanners can give radiologists much more detailed images at a lower radiation dose than conventional CT. Photon-counting images have a higher contrast-to-noise ratio, resulting in higher resolution and the correction of artifacts like beam hardening. Siemens claims that photon-counting CT will be the standard within ten years. So, that creates a fascinating thing to watch at this year’s RSNA. What’s the response from Siemens’ competitors like GE, Philips, and Canon? We are probably in for a treat listening to the marketing gurus spin their company messages. GE in 2020 made a major investment in the future of photon-counting CT by acquiring Prismatic Sensors, a Stockholm-based developer of the technology using silicon. But is “Deep Silicon design” enough to blunt the splash Siemens has made? Inquiring minds want to know…..

Mobile imaging solutions featured prominently – As I outlined in a previous post, the options for bringing medical imaging to the point of care have grown with the introduction of portable CT, MRI Ultrasound, and next-generation digital x-ray systems. Hyperfine will be exhibiting its Swoop mobile MRI system. Samsung and Siemens will be showing their portable CT systems. Butterfly, GE, Philips, and others will be highlighting their handheld ultrasound systems. And multiple vendors will be showing redesigned mobile digital x-ray systems. The COVID-19 pandemic and the Hospital@Home movement have prompted health systems to rethink their approach to point-of-care imaging. And, many are adding capabilities to their fleet of services to meet the expected demand.

My most anticipated RSNA reporting – Every year, I look forward to reading Michael Cannavo’s PACSman Awards article on AuntMinnie.com. Michael J. Cannavo is known industry-wide as the PACSman. After several decades as an independent PACS consultant, he worked as a strategic accounts manager and solutions architect with two major PACS vendors. He has now made it back safely from the dark side and is sharing his observations. I had the opportunity to work with Michael during my tenure at Philips Healthcare. And I love his irreverent but highly accurate look at the world of the RSNA technical exhibition. If you haven’t experienced Michael’s annual post, here’s a link to his 2020 RSNA PACSman Awards.

Wild cards – Lots of pre-RSNA online postings (primarily Twitter, Facebook, and Press Releases) from one company about a new system with a “novel x-ray source” that’s going to “revolutionize” digital radiography. (Hint to the vendor: using the term “cold cathode” in your marketing materials doesn’t mean there isn’t heat generated in creating x-rays. Electrons smash into the target/anode, and only less than 1% of the energy is converted into usable x-rays, while the rest gets wasted as heat. Isn’t it wonderful that the laws of physics apply to everyone?) As to the term “novel” x-ray source, perhaps the vendor in question should look at the portable x-ray machine from Carestream, which uses a carbon nanotube, cold-cathode x-ray source. Or, maybe a review of what Fuji and Micro-x are doing would be in order. I’ll reserve the final judgment on this vendor until after the conference. But perhaps I’ll nominate them for one of Mr. Cannavo’s PACSman awards this year.

So, how much of this will I get right? We’ll know after next week is over. I’ll be posting my highlights of the 2021 RSNA in early December. They might not be as entertaining as the annual PACSman Awards, but they’ll include what was discussed and why I think it’s important. Thanks for reading! My sincere best wishes to you and your families for a happy and safe Thanksgiving gathering.