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RSNA 2011: The Communalization of Imaging?

December 3, 2011
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Expanding the social nature of imaging

Another Radiological Society of North America (RSNA) annual conference has come and gone. So what did Santa bring the Radiology community this year? In one word, my answer is the “communalization” of imaging! From my perspective, the major imaging emphasis is very much on expanding the social nature of imaging in a changing healthcare environment. The following are my first impressions from the meeting that relate to this trend.

Continuing PACS Modularization

Last year I reported a trend I called “PACS Modularization.” In the growth days of Radiology PACS, vendors sold complete systems that acquired, stored, and communicated images. With a saturating market, not everyone is in a position to discard an existing PACS. The emergence of enterprise archives and advanced visualization products allows facilities the opportunity to add capabilities to an existing PACS without throwing away the basic system structure – a far more economical approach! The addition of more enterprise archive vendors and expanding image visualization options continues the trend in 2011.

Cloud Proliferation

Continuing a trend from 2010, one could say that 2011 was very cloudy! It seems that the “cloud” is the buzzword for 2011. Practically every PACS vendor in addition to the classical “VNA” (Vendor Neutral Archive, and yes, I really dislike this term as it is nondescript!) vendors announced some form of cloud. Even the Advance Visualization vendors such as Terarecon (http://www.terarecon.com/index.php) and Ziosoft (http://www.ziosoftinc.com/) are in the game, with cloud based image rendering capabilities. Having a cloud capability is imperative to the communalization of imaging, as it acts as the conduit for accessing images remotely, or with remote devices.

Expanding Image Accessibility

Last year the device of choice for image access mobility seemed to be the Apple iPad. This year Fuji, Carestream, Infinitt, and McKesson, to name a few, added Android tablets as well. McKesson was even able to demonstrate their application on a Kindle Fire! While Apple is prevalent throughout healthcare, Android seems to be growing, and it will be a significant addition for image access mobility. Coupled with the cloud, the ability to access images on tablet-type devices opens up an array of new applications involving the use of images.

Another growing development is CD replacement applications. Prior to the RSNA, Merge Healthcare (http://www.merge.com/) introduced their Honeycomb application for image sharing, including a free service for images in the cloud. The expectation was that this would be a game changer for some of the more established vendors such as LifeImage (http://www.lifeimage.com/), eMIx (http://emix.com/), and Accelarad’s See My Radiology (http://www.seemyradiology.com/). In reality, Merge’s “free” access is limited and did not seem to be a major differentiator to others. What is intriguing about these services is the similarity to other “social networking” applications such as Facebook and LinkedIn. The user interface and methodology for sharing a study either with a sub-specialist or another facility is enhanced by the simplicity of the social networking approaches and will foster their acceptance.

Meaningful Use and Decision Support

Last year several vendors emphasized decision support applications to reduce the ordering of unnecessary studies based on rule sets. This was further expanded this year with the addition of MedCurrent’s OrderRight application (http://www.medcurrent.com/). MedCurrent’s differentiator is a Rule Authoring Studio which enables the facility to modify the ordering rules to their specific needs. For example, assume a facility doesn’t have an MRI. It would be advantageous to modify the rules so that an MRI is not specified. Other vendors argue this is not an issue as their rule sets can recommend multiple options should one not be available. Regardless, the opportunity to generate significant improvement in orders is both favorable from cost and quality perspectives.

Dose Monitoring

Another significant trend is the integration of dose monitoring applications into PACS workstations. Pending legislation changes in such states as California will require closer dosage monitoring. One such company is Radimetrics (http://www.radimetrics.com/default/), which has interfaced its dose tracking application with several PACS vendors. Such capability enables both staff and radiologists to improve their awareness and sensitivity to patient cumulative dose levels and to modify procedures accordingly. Radimetrics also demonstrated a unique application of consumer gaming technology, incorporating the weight measurement capabilities of a Wii Balance Board with the xBox 360 Kinect. The result is a simple mechanism to measure body mass index for more accurate dose selections prior to exams.

Workflow

Expanding from last year, additional vendors have further improved workflow integration with advanced visualization. In the past, a radiologist would review a 2D case and then launch a 3D application. Since there was little integration, the radiologist would then select a protocol such as a Left Atrium Analysis and wait for the algorithm to process before reviewing the results. Building on a more simplified workflow, systems such as Siemens’ syngo Via utilize parameters from the patient header information to identify the type of exam and use it to preprocess the appropriate algorithm. Greater integration of 2D and 3D processes means that physicians can seamlessly move between applications further improving workflow.

Another interesting development was that of AZE (http://www.aze-ten.com/en/topics_news.html), which showed a works-in-progress application called Phoenix. Selecting a patient brings up a screen of interactive thumbnails for all procedures. Selecting a protocol such as Oncology then launches a hanging protocol specific to an Oncology analysis, thereby simplifying how the user presents information. The utilization of unique user interface elements seems to be progressing to simplify and improve the user experience.

SaaS

The advancement in networking and cloud computing have driven efforts to lower the total cost of ownership for PACS. One such area is the growing trend toward Software as a Service PACS, in which on site components are minimized in favor of moving them to the cloud. Carestream Healthcare (http://carestream.com/default.aspx?LangType=1033), and Infinitt Healthcare (http://www.infinitt.com/) both prominently emphasized SaaS product offerings. Both can offer software-only solutions to run on customer’s hardware, to fully hosted applications. Depending on the size of the application, a local gateway can be used to buffer image acquisition. The advent of zero footprint viewers adds the flexibility of enabling image interpretation either on or off site – ideal for smaller facilities that may not have a dedicated radiologist. These advancements in technology have provided even greater flexibility in the application of PACS.

Overall, this was a watershed year for imaging informatics. My perception is that the industry continues to find ways to use innovative technology advancements (many from consumer applications) to improve the efficiency and efficacy of healthcare at a lower cost. Of particular interest to me is how radiology seems to be adapting to changing social practices, particularly with respect to image distribution and access, and at an accelerating pace. Look how fast the tablet PC has been embraced. I for one am glad to see that innovative uses of technology can improve the diagnostic and treatment process in this changing healthcare environment. I can’t wait to see what’s new at RSNA 2012!

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