Start-up firm builds touchscreen into high-productivity PACS

ITL integrates best rad practices in product

Big is not necessarily better in PACS. That is especially true when users need low-cost, tailored systems, as in the case of small community hospitals and imaging centers. Image Technology Laboratories (ITL) built its PACS with this type of customer in mind. But the building blocks that went into the product are robust enough to support a PACS capable of handling just about any size facility, according to executives at the start-up company based in Kingston, NY.

"We're starting small because the company is small," said Dr. David Ryon, CEO and president of ITL. "But the infrastructure of the system is such that we can scale it to any number of radiologists, any number of stenographers, and any number of modalities."

A system configured to support a radiologist reading MR and CT exams, a single stenographer transcribing reports, and a receptionist runs about $300,000. How big the system gets depends ultimately on the needs of the customer.

The integrated PACS/RIS, called ITLPACS, was designed around practices, not technology. Ryon, a radiologist who holds an advanced degree in engineering, began building the system in the mid-1990s to handle tasks at the imaging center he owned and operated in Kingston. When he and his colleagues were done, their system not only handled the imaging center but allowed radiologists in Ryon's group to provide overreading services for five hospitals in the surrounding area. Methods for managing everything from patient referral to diagnosis were programmed into the product.

"We integrated all the pieces, from patient registration to database creation, report generation, and image management," Ryon said. "And we did it in a system that creates a reading environment that is familiar to the radiologist."

Ryon sold his imaging center in 1997 but kept the rights to

ITLPACS. Ryon now runs the company with his entrepreneur wife, Valerie McDowell, and the two codevelopers of ITLPACS, Lewis Edwards, an expert in networking and image management, and Dr. Carlton Phelps, a radiologist with experience implementing commercial PACS.

Wall Street analyst McDowell arranged the financing for the company. Edwards, ITL's chief technology officer, has engineered the product from early on to support the day-to-day activities of radiologists. Phelps and Ryon together refined the interface.

"The placement of buttons and controls was designed and redesigned many times before we settled on what you see now," Ryon said.

The quartet introduced their product at the 2001 RSNA meeting, drawing onlookers to the touchscreen, which serves as the interface between user and machine. Rather than clicking a mouse or tapping a key, the radiologist traces a finger across the face of the screen, which is built into the top of a desk.

"This is an information appliance," Ryon said. "It's like a toaster. The radiologist's finger is a grease pencil for marking images; it's a pointer for choosing things."

The radiologist can circle regions of interest like John Madden circles players on football replays, or call up legions of images on any of nine high-resolution Dome-made monitors that tower behind the touchscreen.

Images appear as thumbnails on the touchscreen. They are displayed at up to 3-megapixel resolution on the monitors. The radiologist dictates reports, which are digitally recorded and sent to a stenographer. Transcribed reports go back for the radiologist to review, digitally sign, and send to the referring physician.

"It is blazing fast," Ryon said. "I don't have to worry about my hand-eye coordination with a mouse or typing anything on a keyboard. All the work is routed to me automatically. All I have to do is use my finger to select what I want."

Two business development consultants, Randee Wood and Judy Flynn, are focusing marketing efforts on imaging centers and community hospitals. For the time being, they are focusing on leads obtained during the RSNA meeting. From this list, the marketing team is setting up site visits and presentations, mostly for imaging centers and small to medium-sized hospitals. But not all of the interest is coming from fixed sites.

"We talked to one company interested in putting our equipment on a mobile unit so they can transfer images and data to a radiologist at another site," Ryon said.

With a system as flexible as ITLPACS, prospective customers can play as big a role in defining the product as engineers in the company.