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.
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
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
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
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
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
"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
Synapse was released in 1999, and more than 50 systems have been
installed to date.
AHRA to develop administrator certification
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
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.