Applied Radiology

As medical knowledge and the complexity of available technologies continue to expand, the need for completely integrated information systems becomes more pressing. Such systems must be able to communicate relevant information to all providers in order to provide efficient, cost-effective healthcare.

Integration put to the test at RSNA

In one step toward achieving the goal of universal integration, 33 vendors representing 74 distinct systems are expected to participate in the Year 2 demonstration of Integrating the Healthcare Enterprise (IHE) at this year's Radiological Society of North America (RSNA) meeting.

IHE, sponsored by the Healthcare Information and Management Systems Society (HIMSS) and the RSNA, was designed to stimulate the healthcare information and management systems industry to develop a means for connecting and integrating clinical information systems, imaging systems, and other information resources.

In 1999, the Year 1 demonstration focused on the perplexing radiology information systems (RIS)/picture archiving and communication system (PACS) modality loop. It showed that 24 vendors, representing 47 systems, could share information in an integrated, open-standards environment and maintain the integrity of the data and images exchanged. The demonstration primarily addressed basic registration, scheduling, and image acquisition and storage in the radiology department. Four simulated healthcare enterprises were created, each modeled a different hospital. Simulated patients presented with conditions ranging from a torn knee ligament to suspected appendicitis. Within each simulation, spectators were introduced to the patient's ailment and watched as information was entered into the hospital's records system, where it became available to the radiology department instantly. From this department, x-ray, ultrasound, and other images were integrated into the patient's record.

This year's demonstration, at the 2000 RSNA meeting this month, is designed to advance the boundaries of integration to address the functionality of these systems and better meet the needs of the end-user. It will focus on mechanisms to deal with a patient who is incompletely identified at the time of registration; access to nonradiology information, such as lab values; image consistency across disparate display systems; and structured reporting. Additional transactions and greater detail will be added to the protocols within the radiology unit.

"The purpose of the symposium this year is to inform attendees about the challenges and current achievements made toward integration of all electronic information systems within a hospital, medical center, or healthcare network," said Keith Dreyer, MD, vice-chairman of Radiology at Massachusetts General Hospital and chair of the IHE Symposium. "We want to show people what electronic integration can provide to radiologists and other healthcare professionals and how the IHE initiatives affect the efficiency of clinical practice."

Kodak introduces new digital radiography systems

Two new digital radiography systems--the DirectView DR 9000 and DirectView DR 5000--are available now from Eastman Kodak Company (Rochester, NY).

Both systems provide imaging through direct digital capture along with the ability to integrate with patient information and archiving systems. Each system utilizes a flat-panel detector composed of an amorphous selenium semiconductor X-ray absorber coating over a thin-film transistor array. Direct detectors automatically convert X-ray photons into electronic signals.

The DR 9000 system has five major components: a direct X-ray capture system, operator console, ceiling-mounted U-arm system, high-frequency X-ray generator and X-ray tube, and a choice of three patient support tables. It can perform a full range of head, chest, skeletal, extremity, and trauma examinations. The DR 5000 system is designed for chest and other upright examinations and includes a direct X-ray capture system, operator console, chest and detector stand, high-frequency X-ray generator, and an X-ray tube and stand. With both systems, images can be reviewed within 10 seconds of exposure for quality assurance, and the image cycle time is 35 seconds. Images can be routed to multiple locations and the systems integrate with PACS and allow electronic connectivity to RIS.

The "Connectathon"

In October, nearly 150 software engineers and marketing/product managers from 33 imaging, modality, and information systems companies met at RSNA headquarters in Chicago for the IHE "Connectathon." They brought a total of 68 different systems--including RIS, PACS, displays, and modalities. This week-long dry run was undertaken to iron out any connectivity or workflow problems prior to the main IHE event at the RSNA meeting.

"The IHE symposium is important to radiologists for a number of reasons," according to Christopher Carr, assistant director of informatics for the RSNA. "In the process of modernizing radiology departments with PACS, RIS, voice recognition systems, and digital modalities, radiologists need to know how to integrate these modern systems into an overall healthcare delivery system, whether it be in a hospital, clinic, or healthcare network. They need to be able to make decisions about which vendors to choose to accomplish effective integration of information systems. That knowledge will improve the efficiency of their practice," he said.

Internet integration in rural healthcare

For years, standard teleradiology has been used to provide 24-hour radiology coverage to an area of rural Texas encompassing several thousand square miles. Recently, this system was replaced with Internet service.

Film digitizers and viewers were placed at each of the hospitals in the region covered by East Texas Radiology Consultants. Using the eRadFiles system by BRIT Systems, Inc. (Dallas, TX), a server was installed in Dallas and additional viewers were placed in each radiologist's home. The entire system was interconnected via the Internet using T-1 lines in the hospitals and cable modems in the radiologists' homes.

Using standard teleradiology, the technologist needed to know the location of the on-call radiologist and the images were sent via telephone lines. With the new system, images are sent directly to a central server from which the radiologist is able to retrieve them. Using the Internet increases the speed of the process and eliminates the interference and long distance charges associated with standard teleradiology.

By using the Internet, each site can take advantage of available technology and can easily upgrade when new technology becomes available.

Ten hospitals to share Mobile PET

Ten hospitals in the Portland, OR area have formed a consortium to obtain positron emission tomography (PET) scanning services using a Mobile P.E.T. Systems, Inc. (San Diego, CA) system. This has created a "virtual PET Center" for the Portland area by giving patients access to the PET scanner 6 days a week.

Diagnostic workstations will be stationed in the radiologist reading room of each hospital. Patients will be scheduled through their own physician and local hospital for cancer detection or staging, examination of neurological and functional disorders, or detection of cardiovascular disease. The PET scans will performed at the local hospital with the images transmitted electronically via Ethernet or telephone modem from the mobile unit to the radiologist reading center for interpretation. The diagnostic results are sent immediately to the referring physician.

Ultra-Fast 3D Option from Siemens

Siemens Medical Systems, Inc. Ultrasound Group (Issaquah, WA) has introduced 3D Express Ultra-Fast 3D Rendering for its SONOLINE Omnia and SONOLINE Sienna ultrasound systems. The 3D Express option, which has been integrated into both ultrasound systems, features freehand, one-touch data acquisition. Three-dimensional fetal images can be acquired in 1 to 4 seconds with any convex or linear array transducer, while implementing a linear or rocked acquisition technique. Such three-dimensional imaging can be used to assess certain fetal abnormalities, such as spina bifida, cleft lip/palate, and polydactyly. Also, subtle features such as low-set ears, facial dysmorphia, or clubbing of feet may be better assessed.