Managing the Flow in Radiology

All-In-One Tool Kit for CR and DR Image Processing
IBM Demos Healthcare Image and Information Grid
High Hopes for Low-Bandwidth Locales!

All-In-One Tool Kit for CR and DR Image Processing

Merge Healthcare released version 3.0 of its Cedara xPipe software tool kit, designed to fully automate the image processing tasks performed on CR and DR consoles. Cedara xPipe, announced at last year’s RSNA in Chicago, is currently the first and only product that includes software for the entire spectrum of postprocessing tasks.

Version 3.0 of the Cedara xPipe software tool kit automates the image-processing tasks performed on CR and DR consoles.

“Competitive products exist for each module, but there is no single tool kit that addresses all image- processing needs of x-ray console manufacturers,” said Peter Bascom, vice president of engineering, Merge Healthcare’s OEM Division. “Integrating a group of disparate modules is a time-consuming and error-prone task. This is what sets Cedara xPipe apart [from its competitors].”

He added, “X-ray devices are one of the most widely used imaging modalities in hospitals. They are used in demanding environments where staff require the highest possible image quality and also need to continually optimize operational efficiencies for cost containment. Cedara xPipe addresses both objectives.”

The tool kit features six modules that can be used in sequence or independently, including individual modules for flat field correction, collimator detection/editing, image stitching/fusion for multiple overlapping images, and window width/level adjustment that optimizes brightness and contrast.

The xPipe also features the Cedara Image Enhancement (CIE) module that targets specific noise patterns and suppresses them, allowing for sharpened anatomical details and improved perceived contrast. Also included as part of the xPipe 3.0 is a new Cedara Exposure Index module, which automatically calculates the International Electrotechnical Committee (IEC) compliant exposure index.

“Several x-ray manufacturers display an ‘indexed’ value of the acquired image. [But] definitions of this index can vary greatly between manufacturers,” Bascom said, highlighting the importance of standardization. “Ultimately, the operator may be unaware of overexposure.”

In order to accurately determine IEC-compliant exposure values, staff would have to take various measurements and then run through a few computations for each scan. Not only would this drastically slow workflow, but also it could potentially introduce user bias.

However, as Bascom concluded, “An automated solution could alleviate these challenges while at the same time balancing the need to limit overexposure with the demand to increase workflow productivity. Patients can be scanned quicker and with minimal operator intervention.”

“With the release of Cedara xPipe, the OEM Division of Merge Healthcare reinforces its position as a leading provider of tools for the development of CR and DR consoles,” said Justin Dearborn, CEO of Merge Healthcare. “The comprehensive, fully automated functionality offered by xPipe enables our partners to deliver state-of-the-art consoles. Inclusion of the Cedara Exposure Index demonstrates our continued commitment to supporting the latest standards.”

While the tool kit comes predefined with standard protocols for various scan settings, it can be fine-tuned to suit each radiologist’s preferences. These settings can be coupled, for instance, to log in information on a network setting, thereby enabling clinicians to view images optimized to their own preferences without having to fine-tune after each scan.

—Ed Wilson

IBM Demos Healthcare Image and Information Grid

From a need for patient-centered data views and robust imaging application architecture, to scalable environments and a move beyond the realm of radiology, the current enterprise imaging climate can be quite difficult for organizations that must integrate different systems.

As announced at the RSNA meeting, IBM hopes to take on that challenge with its new Healthcare Image and Information Grid (HIIG).

“IBM is accomplishing an industry first by offering the most advanced interoperable framework for health care systems with the IBM Healthcare Image and Information Grid,” said Dan Pelino, general manager for IBM Healthcare and Life Sciences. “This award-winning solution will enable an integrated view of patient documents and images across the enterprise to be accessed in real time at the point of care.”

The services-oriented solution is built on open standards and interoperable services that hand over integration tools to health care organizations, as well as a road map for the development of enterprise-wide image enabled medical archives.

The company also demonstrated new software features for the IBM Grid Medical Archive Solution (GMAS), upon which HIIG is built. The high-performance, grid-based storage solution will sport a new software component, GAM 2.1, which supports applications in digital pathology, mass spectrometry, and high throughput screening. The software was initially developed to manage and store large quantities of archive data, such as mammograms and CT scans, which are traditionally written only once, rarely updated, and frequently accessed.

Nevertheless, IBM points out that many health care and research applications can produce large amounts of transactional data that requires capture, analysis, sharing, writing, and modification before it is archived or deleted.

The GAM 2.1 Distributed Gateway adds scalable NAS capability to GMAS for transactional and research data, and it also functions as a conventional GMAS gateway that can be used to archive and protect data for life across any storage tier and location.

The GAM 2.1 Distributed Control Node provides more advanced control node software replication features, looking to improve image access and network performance while enabling universal data access from any location.

Continuing the GMAS record of lowering long-term total cost of ownership, the GAM 2.1 supports IBM Blade Center and IBM System Storage N Series.

According to IBM, customers can see a 100% increase in storage density, a reduction of up to 30% in hardware costs, and 35% savings in power and cooling. VMWARE ESX permits users to see up to a six to one compression of Gateways at the data center.

“IBM GMAS with GAM v.2.1 directly addresses our health care, life science, and research clients’ requirements for a single solution that can handle both scalable NAS and long-term reference data archive requirements across the enterprise, all while lowering IT costs,” said Hugh Rivers, business line executive, health care and life sciences solutions, IBM Systems and Technology Group.

—Elaine Sanchez

High Hopes for Low-Bandwidth Locales!

Image quality, functionality, and performance—these are the three aspects of medical imaging in which users often do not wish to compromise. To avoid sacrifice, many clinicians remain tethered to a workstation, which can impede their productivity or delay care. Ziosoft Inc, Redwood City, Calif, recently released a Web application designed to eliminate—or at least significantly loosen—this leash.

Ziostation Web provides clinicians with speedy remote access to high-quality images.

A complement to the company’s flagship advanced visualization software Ziostation, the Ziostation Web (v3.0) provides clinicians with remote access to medical images via the Internet. The system is HIPAA-compliant and designed to work in low-bandwidth environments without requiring the download of specialized software (not even a Java applet). Users do not sacrifice speed or image quality, and functionality has been designed to match what clinicians most often need when mobile. Workflow is therefore enhanced rather than impeded by mobility.

Zero Software Footprint and Other Benefits

Terry Chang, Ziosoft’s director of marketing, notes that image quality, performance, and functionality also represent the areas in which medical imaging software is frequently judged. Enterprise systems have traditionally been able to meet stringent demands in all three areas more easily than remote systems, whose technology is limited by bandwidth and computing power.

To make up for these deficiencies, mobile systems have traditionally had to compromise in one or more of these three defined areas. Images can be altered during compression (rendering them useless for diagnostic purposes), speed can be slowed to a crawl (making them useless for busy physicians), or functionality can be minimized (turning the remote system into a glorified viewer). Ziosoft sought to offer more with its system, sacrificing where it would be least noticed.

When asked, physicians would not accept a reduction in image quality or performance. “Physicians don’t want to sit around and wait for an image, and they absolutely do not want to sacrifice image integrity, because that is what they make their diagnosis off of,” Chang said. Ziostation responded with a Web product that transmits lossless (or unaltered) images at speeds equivalent to those of an enterprise system.

Fortunately, functionality is an area where flexibility works. “What is needed at a remote or in a low-bandwidth environment is different than what is needed in the hospital. Clinicians need fundamental tools to analyze the image or manipulate it,” Chang said, citing examples that include two- and three-dimensional imaging, volume-rendered imaging, MIP functionality, multiplanar reconstruction functionality, auto-segmentation, measurement capabilities, and collaboration tools.

Resource-intensive features, such as colon and cardiac function analysis, are not needed in remote locations. “Doctors aren’t making cardiac or colon diagnoses from their living rooms,” Chang said. By eliminating these resource-intensive applications, Ziostation Web maximizes workflow for the entire care process.

“It enables the continuum of care from the technologist to the radiologist to the surgeon or specialist to the referring physician and finally to the patient,” Chang said. Cases are saved to the server but can be accessed and manipulated from anywhere; collaboration occurs in real time.

In the past, collaborators each had to use a stand-alone workstation, reducing the opportunity for collaboration. “But being able to spread access within and outside the hospital provides an ubiquitous way for caregivers to collaborate,” Chang said.

The fact that no software must be downloaded to access the program expands use even further outside the hospital. The step is time-consuming and often not allowed on public computers, such as those in hotels, libraries, and business centers. Instead, users access the system through a secure URL. “There is zero software footprint on the client’s computer,” Chang said.

Ziostation Web therefore fills a gap in remote access left by the thin-client software and in the market. “What happens in a low-bandwidth environment?” Chang asked. Ziosoft answers the question with its Web-based application now available in the United States.

—Renee Diiulio