Well, the 2012 RSNA (Radiological Society of North America – www.RSNA.org) is history. Having now had the weekend to think about the event, my initial reaction is that the meeting is even more a dichotomy of messages. Here are some of my initial impressions:
RSNA in Name Only!
Over the past decade, the RSNA has become an international meeting! The Radiological Society of North America is now in name only. This year in particular, there seemed to be a large proportion of international attendees. Unofficial word is that attendance was down from last year, impacted by the state of the European economy. But overall, international attendance seems to be an increasingly important aspect of this meeting.
The “S” in PACS Stands for Segmentation
For the past few years PACS has moved further from an integrated system to segmented sub-systems. First it was the archive as facilities moved to consolidate infrastructure. Then came Advanced Visualization as an extension of existing PACS, the theory being that one could extend the life of a core PACS by adding advanced image processing capabilities. Now vendors are addressing areas such as workflow and clinical viewing capabilities.
There are those that would argue that one could assemble a PACS from among components. For example, one could start with a VNA (Vendor Neutral Archive) and add workflow management, displays, advanced visualization, etc. to assemble best of breed. Several vendors, most notable among them Visage Imaging (http://www.visageimaging.com/) have taken this position for several years, stressing how a dated PACS could be updated simply by adding components from Visage. Similarly, Medicalis (http://www.medicalis.com/) is challenging the very nature of a RIS (Radiology Information System) by offering radiology workflow solutions tailored to electronic imaging workflow. It seems the days of fork lift RIS/PACS updates are all but over.
Meaningful Use MIA
With Stage 2 Meaningful Use now completed and input starting on Stage 3, I would have expected more messaging with respect to Meaningful Use. I was surprised this was not a strong theme by PACS vendors looking to capitalize on imaging’s inclusion in Stage 2, as slight as it is.
Instead, it seemed as if full-service equipment vendors were focused more on departmental applications than with how imaging fits into the enterprise. Some peripheral vendors, most notable, Vital Images (http://www.vitalimages.com/home.aspx, a Toshiba company), and Terarecon (http://www.terarecon.com/wordpress/) emphasized that their focus is on enterprise imaging, but outside of this, MU did not seem to be a major attraction.
Advanced Visualization Dichotomy
Over the past few years the trend had seemed to be for advanced visualization to be moving to a client-server architecture and away from discrete workstations. This would seem to be consistent with an enterprise perspective to imaging and a recognition of the needs of multiple service areas for advanced visualization. I was therefore surprised to see multiple vendors (Agfa, Carestream, GE, McKesson, etc.) promoting the notion of greater advanced visualization applications built into basic PACS workstations. The rationale given is that this enables the radiologist to perform 80 percent of advanced visualization applications without having to go to another workstation.
I am confused by this trend in that it seems counterproductive to efforts to push advanced imaging beyond radiology! Other clinicians have legitimate advanced visualization needs, and that seemed to be well served by the push toward client-server configurations. The dedicated advanced visualization vendors (Vital, Terarecon) still seem to be committed to this approach. It seems like two different playbooks to the same game.
Who Controls Enterprise Imaging?
As above, the lack of emphasis on enterprise imaging was another dichotomy. It seems the full-line equipment vendors are focused on radiology viewing needs outside the department, while the dedicated viewer and archive companies place more emphasis on enterprise viewing.
Yes, just about everybody and his uncle had some form of zero footprint viewer displayed. The real question seems to be the basis for such devices. It is as a convenience for the radiologist to access images outside the department, or to finally make some use of an Apple device? Or is it truly to enhance imaging accessibility on an enterprise level? It seems the viewer and VNA vendors are more focused on the latter strategy than the full-line vendors.
Case in point. Client Outlook (http://www.clientoutlook.com/) put forth the premise that facilities are finding that it takes a long time to implement a VNA strategy due to the necessity to migrate data into the VNA. Hence, sites have not perceived the need for a universal viewer until a VNA is in place. According to Client Outlook, leading with a universal viewer that can draw from individual PACS as well as a VNA means that a site could capitalize on the benefits of a universal viewer even before the VNA is implemented. Acuo Technologies (http://www.acuotech.com/) pointed out that implementation of a federated archive that can pull images from a number of archives could likewise satisfy this need prior to a full migration.
Total Dose Management
Last year Radimetrics (http://www.radimetrics.com/default/) received considerable attention from its radiation dose management application, as managing radiation dose has become increasingly important. Several companies have incorporated the Radimetrics product into their RIS and PACS offerings.
This year, Bayer Healthcare surprised the industry by announcing its intent to acquire Radimetrics. Bayer already had a distribution agreement with Radimetrics, and emphasized “Total Dose Management” as its theme. With the acquisition of Radimetrics, Bayer now offers a complete solution to dosage, addressing both radiation and contrast dose – hence the total dose management moniker.
While several other companies have developed their own dosage capabilities, Bayer seems to be unique in addressing the full picture. It will be interesting to see how others respond to this move.
Smart Imaging Decisions
As I have previously blogged, National Decision Support Company (NDSC - http://www.acrselect.org/) is the exclusive licensee of the American College of Radiology (ACR) for clinical decision support rules. NDSC has licensed the application to a number of companies and is promoting the use of clinical decision support as a means of addressing the overutilization of medical imaging – relevant topic in today’s changing healthcare environment.
Just as it is hard to see everything at the RSNA in five days, it is equally hard summarizing all that I learned in one blog! I’ll have more to say on many of these topics over the course of the year. Suffice it to say, this year’s RSNA was an exciting event of mixed messages. Perhaps as healthcare reform really starts to take hold we will start to see more clarity, and Radiology’s role will become clearer. It should make for some exciting future RSNA’s!