This month’s column focuses on some of the techno-logical advances introduced at the 85th Scientific Assembly and Annual Meeting of the Radiological Society of North America, held December 1999 in Chicago. The author reviews some of the information and imaging systems presented as part of the Integrating the Healthcare Enterprise demonstration.
RSNA 1999: reaching for a global integrated healthcare
Walking through the biggest radiology meeting in the world feels
like a powerful antidote to the poisonous effects of managed care
on healthcare. Just days after the cover of a national weekly news
magazine screamed "HMO Hell," a trip to the 85th Scientific
Assembly and Annual Meeting of the Radiological Society of North
America (RSNA) seems like technological heaven. Maybe the end of
the 20th century marks both "the best of times" and "the worst of
times" in modern medicine.
The RSNA 1999, held November 28 to December 3 at McCormick Place
in Chicago, brings to mind a few more dichotomies. Innovations in
image data transfer progress as fast as lightning, yet the actual
widespread implementation of picture archiving and communication
systems (PACS) moves at the speed of a glacier. Large companies
can't survive unless they merge into gigantic corporations, yet an
entrepreneurial spirit pervades the radiology industry as if it's
an unsettled frontier with newly discovered veins of gold. The
financial assault on academic medical centers threatens the entire
foundation of clinical research while technological innovation
promises to cure or control more diseases at their molecular and
Seymour H. Levitt, MD, president of the RSNA, reported that,
cumulatively, U.S. teaching hospitals will lose $15 billion by
2002. Over the next year, cuts in Medicare will reduce subsidies
for residency training by $700 million in direct payments and $5.6
billion in indirect payments. "Centers of education and research
are under attack due to the dominance of managed care," said Dr.
Levitt. In the midst of this bleak situation, technological
advancement provides hope for the future of medicine.
Integrating the healthcare enterprise
The flow of digital data now moves far beyond a radiology
department. It will become the electronic circulatory system of the
entire "healthcare enterprise," a term that can include a hospital
or a conglomerate of hospitals and clinics spread out over a
geographic area. RSNA 1999 attendees observed the first
demonstration of "integrating the healthcare enterprise" (IHE), a
collaborative effort between the Healthcare Information and
Management Systems Society (HIMSS) and the RSNA. The demonstration
showcased 46 separate information and imaging systems operating in
an open-standard environment. Many radiology equipment and
electronic companies participated in simulated healthcare
enterprises with various patient care scenarios.
The goals of IHE are to promote connectivity among healthcare
imaging and information systems and to share medical data
throughout the enterprise. The scope of IHE today is PACS,
radiology information systems (RIS), and hospital information
systems (HIS). This integration should avoid redundancy of data
entry in patient registration, order entry, procedure scheduling,
and image archiving and retrieval. In one IHE scenario, the
demonstrator emphasized how every bit and byte of medical data
would become part of the patient's "permanent, lifetime, medical
At the RSNA 2000, the planned IHE exhibit will illustrate how
medical data can be shared electronically between radiology and
other medical specialties. Today we live in a "global village."
Tomorrow we may deliver healthcare from a "global enterprise."
Data general outlines 5 elements of pacs
Data General (Westboro, MA) described its electronic clinical
records strategy by listing five elements of PACS: 1) universal
image acquisition; 2) image management distribution; 3) clinical
image display; 4) enterprise image storage networks; and 5) "image
The company believes it offers a key competitive advantage in
connecting image capability to HIS. "Our fifth PACS element emerged
from the realization that the key to efficient patient
care--integration of patient-centric, multimedia data across a
healthcare organization's enterprise--is achievable only through
image enabling. The result is instant access to critical health
information for clinicians who log on and identify the patient only
once," said Ken Waldbillig, PACS operations manager at Data
Philips predicts ihe will lift burdens from
Philips Medical Systems (The Netherlands) was one of the vendors
participating in the IHE demonstration. "Hospitals are overwhelmed
with the explosion of patient health information. Integrating
systems and electronically processing patient information eases the
'administrative burden' many clinicians experience. We know the
result is better workflow," said John Steidley, director of Philips
Vascular Business Unit. The company showed multivendor
interoperability of its Integris V5000 cardiovascular system and
its Inturis for Radiology PACS, both connected with a third-party
The IHE objective is to use existing data communication
standards, such as DICOM (Digital Imaging and Communication in
Medicine) for imaging systems and the HL-7 standard for HIS--not to
define new standards. "We hope that our customers will also endorse
the aims of the IHE, and ask the vendors to implement
interoperability in accordance with the IHE technical framework. We
are ready for those requests," said Kees Smedema, international
manager for interoperability at Philips.
GE offers integrated imaging solutions and
The Integrated Imaging Solutions business of GE Medical Systems
(Milwaukee) announced new capabilities for its PathSpeed
PACS. In cooperation with Cerner Corporation (Kansas City, MO), GE
offers PathSpeed PRISM, which combines full PACS and RIS features
into a single application. According to GE, PRISM integrates image
viewing and analysis, order viewing, order details, report entry,
and case sign-out.
Following the Internet shopping trend, GE introduced electronic
commerce (e-commerce) with online purchasing of x-ray equipment,
pre-owned imaging equipment, accessories, and supplies. "Customers
will have the ability to immediately access product inventory,
technological specifications, and pricing," said Kathy Warren,
general manager of GE's Accessories & Supplies business.
Integrated pacs/ris from siemens and idx
In another effort to provide bidirectional connectivity between
PACS and RIS, Siemens Medical Systems (Iselin, NJ) and IDX Systems
Corp. (Burlington, VT) have developed an integrated system.
"Integrating PACS and RIS eliminates PACS brokers, allowing users
to perform functions such as viewing and reporting on the same
workstation," said Siemens.
Siemens has also developed "syngo," a common software platform
for all imaging modalities and tasks. The company said that this
software architecture will help radiology departments "connect
throughout the hospital and throughout the world."
Kodak integrates pacs and ris, introduces dr
To "meet the needs of enterprise-wide distribution and use of
images," Eastman Kodak Company (Rochester, NY) demonstrated a
work-in-progress designed to link its PACS directly to a RIS.
Cemax-Icon, a subsidiary of Kodak, is developing a system that will
provide users with one worklist for managing patient exams. "This
integration goes beyond the accepted industry standard of using a
gateway device between RIS and PACS," according to the company.
Besides the shared worklist, other features will include realtime
radiology conference navigation (i.e., radiology conferences
scheduled on the RIS will be propagated to the PACS); integrated
exam reporting (i.e., a radiologist can report directly to the RIS
while navigating through the reading worklist from the PACS), and
realtime exam scheduling (i.e., scheduling information goes
dir-ectly from RIS to PACS, which
triggers prefetching of prior exams).
Kodak also introduced three direct radiography (DR) systems: the
DR 9000, a full-room system for general radiology; the DR 7000,
which converts an existing x-ray room to digital-capture technology
while retaining current x-ray generators and tube hangers; and the
DR 5000, designed for dedicated chest exams. All three systems use
a flat-panel detector with an amorphous selenium semiconductor
x-ray absorber coating over a thin-film transistor array.
"This technology is presently the only viable DR option that
supports truly direct image capture," said Gary Keyes, general
manager of Digital
Capture Products. With the Kodak DR systems, x-rays are converted
by the amorphous selenium directly into electrical charges that are
collected by an array of electrodes. Other available DR systems
require an interim step, he explained, of converting the x-ray
energy into visible light, which is then captured by an array of
photodiodes and converted to electrical charges. "Indirect DR
technology introduces the potential for image degradation because
of visible light scatter," said Mr. Keyes. Direct DR, on the other
hand, can provide superior images by eliminating such image
degradation, he added.
Hologic introduces new dr and bmd systems
The flat-panel detectors for the Kodak DR systems are
manufactured by Direct Radiography Corporation (Newark, DE), a
subsidiary of Hologic, Inc. (Bedford, MA). Hologic also introduced
two direct-to-digital general radiography systems: the EPEX for
general radiography and the RADEX for outpatient exams. The company
plans to make the first clinical installations of both systems in
To evaluate women at risk for osteoporosis, Hologic introduced
QDR bone densitometer, which provides simultaneous assessment of
bone mineral density and existing vertebral fractures. "The
combination of a prevalent vertebral fracture and low bone mass is
far more predictive of risk of a future fracture than low bone
mineral density (BMD) alone," said Harry K. Genant, MD, executive
director of the Osteoporosis Research Group at the University of
California, San Francisco.
Comdisco offers pacs advice and financing
Radiologists today are working "in a time when converging
technology, financial, and regulatory pressures are at their peak,"
said Lynn Dixon, general manager of Comdisco's Healthcare Group
(Rosemont, IL). Although hospitals must control costs, they also
need to invest in digital networking technology or they will be
left behind. Comdisco recommends the most appropriate PACS
technology for various clinical settings. The company also provides
financing and information management services, such as offsite
archiving and disaster recovery.
At the RSNA, Comdisco announced a strategic alliance with
InLight (Evanston, IL), a company that produces multimedia and
Internet-based patient education programs. According to the
company, InLight programs contain data for hundreds of medical
conditions, diagnostic tests, and treatment options. "By using a
touch-screen interface to choose medical factors relevant to each
patient's case, medical professionals can create a customized video
story that helps a patient to better understand his or her
condition and treatment," explained the company.
New web communities for radiology
Two new web communities are now available for radiology
professionals: radiology.com and auntminnie.com.
An electronic journal of radiology, JRAD, edited by Robert
Lufkin, MD, chief of head and neck radiology at the University of
California, Los Angeles (UCLA), will be a central feature of
radiology.com. JRAD promises ultrafast peer review and publishing.
The company also offers free websites to radiologists.
Years ago, radiologists coined the phrase "Aunt Minnie," which
means a recognizable condition on an x-ray image, requiring no
differential diagnosis. (It's like recognizing the face of a
favorite aunt.) Today, auntminnie.com wants to become the most
comprehensive Internet community site for medical imaging
Mitsubishi brings real time visualization to
A first-time RSNA exhibitor, Real Time Visualization (Concord,
MA), a company formed by Mitsubishi Electronics America (Cypress,
CA), offers a new technology for realtime volume-rendering of
three-dimensional (3D) images. Unlike most other 3D technologies
for medical imaging, which consist of software, the Real Time
Visualization product is a hardware solution. The VolumePro 500
accelerator board, a circuit board for PC or UNIX workstations, can
render a 256-cubed dataset in realtime, according to the
manufacturer. The board is configured with 128 megabytes of usable
volume memory, enough to store 512 * 512 * 256 volume slices
"We understand that there are applications capable of gathering
a lot of volume data but there is no realistic and affordable way
to view it," said Jamie Jacobs, general manager for Real Time
Visualization. However, Mr. Jacobs said that this product demands
no trade-offs between speed and true 3D image quality at a price
comparable to other PC-class products. The accelerator board is not
available to end-users, but radiologists and technologists who are
interested in realtime volume rendering can ask their equipment
vendors to include it in their systems, explained Steve Sandy,
director of business development at Mitsubishi and a founder of
Real Time Visualization.
In addition to radiology, the VolumePro 500 accelerator board
has applications in seismic imaging, atmospheric research,
geospacial visualization, and animation. New electronic products
with applications in many fields will be much more economical for
radiology, noted Mr. Sandy, than custom-designed technology that
was developed and manufactured specifically for medical
Picker changes name to marconi medical systems
After 85 years in business as Picker International (Cleveland, OH),
the company will enter the next century as Marconi Medical Systems.
The company known for its x-ray equipment and scanners wants to
shift its radiology focus to imaging and information systems. The
parent company, GEC (London, UK), will also change its name to
Marconi plc, marking its transformation from a defense-oriented
conglomerate (aerospace, naval shipbuilding, defense electronics)
to a communications and information conglomerate. The rechristened
company traces its name to Guglielmo Marconi, recognized as the
"father of radio" whose work paved the way for modern communication
networks. Was it just five years ago that we celebrated the 100th
anniversary of William Roentgen's discovery of the x-ray? Maybe at
RSNA 2095, our radiology descendents will remember Marconi and
Roentgen as equally significant historical icons.
At RSNA 1999, Marconi introduced LifeFlight
, an x-ray computed tomography (CT) trauma suite that features the
, a multislice CT scanner that the company says can examine a
patient from head to toe in less than 60 seconds. This trauma suite
is designed for immediate identification of critical or traumatic
injuries. "Pulmonary embolus evaluation, multiple fractures, and
cardiac abnormalities could be completed better, faster, and more
accurately," said John Haaga, MD, chairman of radiology at
University Hospitals of Cleveland.
This Technology & Industry column, published regularly in
, gives radiologists an inside look at the imaging technology
offered by the radiology industry. For the most part,
technological advances are introduced at the annual RSNA meeting.
Highlights of RSNA news will be covered here, updated as
necessary, throughout the year, including the latest innovations
in ultrasound, magnetic resonance, CT, and nuclear medicine.