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 THE STAT 26Percentage of wireless customers who use their cell phones to take picturesMore Vitals
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OCTOBER 15, 2002 SPECIAL REPORT: MEDICAL MIRACLES Focusing on Picture-Perfect Diagnoses As noninvasive imaging improves, more patients agree to tests. That means ailments are identified sooner -- and cost less to treat Once administered to more than 1 million people in the U.S. annually, the angiogram left patients with aching groins, not to mention the possibility of dire side effects like kidney damage and strokes. Today, most heart patients avoid that ordeal. The newest computer tomography (CT) imaging machines produce clear, noninvasive pictures of the heart. This gear, which has been shipping in volume since last summer, rivals a regular angiogram at spotting blockages, although the old test is still required in some cases. SAFER, FASTER, CHEAPER. Perhaps the CT exam's greatest advantage, the area where it surpasses past methods, is that it lasts only minutes, vs. the entire day for an angiogram, which requires patients to spend six hours on their backs after the procedure to prevent bleeding. "You're going from a very invasive, very expensive study to a lower-cost, less invasive one," says Elliot Fishman, head of the Advanced Medical Imaging Laboratory at Johns Hopkins Medical Institutions in Baltimore. Of all the advances in medical technology over the past year or so, better imaging may be the most important. Safer, faster, and cheaper than past procedures, it also appeals to patients, who no longer need to face the danger and discomfort of being invaded by tubes and wires. The number of patients examined with the latest imaging techniques -- CT and a half-dozen other technologies -- has doubled in the past 10 years, estimates Michael Kline, president and CEO of privately held Sunnyvale (Calif.) medical-imaging software company R2 Technology. As the popularity of these technologies spreads, product lifecycles shrink. The top three imaging-equipment manufacturers -- GE Medical Systems, Philips Medical Systems, and Siemens Medical Solutions -- now produce new gear every year, rather than working to a five-year cycle, says Didier Thibaud, a vice-president and general manager at Mercury Computer Systems in Chelmsford, Mass., an independent maker of parts for imaging equipment. LOOKING AHEAD As the new equipment has proliferated, radiologists have taken to viewing several types of scans before making a diagnosis -- perhaps a CT, which shows anatomical structure, plus a positron emission tomography, or PET scan, which displays the body's chemical functions. The next step will allow doctors to look at the molecules in the body and diagnose diseases years before symptoms occur. By then, imaging may become as routine a part of an annual physical as drawing a patient's blood. All of which helps explain why market researcher Business Communications in Norwalk, Conn., expects the medical-imaging market to grow from $8.2 billion this year to $10 billion by 2007. The new bounty of information threatens to overwhelm radiologists. CT technology has been around since the '70s, but the newest version, known as 16-slice CT, differs from previous generations in that it takes hundreds more pictures -- or slices -- of the internal anatomy. The resulting full-body scan is so detailed that it can fill about 200 floppy disks. That's far too much information for the average radiologist to process. "There's no way you can sift through these files and find a tumor the size of a pea," says Tom McCausland, president and CEO of imaging-equipment outfit Siemens Medical Solutions USA. "INFORMATION OVERLOAD." New generations of other imaging technology, such as magnetic resonance imaging (MRI), that's used in heart exams also generate gobs of data. "It's just an information overload," says Robert Edelman, chairman of radiology at academic teaching hospital Evanston Northwestern Healthcare, who notes that the number of radiologists nationwide is growing by only 3% annually. In response to this problem, the scanner makers offer four tools to simplify matters: Computer-aided detection (CAD) software, three-dimensional image reconstruction, so-called smart software, and faster image processing. CAD software, currently available from R2 and several smaller competitors, can help scan mammograms and works like "a spell-checker for doctors" by searching images for tumors and marking them, says R2's Kline. When a radiologist takes an independent look at the images, as required by law, he can then compare his findings with the CAD results. A 2001 study of 12,860 women, published in Radiology and conducted by the Women's Diagnostic & Breast Health Center in Plano, Tex., showed that R2's ImageChecker systems increased breast-cancer detection by 20%. Already, 14% of the 35 million mammograms conducted every year are reviewed using an Image Checker, which costs between $130,000 and $220,000. The system has been so popular that R2 hopes to introduce a similar product for detecting lung tumors by early in 2003. Four hospitals are already testing this tool. Now, competitors such as GE Medical are planning rival products. AN EASIER EXAM Imaging companies have also started to examine complex data via three-dimensional analysis. One oft-cited new application is the virtual "fly through" exam of the colon. Before imaging technology was developed, a physician inserted a long, flexible viewing tube into the patient's rectum, then guided it up the colon. The colonoscopy, as it's called, lasted up to an hour and could be painful for unsedated patients, sometimes even causing a punctured colon. And while the American Cancer Society recommends that people over 50 undergo the procedure at least every five years to detect polyps and cancers, more than 80% of patients simply refuse. Thanks to the virtual exam, a colonoscopy can now be done noninvasively. The patient simply slips into a doughnut-shaped CT scanner, which snaps pictures of the colon. After that, software assembles the images so that a physician can search for tumors in a virtual representation of the colon. EARLY DETECTION. Boston University studies show that colonography, as it's called, is better at detecting large and midsize polyps than the old, invasive test. The original procedure is still better at detecting tumors, which is why many doctors continue to recommend it. Insurance companies favor 3-D visualization because it costs 65% to 75% less than an invasive procedure, Johns Hopkins' Fishman estimates. And the less painful the test, the greater the number of people who are likely to take it. Colon cancer, for instance, can be headed off by early detection of polyps. And with early detection, "the lifecycle costs" of caring for a patient are lower, notes GE's Saragnese, who adds: "Technology is the solution to the health-care [cost] crisis." John Hart, a director on the molecular imaging advisory board at Philips Medical Systems, cites company studies showing that, when imaging tests eventually replace traditional ones, the number of patients taking heart exams, for example, should grow fivefold. SEE IT NOW. Special software can also help radiologists compare and manipulate images. GE's Cardiac IQ removes extraneous images so that coronary arteries are easier to find. And its advanced lung analysis feature can automatically compare the size of a tumor found eight weeks earlier with the current image. Processing data quickly -- reducing the time required to display data on the screen -- is vital, since imaging is often used during surgery. Here, too, immense progress is being made. Siemens's InSpace feature can make more than 1,000 slices from a CT scan available for viewing in less than five minutes. The company's goal, ultimately, is to process the images in real time. Improved image resolution will be necessary before doctors can dispense with their traditional tools for viewing the tiniest arteries, says Edelman of Northwestern Healthcare. Many CAD imaging techniques can't detect tumors less than 5 milimeters, he says. Yet at the rate that medical imaging is improving, solving that problem should be only a matter of time.  By Olga Kharif in Portland, Ore. Get BusinessWeek directly on your desktop with our RSS feeds.  Add BusinessWeek news to your Web site with our headline feed. Click to buy an e-print or reprint of a BusinessWeek or BusinessWeek Online story or video. To subscribe online to BusinessWeek magazine, please click here. Learn more, go to the BusinessWeekOnline home page  | | OCTOBER |
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