Managing the Flow in Radiology

New Applications for Dual-Detector CT
Make Room for Another RIS
Virtual Dictation and Transcription Arrives
Communicating Critical Results

New Applications for Dual-Detector CT

Siemens introduced four new applications to enhance the company’s SOMATOM Definition.

To supplement the offerings of its dual-source CT system, Siemens Healthcare has unveiled four new applications developed for the simplification of diagnosis of heart, brain, lung, and extremity joint disease using the SOMATOM Definition.

Executives say the dual x-ray tube and dual-detector design captures high-quality images at half the dose of previous Siemens systems.

The new applications supplement the six existing CT applications with dual energy features, including: the syngo DE Direct Angio, for the distinction of bone and vessel structures; the syngo DE Lung PBV, for perfusion assessment of lung tissue; the syngo DE Musculoskeletal, for the display of ligaments and tendons; the syngo DE Calculi Characterization, for the automatic distinction of the biochemical composition of renal calculi; the syngo DE Hardplaque, for the display of body calcification and vessel status determination; and the syngo DE Virtual Unenhanced, for the subtraction of contrast medium in abdominal scans.

“The SOMATOM Definition moves CT to an entirely new dimension of diagnostic sensitivity where contrast in the image is not merely limited to x-ray attenuation differences, but may include elements of functional and tissue characterization,” said Peter Kingma, vice president, CT, Siemens Medical Solutions USA Inc.

According to Siemens, the SOMATOM Definition provides images at twice the temporal resolution, speed, and power of single-source systems. Even for hearts that beat at a high rate or irregularly, the two x-ray tubes, in a single scan, can effectively operate simultaneously at different voltage levels. The process results in two data records with different patient information, allowing for the display of tissue and fluids and the distinction of vessels, bones, and soft tissue.

“The Definition already offers enhanced resolution, speed, and power,” Kingma continued. “Now, we are adding convenience of use to the mix.”

For example, the syngo DE Heart PBV (Perfusion Blood Volume) brings about color-marking of nonperfused parts of the myocardium during cardiology examinations—such as the isolated display of the heart without thorax structures. After an infarction, the heart perfusion is examined to determine damaged areas of the organ. DECT, for the first time, is able to detect a stenosis and its degree, in addition to the location and extent of the resulting reduced perfusion in the myocardium, in a single scan.

Through syngo DE Gout, CT can be utilized for gout detection, which can then examine the damage to cartilaginous and osseous substance from deposits of uric acid crystals in the patients’ joints. The dual-energy application helps physicians to monitor changes in the crystals during the course of treatment.

Enabling the detection of nonperfused blood vessels, this time in the lungs, the syngo DE Lung Vessels offers a range of applications to assist physicians in CT examinations of patients with suspected pulmonary embolism. The “lung isolation” application, for example, isolates the entire organ to make way for assessment for the perfusion situation without obstructing neighboring organs.

As the last of the four new applications, the Syngo DE Brain Hemorrhage is used in the event of cerebral hemorrhage to help distinguish new and old hemorrhages. The two energy levels of the x-ray tubes are employed to fade out the contrast medium; a process that in the past mandated two scans. Now, with the contrast medium subtraction, there are a couple of advantages, Siemens points out—a non-contrast medium-enhanced examination is not necessary, and the patient is spared the dose that comes with a second scan.

—Elaine Sanchez

Make Room for Another RIS

There’s always room for a new radiology information system (RIS), especially when it has been developed based on the input of radiologists. CoActiv LLC, Ridgefield, Conn, just launched its EXAM-RIS, the company’s new Web-based, PACS-integrated RIS product. EXAM-RIS boasts an array of features to support complete electronic workflow, including single- and multi-site scheduling, charting, and document scanning.

“Our RIS was developed the same way our PACS was developed,” explained CoActiv CEO Ed Heere. “We were providing IT support to a number of multisite radiology businesses, and they were less than happy about their RIS/PACS situation. We learned what everybody does and doesn’t do, and asked what the radiologists liked and what they hated.”

Likes included the capability to support multiple sites from a RIS for dayhawking and remote reading, an incorporated dictation/transcription system, both individual and group worklists, and single-button loading. “We took an existing client of ours who’s had a RIS for a number of years and went through the question-and-answer period with him,” Heere said. “He had a high level of dissatisfaction with his current RIS, both its performance and the support.”

The CoActiv team incorporated the client’s requests into its RIS system, then added some new ideas. “We’re very fast,” Heere noted. “The RIS is based on innovative database products. We also give them the option of hosting the server at their place or in our data center, which has a high amount of bandwidth; they don’t have to tie up their own bandwidth with it. We offer the same option on our PACS, allowing users to have a completely virtual RIS/PACS system.”

Another important factor is service to referring physicians. “Radiology practices have a lot of demands from their referring physicians,” Heere said. “They depend on them for their business. With EXAM-RIS, referring doctors can request a time slot for a particular exam within the system. Then their office can check the progress—has the patient arrived yet, has the exam been performed, is the report done. Once it’s done, it’s available online.”

At the 2008 meeting of the Health Information and Management Systems Society, CoActiv debuted its paperless PACS; the new RIS is paperless as well. “Radiologists don’t want any paper whatsoever,” Heere noted. “That’s especially important when you’re reading remotely.”

Additional features include customizable reports and the ability to open an exam from either the RIS or the PACS. “We’re great believers that an imaging center should be RIS-driven,” Heere said. “The RIS carries all the historical information about the patient; that should be the driving force. But some radiologists like the worklist that’s available from within the PACS system, so we allow it to be configured either way.” Pricing is available on either a capital or a per-exam basis.

Finally, Heere said, the EXAM-RIS is designed to facilitate easy adaptation to future EMR systems. “Our intention is to sell this as a completely integrated product that we can then integrate into the larger EMR systems out there,” he said. “That’s what the next step will be in this industry. Once there’s a national health record, we’ll be asked to drop our reports into the system, and we’ll be prepared for that.”

—Cat Vasko

Virtual Dictation and Transcription Arrives

A million-dollar idea that costs a lot less

BayScribe has launched a dictation and transcription appliance that cuts down on hardware costs by consolidating computer servers, with the use of a computing innovation called virtualization.

One BayScribe customer with a five-hospital system got a proposal from a competing company that would have cost more than $1 million just for hardware, said Steven Bonney, vice president of business development for BayScribe, which is based in Edgewater, Md.

But the BayScribe Virtual Appliance is a software solution and customers pay based on their use, which is less costly for a customer than buying a lot of hardware, Bonney said.

“They couldn’t spend a million dollars with us in 10 years, based on their usage—it wouldn’t even be close,” he said.

BayScribe’s Virtual Appliance uses virtualization technology from VMware, which thousands of facilities already use, according to BayScribe. Virtualization involves using software to run multiple operating systems and multiple applications on the same computer at the same time, which cuts down on how many servers an organization has to use.

Unlike the BayScribe Virtual Appliance, the traditional dictation and transcription system could require a half-dozen servers, including a transcription server, a voice-recognition server, and an interface engine, to send transcribed documents to a PACS, BayScribe officials said.

Instead of using all that hardware, the BayScribe dictation and transcription software interfaces with the VMware computer virtualization system, and customers who have VMware can just download BayScribe’s product from the Internet. “We literally deploy the system in a couple of days, as opposed to several weeks,” Bonney said. BayScribe officials say their dictation and transcription service is the only one of its kind that works with VMware.

The BayScribe Virtual Appliance works with any standard, off-the-shelf speech microphone. Customers have to provide their own Internet bandwidth. The system uses Voice over Internet Protocol (VoIP), so clients can quit relying on analog phone lines for their voice-capture needs, according to BayScribe.

For radiologists who are dictating over the phone instead of with a speech microphone, the system accepts almost any number of phone calls, because it’s streaming over the Internet instead of on a hospital’s limited number of analog phone lines, Bonney said.

The Internet-based system allows users to log on to a Web site and access their reports from anywhere. “You really can extend the system to as many people as you want, because you’re not paying extra to have other people view it,” Bonney said.

BayScribe’s competitors include Nuance’s PowerScribe for Radiology Workstation, which is also a Web-based application.

BayScribe started working with VMware in January, and it announced the launch of its dictation and transcription technology in April. The software integrates with a PACS, or it can work as a stand-alone system. A radiologist using film can enter a bar code into the program and begin dictating, to have the report linked to an image on file.

“Our application is pretty easy to use; we designed it that way—the virtualization just makes it easy for the hospital IT department,” said Ron Neuenberger, BayScribe founder and president. “There’s no additional hardware to support,” he said. “They’re just supporting what they already have, which is really attractive for IT departments.”

After customers download the BayScribe system from the Internet, they pay a month-to-month licensing fee based on usage. The low-tier cost is about $1,000 per month, at 2.5 cents per line of text, Bonney said.

BayScribe officials said that for customers who do not have VMware, it would connect them to a hosting company that will host VMware-equipped servers for them. That allows BayScribe’s Virtual Appliance to work at the medical facility without having VMware on-site, company officials said.

—Alex Dobuzinskis

Communicating Critical Results

Veriphy-Ready HL7 Integration Server (VIS) is designed to help quickly and effectively communicate critical test results and to speed workflow in radiology facilities.

A physician sends a patient for a radiology exam and the test results reveal an unexpected finding—a potentially malignant tumor. The results are mailed to the referring physician, but the paperwork gets misplaced before the physician can see it, and the radiologist never knows the physician was not alerted. After that, the patient’s cancer may get worse before it is detected.

To prevent those kinds of human errors, Nuance Communications, which is based in Burlington, Mass, has released a product called the Veriphy-Ready HL7 Integration Server (VIS). The system is designed to help prevent critical test results from getting lost in the shuffle, and to speed workflow in radiology facilities.

VIS is a Windows-based application platform that allows organizations to better integrate Vocada Veriphy, another Nuance-owned product, into their existing applications and systems. Vocada Veriphy, which automates the process of communicating critical test results from hospital diagnostic departments to ordering clinicians, is used at more than 175 hospitals nationwide.

“I wouldn’t want to practice radiology in the 21st century without it,” said Steven Defossez, MD, medical director at North Shore Magnetic Imaging Center in Peabody, Mass.

Defossez said he views the system, which is in place at his center, as a vast improvement on the old way of communicating critical test results. “We relied on the fact that these faxed reports are going to the doctors’ offices, and the paper copies get mailed to the doctors’ offices,” Defossez said. “But it is an unfortunate reality that without Vocada, some of these important findings don’t make it to the treating physician.”

Less than 2.5% of radiology test results come back as critical, but when it happens, a radiologist often wants to alert the referring physician immediately, said Tom White, general manager of Veriphy in the Dictaphone Healthcare Division at Nuance.

“They pick the phone up, as a radiologist, and they’re dialing for dollars,” White said. “They want to get hold of the referring physician … but as everyone has gotten busier and busier, the opportunity to connect live has gotten rarer and rarer.”

With the Vocada Veriphy system, a radiologist records a short audio message about a patient’s test result. The radiologist classifies the finding based on its level of urgency.

The system then sends an automated message to the referring physician, calling her office line or mobile phone—or whatever means of contact the physician has said is the best way to reach her. For urgent messages, an automated call will go out every 10 minutes until the physician is reached, while for less urgent results the calls can be spaced hours apart.

When the physician answers the call, she will hear a recording telling her to retrieve the radiologist’s recorded message about her patient by calling a number. After the physician has listened to the message, the system automatically pulls the patient’s report and notes that the message has been communicated to the physician.

Defossez said that aspect of the system helps his center guard against malpractice lawsuits, because it generates a case history that can be used in court to vindicate the radiologist if a physician overlooks a critical test result. “Before we had this system, I would dictate a report and hope that the doctor got it, and hope that he would treat the patient well,” Defossez said. In radiology, more than 70% of malpractice lawsuits stem from a breakdown in communication, experts say.

North Shore Magnetic Imaging Center sends out more than 100,000 reports per year.

Physicians’ offices are flooded with paperwork, too, and sometimes nurses put critical test results in a patient’s file before the physician has a chance to see them, Defossez said. In that case, the physician may not see the result until the patient comes back for another office visit months later.

Company officials hope that more hospitals will start using Vocada Veriphy following the March release of VIS, which they say allows hospitals to overcome any integration challenges they may have with the system.

—A. Dobuzinskis