Managing the Flow in Radiology

Making PACS Work
Customizable MammoSmart DVDs and CDs from DatCard
Teleradiology Expands Reach, Enters New Markets
Companies Partner to Offer Mini-PACS Solution

Making PACS Work

Vendors roll out features designed to improve functionality.

Editor’s Note: This RSNA 2006 PACS wrap-up is the first in a two-part series. Next month, we’ll feature PACS solutions that are empowered with results notification and new administrative tools.

The bright news off the exhibit floor from PACS vendors at RSNA 2006 was enhanced workflow. Fed up with hard-to-use applications, distracting icons, and multiple sign-ons, radiologists sent up the flares; vendors responded by optimizing their systems for the way radiologists work, with native advanced visualization tools, improved worklists, and agnostic full-field digital mammography (FFDM) workflow.

Agfa HealthCare, Greenville, SC, poured into its tightly integrated RIS/PACS a number of applications to enhance workflow. By integrating STATdx from Amirsys Inc, Salt Lake City, Agfa has added decision support that can be launched by hitting one button. “By intelligently using the information in the DICOM header, the application goes straight to the information that the radiologist is looking for,” explains Lenny Resnick, director of image and information solutions at Agfa. The company also has enhanced its existing Web portal product to perform a real-time query into laboratory, pharmacy, and other systems without requiring radiologists to log in to other systems. Agfa also added a new collection of advanced clinical applications, including virtual colonoscopy and fusion.

BRIT Systems, Dallas, also enhanced its visualization tools, including much-improved multi-planar reformatting (MPR)—and switched out the underlying mechanism for developing those tools. “We are using a toolkit from Kitware that helped speed the development process,” explains Michele Fisher, vice president of sales at BRIT. The company also has C-COW (clinical-content object workgroup)-enabled its workstation, so that if properly implemented, an electronic medical record (EMR) will handle a single log-in, enabling physicians to switch from one information system to the next within the patient context.

GE Healthcare Integrated IT Solutions, Barrington, Ill, touted Centricity’s new RIS workflow, following the tight integration of the ImageCast RIS into its Centricity PACS. The company also took the top applications from its Imaging AW stand-alone workstation and loaded them onto Centricity. Customers can buy a basic package that includes volume viewer, volume rendering, maximum intensity projection (MIP)/MPR navigation, and PET/CT, according to Atul Khosla, marketing manager for imaging at GE Healthcare.

Fuji’s Synapse version 3.2 offers the workflow, visualization, and image processing tools required for the interpretation of FFDM.

NovaRad, American Fork, Utah, gave the RIS portion of its RIS/PACS an overhaul, adding contraindications, a new scheduling tool, document scanning directly into the system, and fully integrated voice recognition and transcription with bidirectional interface into the billing system. “We are focused on the small hospitals,” notes Paul Shumway, senior vice president of NovaRad. “They have been the most neglected, and now everyone wants them because that’s all that’s left.”

Philips Medical Systems, Andover, Mass, added iSyntax to iSite to provide enterprise access to advanced visualization tools. The company also loaded its PACS with applications plucked from the modality side of the business: 3D Merge View, which merges 2D and 3D MIPs; more advanced MIP and MPR tools; iSite Colonography for colon fly-throughs; and a CAD function that is pending 510(k) approval. The tools will be available in Q107. “If you have a PC with a nice graphics card at home, you will have access to advanced visualization and clinical applications at home,” says Sybo Dijkstra, senior marketing director and chief medical office of Philips Medical.

Sectra, Linköping, Sweden, revamped its underlying platform using Microsoft .NET to optimize its system to handle large data sets with speed and efficiency on any network. “We have a patented way of retrieving data from the server and displaying it instantaneously, no matter the size of the stack,” says Staffan Bergström, vice president of marketing at Sectra. “If you have a network with high latency (a lot of switches and routers), it asks a lot of questions of the server, so it is optimized for remote reading over wide area networks.”

Solving the FFDM Conundrum

The results of the Digital Mammographic Imaging Screening Trial (DMIST) steepened the incline on the FFDM adoption curve, but the workflow and informatics challenges associated with digital mammography are legion. Several vendors addressed the issues in their RSNA releases, including FUJIFILM Medical Systems USA, Stamford, Conn, which introduced Synapse 3.2 to contend with the challenges presented by FFDM and its new FCRm FFDM, introduced last year.

“Digital mammography is to this year’s RSNA as 64-slice was to last year,” notes Bob Cooke, executive director of marketing and product development at Fuji. “There are challenges in the digital transformation from the perspectives of architecture, workflow, and stability of the PACS. MDCT [multi-detector CT] is digital to digital, but FFDM presents its own set of distinct challenges: compression, analog-to-digital, the sheer size of the data sets, CAD workflow, and the experience of digital with the user base. It’s a significant digital transformation challenge. We integrated mammography into PACS. There are no seams.” Synapse 3.2 provides for reader preference in viewing protocols and adds specific features to enhance the presentation of all critical image data, such as support for Mammography Quality Standards Act of 1992 (MQSA)-compliant overlays, the integration of CAD into the technologist and radiologist workflow, and support for Fuji’s Application-Oriented Network-ing compression algorithm.

The mammography solution from Dynamic Imaging, Allendale, NJ, leverages the system’s robust back end to auto-fetch and load the next studies in the queue directly from the worklist. “With mammography, you are looking at 40 to 200 megabytes per study,” notes Brad Levin, vice president of marketing at Dynamic Imaging. “You need to optimize the delivery vehicle of the study that locks prospectives into the worklist of mammography, so as you read one study, the second and third and fourth are brought onto the desktop and stand in memory.” Adds CEO Alex Jurovitsky, “Mammo-graphy is a high-volume, low-reimbursement modality, so speed is of the essence.”

Philips Medical’s iSite Advanced Visualization provides enterprise access to slab MPR, MIP, and advanced Volume Visualization.

Dynamic Imaging also developed software that combs the RIS and auto-routes images from a legacy digital mammography archive based on a scheduled order. “We are embracing legacy installs so that the client can use the old workstation as a reading station,” Levin notes. “It’s no longer the viewer game. It’s what you can do for the enterprise.”

DR Systems Inc, San Diego, released the production version of its FFDM capabilities—release 7—at the show; it incorporates feedback from beta sites. New features include image shuffling between previous and current images, and pixel-tracking software verifies that the radiologist has looked at every pixel of the image before it will verify the image to be read.

BRIT Systems already had laid some of the groundwork in preparation for the RSNA release of its Mammography Worklist and Multimodality Worksta-tion. “A long time ago, the American College of Radiology said you had to have 2.5 line pairs per mm, so for 5K, we were already aligned with them,” Fisher notes. “Our applications were already efficient enough to handle 5-megapixel requirements. We needed to add hanging protocols and figure out how to handle additional information in a mammography study.”

Other BRIT highlights include side-by-side viewing, with one-click priors and links to allow the reader to run through a series of hanging protocols; Smart Zoom, which finds an area of interest in the current and prior exams; the automatic display of related images once the four standard views have been reviewed; and three-click normals. A box is checkmarked if the image is seen in full resolution.


The traditional practice pattern of on-site reading has all but vanished, so the need for flexible new worklists continued to drive new introductions at the RSNA.

AMICAS Inc, Boston, is moving its work-in-progress, RadStream, closer to market, with plans for a beta site by the end of May. AMICAS picked up the exclusive rights to license the software from Cincinnati Children’s Hospital designed to prioritize studies by patient acuity. “It’s all about reducing interruptions and prioritizing the worklist,” notes Paul Merrild, director of marketing at AMICAS. “We’ve made it commercial-grade and standards based.” AMICAS is adapting the software to work with any PACS viewer, as well as to leverage the shared worklist in its Vision Series PACS 5.0 to integrate the worklists of the different PACS that a practice might utilize in the course of covering multiple sites.

Intelerad Medical Systems, Montreal, introduced a new workstation for its InteleViewer Web-based PACS featuring new reporting and transcription tools, dictation tools, and a teaching files application developed with McGill University. “We are still finding that tele-radiology is quite important, and our clients are customizing their worklist,” says John B. Wimbere, marketing specialist at Intelerad; he notes that the system had its start in the teleradiology market. “There are a lot of variables, and our system is working well in this setting.”

Kodak’s Health Group, Rochester, NY, unveiled the Virtual Desktop for its Carestream 10.1 PACS release, featuring both a local and a global worklist. “We are trying to optimize the performance, flexibility, and profitability of radiology,” notes Ulf Andersson, worldwide general manager of PACS and 3D applications at Kodak.

And finally, the 11.0.5 release for Horizon Medical Imaging from McKesson, Richmond, BC, features a new emergency department discrepancy workflow that promises to solves the fundamental problem of communications between the emergency department and the radiologist.

—C. Proval

Customizable MammoSmart DVDs and CDs from DatCard

DatCard’s MammoSmart solution creates patient-centric CDs and DVDs with the facility’s own branding.

MammoSmart, the newest product from DatCard Systems Inc, Irvine, Calif, brings personalized medicine to patients on an automatically produced DVD or CD. Offering patients their complete mammography history and breast care information in a user-friendly package, the MammoSmart system is valuable both as an educational tool and as a workflow facilitator.

Each disc contains patient information, such as family health care history for high-risk patients, personal demographics, insurance information, and medical history; educational information covering the complete spectrum of mammography and complementary services; breast self-examination and introduction to mammography videos; answers to frequently asked questions; tools for further research through support group Web site links; and digital mammography images and diagnostic results.

The customized disc includes a video capture of the procedure for which the patient has been referred, allowing the patient to prepare herself for the procedure in the privacy and comfort of her own home. Facility staff can then move her more efficiently through the process without compromising care.

The MammoSmart solution also allows facilities to customize the look, feel, and content of their DVDs and CDs; marketing information and announcements regarding facility news and events can be incorporated, and facilities are free to prioritize information on the discs according to what they feel would provide the most value to their patients. MammoSmart also helps meet Mammography Quality Standards Act of 1992 requirements for patient education.

DatCard currently is developing a similar product for the cardiology imaging market. For more information, visit

—C. Vasko

Teleradiology Expands Reach, Enters New Markets

By Cat Vasko

As the need for teleradiology grows, leading providers of remote reading services are expanding their reach. Axis Imaging News spoke with three market leaders about what’s in store for teleradiology in 2007, and their answers—focusing on subspecialization, enhancing quality of life, and leveraging technology for efficiency beyond what anyone thought possible a decade ago—might just reveal the direction of the imaging industry as a whole.

Franklin & Seidelmann: Specializing in Subspecializing

Franklin & Seidelmann Subspecialty Radiology (F&S), Cleveland, brings together a network of more than 30 subspecialists, who combined are licensed in all 50 US states. “Our whole group is dedicated subspecialists,” says F&S Co-founder Frank Seidelmann, MD. “We have specialists with a very high level of expertise in very narrow areas, so we can triage a large volume of cases to the foremost experts in the country. We don’t just have musculoskeletal experts. We have musculoskeletal shoulder experts, and musculoskeletal ankle experts. We always have a true expert reading every case, no matter how difficult or where it’s from.”

Adds F&S President Scott Seidelmann, “Radiologists are, by their very nature, generalists. They’re forced to do everything. So, while most teleradiology companies are really focusing on helping out at night, we’re coming at it from another direction. We’re saying that teleradiology is here, it works, and let’s use it to deliver highly specialized care.”

Why should your facility be interested? “Imaging centers are now trying to differentiate themselves not so much with equipment, because that has really stabilized, but with the level of expertise,” Frank Seidelmann says. “If an imaging center can only afford one radiologist, we can bring a neuroradiologist for every neuro case. We can differentiate them from the center down the street.”

NightHawk: A Pro-Radiologist Solution

Paul Berger, MD

Paul Berger, MD, founder and CEO of NightHawk Radiology Services LLC, Coeur D’Alene, Idaho, does not mince words when it comes to stating his company’s goals for 2007: “We’ll let radiologists tell us where we’re headed.” NightHawk’s US-trained, board-certified radiologists work from centers in Australia and Switzerland, turning around night reads in as little as 20 minutes to attending physicians in the United States.

“Our focus is simply to be a valuable resource for radiologists and their patients,” Berger says. “One of the ways we can help is to make them more efficient. We also can provide coverage for them during the off-hours or whenever they need assistance, hopefully improving their quality of life. I’m a radiologist, I’ve been one for more than 30 years, and we offer what I would want—a high-quality service at an appropriate price. We’re very pro-radiologist. As long as we can keep improving the world from their perspective, that’s what we’re going to do.”

NightHawk became the country’s first night-time reading service in 1994, and its radiologists are now performing night-time, weekend, and holiday reads for more than 1,000 US hospitals.

Virtual Radiologic: All About the Infrastructure

Virtual Radiologic, Minneapolis, takes a slightly different approach—its staff of radiologists can work from anywhere in the United States on advanced home workstations linked to the company’s powerful infrastructure solution. “We operate on a Web-based RIS environment integrated with Synapse PACS [from FUJIFILM Medical Systems USA, Stamford, Conn],” explains Ron Corbissier, executive director of marketing. “Our system talks to every PACS out there, so all cases come into a single worklist, a single PACS environment.”

For imaging centers and hospitals, this means “a Web-based, thin client solution,” Corbissier says, “with no capital expenditure upfront. It’s all on a per-study basis. A scheduling module routes cases to specific radiologists based on a number of things—subspecialty, time of day, the amount in their queue, and turnaround requirements.”

And for Virtual Radiologic’s radiology staff, it means an unprecedented level of comfort. “They can work anywhere in the United States, and we’ll take care of the equipment, start-up costs, licensing and credentialing, malpractice insurance, and scheduling,” he says. “Our 24/7 operation center handles all case management, removing that aspect of sitting around on the phone waiting for the referring physician to pick up in the ER.”

Cat Vasko is associate editor of  Axis Imaging News. For more information, contact .

Companies Partner to Offer Mini-PACS Solution

At RSNA 2006, Toshiba America Medical Systems, Tustin, Calif, and McKesson Corp, San Francisco, introduced the Horizon Medical Imaging Store 100, a cost-efficient mini-PACS solution for small hospitals and imaging centers looking to store data in a manageable way without the use of an enterprise PACS or DVD storage.

“Our partnership with McKesson makes it possible for us to offer tailored storage solutions for a variety of customers,” Doug Ryan, senior director of the CT business unit at Toshiba Medical, said in a press release. “Now, facilities that do not require a full PACS but need an efficient way to store data have a customized solution.”

The Store 100 offers the ability to safely and efficiently store cases online; it is compatible with Toshiba Medical’s CT and ultrasound products, including the Aquilion, Aplio, Nemio, and Xario product lines. Should a facility using the solution need to expand its storage capacity or upgrade to an enterprise PACS, the Store 100 can act as a foundational platform for the McKesson Horizon Medical Imaging PACS, which received the top ranking in the KLAS Community Hospital PACS 2006 and 2005 reports.

“This archive allows for a combination of modalities to be connected at one time,” said Gordon Parhar, director of Toshiba Medical’s ultrasound business unit. “It also will allow for DICOM data review at the workstation, which will increase efficiency for our customers.”

Earlier in 2006, Toshiba Medical and McKesson signed a distribution agreement to offer the Horizon Medical Imaging PACS with Toshiba’s diagnostic imaging products.

—C. Vasko