Kathleen M. Dallessio
First introduced at the 1998 RSNA meeting, the Catella Advanced
Digital Workstation from American Medical Sales, Inc. ([AMS]
Hawthorne, CA) has evolved from a simple workstation into a full
picture archiving and communications (PACS) system that uses voice
commands and includes a transcription/dictation system.
"Catella started out as a workstation and now it's expanded to a
full PACS solution," said Greg Perry, director of sales and
marketing at AMS. "The workstation is used to read soft-copy images
from a number of modalities including magnetic resonance imaging
(MRI), computed tomography (CT), ultrasound, digital radiology, and
conventional radiology." The included film digitizer permits the
older reference films to be digitized for comparison with current
images. Images can be manipulated by use of either an input device,
such as a mouse or trackball, or by use of voice commands.
A "low-tech" look
The most striking initial impression of the Catella is its
resemblance to a traditional lightbox (Figure). "In our research,
one of the things that made people uneasy with PACS was the
computer element," Perry explained. "What they were really
comfortable with was something similar to what they were using,
which was a typical lightbox reading room. So we started to move
the design of our product toward what we already had 40 years of
experience with: designing reading rooms and building illumination
rooms and products. We took the concept of what do we now with that
reading environment, and imagined how to transfer it to something
that would allow the physician to transfer very smoothly and
simply. We hid the computer and the keyboard, and this set-up has
worked very well for us."
A variety of monitor configurations are available, ranging from
a single-monitor workstation up to a traditional 4-over-4
configuration. "For a long time, radiologists were saying 'Why
would a new digital technology product allow me to see only 2 films
at a time when I read CTs and MRs that have the equivalent of 6, 7,
or 8 films?'" said Perry. "So our system can be configured from 1
to 8 monitors." Regardless of the number of monitors, however, the
cursor/control motion acts as one large monitor with contiguous
motion across all viewing screens.
Workflow
The system can receive images in DICOM 3.0, lossless JPEG, TIP,
and BMP formats, as well as lossy formats, either directly from the
modality, from the digitizer, or via a network. Whenever possible,
the system automatically displays the image in its optimal format
by filling the monitor with the images (100% zoom factor) along
with the patient's name and identification number, image date and
time, as well as any other pertinent information contained within
the DICOM header.
Studies on the system are arranged in a worklist that keeps
pending and recently read studies readily available to the
radiologist. The system typically prioritizes studies in a "first
in, first out" manner; however, this feature can be customized to
meet the individual radiologist's needs. A customizable feature can
be set to deal with emergency studies. For example, the system can
be set so that all studies labeled "emergency" immediately move to
the top of the worklist and appear on the screen seconds after the
currently study is completed.
Capacity
The standard system uses a hard disk storage system for its
short-term storage. Basic capacity is 100 2k x 2k images (typical
chest x-rays) or 4,000 512 x 512 images (typical MRIs); sufficient
to hold several days' work at even a busy medical center. The
system can be expanded to hold more than 10,000 2k x 2k or 400,000
512 x 512 images. The system is not designed for long-term storage
but can be connected to an archiving system or image library.
Active voice command
Another unique feature of the Catella system is its active voice
command that permits the user to control most features of the
system by voice control. "This allows a user of any comfort level
with technology to sit down and begin using the system almost
immediately," said Perry. "The training program with voice is
simply a matter of learning 30 or 40 commands. With a typical
workstation you have to learn how to operate a mouse or a
trackball, to find menus and icons, and how to use the different
manipulations."
Dictation
With the voice-command system in place, Perry explained that the
next logical step was to incorporate dictation capabilities into
the system. "When we showed people that we could capture their
voice and give the system the ability to move on voice commands, it
was almost automatic that we created a system that would allow them
to dictate into the system," he said.
To use the dictation system, the reading radiologist simply
steps on a foot switch and the system captures the dictation. All
of the information contained in the DICOM heading, such as the
reading radiologist's name, the patient's name and ID number, and
any other pertinent patient information, is entered automatically
and does not need to be recorded. "By not having the radiologist
repeat that information from the DICOM header, we give 20 or 30
seconds per study back to the radiologist," said Perry. "We also
take out the possibility of the radiologist's misreading the name,
the number, the physician's information, or something else."
When the dictation is complete, the radiologist simply says
"Next patient," and the file with the header information and the
voice WAV file is sent to the transcription module immediately.
With the optional transcription station, called Catella Scribe, the
transcription station screen is automatically prepopulated with the
header information so that the transcriptionist does not have to
retype the pertinent patient information. The transcriptionist then
listens to the WAV file using a typical transcription-style device
or personal computer. Once the file is complete and corrected, it
is routed automatically back to the workstation from which it
originated.
The two-word normal report
As part of the developmental research, AMS found that up to 50%
of a typical radiologist's normal day is reading normal cases,
those with no significant findings. "But they still have to file
all the normal reporting information," said Perry. "We can take a
script from the doctor and code it into the Catella system. So, if
he or she is viewing a study and it is a normal report, all the
radiologist has to do is say 2 words, "OK, next," and a normal
report is sent out to the transcriptionist with all the pertinent
information programmed in."
C-mail
Another standard component is what is known as "C-Mail." With
this feature, the radiologist is able to send the WAV file and
compressed images anywhere, such as back to the referring
physician, via the Internet. "All they have to do is to pull up the
C-mail menu, pick out the address, and send it," Perry noted.
Real-world experience
Ashok R. Patel, MD, president of Hazard Radiology Associates
(Hazard, KY), a private group practice, purchased the Catella
system with a 2-over-2 monitor configuration approximately a year
ago. He spoke with
Applied Radiology
regarding his experience with the PACS.
"I first saw it displayed at the RSNA meeting. I had looked at
several systems and this one looked more user-friendly," said
Patel. "The layout on the screen was much better with a better
image display."
Prior to purchasing this, his first PACS system, Dr. Patel had
to drive 35 miles to the clinic to read films. Now the images are
sent to his office via T-1 lines and he is able to respond
immediately. CT images are transmitted without the use of printed
film. Images from other modalities are printed and then digitized
for transmission. "It has saved me a lot of travel time," he
reported, "and I don't have to worry about the weather or travel
conditions. Also, it saves me time interpreting because I don't
have to spend time setting up the films."
"It's a very compact unit and very affordable," concluded Patel,
"but the main thing is that it's user- friendly. We don't have to
train the system; we just use certain passwords; therefore,
anybody, with any accent, can use it within 10 minutes."