“If we expand our thinking to the patient’s perspective, we will find that imaging’s value extends beyond the tight focus of the radiologist or radiation oncologist.”Bruce G. Haffty, MD., RSNA President
For medical imaging professionals, Thanksgiving weekend is usually an abbreviated affair. After enjoying dinner with family and friends on Thanksgiving day, they pack their bags, brave the busy travel issues, and head to Chicago for the annual Radiological Society of North America Conference and Exhibition. For over forty-five years, that was part of my schedule every year too. Now I follow the conference virtually and thought I’d share some thoughts on what’s being featured this year.
Based on the early figures released by the RSNA, total attendance returns to typical figures, although they are still slightly below pre-pandemic levels. Total advance registration this year was 34,385, a 61.4-percent increase over the 21,300 registered on this equivalent day in the conference in 2021. Among the 34,385, 19,485 were registered as professionals. Last year, COVID-19 was still impacting attendance, while the 2020 conference had to be made entirely virtual because of the pandemic. The attendance figure for RSNA 2019, the last year before the pandemic hit, was 47,011 (with 21,837 professional registrants); in 2018, that number was 48,615 (with 21,837 professional registrants), while in 2018, the figure was 48,615, and in 2017, total attendance had been 48,445. There is still a mix of in-person and virtual attendees, and the international attendance figures appear to be closer to normal numbers, even with outbreaks happening in China and other countries at the current time. So, RSNA still lives up to its reputation as the largest medical conference in the world.
The number of vendor companies was up considerably as well. This year, 647 vendors are exhibiting at McCormick Place, a 13.3-percent increase over the 571 vendors that exhibited last year. Back in 2019, the last pre-pandemic year, 789 vendors had exhibited, while in 2018, 693 had exhibited.
The virtual vendor experience
I spent some time exploring the various vendors’ online virtual booths to try and understand what was new and how they were positioning their products this year. Virtual RSNA evolved from the years when COVID prevented onsite meetings. The first year left a lot to be desired, but it has evolved and become much better since then. But the user experience is decidedly mixed. Some of the interfaces are unintuitive, and the loading times are really slow – surprising in this day and age. Several websites give you information that is untainted by fluff, but so many are poor at best and abysmal at worst. I wish I had a nickel for every vendor who “developed the DICOM standard” or “is leading the charge in AI in medical imaging.” I could fund a vacation with the money.
What was being featured this year
A.I. Again – Once again, this year, there’s a big focus on A.I. applications in medical imaging. AI has applications across the radiology spectrum, including using natural language processing algorithms to help collect and process data for clinical research. Using the Gartner Hype Cycle framework, I think we’ve reached the point where AI is exiting the “peak of inflated expectations” phase and heading down to the “trough of disillusionment.” Practical experience in everyday practice has exposed the challenges of implementing AI. The biggest challenge is integration – at every step in the imaging value chain.
Which algorithms should be used and for which applications? How does the AI fit into the radiologist’s workflow? How does AI complement the radiologist’s diagnosis? And how does it impact the care pathway? These essential questions must be answered to allow for the widespread adoption of the technology.
Cloud, Cloud, and more Cloud – The benefits of Cloud solutions, such as their cost-effectiveness and predictability, unlimited scalability, and deployment flexibility, have started to outweigh the perceived risks. This is especially true in medical imaging, where the unending growth in image data volumes, coupled with long-term data retention policies in place, makes traditional storage upgrades and scale-up mechanisms unsustainable over the long run. This is why, since the early 2000s, Cloud-based solutions have provided a viable alternative to tape- and truck-based solutions for the long-term archival of medical image studies.
Two simultaneous and complementary market trends are advancing Cloud-based imaging informatics into new use cases: the continuous expansion of medical imaging applications into niche subspecialty clinical areas and the ongoing diversification in the points of care where medical multimedia content is produced and consumed by various enterprise imaging stakeholders.
Every major vendor of cloud solutions exhibited at RSNA this year: Microsoft. Google, Nuance, and NVIDIA all had major exhibits.
Photon counting CT – Photon-counting detector (PCD) CT is a new CT technology utilizing a direct conversion X-ray detector, where incident X-ray photon energies are directly recorded as electronic signals. The design of the photon-counting detector itself facilitates improvements in spatial resolution (via smaller detector pixel design) and iodine signal (via count weighting) while still permitting multi-energy imaging. PCD-CT can eliminate electronic noise and reduce artifacts due to the use of energy thresholds. Improved dose efficiency is vital for low-dose CT and pediatric imaging. The ultra-high spatial resolution of PCD-CT design permits lower dose scanning for all body regions. It is particularly helpful in identifying important imaging findings in thoracic and musculoskeletal CT. Improved iodine signal may be helpful for low-contrast tasks in abdominal imaging. Virtual monoenergetic images and material classification will assist with numerous diagnostic studies in abdominal, musculoskeletal, and cardiovascular imaging. Dual-source PCD-CT permits multi-energy CT images of the heart and coronary arteries at high temporal resolution.
Multiple presentations at RSNA this year highlighted the benefits of photon-counting CT in medical imaging. For example, PCCT is feasible for the imaging of heart defects in neonates and infants, offering a superior signal-to-noise ratio and image quality than conventional CT.
Empowering Patients – I was pleased to see this topic as a focus this year. To the patient, imaging can remove uncertainty, decrease anxiety and give hope. A significant challenge is objectively quantifying the patient’s perception of value to demonstrate its importance to the greater medical community. From the time a patient schedules an appointment through every follow-up, effort should be made to ensure they feel comfortable, informed, supported, seen, and heard. Image results are the tip of the iceberg. Imaging’s actual value through the lens of the patient—quality of life, comfort, peace of mind, certainty, hope, and trust— all lies below the surface for us to explore together.
What we didn’t see – There were no significant new product introductions at the meeting this year. Vendors essentially rounded out their product portfolios with missing elements at lower price points. I think that reflects the current market conditions where health systems are under intense margin pressure, meaning less capital is available for purchasing big-ticket items like MRI scanners. The case vendors need to make is all around efficiency, throughput, clinical benefit, and cost reduction.
Final thoughts – RSNA is still my favorite conference to follow during the year. It’s the one place where medical imaging professionals gather to review the state of the industry, explore new products and technologies that are entering the market, share clinical applications that broaden the use of medical imaging throughout the care continuum, and celebrate the contribution that imaging makes for improving the lives of the patients we serve.