Managing the Flow in Radiology

Bright Idea: Color Monitor Coming Soon
Faster, Easier Advanced Visualization
Leader of the PACS!
One-Stop Viewing for Cardiologists

Bright Idea: Color Monitor Coming Soon

Color monitors are becoming an increasingly valuable medical tool, as more images are post-processed for three-dimensional viewing and as image quality in color has improved with new advancements. As its newest offering in the color monitor field, NEC Display Solutions of America is releasing a 30-inch MultiSync MD304MC widescreen LCD color display for radiology and emergency department environments.

The MD304MC LCD color display from NEC features a 4-megapixel color display with a wide screen that can accommodate side-by-side patient images.

“There’s more and more color usage coming in, and if you have a color monitor that has similar or better performance than a grayscale monitor, then you really don’t need grayscale,” said Stan Swiderski, product manager for NEC Display Solutions. “There’s going to be room for both, but a slow but steady transition to color is what I think is going to happen.”

The MDC304MC has a 4-megapixel color display, with a screen wide enough to display side-by-side patient images. It has a native resolution of 2560 x 1600. “You can view the same amount of information as you could with two monitors side-by-side,” Swiderski said. “It will save you real estate, also it’s more affordable.”

NEC anticipates that the monitor will primarily be used as a basic diagnostic tool for radiology, or in a clinical setting, Swiderski said. But it could also be used in an emergency department or a surgical suite to confirm pathologies identified in radiology.

NEC presented its MD304MC display to participants at the Society for Imaging Informatics in Medicine’s annual meeting in Seattle on May 15-18. “They were very happy with it; everybody was very pleased with the image performance and basically said it’s a beautiful display,” Swiderski said.

NEC anticipates it will start selling the MD304MC within a couple of months. Approval is still pending from the US Food and Drug Administration, but that is expected to happen by fall, Swiderski said.

The LCD monitor can display images in portrait or landscape orientation, with multidirectional controls for ease of use in either mode. The monitor will sell for $3,599, according to NEC. That is less expensive than other similar 30-inch monitors on the market, which can cost up to $9,000, Swiderski said. The MD304MC monitor comes with GammaComp MD software to ensure consistent image quality.

The monitor is also calibrated to the DICOM grayscale function for luminance. And its X-Light Pro backlight system helps deliver consistent brightness, by adjusting the power of the backlight as the machine ages to ensure that it does not get dimmer with time, Swiderski said. The monitor can display 12 image slices at a time, Swiderski said.

The MD304MC has in-plane switching (IPS) technology, which minimizes off-angle color shift. The company says that makes the MD304MC display ideal for medical settings, because doctors are often asked to validate a diagnosis as they stand to the side of the doctor viewing the monitor head-on. “It’s really designed for medical usage,” Swiderski said.

The IPS technology also reproduces grayscale images with excellent definition, according to the company. The monitor has stand-alone calibration and matching, which enables the sensor to be connected directly to the monitor and eliminates the need for a personal computer for calibration. And it has a 12-bit gamma look-up table, for high-quality rendering of color images.

The display also comes with a 3-year limited warranty, and it contains fully disposable plastics and minimal amounts of hazardous materials, such as lead and cadmium, according to the company.

Faster, Easier Advanced Visualization

With a new Web-based solution, Calgary Scientific Medical Group is giving physicians an advanced visualization tool that requires nothing more than having a computer with the widely available program Flash Player, according to the company.

The company’s new system is a thin-client solution that allows doctors to view high-resolution CT and MRI studies without the aid of expensive workstations.

Instead, the system operates in conjunction with a PACS by having a special server for visualization that is co-located with the PACS server. Doctors can use a secure Internet connection to access the server and perform sophisticated visualization operations with just about any computer.

Calgary Scientific officials say their Web-based solution makes it possible for general physicians to show patients volumetric images from studies done on those patients.

“Patients are treated better when they understand what’s going on, and when the physician can clearly show them the cause of their problem,” said Colin Holmes, director of strategic account development for Calgary Scientific. “They can see what’s wrong, and they can take personal action to make sure they do what their physician recommends to get better.”

But Calgary Scientific officials say the primary users of their system will be radiologists.

With the ever-increasing number of image slices that radiologists work with from multidetector CT (MDCT) systems, they need a way to look at all that information, Holmes said.

Calgary Scientific’s visualization solution allows a radiologist to use multiplanar reformatting (MPR) to reduce the number of slices they need to look at, Holmes said. The radiologist can choose the thickness of the “slab” of slices to be displayed with the visualization tool.

The company demonstrated its visualization appliance at the annual meeting of the Society for Imaging Informatics in Medicine on May 15-18 in Seattle.

Calgary Scientific is working in conjunction with Los Angeles-based PACS vendor Intuitive Imaging Informatics LLC, which has a Web-based product called the ImageQube PACS, to introduce its visualization solution to the market. The visualization solution that Calgary Scientific is selling in partnership with Intuitive costs $30,000, and it allows for four radiologists to use the system concurrently, Holmes said.

“Our philosophy and our approach have become part of the PACS device itself and add just the medical imaging value to that system,” he said. While data-heavy MDCT studies can clog up a hospital’s network when they are moved from the server to the workstation, the Calgary Scientific tool avoids those problems, Holmes said.

The Calgary Scientific visualization server co-located with the PACS server reconstructs images on-site and moves them across the Internet in Flash format to the workstation, avoiding the need to move data-heavy PACS images to the workstation, he said.

That allows radiologists to get images from a study faster. The 8-bit images that the solution sends to workstations are intended for clinical review, not for diagnostic purposes, Holmes said. Diagnosis can be done by relying on images directly from the PACS.

“The final determinant of what’s good enough is the radiologist,” said Holmes. “There are all sorts of interesting information in different viewpoints that the radiologist may want to read from or not.”

But with its potential use by general physicians, as well as specialists and other doctors, Calgary Scientific anticipates that its appliance will be used for more than diagnosis.

“What our system does is allow people outside the traditional reading room to access a very advanced imagery using a very low-cost platform,” Holmes said.

Leader of the PACS!

When Community Medical Center of Izard County last year obtained a new PACS, having it installed was only half the battle. Staff at the small rural hospital, based in Calico Rock, Ark, needed to know how to manage its PACS and troubleshoot all the technical problems that inevitably come up with a new system.

So Philip Hughes, the hospital’s chief information officer, traveled to Jacksonville, Fla, in October to attend a 4-day training session from Viztek, the company that made and installed the hospital’s PACS.

After taking the training, Hughes said that staff at his hospital rarely needs to call Viztek for technical support. You could say the training turned Hughes into the leader of the PACS system at his hospital.

“It certainly helps, it really does, if there are things that we can handle internally,” Hughes said. “It only leads to quicker resolution and, along with a quicker resolution, makes the staff involved happier and they can get their job done.”

The company’s training series covers its Opal-RAD line of PACS and RIS solutions and the Viztek-distributed Kodak Point of Care Computed Radiography (CR) units.

Because of the training Hughes received, he was able to replace a piece of CR hardware that otherwise could have required a site visit from the vendor, he said.

“Had I not taken that course, there is absolutely no way I would have been confident with that,” Hughes said. “But you can imagine having to schedule someone to fly out [here]. We’re in rural Arkansas, so you can imagine how hard it might be to do that.”

Viztek is a turnkey digital imaging hardware and software company. The company has been running its training program for more than 2 years, said Steve Deaton, vice president of sales at Viztek. But in the last 6 months, the company has been marketing its classes more, filling them up, and offering them more regularly, he said. Viztek’s PACS administrator course is offered once a month, he said.

The company trains staff at each hospital where it installs a new PACS, Deaton said. But often questions come up after a system has been installed and the Viztek company officials have left. “It helps when you have someone on-site who came and did our PACS admin course and they can be the go-to” person, Deaton said. For a hospital, having someone on staff who fully understands the PACS helps ensure that the rest of the staff accepts the product, he said.

Viztek offers the training at its home base in Jacksonville, in a room that has enough space for 15 participants. Hughes said that the first 2 days of his training were focused on the CR unit, while the next 2 days revolved around PACS issues. As part of the CR training, Hughes and the other participants field-stripped a CR unit and put it back together, he said. That key lesson later helped him replace a piece of CR hardware at his hospital.

The training session was included as part of the price of installation that Community Medical Center of Izard County paid for its Viztek PACS, which was installed at the hospital in July 2007, Hughes said. “As a customer, it’s a really neat feeling to be able to go down to their shop, meet their staff, and work with them,” he said.

Since taking the training, Hughes has several times used what he learned to go into the PACS and make fixes, such as when data is entered incorrectly, he said. “At this point, it’s pretty safe to say that I rarely have to call Viztek,” he said. The training sessions are geared to new customers, new users at existing facilities, and Viztek dealers.

One-Stop Viewing for Cardiologists

When Dr Kirk Spencer is looking over a heart patient’s case, he wants to see images from all the different modalities used on that patient—from MRI to angiography.

“I want to sit down in one chair, and I want to see everything that has to do with the heart,” said Spencer, associate director of the noninvasive cardiac imaging lab at the University of Chicago Medical Center.

A new information management, analysis, and reporting system from Philips Healthcare called Xcelera R2.2 allows Spencer to have that comprehensive look at a patient, without using a different viewing station for each modality. The system allows cardiologists to view images and data from key cardiac subspecialties, including cardiac catheterization, noninvasive vascular ultrasound, nuclear cardiology, cardiovascular CT, cardiovascular MRI, echocardiography, and electrophysiology.

Spencer said that when each modality at his medical center had its own viewing station, a situation he dealt with before the center got Xcelera, he had to do a lot of walking.

The MRI viewing station was in the hospital’s basement. To view an image from an angiogram, he had to walk a couple of hundred feet down the hallway. Viewing a CT scan required a trip to the outpatient center attached to the hospital. The result was that doctors did not always take the trouble to view all the studies done on a patient, Spencer said.

With the Xcelera system, Spencer said cardiologists are more likely to view all the relevant studies and reports for each patient, incorporating information taken from modalities that in the past have not always been well integrated.

“To me, it really highlights how powerful we’ve been in our own little silos, but how unbelievably uncoordinated we’ve been at talking to each other,” said Spencer, an associate professor at the University of Chicago.

Philips’ Xcelera R2.2 lets cardiologists view images and data from all the key cardiac subspecialties.

The Xcelera system allows cardiologists to focus more on the patient and less on the different modalities used to study the patient, he said. “Now it’s just literally a click of a button in Xcelera, and Xcelera knows ‘OK, this is an angiogram, I’m going to display this in an angiogram viewer’ … and if it’s an echo, it’s going to display it in the echocardiogram viewer,” Spencer said. “It’s a change in the way in which cardiology has traditionally been driven.”

The University of Chicago Medical Center is a 500-bed hospital with 32 cardiologists on staff. A few years ago, the center bought an older version of Xcelera that supported studies from catheterization procedures and echocardiograms.

The new version of Xcelera the hospital obtained in April supports nearly all the cardiac imaging modalities, Spencer said. The center has 31 Xcelera workstations, all connected to a central server. The system stores images, which is important for the University of Chicago Medical Center, which does more than 10,000 echocardiograms a year, Spencer said.

Officials at the medical center had envisioned using a PACS for cardiology, but they scrapped those plans because a PACS cannot show moving images in the way a cardiology-specific system such as Xcelera can, Spencer said. Since the heart is an organ that is always in motion, it’s important to capture that motion. “The idea that we’re just going to take the radiology system and make it work for cardiology is not a meaningful model,” Spencer said.

The new Xcelera R2.2 version supports the new AutoQUANT v7.0 nuclear cardiology quantification package, which allows doctors to quickly analyze heart structure and function, according to Philips. The system is also compatible with the Philips QLAB suite of advanced ultrasound quantification tools. Those tools are in line with the direction that cardiology is taking, Spencer said. “Cardiology is really trying to be more quantitative with the assessing of the heart,” he said.