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Coverage from ECR 2010

What are the next steps for the information systems used in digital medical imaging? For Derek Danois, Accenture’s newly-appointed managing director for medical imaging services, the emphasis has to be on helping healthcare organisations to “build value in their investments and deliver value over a long period of time.”

“It’s not about refreshing that existing infrastructure but [about] how you take advantage of that infrastructure,” he said. One of the areas in which he sees advances in prospect is the use of analytics from digital medical images and their associated reports to monitor and improve the quality of care.

For example, he explained, analytics can be used to understand the effectiveness and quality of different radiological protocols laid down by bodies such as the UK’s Royal College of Radiologists. Reports can show whether protocols are being followed, while tracking deviations from protocols could indicate that an investigation or intervention is needed.

On a wider scale, he added, analytics can also be used to look at the effectiveness of different radiological protocols across different centres. How far away are these developments? “We are looking to deliver for some clients in the near term,” said Danois.

Clinical decision support to reduce inappropriate radiological examinations

Research indicates that up to one third of radiological examinations are totally or partially inappropriate. How can IT help to reduce that?

A team in Western Australia, led by Professor Richard Mendelson, is exploring how clinical decision support (CDS) can be used to reduce these inappropriate examinations, which create a risk for patients, use up time and money and produce no benefit.

Professor Mendelson emphasised that the work was in its early stages. But the team has found that stand-alone CDS achieves little in reducing the problem.

CDS needs to be embedded into clinical workflow and ideally into electronic requesting. The team has managed to do this, but only in a test environment so far, he reported. Further information about the team’s work is online.

Advanced imaging software

Graphic boards developed by the gaming industry lie behind new, advanced imaging software on display at the Siemens stand in the ECR exhibition.

Syngo.via is imaging software for multimodality reading of clinical cases. It places a special focus on reading efficiency through automated case preparation and structured case navigation across multiple specialties, including cardiology, oncology, and neurology.

In simple terms this means that, for example, when calling up a cardiac CT case, syngo.via selects a suitable cardiac application, automatically removes the blood pool and ribs, selects an appropriate cardiac phase, and displays the images in the corresponding layout.

The coronary arteries are displayed in a way that allows the physician to immediately begin reading the case.

Syngo.via’s client server-based architecture also enables images to be read at a conventional workstation, on a regular PC or on mobile devices such as iPhones.

“It’s a very open system – it will work with other vendors’ PACS,” says Nikolaus Bolle, vice-president, product marketing. Images are available on the Siemens website.

Digital mammography

The migration of the NHS Breast Screening Programme from analogue to digital technology was fuelling UK interest in developments in digital mammography.

Agfa launched its IMPAX for Breast Imaging solution at ECR. The solution extends Agfa HealthCare’s PACS into breast imaging with some new features.

It implements the IHE Mammography Image profile, which solves image display problems typically encountered in mixed vendor environments (orientation, size, justification, consistency of grayscale contrast, completeness of annotations). It also introduces an innovative “1:1 Navigator” which allows for a fast review of mammography images at full resolution.

Portable media and PACS

Away from the exhibition, a congress session heard that the adoption of IHE protocols for portable media, notably CDs, would help to reduce the problems associated with their use.

A world where seamless transfers of digital medical imaging studies are routine still eludes the UK NHS. Although there are promising projects in hand , the reality is many radiology departments rely on CDs to receive images in a wide variety of situations. These include emergency admissions, multi-disciplinary team meetings, and outsourced image reporting.

In a refresher session on portable media, Dr Nicola Strickland, consultant radiologist at the Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, listed problems that flow from the use of CDs.

They may be unreadable for a number of reasons; uploading to the PACS and RIS is a manual process; direct study comparison between different imaging studies on CD and PACS, or on two different CDs requires two screens; loading and scrolling through images from CDs can be very slow.

Some of these problems could be eliminated by the adoption of IHE protocols for portable media, Dr Strickland said. The standards are PDI (Portable Data for Imaging)  and IRWF (Import Reconciliation for Work Flow) . If used, these standards eliminate some of the common problems such as CD files not uploading to PACS or not opening.

Adopting the protocols not only affects the portable media but also the acquisition and CD burning modalities, the diagnostic and review workstations and the PACS. Dr Strickland urged radiology and IT staff need to press manufacturers to make their products compliant and ensure that requirements are included in specification documents for replacing or upgrading equipment.

In conclusion, though, Dr Strickland said: “In planning for the future, we really must minimise the exchange of portable media. We must recognise that we can’t eliminate portable media but it really should be the last resort reserved for low volume, non-urgent imaging studies, where no other means of data exchange is possible.”

Image sharing

The need to collaborate across specialities, sharing expertise, sharing images and sharing patient data in a controlled and secure manner, was named as a top issue by Martin Håkansson of Sectra, the Swedish vendor which holds contracts for the NHS in London and Northern Ireland.

“That’s a key trend and I think we can expect that to continue for many years,” he predicted. The promise of readily being able to exchange digital images was one of the big attractions of a national PACS programme, but it has not materialised on the large scale needed.

In particular, traditional local referral networks are not often not digitally connected, and frequently do not fall within the geographical boundaries of the NHS Connecting for Health clusters. As discussed earlier, this has left radiology departments dealing with large volumes of CDs, which are used to transfer medical imaging studies around and between NHS organisations.

Sectra has been developing the use of its RapidConnect technology for sharing images and patients data. Håkansson told E-Health Insider that the Northern Ireland installations included sharing technology on quite a large scale, while in Southern Sweden RapidConnect is used to share images and reports between hospitals using five different PACS and four RIS.

In England, various local initiatives to facilitate image sharing have sprung up. In a brief ECR discussion of the issue, the Image Exchange Portal (IEP) was described by Dr Strickland as “the best thing we have had so far, although still far from perfect, and it does not currently adhere to IHE defined cross platform data sharing profiles for imaging (XDSi).” Her optimism was, she emphasised, cautious.

SuperPACS

Derek Danois of Accenture agreed that image sharing was a high on the agenda and said that bandwidth and network considerations drove the case for remote viewing of stored images.

“I think there will be lots of attempts to figure this out and many facilities can’t wait for the perfect solution,” he said. There was a need to deliver “something that works today”, even if it might be an interim solution.

SuperPACS, a technology that enables cross-site, collaborative workflow, was on display at Carestream Health’s stand. SuperPACS’ architecture enables radiologists on any on-site or remote location to read from a global worklist that provides a unified set of imaging studies created from multiple-vendor PAS located throughout the enterprise.

Carestream says that tunnelling technology used in SuperPACS enables data-intensive studies to be delivered to the radiologists on demand from any location without a requirement for pre-fetching and pre-archiving the image dat at a central location.

Instead, patient information and metadata from existing archives are synchronised in a central database, avoiding the expensive and time-consuming migration of pixel data.

The numbers game

Conference organisers generally issue a few headline figures for numbers of participants and exhibitors but the ECR, showing meticulous attention to detail, went step further.

It announced there were: 18,000 participants from approximately 100 countries; 305 exhibitors from 58 nations; 70 European Society of Radiology staff; 256 temporary ESR staff; 505 invited lectures; 880 scientific papers, 3,427 scientific and educational exhibits and 89 satellite symposia lectures.

It also gave out: 10,000 congress bags; 10,000 books of abstracts; 11,000 final programmes; 11,000 ECR guidebooks; 11,000 art and culture brochures; 20,000 copies of ECR Today (the daily congress newspaper); 12,000 pens; 11,000 notepads; 45,000 water bottles; 37,000 sweets – and 40,000 apples.

Amid all that, there was a rich variety of new IT on display and new ideas being aired. If you were there and saw more – or want to flag up other developments – have your say below.