Quality of PACS/IT offerings buoys enthusiasm

The excitement surrounding PACS is palpable. Vendors describe PACS as a growth market with double digit compounded annual growth and a target market only 15% to 25% penetrated. Current estimates have the global PACS market pegged at more than $2 billion, with individual RIS sales adding another $200 million plus. By the end of the decade, demand for RIS and PACS is expected to grow to more than $4 billion worldwide.

This special breed of IT is riding the backs of several allies:

• cardiac and orthopedic applications migrating from dedicated workstations onto networks

• teleradiology and its battle against the shortage of radiologists

• digital mammography, with the rising tide of data streaming from the increasing number of full-field digital mammography systems

But none is more powerful - or fundamental - than the advanced visualization tools now becoming available. Impressive 3D capabilities are being leveraged, particularly volumetric reconstructions, to lift radiographic data to a new level. These data, obtained tomographically using articulated arms holding flat-panel detectors, are being processed onboard the Philips, Siemens, and GE systems that acquire them.

Vendors are also coming up with new and better ways to deal with the large data sets coming from digital mammography. Brit Systems is approaching this and 3D PACS with a multimodality mammography workstation and PACS-native 3D tools. On the horizon are 3D reconstructions of advanced-slice CT, which are sure to boom with the introduction of Toshiba's 256-slice scanner in 16 months.

RIS/PACS integration drives productivity through the secondary growth of tools designed to handle administrative functions, often modules or integrated capabilities, either optional or standard. Houston-based Absolute Medical Software Systems has enhanced the practice management functionality of the RIS for claim submissions, insurance, and self-pay collections.

Meanwhile, CAD is growing on the heels of increasing adoption of digital mammography, which could accelerate rapidly with rising use of computed radiography. This modality continues to evolve from mammography into other areas, notably chest radiography, particularly with the decision this year by third-party payers to reimburse for lung CAD. In the future, any element of the diagnostic imaging process that challenges interpretation is fair game, particularly virtual colonography and coronary CT angiography.

CAD developers will have to adapt, however, to an increasingly volumetric world. As 3D interpretations take over, CAD programs must deal with these reconstructions, a situation already apparent in lung CT. Emphasis will continue to be on reducing false positives, which are the bane of interpreters. This inherent flaw of CAD, the need to look back or even just include the assessment of a computer-generated analysis, is being mitigated by the tighter integration of CAD into PACS and radiologist workflow. Specifically, PACS developers are making CAD markings and analyses part of the presentation.

Scalable archive technologies have become indispensable as facilities try to maintain flexibility. The devastating effects of Hurricane Katrina and the prospect of another rough hurricane season underscore the importance of disaster recovery and backup capabilities, not only along the U.S. coastline but wherever trouble can strike. InsiteOne has come out with its next generation of InDex to address both needs, a virtual storage architecture based on intelligent archiving software to manage and archive critical patient data throughout the clinical organization.

Offsite storage facilities have also gained allure. Interest in application service provider (ASP)-like PACS, however, is arising mostly from budgetary considerations and the freedom the systems provide from the constant need for capital investments. Philips Medical Systems iSite PACS, which the company recently upgraded to version 4.0, is an example.

Teleradiology is having an effect as well, particularly on small facilities such as community hospitals that require subspecialty coverage as a result of the inevitable creep of technology into superpremium performance and the increased clinical capability that comes with it. To answer that subspecialty coverage need, Neurostar has come out with RadExpertOpinion.com, an innovative service providing radiologists with Internet-based subspecialist consults as needed.

Two leaders in teleradiology, NightHawk and Virtual Radiologic, are packaging homegrown productivity tools for the radiology community. NightHawk's Talon, a version of the company's workflow engine, creates, updates, and routes work lists and images. Virtual Radiologic's Infrastructure Solutions suite comprises workflow technology and business operations support for teleradiologists who want to improve productivity.

This multifaceted activity has spurred a rash of new companies to enter a marketplace they see teeming with activity, littering the landscape with value-priced PACS products that provide the basic capabilities most demanded in radiology. These vanilla-wrapped products are to IT what generic drugs are to pharmaceuticals and, much as generics are hitting a sweet spot in a cost-challenged marketplace, so are these low-cost PACS appealing to budget-strapped hospitals and imaging centers.

Simplicity is the key to addressing this marketplace. Meta Fusion has launched Helium RIS/PACS for imaging centers and small hospitals. Helium ships preconfigured to a customer's specifications, eliminating the need for IT support. Setup requires only that the site attach to the network and add minimally configured a PC-based viewing station.

Other established vendors are ratcheting up the performance of their products. Merge is about to come out with its Fusion RIS/PACS MX, and Misys has developed software to simplify the operation of the ambulatory imaging center.

The largest vendors of these products are now looking to midsize and small facilities to grow their sales. Established vendors will have an advantage, not only in their credibility but also in their ability to migrate capabilities from premium products to lower priced ones, mirroring the scalability that is becoming so important in data archives.