Managing the Flow in Radiology

Bringing Enterprise Intelligence to the Health Care Market
Two Workflow Tools from TeraRecon
FDA Clears PicomEnterprise for Digital Mammo

Jim Traficant, vice president
Bart Harmon, MD, MPH

Bringing Enterprise Intelligence to the Health Care Market

Making its entrance into the health care arena at this year’s HIMSS was Harris Corporation, an international communications and information technology company that has developed communications products, systems, and services for the government and commercial markets.

During the February event, the Melbourne, Fla, firm announced its collaboration with Cancer Treatment Services International (CTSI), an organization that is dedicated to advancing the quality and delivery of radiation oncology. Together, the pair plans to use Harris’ expertise in image processing and enterprise intelligence to help CTSI effectively deliver the highest quality cancer treatment to larger populations of people.

Jim Traficant, vice president of Harris Healthcare Solutions, recalled attending HIMSS a year ago to see how the company’s imaging solutions could be applied to the needs of the medical community. During a group session that involved vendor executives, one of the first remarks made regarding the next goal in health care was “managing, moving, and mining very large data sets and being able to display these things in real time with no latency,” Traficant said. Harris already had accomplished this in its work for the intelligence community in moving very large imagery around the globe to support military operations and national security. “We would go off through a series of class networks, access the data, and send it off in the world to any device that was registered to receive the information,” he said. “If the information doesn’t get through, the mission is compromised.” Why not apply the same concept in health care?

After a consultant group called Toffler Associates put Traficant in touch with Jeff Shogan, MD, CTSI chairman and renowned oncologist, the two immediately hit it off and talked about the potential to deliver cancer treatment in a remote capacity. They also set out to work toward bringing home “the holy grail” for image-guided radiation therapy—achieving feedback in a real-time setting.

According to Shogan, the pressing question is how to automate imaging content to delineate the cancer’s location, essentially using the information from various modalities to contour the tumor. With a focus on building cancer centers nationally and internationally, Shogan is developing the technology particularly for use in the Third World, where a burgeoning need for health care exists. Both Harris and CTSI are looking to move the data around in a constrained network for remote expert analysis, which would allow for wireless collaboration. “Going through a digital medium is very empowering not only for the health care personnel involved, but also for the patient,” commented Harris’ chief medical officer Bart Harmon, MD, MPH, who had more than 10 years working for the US Department of Defense under his belt before taking on his current position earlier this year.

Traficant knows this firsthand. Four years ago, his liver was failing, along with his major organs, and his prognosis was grim. One liver transplant resulted in the need for an immediate second one; however, doctors couldn’t formulate a pathway of care without his most recent pathology report. As Traficant was too weak to endure another biopsy, his wife had no choice but to spend precious time driving home to retrieve his tissue sample.

Although the story ends happily for Traficant, he reflects, “What if that tissue sample was digital? The electronic health record could be up on a screen in the hospital room and doctors could be making decisions on the pathway of care, right on the spot. I think that would save lives, advance care, and accelerate the number of patients who get access to care,” he said.

Shogan believes today’s medical environment houses the tools that are necessary to achieve the mission of CTSI and Harris—it’s just a matter of understanding them. “I think the number of technologies we have now are incredibly sophisticated, but they are limited as far as their applicability because there is only a small pool of people with the amount of high-level training this requires,” Shogan said.

—Elaine Sanchez

Two Workflow Tools from TeraRecon

TeraRecon Inc, San Mateo, Calif, is helping radiologists be doubly productive. In late 2007, TeraRecon introduced two workflow enhancements for the company’s Aquarius iNtuition advanced visualization platform: “Workflow Templates” and “Workflow Scenes.”

“Workflow Templates and Scenes provide any user who is part of the patient care cycle the ability to quickly achieve consistent patient outcomes over thin-client architecture,” explained Jeff Sorenson, vice president of US and Canada Aquarius sales for TeraRecon. “Workflow Templates provide automated, customized postprocessing protocols that can be used as a step-by-step guide, ensuring that all the necessary clinical tools are utilized to perform the data rendering. Workflow Scenes provide the ability for the patient data to become a works-in-progress throughout the enterprise, leveraging review and edits, if necessary, with all stakeholders involved.”

These enhancements are designed to focus radiologist time on interpretation and therapy planning. “A Workflow Template is more than a volumetric saved state,” said Sorenson. “It is all defined key views that the physician would like preprocessed, and all of the images and saved states that comprise it. In order to accomplish this, TeraRecon developed an innovative human atlas within the product to compare the current clinical study, identify the study type, find landmarks, and create the desired views.”

iNtuition designates which workflow elements are generated automatically by marking them with an “A”; once the technologist or physician perfects them, they can be marked validated with a “V.” “The customizable nature of the iNtuition architecture enables Aquarius to be configured as an advanced, procedural workstation for the 3D technologist, a powerful reading tool for the diagnosing physician, and a fast, simple review tool for the referring MD,” said Sorenson.

Workflow Templates are the foundation of Workflow Scenes, Sorenson explains; the templates provide visual steps throughout the workup that are perfected and saved as scenes. “This bundle of visual images now becomes a PACS-compliant image object that can be opened and reviewed by other stakeholders for further analysis or processing,” said Sorenson. “This is really a unique innovation that brings advanced visualization to a new level of usability, collaboration, access, and efficiency.”

iNtuition is able to accommodate the workflow needs of multiple users so efficiently because of its thin-client foundation, Sorenson notes. “Because it is client-based, the system will interact differently to two users who are using the same system from the same location,” he said. “Moreover, the system is anatomically aware and can create oblique views, add centerlines, remove bones, apply algorithms, and so on.”

The newly enhanced platform also offers increased automation. “One challenge of automating workflow is that different facilities may place different information in the DICOM headers to identify a particular study type,” said Sorenson. Using its anatomic awareness capabilities, as well as the attributes of the scan being processed, iNtuition applies the correct algorithms to the study even when the DICOM header information is inconsistent or missing.

“The great thing about the Aquarius iNtuition platform is that you almost feel you have a dedicated 3D technologist working for you behind the scenes,” said Christopher Herzog, MD, chief of radiology at the Red Cross Hospital, Munich. “Certainly, a competent physician can get the answer eventually on more or less any 3D workstation, but when 80% of the routine work is done for you before you even open the case, it’s a great benefit that allows us to focus precious time on clinical interpretation, rather than struggling to prepare the case to a presentable form.”

—C. Vasko

FDA Clears PicomEnterprise for Digital Mammo

ScImage Inc, Los Altos, Calif, has received FDA 510(k) premarket clearance for primary diagnostic review of mammographic images using its PicomEnterprise PACS platform. Version 3.0 automatically displays the images in a format familiar to radiologists, including features such as default hanging protocols for standard screening exams, automated hanging protocols for prior comparison, and linked window/level and pan/zoom functions.

“We’ve always had the ability to show mammography for referring physician use using only Picom online,” said Imad Nijin, ScImage product manager. “Now we’ve made those images available for primary interpretation. We had to make a few adjustments to our viewer and new advancements to our hanging protocols to make it more appealing for the mammography reader. We have the ability to window/level two images at the same time, zoom two images at the same time, and so on.”

Version 3.0 of PicomEnterprise also maintains the platform’s enterprise-wide, Web-only functionalities, enabling radiologists to view and compare images from multiple modalities. “Our biggest strength is that this is an enterprise solution,” said Nijin. “As a radiologist, I can now see breast MRs, ultrasounds of the breast, and biopsies all in the same worklist and viewer, using all the same tools, in the same comfortable environment.”

Implementation is a snap. “We’re not talking about a forklift install for existing users,” said Chris Carr, marketing manager for ScImage. “We’re talking about a minor revision to bring in a new application, and then the additional training that will be required to get the user of the system familiarized with the tools. But the user experience is the same as it was before the mammography toolset was available to the user.”

Version 3.0 offers advantages from an administrative standpoint, as well. “A big benefit from the technology side is that you can continue to use the same PACS administrator, who’s already been trained,” said Nijin. “You have the same storage and archive. You have the same disaster recovery system. So you save a lot of money on the technical side of things.”

“PicomEnterprise is designed so that you can set disaster recovery policies according to regulatory requirements,” added Carr. “From a compliance standpoint, we can support whatever policies the hospital has in place.”

The latest release of PicomEnterprise also features roaming profiles: “All your studies go with you wherever you log in,” said Nijin. “It’s smart enough to know how many monitors you’re using.” And the system boasts a new workflow management foundation that combines DICOM and HL7 functionality as part of the core server architecture, offering new productivity-enhancing features.

“The ideology that we try to employ is keeping the physician immobile at the workstation as long as possible by giving them the tools they need to do their job,” said Carr. “The longer they can sit in one spot and read, the more productive they can be. That’s the driving force behind the way we’ve designed our products.”

—C. Vasko