Running the Numbers
Post Enhancements: Is Your PACS All It Can Be?
IEC Publishes Third Edition of IEC 601-1 Electrical Safety Standards
The Future of Biometrics in Medical Imaging
Gotta Look at Yottalook, a New Medical Imaging Search Engine
Vendors Partner to Offer Advanced Morphology Interpretation Software
Running the Numbers
55% of end users indicated suffering from problems with hardware, software, or media failure in attempting to recover data, according to the results of a storage-focused survey by PowerFile Inc, Santa Clara, Calif. The survey queried more than 450 IT staff and storage administrators to determine the level of archival storage problems and find out the current approaches to meeting long-term archiving needs. Other findings include:
- the top three storage issues are running out of primary storage (50%), dealing with long backup windows (62%), and having problems with retrieval time of archived data (45%);
- more than one third of respondents said that fixed content composes at least half of their corporate data; and
- 85% indicated that they were open to a solution that includes optical components in satisfying long-term archiving requirements.
For more information, visit www.powerfile.com.
Post Enhancements: Is Your PACS All It Can Be?
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By Vicki Petersen, MS, RT(R), FAHRA
The statistics would indicate that the majority of people reading this column are working in a facility that uses PACS. Some of you early adopters who installed PACS more than 5 years ago might be considering a major upgrade or replacement. You?re probably evaluating all of the new technology, communication tools, and integration options, as well as how you?re going to eliminate dozens of workflow issues. There?s nothing like spending big money to require your focus on all of these opportunities. But what about those who are in year 1 to 5 of installation? Just how much time are you looking at to fine-tune your system?
How much have you really evaluated those goals and cost savings on which you sold the board of directors? In some facilities, you?re invited back a year later to accomplish just that. It still surprises me how much some facilities are spending on film 1, 2, or even 3 years after implementing PACS! For many years, we used a graduated scale for reducing film with year 1 being a conservative 65% reduction. Today, it is a rare occasion that film usage is not reduced at least 85% by the first year after a full implementation of PACS. What is causing these barriers to full-scale adoption in so many sites with PACS?
Is it because newer technology takes away more of the painful steps we endured or never addressed? One of the guaranteed workarounds that everyone had to deal with in their own way was: “One patient, multiple exams, but one continuous scan.” In CT, this was the case with an order for a chest, abdomen, and pelvis. Did you choose to put all the studies behind one accession number? Wasn?t everyone supposed to know that the other studies would be found under the most superior study, or did you manually split out your studies? Another popular option was to create “combo codes” and break out the charges behind the scenes. Remember, it isn?t always technology changes within a PACS that finally address issues we have been dealing with for years. If you?re purchasing that new CT scanner, these nightmares might finally be behind you.
How many of you are using human intervention to provide the link in communication and notification? With so many different variables from one place to another, there?s no one single solution that is a PACS cure-all. However, you must use the technology as an enabler, and pull from other clinical areas to leverage your investment. Nurse call systems have been using technology to automatically provide notifications. Did you know that the same system might be able to provide notifications for you in radiology? CIOs have been able to maximize a system already in existence in some facilities for applications with PACS. Be inquisitive?ask the unthinkable, and you?ll be surprised when you hear about the possibilities.
As you were installing your PACS, many of your committee decisions were compromising trade-offs. Quite possibly, these new decisions or compromises might have impacted how scripts, clinical history sheets, and requisitions are now handled and processed. Going forward, how are these critical pieces of information (data) going to be available, stored, and accessible at later dates? Was the original solution to install document scanners everywhere? Newer levels of integration between information systems and modalities have allowed us to eliminate a lot of these “add-ons” to the images. Have you let them go, or are you still doing the same as always?
No matter where you are in the PACS continuum, as with any new technology, you must plan strategically down the line. We all are hearing about the incredible amount of data that we will be required to manage, store, and, just as importantly, keep from being lost. Where are you spending your investment dollars? Does it match the organizational data-management goals and strategies? The lines between cardiology and imaging are blurring for many reasons. Look at what happened to the line between information technology (data) and telecommunications (telephones); it is a history lesson. Throw in the other “ologies”?you don?t want to be standing on your own when that bill arrives.
It should be no surprise that PACS, like any other new technology, requires constant fine-tuning. The good news is that it continues to get better and better. Focus on opportunities, take advantage of technology changes and new levels of integration to bury all those workarounds, and look strategically toward the future. Keep asking the unthinkable, and the answer will become your reality. Help your PACS be all it can be.
Vicki Petersen, MS, RT(R), FAHRA, is the director of the PACS consulting program for Premier Consulting Solutions, Charlotte, NC. To have your informatics-related questions answered or for more information, contact .
IEC Publishes Third Edition of IEC 601-1 Electrical Safety Standards
The International Electrotechnical Commission (IEC), Geneva, recently issued the third edition of the 601-1 electrical safety standards for medical equipment. “This will have an impact on how devices are designed,” says Richard Mentelos, CEO of RAM Technologies, Guilford, Conn, a power-supply manufacturer. “In some regards, they relaxed the standards, and in other areas, they made them more stringent.” These changes primarily affect two areas: hazard analysis and leakage current.
Hazard analysis is a requirement new to the third edition, Mentelos explains?one that could cause quite a headache for manufacturers. “Now, when you submit your product for safety testing, you have to do a separate safety analysis, whereas with the second edition, you really didn?t have to do that,” he says. “You just submitted it, they tested it to a certain series of standards, and it either passed or failed. The third edition explains those standards and includes this hazard analysis. That?s going to complicate things.”
Mentelos also notes changes to the leakage-current requirements. “In the old standard, they had chassis leakage current and earth leakage current,” he says. “In the new standard, they eliminated chassis leakage current and renamed it touch current.” The new label is intended to be more intuitive, and it corresponds with the terminology used in the IEC 950, which is the commercial version of the electrical safety standards.
The voltage limits for the earth leakage current also have changed. “In the old standard, it was 500 microamps under what they called a normal condition,” Mentelos says. “In the new standard, it?s 5 milliamps, which is 10 times the old current in the normal condition, and 10 milliamps in the single-fault condition.”
The third edition of the 601-1 standards will be available for purchase in the United States from Underwriters Laboratories Inc, Northbrook, Ill. Visit www.ul.com for more information.
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The Future of Biometrics in Medical Imaging
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By Hwa Kho, PhD, MBA
Dr. DiFiori walks into the patient examination room and greets his patient: “How are you, Mr Jones? The MRI scan of your left knee confirms my suspicion that you have a torn meniscus. In fact, part of the meniscus is caught between the tibia and the femur, which is causing the pain you are experiencing. Here, let me show you.”
DiFiori leads his patient toward a large LCD on the wall. As they approach, a small camera above the screen captures and transmits their facial images to “Symphony,” a workflow automation program. Using facial biometrics technology, Symphony recognizes DiFiori as an authorized physician user of the PACS and Jones as a patient. Symphony automatically logs DiFiori into the PACS and instructs it to display Jones? latest study. Within a few seconds, Symphony has Jones? MRI images up on the screen, leaving DiFiori free to focus his attention on his patient. Symphony continues to track DiFiori?s presence in the room as he consults with the patient. When he finishes his consultation and leaves the room, Symphony automatically logs him out of the PACS and awaits the next physician.
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Symphony is fictional; it does not exist. But it?s exactly what I wished we?d had when we went live with a new filmless orthopedic clinic 2 years ago. The physicians had to log on to the PACS workstations in the examination rooms and search for the patients? studies. They had problems remembering their passwords and searching for the right studies. They were used to having the patients? films set up on the light boxes by the nursing assistants, so from the physicians? perspective, the digital environment was far less efficient than the previous film world.
But biometric technologies are at a point where systems like Symphony soon could be feasible. Using individual traits?such as fingerprint, handprint, voice pattern, retina pattern, and facial pattern?to identify a person, biometrics hold exciting promise for addressing a host of challenges in health care. These challenges fall into three areas: user authentication, patient identification, and workflow automation.
Biometrics for health care, however, is still in its infancy. Very few institutions have deployed biometrics identification. Where biometrics has been deployed, it is mostly for user authentication. The most basic application is using fingerprint recognition to replace keyboard log-ins. However, this technology easily could be extended to become part of a “multifactor authentication” process, whereby?in addition to the biometric measure?users are required to present something that only they would know, such as a password, and/or something they possess, such as a smart card. This makes it much harder for unauthorized users to masquerade their way into the system.
An even more sophisticated implementation would be to track the user after the initial log-in to ensure that the user has not been replaced by another person. This is a common problem in busy clinical areas where computers are shared by many people. Users leave their computers without logging out, making the unattended computers accessible to anyone. At RSNA 2006, GE Healthcare, Waukesha, Wis, demonstrated the use of facial recognition for logging in to a PACS workstation. The system continues to track the radiologist after he or she is logged in and automatically logs him or her out when he or she leaves, thus securing the unmanned workstation.
As important as user authentication is, the average user cares more about convenience than security. The typical user in health care must remember several different passwords, which change constantly as they expire, in order to access different applications. Deploying biometric authentication?which, in practice, might be slower or more cumbersome than typing in a user name and password?for one or two stand-alone systems brings little, if any, value to the user. The value for users will come when the same biometric measure can be used to access all applications. Imagine being able to access all the applications you use?PACS, RIS, dictation system, medical records, that special 3D processing workstation?all with your fingerprint and not having to remember any password!
And don?t forget the patients. In the context of medical imaging, the technology exists today to verify every patient through fingerprint recognition before a scan is taken. The next step would be to embed the fingerprint with the image set to resolve any doubt about which patient the images belong to. It could be time for the DICOM standards committee to start considering standards for including biometric patient identification with medical images.
Although user authentication and patient identification are the most obvious uses of biometrics in health care, the cost of a full-scale implementation easily could run into the tens of millions of dollars and might be difficult to justify financially. What might accelerate the deployment of biometrics is its potential use in workflow automation, as in the fictional scenario previously described, where economic efficiencies could be realized in terms of time or resources saved. At the heart of any workflow automation program is its ability to read the target environment and derive the correct context in order to carry out the required tasks. Such technologies as radiofrequency identification tags have been used to track people and equipment to provide environmental inputs. What biometric technologies can do is to bring another dimension to its “senses” to enable the program to work smarter, more securely, and with less human interaction. Unintrusive, contactless deployments using facial or voice recognition offer the most promise for this purpose.
Many technical and financial challenges still must be overcome before we can expect to see widespread adoption of biometrics identification in health care?not to mention cultural challenges, which could turn out to be even more difficult to surmount. It will be interesting to see if patients accept widespread databasing of their fingerprints. However, health care has such a rich field of problems for which there may be no viable alternatives to biometrics. For example, biometrics may provide the only practical solution to HIPAA requirements on protecting and tracking access to confidential patient information. Biometrics may very well drive the next wave of IT innovations in health care.
Hwa Kho, PhD, MBA, is director of imaging informatics at the University of California, Los Angeles, Medical Center, and is a member of the Medical Imaging Editorial Advisory Board. For more information, contact .
Gotta Look at Yottalook, a New Medical Imaging Search Engine
A new search engine developed by a team of medical-imaging clinicians and researchers at iVirtuoso Inc, Baltimore, rapidly finds relevant context-specific images and full-text references from within peer-reviewed articles on the Web and quickly delivers results that conform to radiologists? search criteria. Named for the largest prefix formally introduced by the International System of Units, Yottalook uses Google indexing technology layered with special filters to crawl the Web.
“We have our own filters to filter out nonradiology content, and we also have our own relevance and clustering technology,” explains Steve Severance, chief technology officer at iVirtuoso. “For example, if we?re looking for information that?s related to pediatrics, we?ll get only results that are related to pediatrics. We also have relevance, which is partially weighted by criteria, like a journal?s ISI [Institute for Scientific Information] index. So, if we have content from somewhere like the New England Journal of Medicine, that content will have more weight to it than content that?s been published in a less prestigious journal.”
Launched on January 5?the 111th anniversary of the announcement of Wilhelm Roentgen?s discovery of the x-ray?Yottalook already indexes between 750,000 and 1 million Web pages, Severance estimates. “We were really unsure what kind of traffic we would get, and we?ve seen an exponential growth of traffic in the first week,” he says. That?s important, Severance notes, because iVirtuoso hopes to see Yottalook in use as a point-of-care solution. “That?s the focus, rather than something designed only for academic radiologists, even though they will be heavy users of it as well,” he says. “But we want it integrated into clinical workflow. Doctors have been increasingly using Google at the point of care. There?s an article that was published in the British Medical Journal 1 about how clinicians are using Google for diagnosis, and having a search engine that can verify content is very important in that.”
In the coming months, iVirtuoso hopes to add features like an image-preview function and tools to personalize the search experience. “We?re adding an anatomy search to it, and we?re looking at how we can use collaborative filtering, where users can submit and rate content,” Severance says. “Say there?s a journal article that appears in a less prestigious journal, but it?s really, really good. Users will be able to basically vote yes, this article?s good, or no, this article isn?t good, for different content. And that will incorporate back into the search results.”
Also, iVirtuoso has developed an installation package, which should launch this month, to integrate Yottalook into browsers. “Just like people use Google toolbar to do searches, you?ll be able to do a Yottalook search,” he says. “We have that working; it?s just a matter of putting together an installation package. We also started something we call Yottalook Labs, which is where we?ll be putting new stuff that we?re developing at the beta phase, things to try out before we add them to the main search engine.”
Access the Yottalook search engine at www.yottalook.com. Yottalook Labs can be found at www.ivirtuoso.com/search/labs.
- Tang H, Ng JHK. Googling for a diagnosis?use of Google as a diagnostic aid: internet based study. British Medical Journal. 2006;333:1143?1145. Available at: www.bmj.com/cgi/content/abstract/333/7579/1143. Accessed January 30, 2007.
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Vendors Partner to Offer Advanced Morphology Interpretation Software
Invivo Corp, Pewaukee, Wis, a subsidiary of Intermagnetics General Corp, recently announced its agreement with Clario Medical Imaging Inc, Seattle, to integrate the two companies? visualization technology into one software package. Under the terms of the agreement, Clario?s z3D 2.0 software, which offers visualization tools for the interpretation of morphology, will be integrated with Invivo?s DynaCAD system. Invivo will license and distribute Clario?s software to its customers on an exclusive basis.
“We are excited to work with Invivo to provide tools for the interpretation of regions identified by CAD,” Chris Wood, president and CEO of Clario, said in a statement. “z3D 2.0 focuses on visualization of morphology and will complement DynaCAD?s advanced image-analysis capabilities.”
DynaCAD provides selectable 2D/3D image registration for suppression of image-motion artifacts and automatic image subtraction; functional color parameter maps to visualize changes in MRI signal intensity; dynamic maximum-intensity projections for interaction functional 3D visualization; interactive access to time-intensity curve data; automatic calculation of target coordinates for MRI-guided interventions for improved speed and accuracy; and standardized reporting options, including the ACR BI-RADS Atlas for classification of breast lesions. To this, z3D Contrast Acuity will add its advanced computer graphics, enhancing image visualization by using height animation and interactive viewing to maximize the eye?s ability to detect motion, color, and shape.
“The incorporation of new features designed for interpretation of lesions into DynaCAD reasserts our commitment to provide the most advanced, comprehensive set of tools for our customers,” said Thomas Tunes, director of clinical solutions at Invivo. “The addition of z3D is an excellent fit with the advanced lesion characterization capabilities of our next generation DynaCAD platform.”
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