Managing the Flow in Radiology

BRIT Unveils Two New Advances
How Low Can You Go?
Embracing 3D

BRIT Unveils Two New Advances

BRIT Systems of Dallas, has recently announced the introduction of BRIT SpeechWorks, an integrated voice recognition and structured reporting system that processes spoken language to use words in the proper context, then translates words into data. BRIT SpeechWorks creates reports with built-in intelligence for real-time structured reporting and builds a database of information about the report that can be used to assist in coding, developing statistics, or mining information.

The Roentgen Works PACS from BRIT Systems.

Shelly Fisher, president and one of the founders of BRIT Systems, says that radiologists were the last to adopt structured reporting. “Now they can get knowledge automatically by going out to the Web to make a real-time query.”

By using the latest Web technologies, BRIT SpeechWorks provides real-time workflow across a virtual environment with minimal user intervention. The worklist is derived from the DICOM storage of studies, an optional HL-7 interface, or data entry into the workflow server. The application is flexible and allows users to report findings by dynamically selecting one or more combinations of natural language reporting, voice dictation via recording a file, or typing, or by signing the default, two-click normal report.

“The speech recognition aspect has improved,” said Fisher. “We narrow down the vocabulary to pinpoint the appropriate body region. Only a small training period is required.”

When used with the BRIT Vision multimodality diagnostic workstation, the solution marries image viewing with reporting for an integrated solution from image acquisition through report distribution, including critical results reporting. With one click, key images or measurements marked on BRIT Vision are automatically inserted into the SpeechWorks report; key images in the report launch the study in BRIT Vision.

“BRIT’s focus has always been on efficiency, and combining an intelligent voice recognition with real-time structured reporting is a significant evolution for the industry,” said Fisher. “We believe that marrying image viewing with reporting is revolutionary and provides another leap in radiology efficiency and reporting accuracy.”

BRIT SpeechWorks is designed to meet the challenges of reporting for multiple facilities. Reports can be customized to appear differently to different users and are delivered via the Web, fax, and/or e-mail depending on ordering physician and location preferences. The solution is a modular component of BRIT’s next-generation browser-based PACS, Roentgen Works.

New Browser-Based PACS

BRIT Systems also announced that the company’s next generation, browser-based PACS has received FDA 510(k) approval. The Roentgen Works PACS product line represents a new era of PACS development for BRIT Systems by utilizing leading-edge Web technologies such as cloud computing, Linux cluster, and AJAX, which is used by Google.

“The introduction of Roentgen Works PACS and its browser-based tools is the most significant product introduction since BRIT first launched teleradiology and PACS products over 15 years ago,” said Fisher. “This is more than just Web-based PACS; rather it is a family of browser-based tools that facilitate the overall communication needs in radiology by utilizing the same Internet technologies that power Web sites such as Google and Amazon.”

The Roentgen Works Web Server boasts a new server architecture that complements remote reading and distributed workflow environments. Roentgen WorksFlow, introduced at SIIM 2008, is a workflow solution that enables radiology groups of all sizes to provide outsourced radiology reading services.

According to Fisher, using the latest generation of Web technologies, such as AJAX, in the design of Roentgen Works provides radiologists with the tools they need to work and communicate more efficiently. This includes BRIT’s new UrgentWorks, which addresses ACR and JCAHO requirements for reporting critical tests and findings. UrgentWorks harnesses the power of browser-based technologies to place phone calls, deliver reports via e-mail or fax, and document all attempted and successful communications.

“This development represents a changing of the guard,” adds Shelly. “No application is necessary. Even the patient can access their own records. It eliminates big expensive servers and a lot of software and hardware.”

The FDA approval includes a multimodality workstation with specialized tools for viewing mammography studies. Fully DICOM compliant, Roentgen Works will also offer permanent, replicated off-site storage of medical images and data in a DICOM archive.

BRIT Systems is also introducing WebWorks, a 100% browser-based report/image viewer for clinicians and referring physicians. WebWorks integrates with browser-based electronic medical records/electronic health records and is Google Health Record enabled.

—James Markland

How Low Can You Go?

A recent import from Sweden is gaining support for its ability to lower patients’ exposure to radiation during CT exams.

Through clinical trials from Massachusetts General Hospital in Boston, SharpView CT, manufactured by the company of the same name, has demonstrated that its software can lower CT dose by 30% to 70%, depending on the organ being scanned.

Two presentations at the American Roentgen Ray Society meeting in April discussed how the technology is an effective technique for dose reduction for abdominal CT. In particular, in the “Application of an Adaptive Non-Linear Post Processing Filter for Improving the Image Quality of Low Radiation Dose CT: A Double Blinded Comparative Study,” the authors stated that “Contrary to previously reported studies of prior versions, new adaptive nonlinear filters can help reduce abdominal CT radiation dose by up to 50% without compromising image contrast or conspicuity of small structures.”

“We found that these filters can help reduce CT radiation dose for kidney assessment by as much as 75% and by at least 50% in abdominal examinations,” said Mannudeep Kalra, MD, radiologist at Massachusetts General Hospital. “The software preserves sharpness, reduces noise, and, most importantly, reduces CT radiation dosage. This is an effective algorithm that we have evaluated. We believe it is possible to decrease radiation dosage even further in the future.”

The company has an exclusive agreement with ContextVision AB to sell its GOP technology, a CT image enhancement software that is embedded in SharpView’s software. The technology assists in improving medical images by using adaptive, nonlinear filters. According to SharpView, “The algorithm is similar to how the human brain handles visual impressions. It differs between noise and structure by analyzing various sized areas around each pixel in the image. This makes it possible to determine if the pixel is part of a structure or not.”

Although the technique is traditionally time-consuming, SharpView noted that the algorithm is “virtually instantaneous.”

Available for any kind of CT scanner and brand, SharpView’s DICOM-compatible software is designed to seamlessly integrate into the workflow between CT equipment and PACS, the company stated. Filtrated images are delivered automatically into the PACS. Moreover, the software can be customized with a range of parameter settings, depending on the views, dose levels, and anatomical areas preferred. Adjustments take approximately 1 day, according to the company.

“During the past year, the problem of CT radiation doses has become increasingly noticed and debated in the United States. The adoption of our technology will greatly benefit patients, making millions of CT scans every year a lot safer,” said Magnus Aurell, SharpView president.

Jeff Grenier has been named US Sales Manager for SharpView Inc. His list of achievements includes establishing the US presence of Hermes Medical Solutions, and he has extensive experience in medical imaging sales, marketing, and management. Prior to joining SharpView, he was managing director in Chicago and director of marketing at Hermes’ international headquarters in Stockholm, Sweden.

—Elaine Sanchez

Embracing 3D

For Advanced Radiology Consultants (ARC), an imaging organization in Connecticut with eight imaging centers performing more than 150,000 procedures per year, the best care comes from continually enhancing the experience of doctors and patients. As the industry moves toward 3D imaging, and the need for highly mobile work expands, ARC has recognized the need for new technological capabilities.

The Visage PACS tool is a sophisticated Web-based viewing and 3D thin client technology.

ARC has enlisted Visage Imaging for their Visage PACS tool, a sophisticated Web-based viewing and 3D thin client technology. Retaining their existing system, which has been highly efficient and useful for the organization, ARC is relying on Visage for some powerful new capabilities that will improve radiologists’ and patients’ experiences.

“We selected Visage Imaging PACS because their platform is terrific,” said Duleep Wikramanayake, chief information officer at ARC. “It fits perfectly with our systems, and it’s truly a Web-based solution, giving us the ability to literally read images from anywhere. Our radiologists can work from any work station or location, give superior diagnoses with advanced visualization with less hassle, and ultimately provide better patient care.”

The Visage Imaging PACS tool was the ideal solution for ARC due to their size, their growing roster of radiologists, and their need to continually improve processes and efficiencies. Visage PACS is a Web-based solution for primary interpretation, image distribution, and archiving across an entire health care enterprise, whether that means a departmental Mini-PACS or a multisite image management and distribution system. Visage PACS is designed in a modular fashion, and provides a range of clinical tools and applications in a single system, with functionality being configurable depending on different user roles.

ARC has also found that the company itself is highly amenable to creating personalized solutions for organizations. The group conducted a pilot study with the Visage PACS tool over a 4-week period, allowing their physicians to test the application with real data and real patients. After their experimentation, the organization decided it didn’t quite meet their high standards yet.

“Visage said they would configure the PACS to bring it up to our standards,” said Wikramanayake. “The company wanted to accommodate our needs, but also to improve their product. They’re now internalizing our experiences and comments, and making our standard theirs. You don’t see that level of service and commitment to quality from other companies.”

Visage PACS promises to provide ARC with powerful new resources, but also serve as a transition to the future.

“While reimbursement from insurance carriers is still based today on 2D imaging, 3D will someday become the norm,” said Wikramanayake. “By integrating Visage PACS now, our radiologists will be very proficient with the technology to improve patient care, but also to be ready when this reimbursement change occurs. This fits with our commitment to clinical and service excellence.”

—Amy Lillard