Integration with PACS, 3D dominates IT offerings

December 20, 2004

The need for increased productivity throughout radiology, from the smallest to the largest institutions, has energized vendors, leading them to integrate PACS with other information systems and postprocessing capabilities. RIS integration led the charge to turnkey integration. Specialty vendors’ products focused on community hospitals and imaging centers were joined by others from major vendors that sought to expand their reach beyond super-sized early PACS adopters.

The need for increased productivity throughout radiology, from the smallest to the largest institutions, has energized vendors, leading them to integrate PACS with other information systems and postprocessing capabilities. RIS integration led the charge to turnkey integration. Specialty vendors' products that focused on community hospitals and imaging centers were joined by others from major vendors that sought to expand their reach beyond super-sized early PACS adopters.

Postprocessing became an integral part of PACS. Vendors highlighted seamless and bolt-on 3D packages as the means for handling increasingly large data sets created by multislice CT and high-resolution MR. Some were homegrown; others were acquired through alliance or merger.

Agfa HealthCare

The latest release of the Impax ES offers data synchronization, dictation software, and computer-assisted reading (CAR) capabilities, as well as a mammography workstation. An advanced RIS solution was designed specifically for imaging centers in the U.S. and Canada. Orthopedic software is being developed to assist in surgical planning.

  • Impax Web1000 5.0 ES features a Data Currency capability that improves communications by continually synchronizing information from the Impax Server to the Web1000. This translates into faster log-ins and image display speeds and greater memory. Conference mode allows authorized users to work interactively.

  • Impax integration with CAR software, which is similar to CAD, provides guidance in reading digital images. Days before the meeting, Agfa signed a letter of intent with Medicsight, the U.K.-based developer of the software, to integrate the software with its own platform and to distribute the package, which detects and measures colon polyps, lung lesions, and coronary artery calcifications.

  • The new IMPAX RIS, integrated with the company's PACS, is tailored to the workflow, integration, and implementation needs of imaging centers. It combines RIS, PACS, speech, document management, billing, and practice analysis workflow with Web access to reports and images.

  • TalkStation 3.0 provides advanced workflow and intuitive user interfaces.

  • Impax MA3000, a new mammography diagnostic workstation, retrieves, displays, archives, and distributes digital mammograms and can handle images from other digital modalities.

  • Orthopedics Spine Module, shown as a work-in-progress, is designed to help surgeons plan spinal surgeries, calculate scoliosis and vertebral rotation, estimate skeletal maturity, and compare patient values to normal ones.

Amicas

RealTime Worklist integrates the Amicas Vision Series PACS and Heartlab's Encompass cardiology PACS, providing access to cardiology and radiology images and reports. Patient status is coded by color for radiology and cardiology studies. Both the Heartlab Encompass and Amicas Vision viewer can be launched from within the RealTime Worklist; either allows access to the full suite of image manipulation tools appropriate to a specific study type. The integration evolved from a comarketing agreement between Amicas and Heartlab.

CoActiv Medical Business Solutions

Exam-PACS, an affordable modular PACS for imaging centers and hospitals with tight budgets, features enhanced access for referring physicians, robotic capabilities for CD burning, and the ability to integrate its archiving system with other PACS.

Communication Synergy Technologies

New document preservation and archiving technology addresses record-keeping problems. The software-based solution captures, preserves, and allows retrieval of radiology reports and other documents as part of the company's InForm RIS.

Document Vault, a black box about the size of a toaster, serves as an intuitive archive, capturing and preserving nonimaging data automatically. The vault can be installed physically onsite, or CommSynTech can provide the service as part of an ASP. Installed in the flow of data as part of the company's RIS, Document Vault:

  • archives radiology reports, intuitively autoindexing each one according to a predetermined filing and record retention strategy

  • manages compliance issues that have evolved from government regulations, most notably HIPAA.

DR Systems

RIS/PACS Release 7 incorporates radiology, cardiology, and pathology and enables Web-based scheduling and productivity tools. Features include:

  • autopulling of cases and reports

  • automatching of ICD-9 codes

  • improved RIS interfaces

  • expansion of mammography reading.

Dynamic Imaging

IntegradWeb, the company's Web-based PACS, features a new architecture and expanded clinical applications.

  • Fault Tolerant Grid Architecture is designed to assure continuity among multisite PACS deployments in the event of a network crash, allowing each site to function independently. Once the connection is reestablished, the architecture automatically resynchronizes each site with the central server to ensure integrated image access and workflow across all locations.

  • New software supports orthopedic templates, as well as streamlined analysis, management, and storage of multislice CT images. Postprocessing capabilities include an engine that automates image formatting to minimize storage space requirements after postprocessing. A new Slab Scroll Tool reformats in-plane images on the fly. A configurable data compression utility automates lossy image compression over time to create smaller file sizes as studies age.

Eastman Kodak

An enhanced version of DirectView System 5, scheduled for release in early 2005, allows improved customization and the ability to save display protocols. Also shown were a new PACS upgrade to mammography and a RIS tailored for use by freestanding imaging centers.

  • The new RIS/PACS version features an improved graphical user interface, streamlined exam reporting, an advanced report search engine for pulling up related cases, new radiologist-defined display protocols, and the ability to add electronic notes to imaging studies, as well as advanced processing tools such as 3D volume rendering. Referring physicians will be able to receive radiology reports e-mailed or embedded in an electronic medical record holding key marked images, with the option to view an entire imaging study via secure Web-based access.

  • DirectView Mammography Workstation, featuring an ergonomically designed hand controller, integrates digital mammography with general radiology workflow. It is part of the company's mammography PACS upgrade, scheduled for delivery in the first quarter of 2005. The upgrade supports image review and storage of full-field digital mammograms, as well as images obtained through other digital modalities. Display protocols are designed to enhance productivity. The hand controller is meant to reduce repetitive stress injuries such as carpal tunnel syndrome.

  • A work-in-progress RIS is being tailored for freestanding imaging centers. The company exhibited a prototype of this RIS 2010 version as part of a broader effort to meet the needs of imaging centers. Other efforts address teleradiology and scalable PACS.

FujiFilm Medical Systems USA

Synapse version 3.1 offers advances in data processing and presentation, extended dictation support, and DICOM query and retrieve functionality. The features will work when interacting with PACS other than those made by Fuji. The new software version is scheduled for commercial release in the first quarter of 2005.

  • An enhanced protocol reading function, called Clinical Conferencing and Series Renaming, saves the presentation of past series and changes series names, when necessary, to make them more consistent and easier to find and review. The "save" function eliminates the need to rearrange and navigate through images when revisiting a past study as part of a later collaboration or conference. The renaming feature further streamlines the diagnostic process.

  • DICOM SCU (service class user) makes other PACS behave as if they were Synapse, mapping the information contained in these systems into the Synapse infrastructure and allowing their images to be viewed using Synapse tools. This permits Synapse to be at the core of a multisite PACS implementation, as well as to operate within a multiPACS site.

  • Extended integration options for dictation systems supports vendors including G2 Speech, Lanier Serial Port, Powerscribe, Provox, Quadrat Speech Technology, and Talk Technology.

  • Dynamic Range Control and Image Sharpening, a work-in-progress, is being developed to port image optimization algorithms from computed radiography to volume-based exams such as multislice CT. When completed, this function will enhance and sharpen the borders of tissues with different densities such as bone and soft tissue, potentially improving diagnostic certainty in the interpretation of CT studies.

GE Healthcare

GE Centricity modules have been developed to display, archive, and transmit various forms of patient data from images to physician notes. Centricity EE is designed for large enterprises, while the newly developed Centricity SE is intended for use by community hospitals and imaging centers.

  • Centricity SE is a plug-and-play, PC-oriented, scaled-down version of the enterprise edition. SE, configured for image review and analysis but not for archiving, costs about $300,000. A fully functional configuration, including archiving and retrieving, costs up to $1 million. SE was developed in partnership with EMC, using that company's newly developed, low-cost Clariion AX100 networked storage system.

  • Centricity AW Suite complements both the EE and SE versions, offering the advanced computing capabilities of a dedicated workstation and the workflow benefits of a PACS in a PC-based, network-compatible workstation.

Guardian Healthcare Systems

FlowPoint RIS/PACS, obtained with the acquisition of U.K.-based Wise Systems in July, features Web-based and multilingual capabilities. FlowPoint PACS' Web services are embedded in the company's RIS, providing radiology patient information, image management, and Web-based imaging capabilities. FlowPoint enables enterprise-wide scheduling to optimize the use of radiology equipment and facilities. The comprehensive radiology patient record integrates images, voice, and data. Images and data are sent as a single digitized package.

  • Virtology Web services architecture uses the XML, DICOM, and HL7 standards, offering a versatile clinical platform that integrates disparate healthcare information systems.

  • DEVision image compression technology captures and compresses images to save disk space and transmission time.

  • MCubiX comprises methods for identification and knowledge extraction of images, text, and data.

Intelerad Medical Systems

Web-based InteleViewer supports image display and Tracer Tools that track the status of patient studies. The latest release features:

  • 3D capability, including MPR

  • tagging and indexing of images using CPT codes and other parameters to streamline the search and display of teaching cases.

McKesson Information Solutions

Newly developed Horizon Rad Station, a core component of McKesson's Horizon Radiology RIS/PACS suite, unites image and information management. The Web-based RIS/PACS includes image management, navigation, information management, workflow automation, and digitization of the patient record. The system integrates billing, claims, data distribution, and reporting functionality in configurations that can be stretched to handle imaging and outpatient centers, small hospitals, and large multisite enterprises.

Horizon Rad Station automates workflow by streamlining the assessment of images and patient data. Advanced features include:

  • adaptive image loading to optimize image display and navigation

  • virtual image management to support the visualization of data obtained using multislice CT and other high data volume modalities

  • clinical series mapping that enables common display protocols for vendor-specific DICOM implementations.

Merge eFilm

Two new software upgrades were released, one for the company's workstations, the other for its Fusion PACS and RIS/PACS.

Version 2.0, the company's new downloadable software version of its eFilm Workstation, allows the use of thumbnail images and PET/CT fusion and enhances user and log-in authentication.

The enhanced RIS/PACS Fusion eFilm 2.0 uses an advanced hanging protocol engine that provides automated, tailored display of diagnostic images.

  • Image layouts can be designed to speed image interpretation, accelerating productivity.

  • Protocols, which can be configured to meet the preferences of individual radiologists, are built with the emerging DICOM Hanging Protocol Standard to ensure future upgradeability.

  • A Roaming Profiles feature ensures that preferences can be accessed from any workstation on the network.

  • The Key Images upgrade allows radiologists to mark and save sets of key images from the studies. These images are then automatically displayed when cases are accessed by referring physicians.

Misys Healthcare Systems

The Misys Optimum family of clinical products, including Misys RIS-PACS solutions, connects community-based physicians to acute-care enterprises, using Web technologies. RIS/PACS solutions include a Misys Radiology information system interfaced with the Misys PACS Integration Module (PIM) and Image Management features.

  • Misys Radiology integrates information, images, and voice into a single information source.

  • Misys PACS Integration Module integrates Misys Radiology with any PACS via DICOM services, complying with IHE (Integrating the Healthcare Enterprise) guidelines.

  • Misys Image Management delivers, manages, and stores medical images, reports, and other data throughout the healthcare enterprise. Working over any TCP/IP network using a VPN, high-speed LANs or WANs, or low-bandwidth modems, the PACS hierarchical architecture provides centralized and distributed data management across multiple servers.

Neurostar

Virtual Radiology Network provides healthcare organizations a cost-effective way to connect to multiple facilities and to a virtual staff of radiologists, leveraging virtual or remote resources for radiology readings.

  • Virtual Radiology Network's architecture supports the management, flow, and archiving of images across a distributed network of sites and service providers. Readings are managed through configurable and comprehensive rules-based workflow, based on preset criteria such as date received, priority of case, and location of patient.

Philips Medical Systems

EasyAccess, Philips' PACS for radiology, has been bolstered by new features, an integrated RIS, and an advanced version of Philips' multimodality workstation.

  • EasyAccess has been enhanced with new software, hardware, and service tools that address the large-volume data sets being produced by multislice CT and high-resolution MR. EasyAccess Web has been redesigned to improve performance for offsite referring physicians.

  • ViewForum 4.1 offers improved handling of large data sets using Intelligent Volume Inspection to support protocol-driven viewing of large data sets in 3D with links to 2D images in a combined display on a single screen. Multiple exams (e.g., current and previous studies, pre- and postcontrast scans, and images from several modalities) can be viewed simultaneously.

  • Xtenity RIS integrates modalities, workstations, and other IT systems, including HIS. It features a rule-based scheduling engine, clinical documentation templates and shortcuts, automated charge capture for billing, and integrated speech recognition.

RealTimeImage

Homegrown Web-based iPACS technology supports scalable PACS such as the company's iPACS Prism for radiology.

  • Newly developed iPACS Cardio serves as an advanced cath lab solution, enabling full digital cardiology image analysis and workflow support.

Sectra Imtec

Sectra PACS can be tailored to cover radiology, orthopedics, cardiology, and mammography. The latest release features an enhanced workflow environment along with image distribution and remote reading capabilities. These include:

  • integrated RIS/PACS

  • enterprise-wide 3D and MPR/MIP functionality for multislice CT

  • streaming technology to facilitate image distribution

  • a Control Tower to monitor performance

  • an Interactive E-learning program.

A new workstation offers improved multislice visualization tools. A volumetric reconstruction package is now standard. Features support:

  • oblique and curved MPR measurements

  • bookmarking that allows radiologists to store and communicate findings and measurements to referring physicians.

Siemens Medical Solutions

Sienet Cosmos RIS/PACS, exhibited as a work-in-progress at the 2003 RSNA meeting, features the common syngo user interface and integration with the company's Soarian IT system, allowing access to electronic patient records. The Cosmos RIS/PACS, which can be scaled across hospital enterprises or to individual hospitals and imaging centers, can serve as a building block for an electronic health record system, according to the company.

  • An Internet browser allows exam and report viewing from any location in the network.

  • An integrated RIS component guides workflow from exam planning to image distribution and documents billing.

  • A fast transmission protocol, iMaxcess, accelerates image and data transfer, a development driven by the need to handle large image data sets such as those generated by increasingly powerful multislice CTs.

Siemens' Novius RIS enhancements include:

  • paperless workflow, including the ability to scan, manage, and distribute documents

  • predefined clinical alerts to notify users when clinical conditions have been met

  • clinical workflow improvements, such as flexible worklists and extensive teaching folder functionality.

SmartPACS

Economic PACS solutions are designed for small to medium-sized hospitals and imaging centers. The company's PACS and stand-alone Rapidia 3D software are being enhanced. A RIS/PACS, with software developed by Infinitt of Seoul, Korea, debuted as a commercial product along with a work-in-progress 3D workstation.

  • The Web-based system provides single log-on access to both RIS and PACS through the StarPACS.net Web server. The shared database expedites the transfer of data between the two systems.

  • Rapidia 3D now includes capabilities for brain subtraction and vessel analysis

  • The Infinitt RIS/PACS/3D Fusion, a work-in-progress diagnostic workstation, will be tightly integrated with RIS, PACS, and Rapidia 3D software, featuring a single log-on and single shared-user profile.

Stentor

The iSite PACS/RIS product line includes iSite Enterprise, iSite Radiology diagnostic reading station, and iVault online solution for long-term storage.

iSite PACS version 3.3 adds clinical features and functionality. These include:

  • remote reading/caching of exams for teleradiology

  • exam memos for improved collaboration among physicians

  • image processing filters to aid interpretation and diagnosis

  • a localizer tool for improved diagnosis and image navigation

  • updated key images tools

  • a CD manager for easy image distribution and management.

The iSite Platform program includes a core API (application programming interface) and supporting technologies that permit third-party applications to work seamlessly within the iSite PACS environment. Such applications can share user context, images, and related clinical information with other ITs and processing tools, such as electronic medical records and 3D imaging.

TeraRecon

AquariusNET 1.5 supports distributed user-friendly 3D applications through an enhanced image-processing server working in concert with PACS. Agfa, Amicas, Sectra, Delft Diagnostic Imaging, and Intelerad Medical Systems took advantage of TeraRecon's latest technology, integrating the AquariusNET 1.5 server on the RSNA exhibit floor, each with its own PACS.

  • Real-time 3D includes MIP (maximum intensity projection) and MPR (multiplanar reconstruction) tools.

  • Among special visualization tools are bone removal, vessel analysis, improved procedural workflow tools, and volumetric support for images acquired from the latest generation of 64-slice CTs.