Ziosoft Helps Hospital Create Virtual Patient

By Elaine Sanchez

Ziosoft?s PhyZiodynamic solution produces 3D and 4D images based on CT, MR, and PET scans of the brain, lungs, and other organs.

In The Republic, Greek philosopher Plato introduces the Allegory of the Cave, in which a group of prisoners inside a cave can see only the shadows of objects. After one of these individuals is able to escape, he tells his fellow captives that the real world is actually vibrant with color.

Applying this parable to the world of radiology, Methodist Hospital in Houston has teamed up with Ziosoft Inc to deliver images that break free from the accepted mold. The facility’s Plato’s CAVE, or Computerized Augmented Visual Environment, uses Ziosoft’s PhyZiodynamic solution to create a virtual patient, building from the person’s existing DICOM studies.

“The idea is that we are all prisoners of the current standard way that we look at things, and that we need to look at our world differently,” said E. Brian Butler, MD, chairman of radiation oncology and founder of Plato’s CAVE.

Butler explained that through high-end computers and sophisticated graphic cards, his team created “a virtual patient that we can interact with on a virtual surgical table or a virtual radiation therapy table.” The hope was to build a preflight surgical or radiation therapy simulator, eventually incorporating virtual tools and apps that would interact with the patient. Physicians can now take a fully dimensional look into a patient’s internal anatomy and visualize, in multiple dimensions, a plan for surgery or other treatment.

Before Ziosoft entered the picture, Methodist’s CAVE was a clinical radiology-based interactive three-dimensional, volumetric environment. “We were building new tools to interact with the three-dimensional virtual patient,” said Paul E. Sovelius, cofounder and architect of Plato’s CAVE. “Ziosoft builds on other disciplines for increased computational power with new algorithms and applications that would allow us to look at anatomical structures in four dimensions.”

According to Sovelius, PhyZiodynamic technology enables an evaluation of normal and abnormal anatomy in four dimensions, which in turn allows clinicians to understand the disease process in a completely different light. “[O]rgans don’t just move in the anterior/posterior, right and left dimension,” he continued. “Different parts of an organ may rotate differently around multiple axes within the same organ.”

Methodist searched for a vendor partner that would allow for the production of 3D images with high fidelity motion coherence. To narrow down its list of contenders, the Methodist team scheduled various meetings, where company representatives could demonstrate the sophistication of their programs. With guidance from Sovelius, a clinical and scientific visualization expert, as well as anatomical clinical expert Nancy Huynh, the hospital ultimately found that Ziosoft met its needs. Its PhyZiodynamic solution will be used to produce true-fidelity 3D and 4D images based on CT, MR, and PET scans of the brain, lungs, and other organs.

“I believe we are changing the way that we are looking at data and certainly how we interact with new versions of the data,” Butler said. “We are trying to look at the patient in a completely visual sense as opposed to a textual sense. Virtual interaction occurs before real interaction occurs. In the future, we hope to fuse and link the virtual world with the real world.”

According to Butler, the collaboration with Ziosoft opens the window for a whole host of exciting possibilities.

“I believe that we are at the tip of the iceberg,” he said. “This technology will only improve and affect all fields of medicine—from cardiac valve surgery to radiation therapy, liver resections, heart lung transplants, reconstructive surgery, as well as head and neck procedures. It will affect all aspects of medicine.”

Plato’s Cave was launched April 1, 2009.

Simplifying Storage Management

Mark Goros

By Mark Goros

Managing the explosion of digital medical images, diagnostic reports, and patient medical records has become increasingly complex, making the need for an affordable and effective approach to health care information management and storage greater than ever. At the same time, HIPAA, state, and local health care regulations regarding the retention and compliance requirements for medical images and patient data place additional demands on IT staff.

Health care organizations that require large storage environments to store, protect, and retain their medical images also face increasing concerns about budget and how they can afford up-front acquisition costs and ongoing management expenses when dealing with increasingly complex storage implementations. Object-based storage solutions can help with image infrastructure of a health care system from the imaging device or PACS to the electronic medical record (EMR) and the clinical desktop, allowing health care professionals to focus more time and effort on patient care rather than on implementing and using a complex storage infrastructure.

So why should the medical imaging industry be looking at object-based storage solutions? Object storage scales to meet needs ranging from those of a single department or clinic to those of multiple facilities with multiple imaging specialties and gives the health care provider the ability to consolidate image/information management and storage across imaging and administrative departments. Unlike file systems that ride on top of block storage devices, object-based storage systems provide a single, flat address space to store content without the complexity of file hierarchies, folder names, or physical disk locations associated with each file. Because it is self-replicating, it requires no backup.

An object-based storage solution such as Caringo’s CAStor® simplifies storage management and administration, allowing IT personnel to focus more time and effort on clinical systems critical to improving patient care. By providing continuous, real-time availability of patient data and access to radiology studies, all medical images are instantly accessible when a physician needs to retrieve them. CAStor also supplies full life cycle management and worm storage, automatically securing your objects with regulatory compliance for decades if required.

With file sizes as large as multiple gigabytes, medical imaging data continues to outpace available storage availability. An object-based storage solution can seamlessly scale with demand, allowing organizations to grow in the increments needed—up to petabytes—to support greater volume in studies and higher-density radiology images that are growing in size as the technology matures. New storage is added only as needed to the overall capacity and is immediately available as part of the overall storage pool by simply adding another server and booting it up. The system automatically adds it to the cluster with no management needed.

In addition to supporting large files and instant provisioning of added storage, Caringo has also partnered and has seamless integration with leading medical imaging software companies. Integrated solutions include Merge Healthcare’s RadSuite PACS (medical imaging archive software); Acuo Technologies’ DICOM image management, archiving, and migration solutions; Teramedica’s Evercore Smartstore (digital image and patient records archiving software); Dejarnette xDL (medical image archiving software); and Karos Health’s Rialto Vault (clinical information archiving).

Today’s economic climate has IT budgets stretched tight in even the most well-funded environments. Expensive storage technologies like costly SAN- and NAS-based storage are not cost-appropriate solutions for images and other fixed patient data that can be safeguarded on enterprise-grade commodity hardware using object-based storage software. By consolidating existing storage across multiple health care networks, IT administrators can leverage cost and management efficiencies of a single enterprise archive throughout a hospital or health care organization while minimizing the capacity expansion of higher-cost tiers of storage.

Storage infrastructure is a rapidly growing component of today’s health care IT budgets in terms of acquisition, management, and administrative costs. Object-based storage systems like Caringo’s CAStor can deliver tangible reductions in overall TCO (total cost of ownership) from acquisition through long-term operation. It enables organizations of all sizes to start with the lowest cost, eliminate hardware lock-in, reduce system administration and maintenance, and increase the productivity of their IT team.

Mark Goros is Chief Executive Officer of Caringo Inc.

Private Cloud for Providers and Patients

By Chris Gaerig

Joe Moock

It is no secret that teleradiology is a divisive topic in the medical imaging community. From arguments over the legitimacy of some of the industry’s practices to the foreboding notion that some teleradiology firms are attempting to overtake local radiology groups, the practice has stirred a fair amount of discussion. In lieu of these debates, most teleradiology practices claim to partner with local radiology practices, rather than forcing them out of contracts, but few firms take the approach that Poway, Calif-based teleradiology services company StatRad has with its new cloud image storage system.

“We’ve developed our own systems to transmit images in support of our teleradiology business, and found that there’s a growing demand from our clients for the ability to share those images with outside parties,” said Joe Moock, managing partner, StatRad. “Not only would they be available for the referring physicians to increase business for those hospitals or imaging centers, but also for the patients themselves should they wish to personally archive their images rather than collecting CDs.”

On the surface, StatRad’s “cloud-based image distribution” system is not unlike similar solutions—access is given to both patients and physicians on a secure network—but the company is offering the solution free of charge to both their teleradiology clients as well as those facilities that are interested in the technology but do not pay for the company’s services.

“It started because of requests from our teleradiology clients, but we’re actually going to be offering to install this cloud solution for free in hospitals around the country,” said Moock.

The StatRad cloud solution is a HIPAA-compliant system. The private cloud differs from public clouds like Microsoft Windows Azure because of precautionary steps necessitated by HIPAA. For example, to be HIPAA compliant, hardware and hard drives need to be destroyed if they are no longer in use and there was any patient data on them. Public clouds include information from countless sources and are typically unable to follow guidelines like this.

“Basically, we are partnering with organizations that allow us to create the private cloud and balance the retention and distribution of images among multiple facilities and a high number of Internet backbones to ensure uptime,” said Vishal Verma, MD, medical director at StatRad. “We also ensure that everything is completely secure and inaccessible to anyone outside of who we allow access to. We started out looking at all the public cloud providers. They’re very cost-effective and there are a lot of benefits to them, but none of them can be completely HIPAA compliant.”

Vishal Verma, MD

The benefits of this system are both economic and patient-centered. Aside from the free installation and implementation of the system, the use of the cloud-storage solution eliminates the need for physical CDs and storage devices, saving costs to the facilities. In addition, this system is intended to decrease the amount of scans necessary for a patient. If each patient has access to his scans, he can avoid repeat scans by allowing access to referring physicians.

“The other benefit we’re looking at, other than distributing images to referring physicians, is reducing unnecessary or duplicated exams,” said Verma. “If a patient has a scan at a hospital in town and 2 weeks later goes to a different health care system, rather than getting a repeat scan, if both hospitals are connected to the cloud, they can easily access all of the prior imaging of the patient.”

Currently, StatRad has several facilities that will beta test the cloud solution, after which the company will offer it to facilities across the nation. And the sooner they can get this solution into new facilities, the better, because for StatRad the primary goal of this and all their solutions is benefiting the patients.

“It’s really about improving patient care,” said Moock. “We’re not out to take over radiology contracts or displace radiology groups. We’re here to support radiology groups, not only with our reading services, but also with our infrastructure technology and efficiencies. We thought that this was another way we could help improve patient care.”