PACS must bring images 'home' to physicians in remote locations

Custom formats may provide answer

For PACS to live up to its potential, it must deliver images to physicians anywhere-on the road, at home, or in a remote office. The practical problems, however, have been formidable. PACS must distribute diagnostic-quality images without overloading the network or server, and it must do sso without inundating physicians with ancillary information that might keep them from finding the necessary information. The way to do that is to develop technology that gives physicians only the images they need when they need them, customizes image distribution to meet individual physicians' preferences, and adapts to less-than-optimal bandwidth, according to three vendors.

Three-year-old Stentor of South San Francisco uses dynamic transfer syntax, a wave link coding technology licensed from the University of Pittsburgh Medical Center. This technology sends raw imaging data on a just-in-time basis via wavelets to off-the-shelf PCs in the operating room, emergency room, hospital wards, or practice settings. Physicians can navigate through imaging exams, select specific regions of interest (ROIs), and double-click to instruct PCs to process and display full-fidelity images of only those ROIs. In 80 sites across the U.S., Stentor's iSite thin-client model runs on the institution's existing IT infrastructure, which saves on upfront or replacement hardware costs. Hospitals pay a single monthly charge for every imaging study viewed.

Through its patented output data management technology, DR Systems of San Diego tailors image delivery to radiologists' and referring physicians' practice parameters. Rather than randomly dumping a pile of images on PCs, the technology submits case data according to physicians' preselected viewing formats (six on one, four on one, or spread across all monitors) and routing schemes directly to a printer, fax, or specific IP address. In addition to increasing its major installations, which currently tally up to 80 in the U.S. and Asia, the company seeks to capitalize on its customized radiologist and referring physician database by licensing its technology to major PACS vendors, said Richard C. Porritt, president and CEO.

VisualPACS, introduced at the 2001 RSNA meeting by Ultravisual Medical Systems of Madison, WI, is a thin-client, Web-based package that adapts to any bandwidth, even a cable modem, to bring high-end 2D, 3D, and multiplanar image processing, as well as JPEG 2000 image compression and image fusion to the home or office. The company's patented imaging pipeline intelligently assesses the amount of imaging data being sent across the healthcare enterprise, automatically selects and compresses the largest series, and sends the images from the server over whatever bandwidth is available.

"Because our system is launched from a browser, rather than running inside a browser, our launching mechanism delivers the latest version of the software to the (recipient) PC, installs it if necessary, and delivers all the user interface settings, customized protocols, etc., right to the workstation," said Kelly Pickard, vice president of business development. "Regardless of where they are, physicians are 'home' because everything they did at the office, every ER read they did over the weekend, they can get at home."