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A Trendy 2009 RSNA

December 6, 2009
by Joe Marion
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I’ve just returned from the 2009 Radiological Society of North America (RSNA) which ran from November 29th through December 4th in Chicago. This was my 33rd consecutive RSNA, and each year proves to be more interesting than the next!

I thought I would summarize some of the interesting trends that I observed at this year’s meeting. Given an environment of anticipated healthcare reform, imaging vendors seem to be identifying some interesting areas to address to position themselves for the impending change.

Image Sharing

The cost and complexity of sharing images seems to finally be getting some vendor’s attention. Several vendors have identified an opportunity for improvement in the way that studies are exchanged between facilities. Instead of producing physical media (CD’s) and relying on either mail services or the patient to transport them, several vendors are developing applications that use the internet to communicate cases. See My Radiology (http://seemyradiology.com ), OneMedNet (http://onemednet.com ), and eMix (http://emix.com )all demonstrated applications which enable a user to easily upload a patient study from either the imaging device or a PACS, using a downloadable web agent. The user can then utilize various mechanisms on the internet to enable a download of the study to another location. Most use some means of authentication and encryption to ensure a secure transfer. The premise for these applications is that in large centers that receive a lot of outside referrals, the process will save time and resources over the current practice of accessing the CD’s for viewing or download into an existing PACS.

If consumer applications are any indication, these companies are onto something! Consider the fate of BlockBuster Video, and the impact of NetFlicks and others in terms of streaming video. If the internet can be used to lower the cost and improve the access to multi-media, it might certainly do the same for image communication!

Enterprise PACS Exchange

Another sharing trend appears to be bridging the way several facilities in a community might exchange information on a single patient by means of a common patient identification and/or repository. Several companies have been providing such a service for a while, most notably, Compressus (http://compressus.com ), which offers a vendor-neutral means of sharing information between collaborating providers. Now, it appears several large vendors have decided to offer similar services. Most notable amongst such vendors are Carestream’s SuperPACS (http://www.carestreamhealth.com/superpacs.html?gclid=CMyO0IaXwJ4CFchn5Qodf3o1pg ), and GE Healthcare’s Centricity OneView (https://www2.gehealthcare.com/portal/site/usen/ProductDetail?vgnextoid=e6d03954da950210VgnVCM10000024dd1403RCRD&productid=d6d03954da950210VgnVCM10000024dd1403____ ). Both are aimed as bridging the gap between disparate imaging systems or PACS and provide access to all patient data regardless of the originating source.

Such developments are important given the prospect of healthcare reform, in that they may be appealing to providers on a regional basis that may have already organized a Health Information Exchange (HIE) for results. Such capabilities enhance the ability of collaborating facilities to share patient imaging studies, with the potential to reduce the number of retake exams, and to speed up patient care. For example, for a patient presenting in the ER, it may be clinically relevant to access prior imaging studies that may have been done at a number of different facilities. Having the ability to see all the exams done for that patient could provide valuable additional information that might not otherwise be available to the clinician.

Enterprise Image Management and Access

Similar to the enterprise exchange, the topic of enterprise image management continues to evolve. Several companies have been active in this arena for several years, most notably InsiteOne (http://insiteone.com ), TeraMedica (http://teramedica.com ), Agfa Healthcare (http://www.agfa.com/usa/en/he/index.jsp ), Acuo Technologies (http://www.acuotech.com/home.html ), and DeJarnette Research Systems (http://www.dejarnette.com/1280/splashpage.html ). Prior emphasis has mostly been focused on DICOM communication and image storage. Services such as InsiteOne emphasized the ability to provide remote disaster recovery services. Vendors such as TeraMedica and Acuo Technologies emphasized broader services associated with enterprise-scale image management and access, including the ability to life-cycle manage patient studies, and provide simple integrated image viewing.

The latest trends are to extend these capabilities to address the emergence of other “ologies” into the true enterprise archive. There appears to be a difference of opinion regarding the best way to achieve this. Several vendors seem to be rallying around an approach that uses a DICOM “wrapper” to encompass any imaging object, while others take a “System Oriented Architecture” (SOA) approach that allows native objects to be maintained without encapsulation. It is not clear which approach will win out at this point, but the good news is that many vendors are now thinking beyond just one service area in terms of an enterprise solution.

Another trend in this area is an apparent further consolidation between “infrastructure” vendors and what have come to be known as “middleware” vendors. EMC (http://www.emc.com/?fromGlobalSiteSelect ) in particular appears to be further blurring the lines between infrastructure and middleware through the promotion of an Information Services Bus concept.

All of these developments bode well for true enterprise imaging, in that the concept of a true enterprise-scale application seems to be gaining traction. I will have more to say on this subject in subsequent blogs.

Image Enabling the EMR

A frequent panel message in several vendor exhibits emphasized how vendors can image-enable the EMR. Most notable in terms of such developments was Agfa Healthcare’s Xero product. Xero represents a novel approach to remote image access that provides a significant improvement in image display performance. Xero uses a hosted server located in the data center, and a zero footprint application at workstations to provide extremely fast image display and substantial image processing capability. Such viewer technology will be critical to gaining acceptance among clinicians – a key factor if imaging vendors hope to piggyback on the ARRA/Meaningful Use prospect for expanded EMR use.

Advanced Visualization

Advanced visualization applications are increasing as imaging protocols continue to produce ever larger data sets. The latest trend in 3D applications is the movement away from a single-workstation to client-server applications. For larger facilities that employ multiple 3D workstations, this represents a considerable improvement in both cost and performance, as a number of concurrent licenses can be deployed more effectively.

Several vendors including GE (Advantage Windows Server), TeraRecon (http://www.terarecon.com/index.php ), and Ziosoft (http://www.ziosoftinc.com/products_solutions/ ) demonstrated client-server configurations that allowed for rapid image processing, and include intelligent study processing to simplify user analysis. Earlier applications required knowledgeable users and many steps to perform a specific 3D analysis such as a cardiac ventricle analysis. For example, to see the vessels clearly, one step involves removing the boney structures. These modern applications employ intuitive algorithms that examine the file header information, identify exam parameters, and pre-process the images using predefined templates, so that the target view of the information is available when the user displays the study.

One vendor, Siemens Medical Solutions (http://www.medical.siemens.com/webapp/wcs/stores/servlet/ProductDisplay~q_catalogId~e_-11~a_catTree~e_100010,1007660,12752,1008407~a_langId~e_-11~a_productId~e_201741~a_storeId~e_10001.htm ) has taken this process one step further by addressing it from an overall workflow perspective. Fully integrated into the Siemens PACS workstation, the Syngo Via application addresses smart processing, but fully integrates it into the user workflow, making it far simpler to process image data sets. Such applications will become increasingly important as providers look to improve the efficiency of imaging operations to do more with less.

The following is meant to be a sampling of interesting technology seen at the 2009 RSNA. I apologize in advance if I have missed or misrepresented any vendor. I hope these observations are helpful to those who are interested and might not have had a chance to attend the RSNA.

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