RSNA 1999: reaching for a global integrated healthcare enterprise

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 genetic origins.

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 record."

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 enabling" HIS.

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 General.

Philips predicts ihe will lift burdens from clinicians

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 RIS.

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 e-commerce

The Integrated Imaging Solutions business of GE Medical Systems (Milwaukee) announced new capabilities for its PathSpeed ^TM 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 early 2000.

To evaluate women at risk for osteoporosis, Hologic introduced the Delphi ^TM 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 professionals worldwide.

Mitsubishi brings real time visualization to rsna

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 (voxels).

"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 imaging.

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 ^TM , an x-ray computed tomography (CT) trauma suite that features the Mx8000 ^TM , 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 Applied Radiology , 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.