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RSNA 2010: A Year of Imaging Revelations

December 6, 2010
by Joe Marion
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Now it is up to the vendors to deliver on their promises

Well, another year is over! The lights are off, and the floor is empty. 2010 was a transitional year for PACS technology in many ways. In my last blog I made several pre-RSNA predictions, and in retrospect, I didn’t do too badly! I only missed on the messaging riding the coattails of EMR and Meaningful Use. One vendor representative had the best perspective to why this wasn’t more publicized. In his view, RSNA exhibits tend to be cast in concrete by sometime in September. Since certification for EMR’s was not complete in that time frame, many vendors were probably waiting for post-certification for any announcements. That makes sense to me, and probably is a good an explanation as any as to why there seemed to be a lack of relationship to EMR/Meaningful Use.

That being said, it was clear that Meaningful Use is having an impact on PACS and imaging practices. I’ve summarized my preliminary thoughts on the meeting into what I call the “three M’s.”


As expected, my prediction of the highest concentration of iPads was certainly true. A significant amount of PACS vendor effort was devoted to mobile devices, led by the iPad. Practically every vendor involved with image visualization had some form of display capability on the iPad, or similar devices (Dell Streak), but by far and away, the iPad seemed to be the platform of choice.

Most applications demonstrated the ability to act as a remote client for accessing and viewing images. McKesson for one took this one step further, recognizing the limitations of the iPad for full image analysis. Their works-in-progress application had the twist of being able to launch the study on their diagnostic workstation, and even controlling image manipulation on the work station using the iPad gestures.

The other major trend toward platform independence seems to be a zero footprint client. Agfa Healthcare has been most active with their IMPAX Xero application. By using the server to do the processing, the speed and broad accessibility of these display applications is impressive to say the least – particularly as data sets get extremely large.


Up until the past few years, the marketplace viewed PACS as integral systems that did it all, including acquisition, display, and archive. As the technology has matured and expanded beyond just radiology, the core technology has pretty much become a commodity. How many variations can there be in terms of displaying and manipulating images?

As the core product has matured, vendors are looking for ways to extend the technology and generate new business opportunities. The result seems to be an effort to de-systematize PACS! Hence, the emphasis on “vendor neutral archives” (VNA) and “advanced visualization.” One vendor suggested that their exhibit traffic was predominantly people with a legacy PACS who were looking to expand or replace it, but perhaps have budget limitations. They might add a VNA to expand to enterprise applications, while at the same time consider alternative viewing technology that is more advanced or capable than their existing system.

Advanced visualization seems to be going this direction as well. Previously, it was perceived as an add-on application, requiring a dedicated workstation, and specialized processing to produce a result for the radiologist’s review. The current trend seems to be toward client-server applications that require a very thin client and can be accessed directly via a PACS workstation. In addition, many of the vendors are addressing the workflow aspect of the use of 3D processing. Siemens has led the way with their syngo Via application, which can identify from the header information the reason for the study and use this to apply fixed processing algorithms based on the type of study. The result is a seamless integration of 3D with the PACS workstation that enhances the radiologist productivity and encourages the use of 3D processing.




Your predictions turned out to be very prescient! And your observations here are, as always, totally on target. Per meaningful use, I think one of the challenges is that those in the imaging and imaging informatics areas do not perhaps entirely grasp all the implications of HITECH and MU, since some elements remain cloudy.
Meanwhile, you're very right, per data analytics, and I also believe that the reporting out outcomes data will be important. It will be very interesting to see whether stages 2 or 3 of MU recognize the importance of imaging informatics in achieving key goals.