Counting on CT
By Keith Loria
Radiology Today
Vol. 26 No. 1 P. 16

What’s New in CT for 2025

There was plenty of excitement around the CT space at RSNA 2024, as the industry is seeing advancements that significantly improve image accuracy and dose reduction.

Cardiac imaging, screening reimbursements, and AI have become key focal points in CT discussions. CT colonography reimbursement is driving conversations around screening, while AI is revolutionizing workflow efficiency. There’s also growing interest in making cardiac CT more accessible to rural communities, addressing critical health care disparities.

Read on for a roundup of what companies unveiled at RSNA, in response to these trends.

From the Heart
“It’s an exciting time in CT,” says Matthew Dedman, head of CT for Siemens Healthineers North America. “We’re seeing continued growth of cardiac CT procedure volumes. About three years ago, the American Heart Association updated their chest pain care guidelines, and they moved coronary CTA procedures up to a frontline diagnostic tool.”

Just a few weeks prior to RSNA, CMS announced a change for 2025 in coding for cardiac CT procedures, doubling the reimbursement in the hospital outpatient setting.

“We in the CT industry really view this as an acknowledgment of the clinical utility of the test and an acknowledgment of a more proper valuation of the cost structure that hospitals have to administer the test,” Dedman says. “How we see that manifesting from a manufacturer perspective is we see a change in hospital buying behavior. More so now, we see our customers investing in more advanced CT scanners capable of cardiac CT and investing in them at more locations in their health system to increase patient access for cardiac CT procedures.”

Another clinically oriented trend Dedman noticed at RSNA is that many health systems are seeing a rapid increase in emergency department CT procedures. If the growth continues, he says, the only way to keep up with the volume will be for radiologists to get AI assistance with identifying potential pathologies and highlighting cases that need to be moved to the top of their worklists.

Siemens Healthineers also expanded its photon-counting CT scanner portfolio with the introduction of the 510(k)-pending Naeotom Alpha class, which includes the dual-source Naeotom Alpha.Pro and the single-source Naeotom Alpha.Prime scanners. In keeping with current trends, both models incorporate AI for streamlined workflows. The original Naeotom Alpha, now renamed the Naeotom Alpha.Peak, has been in clinical use since 2021, scanning over one million patients globally. Dedman says photon-counting technology provides enhanced image detail while reducing radiation doses, improving diagnostic accuracy and workflow efficiency.

“It is fundamentally different than prior generations and conventional CT technology,” he says. “In a nonphoton counting CT, the conversion from X-ray into electronic signals to generate images has always been a two-step process. The X-ray is converted into a light signal, which is then measured by a photodiode, which converts it into an electrical current, which is then used to create images.” With photon-counting CT, the photodiode is replaced with one semiconductor crystal that directly converts the X-ray into the electronic current to construct images, which yields several benefits.

“It allows us to dramatically improve the spatial resolution we can generate from a CT scanner,” Dedman says. “As a comparison, on conventional CTs, the thinnest slice of data we can acquire has typically been a .625 mm slice; on a photon-counting CT, we can acquire a .2 mm slice.”

Additionally, it’s being done at lower radiation doses than prior CT technology. “We believe this is the future of CT,” Dedman says.

Also at RSNA, Siemens Healthineers relaunched the Somatom On.site, a portable CT scanner designed to enhance imaging capabilities at the patient’s location, providing greater flexibility and efficiency for health care providers.

Software-Driven
Dan Xu, business leader of CT at Philips, says the current and future need for CT is increasing rapidly. “Customers are faced with higher patient volumes, a huge amount of data that they struggle to digest and manage while dealing with staffing shortages and increased cost pressures,” he says. “Additionally, there have been shifts in reimbursement and guidelines for cardiovascular CT, as well as increases in chronic and complex diseases. This leaves health care providers facing higher cost and productivity pressures.”

In response, Philips has combined its AI-enabled systems with its enterprise informatics portfolio with a focus on delivering more precise and predictive imaging while maximizing productivity and performance. “For Philips CT, we do this through delivering solutions that are easy to use and expand the standard of care,” Xu says. “Our portfolio is also designed to provide deep clinical insights that answer challenging diagnostic questions, with smart and fast automated departmental workflow so clinicians can confidently and more easily manage high patient volumes.”

At RSNA, Philips unveiled the new CT 5300 that demonstrates these benefits and highlights software-defined CT. “We believe the next leap in image quality and efficiency is being made possible by refinements in CT software and through AI,” Xu says. “Philips CT 5300 is fully designed with AI in mind with CT Smart Workflow; NanoPanel Precise detector technology, the industry’s first detector optimized for AI reconstruction; and Precise Image, which provides low noise, allowing for ultralow-dose screening programs and high image performance.” According to the company, Precise Image AI reconstruction achieves an 80% lower dose, 60% improved low-contrast detectability, and 85% lower noise, simultaneously.

“And the CT 5300 is built for cardiac,” Xu says. “We’ve applied deep learning intelligence to bring these capabilities to the masses with ease to address the growing procedure volumes and allow clinicians the opportunity to take advantage of increasing cardiac reimbursement.”

Feature Enhancements
Guillaume Grousset, vice president of CT for North America, says the company is committed to empowering customers with innovative solutions that help them deliver exceptional care. “We continue to advance AI-driven workflow enhancements that improve efficiency and accessibility,” he says. “For instance, at this year’s RSNA, we introduced four new AI features for the uCT 550, a cutting-edge AI reconstruction for the uCT 780, and five advanced cardiac AI features for the uCT ATLAS—tools designed to meet the evolving demands of modern CT imaging and support health care providers in overcoming critical health care disparities.”

Grousset adds that customers are seeking high-resolution, low-dose CT imaging alongside streamlined workflows to reduce redundant tasks and improve efficiency. “The new AI features unveiled at RSNA underscore our commitment to delivering exceptional image quality while helping to lower dose,” he says. “Meanwhile, innovations like the uAI Vision 3D camera demonstrate our dedication to simplifying workflows for technologists.”

United Imaging delivers these features to its installed base without additional charge for customers. If the software is available upon initial installation, it is delivered through its All-In Configurations program and, if it becomes available later, it is delivered as a part of the Software Upgrades for Life program.

“These programs guarantee that customers receive the most advanced technology not only at the time of purchase but throughout the entire product lifecycle,” Grousset says. “For instance, all the new AI features we unveiled at RSNA 2024, currently 510(k) pending, will be integrated into our installed systems via the Software Upgrades for Life program— ensuring our customers stay equipped with the latest advancements.”

Positioned for Success
Over the past year, Fujifilm released the FCT iStream, its latest compact, 128- slice CT system that leverages four core Fujifilm technologies, including HiMAR Plus (High image quality Metal Artifact Reduction), Intelli IPV, SynergyDrive, and IntelliODM to enhance the sharpness of images, streamline workflow through AI automation, and significantly reduce patient dose.

“The FCT iStream CT system was a huge focus for Fujifilm during RSNA,” Boshela says. “The system comes equipped with several technologies that drive down patient dose, including Fujifilm’s IntelliODM, an organ-based dose modulation reduction technique that modulates radiation dose in angular and/or slice directions based on patient attenuation.”

Additionally, to streamline technologist workflow, the system captures 60 images per second and uses Fujifilm’s SynergyDrive technology to automate, simplify, and accelerate the scanning process. “SynergyDrive helps streamline the entire image capture process, assisting with automating positioning of the patient inside the CT system, mapping imaging parameters on where to scan, and scanning and archiving the images,” Boshela says.

Also highlighted at RSNA were new features for the SCENARIA View, the company’s high-performance, 128-slice CT system. It features autopositioning powered by a ceiling-mounted, 3D AI camera that detects anatomy and automatically adjusts table position based on the selected target region. “With a single preset button, the table moves to the precise start and height position, as well as shifts the table left or right, ensuring anatomy is centered for the scan,” Boshela says. “The 3D camera image is displayed on the console for easy scan planning by the technologist. To further reduce patient dose, Fujifilm’s 3D mA modulation technology, Intelli EC, automatically modulates mA to lower individual patient dose levels depending on patient anatomy and size, while considering the level of iterative reconstruction selected.”

Flexible Planning
Erdogan Cesmeli, the chief strategy, marketing, and commercial officer for molecular imaging and CT at GE Healthcare, says the company’s latest CT systems rely on AI and machine learning for intelligent efficiency, delivering faster, more precise readings to help radiologists detect subtle abnormalities with greater confidence.

At RSNA 2024, GE introduced the latest capabilities of its CT-Navigation solution, which offers detailed, real-time, 3D CT images for stereotactic needle guidance. Users can plan multiple needles and interpret procedure planning images from the company’s AW Trajectory Planning software. These new capabilities afford interventionalists the opportunity to choose their optimal workflow while increasing visibility and confidence in needle placement.

The company also showed the newest advancements in its Revolution Apex platform, which include new features to improve image quality, workflow, and clinical capabilities, especially in cardiology. The platform’s 160 mm detector configuration, Revolution Apex Elite, can achieve one-beat, high-definition, motionfree coronary images at any heart rate. This capability also extends to the recently FDA-cleared ECG-less cardiac solution, which can acquire cardiac images without the aid of patients’ ECG signal/trace.

Advanced CT
The people who were interviewed for this article agree that the future of CT scanning lies in the seamless integration of advanced AI, enabling faster, more accurate diagnoses with reduced radiation dose and enhanced image quality. Coupled with innovations in automation and remote capabilities, CT will become more accessible, efficient, and personalized, addressing diverse patient and provider needs worldwide.

The industry will also see an increase in photon-counting CT systems, as these systems are proving to have the potential to produce images with less noise, higher contrast and spatial resolution, and lower radiation exposure, offering new diagnostic approaches.

— Keith Loria is a freelance writer based in Oakton, Virginia. He is a regular contributor to Radiology Today.