DOTmed recently
spoke with ContextVision
CEO Jan Erik Hedborg
spoke with ContextVision
CEO Jan Erik Hedborg
ContextVision Software Is the "Brains" Behind Many Modalities
June 24, 2009
by Barbara Kram, Editor
It is easy to appreciate the sophistication of medical hardware such as a dazzling multi-slice CT scanner, elegant crystalline ultrasound probe, or muscular high-field MRI. Less evident are the brains behind the operations--the image enhancement software that translates electromagnetic or sound waves into clinical vision.
The industry leader in medical image enhancement software is ContextVision, Stockholm, Sweden. For example, the company's GOPiCE technology removes speckle and noise in 3D (volumetric) ultrasound. With 25 years' experience, ContextVision's software is installed in more than 40,000 medical imaging systems worldwide including MRI, CT, digital X-ray and ultrasound units made by more than 50 OEMs.
DOTmed News recently spoke at length with ContextVision CEO Jan Erik Hedborg.
--
DOTmed (DM): The importance of software is undeniable even though we tend to focus on hardware.
Jan Erik Hedborg (JEH): We are a pure software company. In the past we did our own hardware when data processing capacity was not enough and we needed to create our own circuit boards so that we could run the software in the proper manner. But nowadays we are more or less independent of proprietary hardware.
DM: Tell us about your core competency and image software.
JEH: If you ask about the core competency it is image processing--very much the skill of understanding manipulation of images through complex mathematical formulas which we refer to as algorithms. Our roots are in the academic world. We were a research project 25 years ago -- advanced image processing research led to the technology that was spun off in our company.
DM: Your customers are the OEMs?
JEH: We provide the medical imaging manufacturers with our solutions. Our software is embedded the customers' equipment as an integrated part of their solution. We are not very visible to the end user as we reside under the hood of our customers' equipment.
What we bring to this industry is improved diagnostic value. The purpose of supplying image enhancement is to improve the quality of the image in a way that makes the diagnosis for the doctor easier and more comfortable. For some of our customers, the time to market has an impact. They might want to consider doing it themselves, but we are totally dedicated to this technology, and therefore are always improving and offer the best possible technology at all times. In a nutshell we are in the market to add this value to the manufacturers.
DM: How is the market now? It must be down considering equipment sales are down.
JEH: We certainly have seen a slow-down in the market. We saw it coming in the fall [of 2008]. The impact on the medical device and imaging market came later than in other sectors. But it certainly had an impact on the investment climate and the tendency is that expensive high capital goods are more affected. Certain other segments in the medical imaging market might have seen improvement because people might select cheaper solutions or upgrade solutions rather than investing in totally new solutions. That is something we all are thinking about--in what way can we capitalize on those conditions?
But the climate is quite a bit tougher [than in the past]. We saw the big manufacturers report a weaker Q1 but it is not as dramatic as in other sectors. So it is far from being a collapse and actually there is limited growth. The 5-6% annual growth we have seen has slowed to about half of that. But still it is a sound market and there is an underlying demand for these solutions.
DM: Does your company also produce software upgrades to existing equipment that the OEMs could then install?
JEH: Yes. That is something we can offer the market. Indirectly it prolongs the lifetime of the product.
DM: What influence do software upgrades have on the market?
JEH: We recently had an X-ray customer that introduced our technology into its device. In this case it was an X-ray device and it was introduced as a new release, part of other improvements done by the manufacturer. But they also offered [image enhancement] as an upgrade release to their existing customers because they saw the benefit. It's like a PC and you upgrade your software on a regular basis. We see this happen from time to time. It is not that common but I would say the trend is that it is becoming a bit more common.
DM: How does your software work?
JEH: One has to look at the different segments of the market. On one hand, you have the X-ray market, the biggest segment. X-ray procedure is the most common medical imaging procedure today. That has been moving from analog film based to digital based where you look at the images on a high resolution display. When it comes to X-ray, image enhancement improvements are achieved in many different aspects such as removing unwanted noise and graininess. There are also other parts of the X-ray image that can benefit from image enhancements such as the contrast of edges. When you look at small details in an X-ray image, details can be very important in certain procedures. We work with hundreds of parameters to achieve the optimal image quality. We do this together with clinical experts, including our customers' experts, to reach the optimal level on a specific device. It is always customized for a specific device. It is not like a plug-and-play where you use our software. It is customized for the purpose of reaching the optimal image quality based on each customer's specific goals.
DM: What about CT?
JEH: As you reported (www.dotmed.com/news/story/9139), SharpView is our sister company whose core technology is provided by us. In CT our technology has been used to reduce dose. The way it works is basically the same methodology as when we improve the image, because when you lower the radiation dose in a CT scanner, the image degrades in terms of quality. There will therefore be more noise and more defects. What we do is apply image enhancement software to restore the quality to what it was before the dose reduction...allowing lower dose to be used [in the first place].
DM: I understand that you have new ultrasound image software. Tell us how your work informs that modality.
JEH: One big difference with ultrasound is the use of moving images compared to X-ray, MRI and CT which lack movement and the passage of time. From our point of view it makes quite a big difference.
When we started to look at ultrasound and consider how to improve the image quality, the big challenge was to make this happen fast enough because image enhancement requires quite a lot of calculation in terms of applying the algorithm to the images. Since early 2000 we understood that we could do something that would have a very good impact in ultrasound. But then the PC market (Intel) drove the capacity to higher levels, so in 2003 we improved our algorithm to show a solution in real time to achieve immediate improvement while a doctor was applying the process to the patient. We were among the first to show real-time ultrasound image enhancement that was very visible to the doctors with details coming forward in a more accurate manner. Edges, border lines and textures came out in a better way than an unenhanced image. Our customers' customers--the doctors--had a preference for this type of enhancement. Our customers [OEMs] showed a strong preference for the benefit of using our software in their devices. They could basically increase their competitive edge and move upward to a high-end solution because the image came out much better.
DM: What is volumetric image enhancement?
JEH: That is the next step of Ultrasound image enhancement, that we introduced at AIUM [American Institute of Ultrasound in Medicine, April 2-5, 2009 in New York]. So far we have been using two dimensional image data in applying image enhancement. We really had looked at just the X and Y planes. Because ultrasound, as well as other modalities, generates volume data and ultrasound is an echo that fills up volume in terms of image data, we saw the potential to use the volume to bring forward more details in the enhancement than we can do with 2D. We took the lead in being the first to introduce image enhancement on a volumetric image. We are very excited about it and see great opportunity to bring more information up to the surface--volumetric data compared to two dimensional data.
DM: What about 4D motion pictures in ultrasound?
JEH: We can achieve a short-duration 4D solution today: on 128 cubic pixels we can run up to 24 volumes per second, which gives an indication [of how far along we are in achieving real-time 4D]. We intend to take it to the full real-time so it becomes a full-fledged 4D solution.
DM: I guess, as in the early days, you are limited only by the capacity of the processors.
JEH: That is correct. Right now we use GPU, a graphical processor unit, which is very popular in the gaming industry. And we see the trends moving toward that type of solution to really get the best possible performance of the processor. The GPU industry is moving faster than the CPU. However, we believe the CPU will win back its leadership in terms of performance growth in the future.
DM: Is ultrasound a modality that is very promising in terms of likelihood to benefit from software innovation in the future?
JEH: What makes ultrasound interesting is that it is the easiest and in many respects the cheapest way of applying some sort of imaging diagnostic. In that sense, ultrasound has grown to be used in many other types of procedures than five years ago. The whole hand-carried ultrasound market has brought the ultrasound devices to other parts of the hospital. So there has been a dynamic growth in usage of ultrasound. When it comes to the software, I would say the software is taking on an increasingly important role in all the modalities. You might say software takes on a slightly larger importance in ultrasound than other heavier modalities -- than MRI or CT -- because those devices have a lot of hardware compared to ultrasound.
DM: What about MRI?
JEH: ContextVision started out of MRI, where we introduced image enhancement into low tesla MRI units. We could see very good impact on the image by using image processing in such cases. By the mid-1990s we dominated the MRI market in providing image enhancement: Out of 10 MRI units sold worldwide, seven used ContextVision image enhancement.
The next big challenge for us after having introduced the 3D volumetric ultrasound, we will do the same for MRI and provide the image enhancement for volumetric data in MRI. And that is very exciting and also a very challenging step to take but we have high expectations in this area and we believe we can contribute a lot of improvement.
DM: Will that effort require a higher field MRI or would a 1.5T benefit from some of these software approaches?
JEH: We are looking at introducing our technology on 3T machines later this year for one of our customers. I think volumetric enhancement will be a very important and powerful solution that we contribute to taking the image to a new level.
DM: But as things now stand, there is no volumetric MRI image enhancement?
JEH: Correct. We have announced that our next big product introduction will be 3D enhancement for MRI, but we have not yet set the time for it. We are still exploring different ways of introducing the technology. I would say within a year is reasonable.
DM: What about image fusion, is that a software function?
JEH: Yes, you overlay images from different modalities and by doing that you can show information more extensively than if separated. This is something we are not directly involved in, the fusion itself. It is an interesting discipline in terms of value. But we would be involved in the step before image fusion.
DM: Last year, ContextVision added an interventional radiology product to its product line. Can you comment on the clinical value of interventional radiology?
JEH: Interventional Radiology is the combination of diagnostic imaging and therapeutic treatment, basically at the same time. It uses the diagnostic imaging data to guide a therapeutic solution to the appropriate site, taking the therapeutic action and then following with a fresh diagnostic image to ensure the therapy was positioned accurately. This real-time combination of diagnosis and therapy leads to reduced hospital stays and better clinical efficacy. This type of minimally invasive medicine is the direction that medicine is going in because it leads to reduced cost and better medicine. Additionally, an IR product like GOPView iRVPlus can enable a dose reduction up to one-third, which minimizes both patient and staff exposure.
DM: What aspects of software and medical technology would you like to leave our readers with?
JEH: We are dedicated to medical image enhancement. It is in our vision to remain on top and look for improvement at all times. It is a combination of being ahead in terms of mathematical algorithms and in understanding the clinical value--working extensively with university hospitals in the U.S. to stay ahead of providing the best possible solutions at all given times. This is really the driving force for us going forward.
Entering volumetric image enhancement is certainly a very big step. It is a conversation that takes place between the doctors, ourselves, and the manufacturers in terms of pushing the boundaries. This is very exciting for us and the people in our company that want to stay on the leading edge.
--
Read more on DOTmed.com:
ContextVision Announces Positive Clinical Evaluation for GOPiCE US Volumetric Image Enhancement
https://www.dotmed.com/news/story/9455/
CT Radiation Can Be Dramatically Reduced With SharpView's Software
https://www.dotmed.com/news/story/9139/
AIUM Meeting Sharpens the Focus on Ultrasound As a Premier Imaging Option
https://www.dotmed.com/news/story/8739/
ContextVision Unveils First Real-time Volumetric Ultrasound Image Enhancement Tool
https://www.dotmed.com/news/story/8650/
ContextVision Continues to Bolster its X-ray Division
https://www.dotmed.com/news/story/8502/
ContextVision Receives ISO 13485:2003
https://www.dotmed.com/news/story/8240/
ContextVision Enters Interventional Radiology Market
https://www.dotmed.com/news/story/7570/
The industry leader in medical image enhancement software is ContextVision, Stockholm, Sweden. For example, the company's GOPiCE technology removes speckle and noise in 3D (volumetric) ultrasound. With 25 years' experience, ContextVision's software is installed in more than 40,000 medical imaging systems worldwide including MRI, CT, digital X-ray and ultrasound units made by more than 50 OEMs.
DOTmed News recently spoke at length with ContextVision CEO Jan Erik Hedborg.
--
DOTmed (DM): The importance of software is undeniable even though we tend to focus on hardware.
Jan Erik Hedborg (JEH): We are a pure software company. In the past we did our own hardware when data processing capacity was not enough and we needed to create our own circuit boards so that we could run the software in the proper manner. But nowadays we are more or less independent of proprietary hardware.
DM: Tell us about your core competency and image software.
JEH: If you ask about the core competency it is image processing--very much the skill of understanding manipulation of images through complex mathematical formulas which we refer to as algorithms. Our roots are in the academic world. We were a research project 25 years ago -- advanced image processing research led to the technology that was spun off in our company.
DM: Your customers are the OEMs?
JEH: We provide the medical imaging manufacturers with our solutions. Our software is embedded the customers' equipment as an integrated part of their solution. We are not very visible to the end user as we reside under the hood of our customers' equipment.
What we bring to this industry is improved diagnostic value. The purpose of supplying image enhancement is to improve the quality of the image in a way that makes the diagnosis for the doctor easier and more comfortable. For some of our customers, the time to market has an impact. They might want to consider doing it themselves, but we are totally dedicated to this technology, and therefore are always improving and offer the best possible technology at all times. In a nutshell we are in the market to add this value to the manufacturers.
DM: How is the market now? It must be down considering equipment sales are down.
JEH: We certainly have seen a slow-down in the market. We saw it coming in the fall [of 2008]. The impact on the medical device and imaging market came later than in other sectors. But it certainly had an impact on the investment climate and the tendency is that expensive high capital goods are more affected. Certain other segments in the medical imaging market might have seen improvement because people might select cheaper solutions or upgrade solutions rather than investing in totally new solutions. That is something we all are thinking about--in what way can we capitalize on those conditions?
But the climate is quite a bit tougher [than in the past]. We saw the big manufacturers report a weaker Q1 but it is not as dramatic as in other sectors. So it is far from being a collapse and actually there is limited growth. The 5-6% annual growth we have seen has slowed to about half of that. But still it is a sound market and there is an underlying demand for these solutions.
DM: Does your company also produce software upgrades to existing equipment that the OEMs could then install?
JEH: Yes. That is something we can offer the market. Indirectly it prolongs the lifetime of the product.
DM: What influence do software upgrades have on the market?
JEH: We recently had an X-ray customer that introduced our technology into its device. In this case it was an X-ray device and it was introduced as a new release, part of other improvements done by the manufacturer. But they also offered [image enhancement] as an upgrade release to their existing customers because they saw the benefit. It's like a PC and you upgrade your software on a regular basis. We see this happen from time to time. It is not that common but I would say the trend is that it is becoming a bit more common.
DM: How does your software work?
JEH: One has to look at the different segments of the market. On one hand, you have the X-ray market, the biggest segment. X-ray procedure is the most common medical imaging procedure today. That has been moving from analog film based to digital based where you look at the images on a high resolution display. When it comes to X-ray, image enhancement improvements are achieved in many different aspects such as removing unwanted noise and graininess. There are also other parts of the X-ray image that can benefit from image enhancements such as the contrast of edges. When you look at small details in an X-ray image, details can be very important in certain procedures. We work with hundreds of parameters to achieve the optimal image quality. We do this together with clinical experts, including our customers' experts, to reach the optimal level on a specific device. It is always customized for a specific device. It is not like a plug-and-play where you use our software. It is customized for the purpose of reaching the optimal image quality based on each customer's specific goals.
DM: What about CT?
JEH: As you reported (www.dotmed.com/news/story/9139), SharpView is our sister company whose core technology is provided by us. In CT our technology has been used to reduce dose. The way it works is basically the same methodology as when we improve the image, because when you lower the radiation dose in a CT scanner, the image degrades in terms of quality. There will therefore be more noise and more defects. What we do is apply image enhancement software to restore the quality to what it was before the dose reduction...allowing lower dose to be used [in the first place].
DM: I understand that you have new ultrasound image software. Tell us how your work informs that modality.
JEH: One big difference with ultrasound is the use of moving images compared to X-ray, MRI and CT which lack movement and the passage of time. From our point of view it makes quite a big difference.
When we started to look at ultrasound and consider how to improve the image quality, the big challenge was to make this happen fast enough because image enhancement requires quite a lot of calculation in terms of applying the algorithm to the images. Since early 2000 we understood that we could do something that would have a very good impact in ultrasound. But then the PC market (Intel) drove the capacity to higher levels, so in 2003 we improved our algorithm to show a solution in real time to achieve immediate improvement while a doctor was applying the process to the patient. We were among the first to show real-time ultrasound image enhancement that was very visible to the doctors with details coming forward in a more accurate manner. Edges, border lines and textures came out in a better way than an unenhanced image. Our customers' customers--the doctors--had a preference for this type of enhancement. Our customers [OEMs] showed a strong preference for the benefit of using our software in their devices. They could basically increase their competitive edge and move upward to a high-end solution because the image came out much better.
DM: What is volumetric image enhancement?
JEH: That is the next step of Ultrasound image enhancement, that we introduced at AIUM [American Institute of Ultrasound in Medicine, April 2-5, 2009 in New York]. So far we have been using two dimensional image data in applying image enhancement. We really had looked at just the X and Y planes. Because ultrasound, as well as other modalities, generates volume data and ultrasound is an echo that fills up volume in terms of image data, we saw the potential to use the volume to bring forward more details in the enhancement than we can do with 2D. We took the lead in being the first to introduce image enhancement on a volumetric image. We are very excited about it and see great opportunity to bring more information up to the surface--volumetric data compared to two dimensional data.
DM: What about 4D motion pictures in ultrasound?
JEH: We can achieve a short-duration 4D solution today: on 128 cubic pixels we can run up to 24 volumes per second, which gives an indication [of how far along we are in achieving real-time 4D]. We intend to take it to the full real-time so it becomes a full-fledged 4D solution.
DM: I guess, as in the early days, you are limited only by the capacity of the processors.
JEH: That is correct. Right now we use GPU, a graphical processor unit, which is very popular in the gaming industry. And we see the trends moving toward that type of solution to really get the best possible performance of the processor. The GPU industry is moving faster than the CPU. However, we believe the CPU will win back its leadership in terms of performance growth in the future.
DM: Is ultrasound a modality that is very promising in terms of likelihood to benefit from software innovation in the future?
JEH: What makes ultrasound interesting is that it is the easiest and in many respects the cheapest way of applying some sort of imaging diagnostic. In that sense, ultrasound has grown to be used in many other types of procedures than five years ago. The whole hand-carried ultrasound market has brought the ultrasound devices to other parts of the hospital. So there has been a dynamic growth in usage of ultrasound. When it comes to the software, I would say the software is taking on an increasingly important role in all the modalities. You might say software takes on a slightly larger importance in ultrasound than other heavier modalities -- than MRI or CT -- because those devices have a lot of hardware compared to ultrasound.
DM: What about MRI?
JEH: ContextVision started out of MRI, where we introduced image enhancement into low tesla MRI units. We could see very good impact on the image by using image processing in such cases. By the mid-1990s we dominated the MRI market in providing image enhancement: Out of 10 MRI units sold worldwide, seven used ContextVision image enhancement.
The next big challenge for us after having introduced the 3D volumetric ultrasound, we will do the same for MRI and provide the image enhancement for volumetric data in MRI. And that is very exciting and also a very challenging step to take but we have high expectations in this area and we believe we can contribute a lot of improvement.
DM: Will that effort require a higher field MRI or would a 1.5T benefit from some of these software approaches?
JEH: We are looking at introducing our technology on 3T machines later this year for one of our customers. I think volumetric enhancement will be a very important and powerful solution that we contribute to taking the image to a new level.
DM: But as things now stand, there is no volumetric MRI image enhancement?
JEH: Correct. We have announced that our next big product introduction will be 3D enhancement for MRI, but we have not yet set the time for it. We are still exploring different ways of introducing the technology. I would say within a year is reasonable.
DM: What about image fusion, is that a software function?
JEH: Yes, you overlay images from different modalities and by doing that you can show information more extensively than if separated. This is something we are not directly involved in, the fusion itself. It is an interesting discipline in terms of value. But we would be involved in the step before image fusion.
DM: Last year, ContextVision added an interventional radiology product to its product line. Can you comment on the clinical value of interventional radiology?
JEH: Interventional Radiology is the combination of diagnostic imaging and therapeutic treatment, basically at the same time. It uses the diagnostic imaging data to guide a therapeutic solution to the appropriate site, taking the therapeutic action and then following with a fresh diagnostic image to ensure the therapy was positioned accurately. This real-time combination of diagnosis and therapy leads to reduced hospital stays and better clinical efficacy. This type of minimally invasive medicine is the direction that medicine is going in because it leads to reduced cost and better medicine. Additionally, an IR product like GOPView iRVPlus can enable a dose reduction up to one-third, which minimizes both patient and staff exposure.
DM: What aspects of software and medical technology would you like to leave our readers with?
JEH: We are dedicated to medical image enhancement. It is in our vision to remain on top and look for improvement at all times. It is a combination of being ahead in terms of mathematical algorithms and in understanding the clinical value--working extensively with university hospitals in the U.S. to stay ahead of providing the best possible solutions at all given times. This is really the driving force for us going forward.
Entering volumetric image enhancement is certainly a very big step. It is a conversation that takes place between the doctors, ourselves, and the manufacturers in terms of pushing the boundaries. This is very exciting for us and the people in our company that want to stay on the leading edge.
--
Read more on DOTmed.com:
ContextVision Announces Positive Clinical Evaluation for GOPiCE US Volumetric Image Enhancement
https://www.dotmed.com/news/story/9455/
CT Radiation Can Be Dramatically Reduced With SharpView's Software
https://www.dotmed.com/news/story/9139/
AIUM Meeting Sharpens the Focus on Ultrasound As a Premier Imaging Option
https://www.dotmed.com/news/story/8739/
ContextVision Unveils First Real-time Volumetric Ultrasound Image Enhancement Tool
https://www.dotmed.com/news/story/8650/
ContextVision Continues to Bolster its X-ray Division
https://www.dotmed.com/news/story/8502/
ContextVision Receives ISO 13485:2003
https://www.dotmed.com/news/story/8240/
ContextVision Enters Interventional Radiology Market
https://www.dotmed.com/news/story/7570/