PACS pioneer Lemke now calls that model inadequate

As imaging and computers become increasingly important to surgery, new models that emphasize communicating real-time data rather than archiving will be needed. The answer could be Therapy Imaging and Model Management Systems, or TIMMS.

"TIMMS will be the 'PACS' of the future surgical suite," said Heinz Lemke, Ph.D., a research professor of radiology at the University of Southern California and senior scientific advisor on medical informatics for Innovation Center Computer Assisted Surgery at the University of Leipzig in Germany.

Lemke is wary of using the term PACS for the infrastructure needed to help surgeons navigate multidimensional information in real-time, including pre- and intraoperative imaging, metabolic measurements, and other real-time functional data. In the last few years, some companies have tried to shift a radiology PACS into surgery, not understanding that surgery needs an entirely different approach. Recognizing this different need, Lemke and colleagues have designed TIMMS, which has been accepted in the DICOM workgroup.

How this approach relates to radiology remains to be seen, but Lemke introduced the concept to radiologists at the 2007 European Congress of Radiology.

"If radiologists would like to play a part in this, they will have to recognize that surgery is not diagnostic. It includes diagnostic components, but the images and the result of processing images is not radiology. It's something different," he said.

It's no longer feasible for radiologists to tell a surgeon that there is a lesion. The images should give the surgeon information about the lesion's dimensionality, pharmokinetic processes, and metabolic processes. The need goes beyond showing surgeons 3D volume-rendered images to help them navigate surgery and includes the fourth dimension of time.

"We have to reevaluate what surgeons need in terms of today's surgical suite, which includes information such as electronic medical records, proteomics, and tissue characterization. All this information has to be available at the surgeon's fingertips, seamlessly integrated in one system," Lemke said.

The key here is the ability of the radiologist to be involved with therapeutic imaging as real-time functional data conveyed to surgeons, according to Lemke. Unlike radiologists, surgeons work in real-time. Every subsecond matters when they are moving within the patient's body. They need images and models, for example, to recognize what's behind the tip of a cutting instrument.

"It's not possible that every surgical discipline can have a team to provide this segmentation, modeling, and preoperative image processing. We need a service in a hospital that understands images and image processing and translates them to the surgeon. The best department that should do this is radiology," Lemke said.

ADVANCED DATA MANAGEMENT

Researchers have designed Therapy Imaging and Model Management Systems, a sort of PACS for the surgical suite, to help seamlessly manage various anatomic and functional data in real-time:
Pre- and intraoperative imaging
Lesion size
Lesion dimensionality
Lesion pharmokinetic processes
Electronic medical records
Tissue characterizations
Proteomics
Other metabolic and functional data