infoRAD showcases integration and “off-the-shelf” PACS

infoRAD showcases integration and “off-the-shelf” PACS

Despite good vendor support, IHE attendance was sparse

By Cynthia E. Keen

The latest advances in electronic technologies for radiology were once again showcased in the infoRAD exhibit at the recent RSNA meeting. While there was little new or particularly noteworthy in the PACS exhibits, 1999 marked the debut of the Integrating the Healthcare Enterprise (IHE) initiative, a combined effort of the RSNA and HIMSS to promote enterprise-wide image and information systems integration.

The 1999 IHE Symposium, “Architecting cost-effective, patient-centered care for the new millennium,” was the first in a series of seminars to be held annually at both the RSNA and HIMSS meetings. The symposium included workshops, lectures, discussion groups, and the first official IHE vendor demonstration, with participation by more than 20 companies. Included were vendors of imaging modality, PACS, RIS, and HIS products, who demonstrated their ability to exchange messages in an open environment based on DICOM, HL7, and related standards.

As was the case with the early DICOM exhibitions at the RSNA meeting, however, interest in the IHE demonstrations was lukewarm. And despite much premeeting publicity, the impact of the initiative seemed to be lost on many of those who did wander through. This appeared to be due in large part to the fact that the majority of RSNA attendees do not yet have an installed PACS and so do not fully appreciate the critical importance of PACS/RIS interconnectivity.

The IHE demo would have benefited from comparisons of the various processes that integrated technologies are meant to improve. That approach was taken in a separate demonstration on image presentation, which focused on showing how DICOM standards help achieve image consistency between hard and soft copies. This demonstration included clinical images viewed on both soft- and hard-copy displays, allowing the viewer to evaluate the effectiveness of each presentation and the achievement of gray-scale consistency.

As was the case on the show floor, not much was new in the PACS portion of infoRAD. However, the hands-on workstation classrooms sponsored by Agfa and GE Medical Systems were excellent and well attended. Elsewhere, much emphasis was placed on the use of structured reporting and the development of standardized reports. In addition, several posters focused on an often ignored but very important area: the ability to evaluate the display quality of monitors.

Among the more noteworthy projects on display at this year’s infoRAD was “A PACS solution for the healthcare enterprise.” With the proliferation of commercial PACS, it was impressive to see a self-developed system grow in both performance capabilities and installations.

Desiring PACS in the mid-1990s but having extremely limited resources, researchers working at Montreal General Hospital, McGill University Health Consortium, the Toronto University Health Network, and Mount Sinai Hospital in Toronto scoured the Internet to locate freeware and shareware from which they could develop PACS software.

The resulting system is based on an IBM PC platform, uses a Linux operating system, and is DICOM and HL7 compliant throughout. Digital linear tapes are currently used for archiving; previously, the system relied on CD-ROM. Other features include audit trails, security systems with embedded firewalls, and the use of CDs to be given to patients who need to take exams to referring physicians.

As with many commercial systems, efforts were made to provide complete functionality to the user with a single login. At the modality workstation, the technologist has access to work lists and schedules, quality control, documentation, and automatic reporting tools. In addition, the radiologist has access to voice recognition and structured reporting (expected to become better when integrated with voice navigation) and the PACS administrator has numerous management tools.

Challenges to the design team include dealing with a system that is continually growing, with ever more users. Radiologists won’t settle for “dumbed down” solutions, which means the workstation software needs to be increasingly sophisticated. Prefetching (access to scheduling through the RIS) has also become an issue. RIS integration with three different systems is expected in the third quarter of 2000, and orthopedic templates are a work-in-progress.

In addition to saving millions of Canadian dollars—which were not available anyway—this academic consortium has achieved a fully functional PACS.

“In-house development support is the only way to go. The system is radiologist-driven, and we can control costs, growth and upgrades, design, and development,” said C. J. Henri, Ph.D., who was involved in the system development.

In addition, changes can be made rapidly and the average development cycle takes only months, rather than years. Commercial vendors are often constrained by verification requirements, whereas a self-developed system can put ideas into practice, see if they work, and make appropriate modifications.

Another interesting project was “What you always wanted your medical workstation to look like but were afraid to ask,” an impressive endeavor by MeVis Technology of Bremen, Germany. The goal of this project was to design a workstation that emphasized display monitor “real estate.” Tool bars can be modified at will and expanded or shrunk to a slim, unobtrusive line. In addition, glare can be masked, and images can be evaluated by task and presented in a hanging protocol that best meets the needs of the radiologist.

© 2000 Miller Freeman, Inc., a United News & Media company.

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