Annual workstation face-off pleases some, quiets others

The duct tape holding down thick electrical cords had barely been ripped off the carpeting at the conference site in San Francisco when the press releases touting individual success at the fifth annual workstation face-off at the Stanford Multidetector-Row CT Symposium began hitting e-mail inboxes and vendor websites.

Philips Medical Systems sent a missive stating that its thin-client solution was the only system to complete all tasks in the workstation challenge. TeraRecon claimed its preprocessing architecture allowed the presenter to complete the assigned tasks within the allotted time and without human intervention. Carestream Health asserted that its new streaming technology was responsible for its presenter being able to process via a thin client a cardiac CT study with 2760 images over a 4-Mb/sec line in less than six minutes.

No such testimonials from the other competitors-Barco, GE Healthcare, Siemens Medical Solutions, and Vital Images-could be found via e-mail or on their websites as of mid-July.

The thin-client exercise was so challenging that the GE presenter needed additional bandwidth to download the cardiac study and the Siemens workstation froze when the user tried to enlarge a coronary artery image. That's not to say that these workstations are inferior. Operators are under severe time pressure, and the exercise is aimed at defining the limits of workstation performance, said moderator Dr. Geoffrey Rubin, chief of cardiovascular imaging at Stanford.

Rubin hopes lessons learned from the June face-off will lead to improved workstation and PACS design. Opportunities include better workflow, user interfaces, core algorithms, networking, and data processing.

When workstations got another chance to prove their mettle at the Society for Imaging and Informatics in Medicine meeting, it became painfully clear that the lack of integration for workstation features affects efficiency and, potentially, quality of care.

Drs. Khan M. Siddiqui and Eliot L. Siegel, both of the VA Maryland Health Care System, placed clinical challenges from the emergency room, cardiology, and nuclear medicine into a PACS and workstation environment (supplied by Agfa, GE, Philips, and TeraRecon). Two radiologists and one cardiologist worked through the interpretation process. They moved hither and yon through a bank of workstation monitors as they resolved clinical questions. In the end, they got their answers, but they suggested that the process involved far more steps than it should have.

"Every single action that happened required these clinicians and radiologists to go through multiple workstations," Siddiqui said after the presentation. "It's not an easy workload to handle."

Clearly, radiologists are interpreting more studies than ever, and each study has the potential to contain thousands of images. Workstations have greatly improved in the last several years, integrating automated features and advance imaging protocols, but they need to continue to improve, Rubin said.

"There should be a wealth of information that the producers of these workstations take home with them," he said.