A Conversation with ... James W. Green

Philips' CT guru talks about technology and the market

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James W. Green (Philips Medical Systems)

In this one-on-one interview, James W. Green, senior vice president and general manager, business unit, CT, for Philips Medical Systems, Cleveland, talks about the industry and how the medical imaging giant is enhancing patient care.

RT Image: What should a prospective buyer look for in a CT system?

Green: As multislice CT continues to evolve, the need to make smart decisions at the right time can be challenging. The scanner that is a good fit really depends on the types of exams for which the user intends to use the scanner. For example, we are seeing more and more specialized scanners and software configurations emerging for dedicated CT use in specialties, such as cardiac and trauma. However, there are some basic questions that should weigh in on every purchasing decision, such as image quality, ease of use, clinical applications, customer support, performance and security of investment.

RT Image: What do you see as the biggest application for CT?

Green: The majority of CT procedures are still what we would consider routine. Further, we believe cardiac and peripheral vascular procedures hold the most growth potential. New advances in stroke assessment applications and the increasing acceptance of CT as the best tool to triage trauma patients will contribute to new procedure volume growth.

RT Image: Is 64-slice CT really needed when processing speeds are still bottlenecking the technology?

Green: At Philips, we are not increasing the number of slices or introducing new technology simply for technology's sake, but to enable CT to perform studies never before performed without costly and risky intervention.

But, it's not about the number of slices; it's about instantaneous volume coverage and resolution. This is important because different companies have spun the number of slices into different meanings. For example, is it really a 64-slice acquisition or is someone sampling the same detector more than once and calling it more slices?

What really will have an impact is instantaneous volume coverage and image resolution. Our new Brilliance 40-slice CT has an advanced detection system that instantaneously acquires 40 channels of 0.625 mm axial slices resulting in an instantaneous coverage of 40 mm x 0.625 mm = 25 mm of patient organ coverage. Or our system can instantaneously acquire 32 channels of 1.2 mm axial slices resulting in coverage of 32 mm x 1.2 mm = 40 mm of patient organ coverage.

This near instantaneous, high-resolution volume coverage enables our CT to cover entire organs – or in some cases, a very large part of entire organs – so quickly that we can virtually capture a freeze-frame picture of the organ in motion. This lets us routinely do what's been very difficult to do in the past – obtain high-resolution views of coronary arteries in fast-beating hearts. We can hover over areas of the anatomy while watching contrast perfuse through the organ, letting us view function and map infarcts and ischemic regions.

For children, we can snap shot view organs in a few hundred milliseconds, without having to administer sedatives and drastically reduce the number of rescans caused by the child moving while on the table.

Back to the data explosion and processing bottlenecks, we all know data management is an increasingly significant aspect of CT scanning. We've addressed the data explosion issue, through the design of our new Brilliance Workspace, which is designed specifically with very large volume datasets in mind. The fastest reconstruction engine (up to 40 images per second) along with advanced viewing applications such as Philips Slab Viewer allow you to quickly move through thousands of slices, improving ease of workflow and thus productivity.

RT Image: Will CT survive as it's own modality or will hybrid scanners eventually make them outdated?

Green: CT is the mainstay of the radiology department and will soon become a mainstay in emergency and cardiology as well. Exams are growing fast, and with enabling technologies we will see more of the invasive diagnostic procedures, such as colonoscopy, coronary angiogram and stroke assessment, migrate to CT. Evaluations requiring functional information, along with the high-resolution anatomy, will continue to be performed on hybrid systems of a PET or SPECT system and CT. So we see the future has growth opportunities for both stand-alone CT and hybrid imaging; however, advances in CT perfusion are making headway into areas previously assumed to be limited to PET, SPECT and MR.

RT Image: The International Commis- sion on Radiological Protection is dis-cussing dose limits to the public for medical activities of 0.25 millisieverts per year. What financial implications will this have?

Green: Of course, we at Philips agree it is of utmost importance to keep medical radiation exposures as low as reasonable achievable (ALARA). We continually work hard on our ongoing DoseWise and DoseRight programs that reduce dose from medical examinations. Not just for CT, these corporate-wide programs are intended to conserve dose (DoseWise) and to provide just the right dose to achieve the best image quality for a particular diagnosis (DoseRight). Some examples of recent DoseWise developments are more dose efficient detector designs and more efficient ways of delivering CT dose through mA modulation according to body attenuation (DOM). These developments are in our products today and reduce dose without sacrificing image quality. We also have worked hard to develop DoseRight protocols, which deliver the right dose for each exam, for each person, from babies to NFL linemen.

The CT division also funds research on "novel dose reduction techniques" at our Corporate Research Laboratories in Germany. Some of the dose reduction research concepts we are working on today will benefit tomorrow's patients. So, you can see that we are spending significant time and money on ALARA doses, but feel that these investments are well worth it and in the best interests of both our company and society in general.

So, the short answer is no, we do not see this having a financial impact on our business.

RT Image: Where do you see virtual colonoscopy going technology-wise?

Green: We see virtual colonoscopy gaining wide acceptance in the near future. The key hurdles to overcome are study evaluation time (again ease of use and workflow) and patient preparation. Philips Unfolded viewing technology in conjunction with automated polyp detection is drastically improving the exam evaluation time. For patient preparation, we're working on a fecal tagging technology that patients will really appreciate, as it will eliminate the dreaded cleansing methods currently required.

RT Image: What's next for CT?

Green: The question isn't about slices; the question is about clinical utilization. Technology isn't the limiting factor. Our concern is more about the applications that are required by our customers to lead them to new frontiers of CT utilization and how we can best get them there.

Every modality has its own strengths, and CT is undoubtedly making progress in doing things that haven't been done before or are currently being done in other ways. The speed and accessibility of new CT scanners certainly opens new doors, but the users, our clinical partners, are really the people who should decide where opportunities lie for CT utilization, not manufacturers. We continually listen to our clinical partners and really work to understand, from their perspective, where improvements should be made and what new ground should be conquered.

— Tom Schaffner