· Old PACS, New PACS
· Tech Zoom: Asset Tracking System Uses Wi-Fi to Find Equipment Throughout Hospital
· Tech Zoom: Rogan-Delft Showcases PACS Technology at ECR 2007
· Maximal Growth at Minimal Bandwidth
· Going with the Flow
· Latest Version of dyseCT Released
· Confirma and Solidcore Team to Advance Breast MRI CAD


Putting a new system in place brings with it a host of challenges

By Dana Hinesly

No matter how carefully you choose a new PACS or plan its installation, switching systems is a daunting task—especially for large medical centers with years of digital imaging under their belts. Thomas Jefferson University Hospital (TJUH), Philadelphia, is one such institution. When the manufacturer of its existing PACS no longer supported the system, TJUH found the perfect opportunity to bring in modern technology.

“We entered this project with the idea of upgrading to new, state-of-the-art capabilities,” said Christopher R.B. Merritt, MD, professor and vice chair of radiology at TJUH. “Our goal was implementing a totally integrated system able to combine the functions of the RIS, PACS, and our automated dictation/speech-recognition system.”

The goal of TJUH’s new system was to integrate PACS, RIS, and speech recognition.

The new PACS also would be called on to serve a brand-new, all-digital breast imaging center as well as a sister hospital located several miles from TJUH. The quest for this ideal system started with a committee of representatives from key departments throughout the hospital.

First on the agenda was developing a comprehensive request for proposal (RFP) that communicated exactly what the hospital wanted—a familiar step that TJUH customized to ensure the desired outcome.

“Our RFP was driven entirely by functional performance, detailing the performance characteristics we wanted to have,” said Merritt, noting that most RFPs tend to be filled with highly technical specifications. “As far as a radiologist is concerned, what happens in the computer room is irrelevant. The technical specifications are important only if they provide convenience and efficient workflow.”

Christopher R.B. Merritt, MD

Making certain the new system would meet technical needs while satisfying the imaging team took diligence. “The first challenge was to really spend enough time in the different areas and with different people, so we had a real understanding of their needs in terms of what they were looking for from a system,” said Merritt, adding that the hard work paid off. “It was very much an RFP that reflected what the radiologists sitting in the reading room felt that they really needed to get their work done efficiently.”

Making the Call

More work followed the responses of the six prospective vendors. Committee members reviewed each document to determine if a company’s offerings—present and future—would be a fit for the hospital.

“That is where the second level of challenge arose, because I think one of the realities of selecting a PACS is that there are always features presented to you that have yet to be developed or to be implemented into the products, but are promised in the next release,” Merritt noted. “If you’ve been in the business long enough, you realize that some of those expectations are met quickly, some are met after great delay, and some are not met at all.”

The team sifted through pledges, identifying which vendors they believed held the most promise. Though no one vendor satisfied all of their requests, the team narrowed the field to two, conducted site visits, and made a final selection: iSite PACS from Philips Medical Systems’ Global PACS Business Unit, Brisbane, Calif.

“We also engaged an outside consultant, who provided valuable input in the negotiating process,” he explained. “The concern was not only trying to get a fair deal, but also making sure the things we expected and had been promised as we spoke with the vendors were actually reflected in the terms of the contract.”

Putting It in Place

The final major task is the actual implementation of the system. Currently, the PACS is not active; however, the hardware is on-site, and interfaces are being created to allow various components of the system to communicate effectively with one another. The data conversion is in progress and being facilitated by the internal PACS team.

Switching from the old PACS to the new presented the problematic issue of converting old data from the large digital archive. This is the single biggest dilemma that anybody making this change faces, according to Merritt. “Incorporating that data into the new archive is not a trivial problem,” he said. “Decisions had to be made about how much data to convert and how we were going to restore cases from the old archive, on demand, in the new system.”

The task was complicated by the fact that for years, the radiology department’s files—roughly 1,000 studies per day—were entered into the PACS without the benefit of worklists. As a result, even the smallest variation in a patient’s name or record number would mean that the RIS did not recognize that patient. Such files must be migrated manually.

After carefully evaluating the recall rate of old studies, TJUH established that putting 18 months of prior data into the new system would provide radiologists with the immediate access to the files they would need the most.

Live and Learn

The last—and perhaps the most important—component is training radiologists and technologists on the new system. This process started at TJUH months ago, through online tutorials and presentations, along with a training room in which staff can familiarize themselves with a pilot version of the PACS—all of which Philips Medical has provided. As the go-live date draws near—estimated to be this month or next—one-on-one, hands-on training will take place.

“Training is an extremely important component, and it is going to be an ongoing activity,” Merritt said. “These are extremely powerful programs, and I think one of the challenges is going to be not only bringing people up to a basic functional level of using the tools, but also actually assisting them in becoming power users of some of the very sophisticated features it provides.”

Dana Hinesly is a contributing writer for  Medical Imaging. For more information, contact .

Asset Tracking System Uses Wi-Fi to Find Equipment Throughout Hospital

A new Asset Tracking System (ATS) from Fluke Biomedical, Everett, Wash, can quickly and accurately locate a hospital’s equipment assets using a standard 802.11 Wi-Fi network. Because the platform leverages the power of the hospital’s existing IT infrastructure, no additional hardware, wiring, or readers are required—circumventing the high cost that is usually associated with radiofrequency identification systems.

The Asset Tracking System from Fluke Biomedical can be purchased in two pilot-kit options for customers who wish to invest incrementally.

“Our customers’ number one complaint is that they waste time searching for instruments that need repair or preventive maintenance,” said Fred Lee, business unit director at Fluke Biomedical. “ATS accurately tracks the location of the hospital’s valuable assets within seconds, increasing the biomed’s productivity and eliminating the need for excess equipment.”

The ATS consists of three main components: the BEACON100, a compact radio tag that attaches easily to medical equipment; the Positioning Engine, which is installed on the server and can accurately locate Wi-Fi?enabled PDA, laptop, or BEACON100 radio tags in real time; and Compass Software, a Web-based application accessible via any PC or PDA with Web access.

Fully deployable in just 7 days with no interruption to operations, the ATS uses very little bandwidth and offers high floor- and room-level accuracy. Location information proffered by the ATS includes asset name, floor, logical area(s), time stamp, and battery level.

—C. Vasko

Rogan-Delft Showcases PACS Technology at ECR 2007

The latest PACS technology from Rogan-Delft, Veenendaal, Netherlands, was on display at the annual meeting of the European Congress of Radiology (ECR), held March 1-6 in Vienna. Offering a preview of upcoming products in the US market, Rogan-Delft showcased its PACS technology, including:

  • Rogan View Pro-X v3.0 64-bit: This is now shown as a stand-alone workstation and prepared for Microsoft Windows 64-bit operating systems.
  • Rogan View Pro-X v3.0 Web WAT: The Web version of Pro-X 3.0 comes with a Web administration tool (WAT) for remote maintenance, remote monitoring, remote configuration, and licensing of the archive.
  • Rogan View Pro-X v3.0 Web is available as Web client or as stand-alone workstation and prepared for Microsoft Windows 64-bit operation systems.
  • Rogan View Pro-X v3.0 Mammo: When purchased with mammography functionality and integrated CAD, the Pro-X solution offers a platform for radiologists wishing to use a single application that can handle multiple dedicated processes.
  • Rogan View Pro-X v3.0 3D Rendering Version: This variation brings advanced 3D medical imaging to an array of medical specializations, available not only in the radiation department but also at home or at the desktops of specialists.
  • Rogan OnLine XS Archiver v6.1 RAIS: This storage solution is one of the fastest medical image archive and image manager platforms available, handling Everything On Line (EOL) and Multiple Archive Storage Servers (MASS) as well as Redundant Array of Inexpensive Servers (RAIS). It also provides enhanced support for IHE security profiles, media presence, and thumbnail support, and can be connected to any DICOM workstation.

For additional information, visit www.rogan-delft.com.

—C. Vasko

Maximal Growth at Minimal Bandwidth

Acuo Technologies helps connect 38 CDI facilities

By Kris Kyes

The Center for Diagnostic Imaging (CDI), Minneapolis, is a 38-center, eight-state imaging company that provides subspecialty neurological, spine, cardiovascular, musculoskeletal, and body imaging, as well as image-guided diagnosis and therapy.

The CDI PACS network is among the most widespread in the United States, reaching from Florida to Washington. All 38 imaging centers are able to function as a single enterprise because a common image-management infrastructure connects them. Because consultation among imaging centers is integral to CDI’s business model, the company has been transmitting images to subspecialists since 1992.

Designing the Plan

In 2002, CDI decided to implement, enterprise-wide, a single RIS from RIS Logic Inc, Cleveland, now part of Merge Healthcare, Milwaukee. By 2003, CDI was ready to choose a PACS; it was especially important for the solution to provide an open environment that would be vendor neutral, so that the reading stations and CAD products already in place would not need replacement.

The PACS installation was accompanied by the need to migrate archived images to new storage technology using a transparent archiving infrastructure. Acuo Technologies LLC, St Paul, Minn, was chosen to provide the dispersed CDI enterprise with image workflow capability and PACS infrastructure.

Bandwidth costs and the geographic extent of the enterprise were only two of the technical challenges involved in this project. In addition, CDI wanted to retain its low-bandwidth T1 networks. CDI needed its user interfaces and its routing and query capabilities to remain consistent on the local, market, and enterprise levels and its user portals to be constructed of off-the-shelf components.

Putting It Into Action

A high-performance system that can be expanded as needed and operated using the existing T1 network was created. It combines the Fusion RIS/PACS from Merge with AcuoMed and AcuoStore technologies for image routing, distribution, and management.

Figure 1. The PACS and storage infrastructure at CDI. Click on image for larger view.

By adhering to the DICOM, IHE, HL7, and JPEG 2000 standards, Acuo’s DICOM Services Grid lets CDI choose best-of-breed tools for visualization and advanced processing.

Architecture and operations do not change when the system needs to be scaled upward; instead, more servers (and more powerful servers) are added to the Acuo DICOM Services Grid. This is a scalable architecture in which distributed servers function as a single unit, allowing growth without decreasing PACS performance.

The PACS is an interlinked, interoperable system in which each imaging center has its own AcuoMed DICOM Services Grid Instance. This performs local PACS functions, including intelligent routing, storage, and workflow configuration and optimization. A local storage cache manages online studies representing the imaging performed during the previous 30 to 90 days.

Rapid, remote installation of AcuoMed and AcuoStore software onto off-the-shelf hardware allows quick expansion as needed. Servers run Microsoft Windows and are swapped out for larger-capacity models as required. Configuration uses Microsoft’s Management Console snap-in modules and is performed as workstations and modalities are installed.

Because CDI’s imaging centers are distributed according to market needs, but the subspecialists who will interpret some of their studies may not be, each group of three to five local imaging centers forms a cluster that is connected to a regional CDI data facility that runs an Acuo Regional Image Manager. An Acuo Regional Intelligence Engine is used to consolidate images from each center in the cluster and provide image distribution, storage, and management.

Each regional facility maintains studies online from the previous 90 to 120 days and is a point of contact on the CDI network, receiving images and RIS updates from other regional facilities and from the central archive. As CDI expands, new imaging centers can be added singly to existing clusters or in groups to form new clusters (with their own new regional facilities).

The central archive consists of two (mirrored) Centera storage systems from EMC Corp, Hopkinton, Mass, running in separate long-term archival facilities. For rapid data migration between storage platforms, the archive uses Acuo DICOM Assisted Migration (ADAM) software.

Using peer-aware federation technology, Acuo’s DICOM router allows radiologists, referring physicians, and PACS administrators to see a unified network, with each patient having a single, consolidated folder accessible from any Web-enabled location. User-customized routing means that images are sent only where needed, and this capability combines with configurable compression algorithms to conserve precious bandwidth.

CDI required high performance, cost efficiency, reliability, and scalability for its DICOM routing and image-management system from Acuo. Since the system’s 2003 implementation, imaging volumes have increased from 53,000 studies (5.5 million images) to more than 250,000 studies (32 million images) per year. CDI’s site count has increased 45%, and data-intensive breast imaging and multislice CT have been added, with no loss of capability. The T1 network that moved 10,000 images per day in 1999 now supports the transmission of 300,000 images daily.

Kris Kyes is technical editor of  Medical Imaging. For more information, contact .

Going with the Flow

Today’s portable technology helps manage radiology workflows

By Renee DiIulio

Radiologists used to have their workspaces defined by film and a light box. Today, they are defined by pixels and bandwidth. And though most radiologists are still tethered to a workstation, mobile technology brings some freedom as well as benefits for workflow.

SmartDraw software includes specialized symbols recommended by health care practitioners; textbook-quality medical images from Lippincott, Williams & Wilkins; and Netter Images from Elsevier.

At the Ready

Adam E. Flanders, MD, professor of neuroradiology and rehabilitation medicine, and director of radiology informatics in the department of radiology at Thomas Jefferson University Hospital, Philadelphia, has come to rely on his personal digital assistant (PDA) to remind him of his schedule throughout the day. “Regardless of whether a radiologist uses a PDA specifically for radiology, the PIM [personal information management] functions are extremely useful,” he said.

Naturally, residents—who tend to be younger and earlier technology adopters—are more likely to use these devices than established radiologists, for both PIM and job-related functions. In a 2005 survey of members of the Radiological Society of North America (RSNA), Oak Brook, Ill, trainees were more likely to own PDAs than attending physicians (61.5% to 42.6%, respectively) and were more likely to have radiology software installed on those PDAs (40.4% compared to 19.5%).

Much of this software is educational. Flanders noted that the big push for mobile devices in radiology initially targeted education. “The emphasis on handhelds has still been education, but more specifically focused,” he said. Users tend to search for precise bits of information rather than read or edit entire articles as originally envisioned.

Because digital files are less cumbersome than large reference books, physicians can keep a wealth of searchable information at their fingertips. Flanders suggested that teaching files and case information can be uploaded and accessed through handhelds as well. Eventually, images also will be readily accessible, though Flanders questioned the desire of most radiologists to read images on a 3-inch screen.

He expects, however, that radiologists will be willing to use the devices to monitor workflow, particularly those in managerial roles. “Many radiology departments are interested in dashboard functionality, which allows a user to monitor the entire workflow, often with graphical interfaces,” Flanders said. Bottlenecks can be identified before they become a problem, and data can be mined more effectively.

Selling Points

Visualized workflow is helpful not only as a managerial tool but also as a selling tool. Jennifer Beaumont, director of information technology at Radiology Imaging Consultants, Chicago, discovered this benefit while contributing to sales presentations for potential clients. “We aim to provide a higher level of service, and we wanted to illustrate that in a professional way, which would be easy for our clients to understand,” she explained.

In looking for a graphics program to assist with this goal, Beaumont sought recommendations and learned about SmartDraw.com, San Diego. The Tablet PC-enabled software guides the development of visual aids, such as flowcharts, organizational charts, floor plans, maps, Gantt charts, office layouts, timelines, sales territory maps, and concept maps; these can be imported into Microsoft Word, Microsoft PowerPoint, Microsoft Excel, and WordPerfect, or saved as an Adobe PDF file. A specific SmartDraw Healthcare Edition features nearly 1,000 professionally designed templates along with related symbols and clip art.

Beaumont took advantage of the trial offer, testing the software before purchasing. “The application is easy to use with multiple ways to export, so we are able to include a workflow chart and timeline in every proposal we send,” she said.

The visual aids are now frequently requested to fill other needs as well. Beaumont cited one instance in which she was asked by the business manager to create a workflow chart for a new procedure. The ability to visualize workflow is particularly important within radiology, Beaumont stressed. “Often, you can think about the way things happen, but until you put it on paper, it may be difficult to really see the difference between processes,” she said.

The ability to compare has been particularly helpful in terms of landing new business. Beaumont has created a number of templates to focus on the most important areas so that every workflow does not need to be developed from scratch. However, the templates can be customized for each facility. Because only about 20% of proposals actually move forward, the time saved in their creation permits greater efficiency.

Renee DiIulio is a contributing writer for  Medical Imaging. For more information, contact .

Latest Version of dyseCT Released

DeJarnette Research Systems Inc, Towson, Md, released version 3.0 of its dyseCT workflow engine for multislice CT. Beginning with this release, dyseCT will ship on a Windows XP platform, leveraging a lightweight Oracle 10g database. This version also includes the ability to break up thoracic spine, lumbar spine, and reformatted studies, as requested by customers, as well as improvements in the pattern recognition engine.

dyseCT is the market’s only workflow engine capable of automatically splitting whole-body CT studies into separate studies based on the RIS order. “The dyseCT algorithm for automated CT study anatomy breakup is now pretty mature,” said Jennings Tracy, national sales manager for the dyseCT product line, in a statement. “We see very significant improvement in the breakup of abnormal CT studies, such as those of surgical patients.”

dyseCT queries the PACS for the DICOM modality worklist, identifies studies with multiple orders, and gives a modified DICOM modality worklist to the CT scanner; dyseCT also receives the studies from the CT scanner, automatically splits them and associates each part with its corresponding order, and then sends the split studies to the PACS.

To manage the thousands of images generated by multislice CT, dyseCT offers configurable anatomical region overlaps, Web-based GUI for easy configuration, a single modified worklist to reduce clutter and confusion, an ultra-small form factor that fits anywhere and comes with a space-saving wall mount, and the ability to assign localizers and processed images to the correct study.

“The next software release will contain a study breakup quality assurance component,” Tracy noted, “which will allow for the detection of algorithm failures and the routing of those failures for human corrective action, in real time.”

—C. Vasko

Confirma and Solidcore Team to Advance Breast MRI CAD

At HIMSS 2007, held on February 25 to March 1 in New Orleans, Solidcore Systems Inc, Palo Alto, Calif, announced that it will partner with Confirma Inc, Bellevue, Wash, to advance Confirma’s breast MRI CAD offerings. By integrating Solidcore’s S3 Control software with Confirma’s CADstream system, the two companies will provide CADstream users with improved uptime, increased security, and reduced maintenance costs—all by preventing unauthorized changes and code from executing on CADstream.

“Physicians rely on CADstream every day for their breast MRI studies, and we recognize that our customers cannot afford to have unauthorized changes compromise our system integrity and availability,” said Confirma vice president of research and development Paul Budak. “Integrating Solidcore S3 Control into CADstream will improve CADstream security, availability, and support.”

S3 Control software for embedded systems is a small-footprint, low-overhead, change-control solution that can be used to enforce the control requirements mandated by the FDA, HIPAA, and the Sarbanes-Oxley Act. The S3 Control solution offers both health care consumers and medical device manufacturers an unprecedented level of security and out-of-the-box compliance for in-hospital systems.

“Change control is essential for any medical device manufacturer, providing complete control over what is allowed to change on those critical systems,” said Jim Sarale, vice president of embedded solutions at Solidcore. “Solidcore’s automated change policy enforcement capabilities enable manufacturers to harden the operating system and prevent any out-of-policy changes that would otherwise create costly system outages and support calls.”

S3 Control will operate transparently on CADstream systems, and will eliminate the customer’s need to maintain and run high-intensity antivirus software applications, which can often slow processor speed. To learn more, visit www.confirma.com.

—C. Vasko