Applied Radiology

For information technology (IT) vendors at the 88th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA 2002) in Chicago in December, the key themes were open architecture, instant Web-based access, increased functionality, and ease of use. Nearly all of the IT products displayed featured enhancements in at least one, if not all, of these areas.

Voxar introduces Voxar 3D

Voxar Ltd. (Edinburgh, Scotland) unveiled Voxar 3D, the newly re-branded upgrade of its Plug-n-View three-dimensional (3D) software package. Diane M. Clifford, senior marketing manager at Voxar, said in an interview with Applied Radiology , "Voxar 3D provides gold-standard maximum intensity projection (MIP), multiplanar reconstruction (MPR), and 3D color volume-rendering (Figure) that allow for the rapid display and analysis of large multidetector computed tomography (CT) and magnetic resonance (MR) imaging data."

Designed for integration across the hospital DICOM network, Voxar 3D includes several new feature enhancements, a task-based user interface, and workflow improvements. With the new software, misaligned scans, or anatomy that does not align with scan planes, can be corrected rapidly to a standard orientation prior to reading. Advanced derived series definition now exceeds the ease-of-use and capabilities of CT and MR scanner consoles, and curved MPR is easier and faster to set-up.

"In addition, the 3D color volume-rendered slab brings the problem-solving benefits of volume rendering to MPR. This makes it easier to visualize and distinguish closely related vessels and anatomical structures," noted Clifford. "Targeted 3D volume review provides an easy link between MPR reading and 3D problem solving." she continued. "Radiologists can clearly and quickly visualize or review complex internal structures and pathology without the need for segmentation."

A bone-removal feature allows 3D angiography and boneless MIPs to be created in seconds, and the "Live Images" feature facilitates rapid DICOM transfer of postprocessing images from the technologist to the radiologist for reading.

One of the main benefits of the Voxar system, according to Clifford, is that it is a "software-only" solution that can be installed on a hospital's existing hardware. "In the past, hospitals had to purchase expensive workstations for their 3D imaging needs," she explained. "For the cost of one or two workstations, Voxar's software-only solutions allow the opportunity for '3D everywhere' by enabling image distribution and postprocessing across multiple machines to meet user demand and increase efficiency. We see Voxar 3D being used by referring physicians and surgeons virtually everywhere needed within the hospital and/or imaging center," she concluded.

Amicas presents the Vision Series

Amicas (Boston, MA), introduced its latest Web-based picture archiving and communications system (PACS) platform, the Vision Series, at RSNA 2002.

"The ever-increasing number of studies is affecting departments across the healthcare enterprise, as well as referring physicians," commented Amicas president and CEO Hamid Tabatabaie. "Today's PACS has to operate much like a FedEx tracking system. Physicians must know not only where a study is at any given point in time, but also who has viewed the images, and whether the images have reached their final destination. Traditional PACS," he continued, "have a highly departmental focus when it comes to workflow. The Vision Series provides an ever-expanding list of physicians and other constituents with real-time access to image studies and reports."

The Vision Series employs a standards-based, hardware-vendor neutral, Web-based architecture that allows it to operate using an enterprise's existing network and hardware infrastructure. The Vision Server provides both images and patient data in a secure, workflow-driven format that can be customized by each user. The RealTime Worklist tracks and stores radiology orders, images, and reports, and provides real-time status to the radiologist and the referring physician.

"RealTime Worklist is much like the large train schedule at the railroad station," noted Adrian Gropper, MD, co-founder and chief medical officer at Amicas. "It is constantly updated with the latest information, it's open to public viewing for authorized users, and users in multiple roles use the same schedule."

The Vision Series workstation--the Web-based LightBeam--features a suite of interpretation tools, including MIP/MPR and one-click access to prior studies without pre-fetching. The workstation supports DICOM and JPEG 2000 lossless and lossy compressed images. The Java-based Web application, LightView, combines browser-based viewing with an intuitive tool set that can be used for both primary diagnosis and clinical review. It allows the user to view, annotate, manipulate, store, and print diagnostic-quality images. Using JPEG 2000 wavelet compression, images can be transmitted from the Vision server to the physician's desktop or embedded in the electronic medical record (EMR).

The company offers several Vision packages designed to meet the needs of a variety of healthcare settings. The Enterprise package includes PACS, image distribution, and teleradiology services that can manage several hundred thousand imaging studies a year. The Enterprise Enabler is designed for institutions with existing PACS that wish to implement a scalable technology bridge within their systems. Radiology Office and Imaging Office are scalable solutions designed to bring on-demand image access and integrated workflow capabilities to smaller hospitals, imaging centers, and individual radiology practices.

"We are able to offer both an incremental adoption approach that allows institutions to progressively implement the features they need when they need them, and an end-to-end PACS from the start," said senior vice president John Ariatti.

Cerner showcases ProVision Web

Cerner Corporation (Kansas City, MO) introduced its new Web-enabled image management solution, Cerner ProVision Web, at RSNA 2002. The enterprise-wide system integrates all images--from radiology, cardiology, oncology, or other departments--directly and permanently into the EMR while supporting user authentication and access tracking.

"Cerner ProVision Web is built within the same Cerner Millennium system as the PowerChart EMR, enabling clinicians to view images and reports at the point of care, when they are needed most urgently," said Heman Goel, vice president of radiology and imaging solutions. "For example, a physician in the emergency room uses FirstNet to view the EMR. One click of the image icon will launch Cerner ProVision Web and give the physician access to the patient's images."

The browser-based system allows for distribution of images across the entire enterprise, including to referring physicians and on-call radiologists, regardless of location. JPEG 2000 compression capability and progressive wavelet decompression technology minimize bandwidth requirements, which reduce network traffic and facilitate faster transmission. The system's ability to use existing computers throughout the hospital and the clinicians' homes eliminates the need for additional hardware purchases.

One of the most important features," concluded Goel, "is that any hospital or radiology facility can reap the benefits of an image management system. You don't have to have Cerner's PACS to implement it. Cerner ProVision Web can be used to enable images for Cerner PowerChart users, sites with a third-party PACS, or as a stand-alone configuration with no PACS."

Misys adds voice-integration technology to RIS package

Misys Healthcare Systems (Tucson, AZ) showcased the latest version of its radiology information system (RIS) that integrates voice-recognition technology and Web-based information access tools.

The TalkStation Radiology voice-integration technology combines speech recognition, digital dictation, and distribution features with image management, internet access, and procedure history. It allows the user to dictate, edit, code, and sign reports with voice recognition support, open architecture, and digital dictation and transcription.

The Misys WebView permits access to patient results data over a corporate intranet and allows the user to review related reports, sign or reject reports, and edit and tag text within documents.

"The current shortage of radiology professionals, reduced reimbursements, and cost containment issues in healthcare are driving our clients to achieve maximum productivity and efficiency in the healthcare enterprise," noted Andrew Lawson, chief operating officer at Misys. "Our integrated solution is designed to provide a broad choice of third-party PACS solutions and eliminate the need to re-enter data and minimize paper and film use. Data and images are available as part of the radiologist workflow, anywhere at any time, electronically within the healthcare enterprise."