Governance, Mission, Growth

A Better Compact Ultrasound?
Mighty Solution for Mini Problem
Remote Reading Services for Any-Size Practices

A Better Compact Ultrasound?

Behind the times or ahead of the trends? Philips Healthcare may be late from the starting gate when it comes to compact ultrasound, but the company says the upside is that they are very clear on what the market demands.

Philips recently debuted the CX50 CompactXtreme handheld ultrasound unit, the first of its kind from the company. The laptop-sized CX50 includes features from the company’s full-sized ultrasound and echocardiography systems, such as the PureWave transducer and XRES adaptive image processing, and supports adult transthoracic and transesophageal cardiology applications.

Philips’ CX50 includes features from the company’s full-sized ultrasound and echocardiography systems, such as the PureWave transducer and XRES adaptive image processing.

“We wanted to really look at the handheld market and see where it was going,” explained Jim Brown, director of clinical and technical marketing for Philips’ ultrasound business unit. “We really investigated what people would want in a compact system, and what we were hearing focused on the capability of being able to complete ultrasound exams anywhere. They found that performance levels just weren’t high enough with current compact designs.”

Philips aimed to address this issue by miniaturizing core technologies from its full-sized iE33 echocardiography system, including advanced image analysis. “Once you’ve learned the iE33 system, you can go from unit to unit with no problem,” Brown said. “The CX50 provides diagnostic-level echocardiography at the bedside, at remote sites, or in small practices.”

Diagnostic-level features include the PureWave transducer, which improves penetration in difficult-to-image patients and reduces clutter, and XRES image processing, which reduces speckle and haze to create clear, noise-free images with excellent edge definition. Additionally, the system includes iSCAN automatic optimization and on-cart QLAB quantification software. Its 15-inch high-resolution monitor ensures optimal viewing.

The CX50 is designed for optimum user-friendliness and includes built-in carrying handles, which make its 13 pounds of weight particularly easy to transport. “A lot of these handheld systems don’t have handles built in,” noted Brown. “We have everything built into the package itself, including handles, a battery, and a DVD drive.” A wheeled travel case adds to the system’s portability; the CX50 also has its own specially designed cart.

Brown notes that the CX50 is ideal for cardiology practices looking to provide premium ultrasound in limited space. “If you want to get as close as possible to the iE33’s level of performance in a very space-restricted office, this would be a good solution,” he said.

The system’s adaptability to multiple environments is one of its key distinguishing characteristics, according to Brown. “Flexibility was a very big part of the design of the product,” he said. In keeping with that imperative, the CX50 boots up quickly and includes wireless DICOM capabilities, so data can be sent directly to and from the system as it communicates with a PACS or other image management system.

Finally, the CX50 is designed to optimize workflow and reduce the need for repeat exams. Tissue Motion Quantification enables the analysis of transmyocardial mechanics without tissue Doppler imaging angle dependency limitations, and native acoustic data can be stored, allowing clinicians to adjust virtually all scanning parameters on single images, clips, or stored data.

“We feel that we’ve achieved premium-level performance in a compact design,” Brown said. “The CX50 gives clinicians the diagnostic quality and confidence level they need.”

—Cat Vasko

Mighty Solution for Mini Problem

More than 3 years ago, an imperfect mini PACS was doing the best it could to keep up with the growing workload felt by Randall Stenoien, MD, and his colleagues at the Houston Medical Imaging (HMI) clinic and Innovative Radiology practice.

“It was small, worked fairly well, and it could handle a lot of images from an MR or CT,” said Stenoien, CEO of HMI and director of a staff of 12 radiologists who make up Innovative Radiology. “But it had issues handling the DICOM file. There were server issues, downtime issues. It just didn’t have the capacity that we needed.”

That’s when Stenoien decided to make the switch to a RIS/PACS, opting for the integrated solution from a trusted vendor: Carestream Health.

“By having a robust RIS/PACS solution, we were able to add business to the group,” Stenoien said. “Since we purchased the machine, it has never gone down. We also receive upgrades, which Carestream begins after the day is done and finishes by 6 the next morning.”

Houston Medical Imaging is a radiologist-owned and operated diagnostic imaging clinic that offers a full range of services to the greater Houston community, including general radiology and fluoroscopy, open and closed MRI, multislice CT, CT/PET, nuclear medicine, DEXA bone densitometry, ultrasound, echocardiography, and digital mammography.

That adds up to more than 25,000 exams per year, Stenoien said. When one adds in the numerous hospitals, outside imaging centers, and several physicians they read for—not to mention the charity reads in Panama—the total goes up to more than 100,000.

From neuroradiology to breast oncology, HMI’s various subspecialties require a streamlined workflow, with good-quality images and fast information transmission. This is something Stenoien enjoys from the Carestream solution, which allows images to be sent securely to specialists who may not be physically at the clinic.

Specifically, the KODAK CARESTREAM RIS/PACS solution allows Stenoien and his fellow radiologists to perform tasks, access information, and provide consults through licensed workstations in different centers, hospitals, and even homes. Display preferences and tools are customized to fit each individual user’s need. Built-in dynamic streaming translates into advanced functionality readily available to authorized users inside and outside the facility.

Additionally, 3D functionality is embedded in the diagnostic workstation software, allowing for volume rendering, maximum intensity projection, multiplanar reformatting, and vessel tracking, among others. The features are particularly helpful to Stenoien, who is starting to perform vessel analysis with CT angiography.

—Elaine Sanchez

Remote Reading Services for Any-Size Practices

When the development team at PACS/RIS company BRIT Systems Inc, Dallas, began to design a new remote reading solution, the innovators looked at the entire workflow process of radiologists and image acquisition sites.

Questions they explored took a variety of issues into consideration:

How can radiologists indicate that a study is not acceptable for reading? How can they communicate with ordering physicians, and how would one track that exchange? How can studies be distributed equally among radiologists? How would they organize critical results? And how would they manage the whole process?

Addressing all these factors, BRIT Systems released Roentgen Works, a Web-based workflow solution that dynamically updates information. It’s set to become part of the company’s second-generation PACS. Moreover, the sophisticated technology provides practices with full capabilities and tool sets traditionally affordable only to larger imaging operations.

“Roentgen Works provides a group practice with a remote reading service so they can compete with the likes of the nighttime reading services—the large remote reading services that have invested millions of dollars into developing these types of tools,” said Michele Fisher, president, BRIT Systems.

Fisher explains that her company makes the solution affordable to smaller practices by hosting it for them with a price per study model. That way, the radiology groups do not have to invest in hardware and incur high up-front costs. Rather than HL7, BRIT uses a DICOM interface, requiring fewer specs and simpler integration than its alternative. Because order information is taken from the DICOM Header, users are not forced to retype any patient information back into the system. In this way, the solution is designed to be efficient. Furthermore, Roentgen Works is able to distribute studies among multiple radiologists, and it uses Doctor Pal technology to keep all studies together for the same patient. Other capabilities include return and report to places with HL7 interfaces and built-in critical results reporting using Skype.

The solution uses the company’s existing tools, such as the Roentgen Router, which provides auto-routing and prefetching of DICOM studies triggered by information in the exam order or study. Yet, it also offers new browser-based tools for reading lists and reporting. Key features include messaging capabilities for the referring site to mark a study or indicate it is a comparison study. Radiologists can fax documents to a study, as well as search for specific studies.

Additionally, they can reprioritize their queues, put studies on hold, mark studies with critical or urgent findings, and track statistics on exam reading, reporting, and critical results.

When the company debuted the product at SIIM, it was surprised that though Roentgen Works was meant for remote radiologists, many of BRIT’s current customers said they would want to implement the tools locally.

“Our existing customers, who are local, still want the tools to communicate that a study is put on hold,” Fisher said. “In a hospital, they may not have the tools to communicate that a study is put on hold. So we’ll have to bring these tools into our current Roentgen Files environment.”

Fisher also mentioned that Roentgen Works empowers the radiologists to cultivate relationships with other radiology groups, keeping their business local “versus sending that reading service overseas and losing that business altogether.”

“Certainly, a key driver for demand is the shortage of radiologists and the need to find better ways to provide remote reading to cover more hospitals,” Fisher said. “But also reimbursement for reading has gone down so to maintain current revenue stream levels in a radiology group practice, they will need to reach out to more facilities and read more studies.”

According to Fisher, BRIT’s goal for its next release is to provide its own dictation tool. Also, the company looks to provide an API, allowing studies to be launched within imaging viewers.

On August 22-24, BRIT conducted a Roentgen Works Seminar in Chicago, where presenters discussed how to build successful radiology remote reading practice. Topics ranged from marketing and promotion of services to referring physicians and financial modeling. “We shared with [attendees] what we’ve learned and hopefully empowered them to stop the slippery slope of radiology reading heading overseas,” Fisher said.

—E. Sanchez