Applied Radiology

As available technology continues to evolve, many large healthcare organizations are looking to Web-based picture archiving and communications systems (PACS) to move images beyond the walls of the radiology department to create "virtual" radiology departments.

In an interview with Applied Radiology, Peter McClennen, national marketing manager for imaging and information networks for FUJIFILM Medical Systems USA, Inc. (Stamford, CT), discussed this trend.

Enterprise-wide PACS systems

"Many of the large integrated delivery networks are now looking at PACS as a way to gain efficiency," McClennen noted. Moving beyond the radiology department, these organizations need to distribute images across a very large enterprise, encompassing a variety of practices and facilities, and covering a wide geographic area.

Two large healthcare organizations have signed agreements for enterprise-wide installations of Fuji's Synapse PACS: Austin Radiological Association (ARA; Austin, TX) and Via Christi Regional Health System Regional Medical Center (Wichita, KS).

ARA is installing the new system in 14 outpatient imaging centers and will provide teleradiology services to 10 local hospitals in the Austin area. "With 60 radiologists and 2500 referring physicians within our 4-county network, we need a powerful system to distribute and view images simultaneously," said Greg Karnaze, MD, president of the ARA group.

The system is expected to handle approximately 300,000 outpatient exams annually. The completely filmless system will operate as a single Web-server data center with all of the facilities and physicians' homes interconnected. All images will be read and distributed on the single system.

For the radiologist, it will mean that all of the imaging information from all of the facilities will be available at any location. "Wherever you are reading, you have access to all the historical images from all the facilities, not just the facility at which you are reading," said McClennen.

In addition to the customizable desktop, each user is given a personal folder within the system that roams with them. "So if you are in the ICU today, you put cases in your own folder and when you are in your office tomorrow and you want to review those cases, they will have traveled with you," explained McClennen.

For patients, there is the benefit of having all of the relevant prior studies available for physicians to review at any time regardless of where the original images were obtained.

Integrated Web technology

According to McClennen, Synapse is currently the only PACS using fully integrated Web technology. Generally, systems that use appended Web technology are designed for in-house radiology use only and employ different systems to distribute images.

By using the integrated Web technology, everything becomes a Web page, noted McClennen. "So, you can easily look at information from one hospital, or click over to information from another hospital, or merge it all together," he said. In addition, the tools available in the radiology department are also available everywhere else within the system. "This creates a more consistent work environment for all the different physicians," said McClennen.

Todd Thomas, director of information technology at ARA noted additional benefits to this type of system. "Both Synapse and our radiology information system use Microsoft Internet Explorer (Redmond, WA) as the user interface. This eliminates a large number of implementation issues," he said. "The familiar user interface also means there is little end-user training required. Since all images are displayed as Web pages, users simply view the images through the browser."

Diana Hilburn, vice president and chief information officer at Via Christi, agreed. "We wanted an open-architecture PACS that could also integrate into our Web portal for physicians," she said, noting that this new system is "synergistic with our hospital's information system strategy of building on primarily Web-integrated solutions."

Virtual radiology

With this type of enterprise-wide PACS, a large healthcare organization can create a "virtual radiology department" with centralized reading and workload sharing. Radiologists will not be limited to reading studies acquired in the same building. With the centralized reading model, images can be matched to the radiologist based on subspecialty rather than geographic location. So, for example, a neurologic radiology subspecialist will be able to read all neurology cases across all the facilities within the organization.

"I think it's really going to break down the barriers," concluded McClennen. "Previously, referring physicians had a difficult time getting information, and when they could get the information via Internet tools, they were very weak tools; tools different from those they used in the radiology department. This system is an enabling technology that allows you to streamline processes."

Synapse was released in 1999, and more than 50 systems have been installed to date.

AHRA to develop administrator certification program

At its 29th annual meeting in Las Vegas, NV this month, the American Healthcare Radiology Administrators (AHRA) Education Foundation announced that they are developing the industry's first certification program for radiology administrators.

Radiologists who wish to participate in this voluntary program will receive study materials and must take a standardized test. Those who pass the test will be awarded a certificate. The certification will be known as CRA, Certified Radiology Administrator, and will meet the standards for credentialing programs set by the National Commission for Certifying Agencies. The first test is scheduled to be administered in conjunction with the 30th annual AHRA meeting next summer in New Orleans, LA.

"The role of radiology administrator has changed rapidly in recent years," noted J.D. Mace, chair of the AHRA Education Foundation. "A credentialing program will identify the current scope of responsibilities and skills that are required for the position, and allow prospective and current radiology administrators to demonstrate their acumen in these areas."

The development of this program was supported through an educational grant from Eastman Kodak Co. (Rochester, NY). "We believe this certification program will help identify outstanding achievements made by individual radiology administrators. It will also showcase the value radiology administrators as a group bring to their healthcare organizations," said Richard F. Cimino, vice president of Eastman Kodak and Americas area business general manager of Kodak's Health Imaging division.

New contrast agent for echocardiography approved

DuPont Pharmaceuticals Company (Wilmington, DE) has received FDA approval to market its new ultrasound contrast agent, Definity (Vial for Perflutren Lipid Microsphere Injectable Suspension). The new agent has been approved for use in patients with suboptimal echocardiograms to opacify the left ventricular chamber and to improve the delineation of the left ventricular endocardial border. It is believed that such improved imaging will allow clinicians to better distinguish between normal and abnormal heart structure and motion.

Phase III clinical trials, involving more than 1,700 patients at more than 20 medical centers, found that echocardiography with Definity produced more detailed images of the heart in difficult-to-image patients versus echocardiography alone. Images obtained with the contrast agent provided a more accurate assessment of segmental wall motion compared with unenhanced images. The study also found that when patients with incomplete images of their heart were re-assessed with contrast, an evaluable echocardiogram was achieved in up to 91% of patients. In addition, the researchers reported that echocardiography with Definity provided statistically significant improvements in endocardial border delineation. The most frequently reported adverse events included headache, back or renal pain, flushing, nausea, chest pain, and dizziness.

"Many cardiologists are challenged by the dilemma that patients who are at the greatest risk of developing heart disease are often the most difficult to diagnose with routine ultrasound," said Martin Goldman, MD, clinical trial investigator and professor of medicine at Mount Sinai School of Medicine. According to research from ARM Inc., of Malvern, PA, up to 20% of echocardiograms performed in the United States without a contrast agent provide insufficient information to make a definitive diagnosis.

Definity, which is the first non-blood-derived ultrasound contrast agent to be approved in the U.S., can be dosed as either a bolus injection or continuous intravenous infusion. It should not be administered to patients with known cardiac shunts, and caution should be exercised in patients with chronic pulmonary vascular disorders and in those who may have cardiac shunts.

DuPont expects Definity to be available in early fall.