d_Orr.jpg (7367 bytes)The Society for Computer Applications in Radiology (SCAR) recently hosted its 20th annual meeting in Boston in June, with a full complement of leading-edge radiology professionals in attendance. The meeting easily drew about 2,000+ radiology and IT folks, filled the exhibit hall space to overflowing, provided a forum for a stellar group of speakers and kick-started the festivities with a superb PACS Administrator Course. For sure, this year’s symposium was a huge success.

The official theme of the SCAR 2003 annual meeting was “Information Explosion: Embracing Our Future in the 21st Century.” Scientific and educational sessions throughout the meeting focused on specific components of the interaction between medical practitioners and information technologies. This obviously means that the revolution of transforming the radiological imaging world from film to digital is well underway, and indeed, 99.9 percent of the attendees were focused on three main topics — PACS, PACS and PACS.

I’m not sure what the founders were thinking 20 years ago when they started, as IBM had Big Iron and a little venture call the PC, Apple had the IIe, and Microsoft was Bill Gates eating a sandwich in his garage. Teletypes (not faxes) were the digital form of communication, Fedex was a startup, cell phones were dreams, but Dick Tracy at least saw the future. X-rays were generated in great quantities, CT scanners were new (priced at $1 million!), ultrasound was emerging, real MRI applications were percolating in R&D, and radiologists were the source of all medical imaging.

So, now we are surrounded by all things digital — phones, email, networks, specialists, workstations, displays, and the PACS that was installed a few years back (at great risk) is looking a little frayed and in need of an overhaul, upgrade or replacement. The best thing to do is obviously find some collegial cell-mates to find out how bad it is at their respective institutions.

Many SCAR attendees brought a headache with them to Boston — many of these have sprung from a similar event occurring at many hospitals in the U.S. — the arrival of a new (16-slice) CT scanner. These monster imaging machines have the ability to swamp everyone’s current network, obsolete the workstations and give 3D system operators a memory overload error. Especially (as is the case at some major facilities) when you add not 1, but multiple machines to your network. But even if it were not the 16-slice scanners today, it would be the neuro MRI, cardiac MRI or any of the proliferating imaging machines that represent the state-of-the-art in radiology imaging — machines that generate massive quantities of images that strain the entire infrastructure of networks, archives, workstations, displays, etc.

So, SCAR attendees were on real-world missions to expand their network archives and capacities without taking on another 18-month “PACS project.”
And the answer was — rename the PACS project as an EMR (electronic medical record) project. You’ll go to the top of the Capital Project queue, receive all of the funds that you need for the job, and no questions will be asked. Seriously, upgrading a PACS is a problem that money can solve, without too much problem.

SCAR also put together a special closing session to help attendees focus on the future of image interpretation with a new initiative called TRIP — Transforming the Radiological Interpretation Process. The focus of TRIP is to find solutions for the problem of image and information overload, driven by the digital technology infusion into medical imaging practices. It incorporates interdisciplinary research on technology, environmental and human factors to better manage the information explosion by focusing on large data sets, navigation devices, manpower and training.

Three guest speakers from NASA (EOS, Earth Observatory System), NIMA (National Imagery and Mapping Agency) and Hollywood (entertainment industry) described their network environments, storage and archiving parameters/issues, security, large data set challenges, etc. While a hospital does not compare in scale today to any of these groups, it may not be that long before the amount of data they support reaches that point. If you add up all the hospitals collectively, then similarities become much more apparent.

A few thoughts about Transforming the Radiological Interpretation Process occurred to me during this session — there is a great deal of imaging and interpretation performed by non-radiologists (OK, we’ll add them into this process later on), training and testing of the interpreters (especially visual acuity and attention span), tele-Radiology may play a role, especially in areas short of on-call or on-site radiologists (memo to State Medical Boards), CAD can both speed up and improve certain imaging tasks (but not all), image analysts (those driving the 3D or advanced workstations) will become as common as R.T.s, and procedure-specific image processing software will become a must-have tool (check out Fuji’s CR-related software suite). NASA and NIMA may prove to be fertile areas for both technical and management cross-pollination in networks and large files.

Looking ahead, radiology departments appear to have a secure future, but only if they work smarter, not harder. I’m certainly looking forward to more in this area.

Doug Orr, president of J&M Group (Ridgefield, Conn.), consults with medical device companies in strategy and business development for emerging growth markets, notably radiology and cardiology. Comments and suggestions can be sent to [email protected].