The iPhone has taken the world by storm, and teleradiology appears to have made an impact with this device as well. From a study performed at the University of Virginia, it was shown that iPhones could be used with a mobile digital x-ray viewer to diagnose appendicitis. Interestingly, the study related that CT images in the same resolution in which they were captured initially from the modality were also seen by the iPhone in the same resolution.1

In a discussion held by author Mark Hagland with information technology and medical experts, the ideas of what is needed and how that will impact teleradiology were discussed. Software systems used in medical environments will need to offer multiple layers of usefulness for all of the different departments that use it. Everyone using the program wants optimized workflow, but with that comes security issues and even business issues, when multiple facilities use the same software for different purposes, and so software designers have a challenging job of creating programs that will work for everyone.2 It will be interesting to see what the future holds in terms of new software applicable for digital radiography environments.

The December 2009 issue of Diagnostic Imaging reports that Carestream Health is working on a PACS improvement that will utilize a unified global work list to accomplish cross-site reading. The upgrade offers enhancements such as the ability to add content to reports directly through voice commands or one mouse click, and an existing patient portfolio will, after the optimization, be able to display both dicom and non-dicom imported data.3

RIS programs have also received a new look from Swearingen Software. Their new RISynergy Web software enables medical personnel to use the web to remotely schedule patient procedures, as well as receive, edit and approve test results online.4

Much more in the progressive field of digital radiography is to come in 2010.

1. http://www.gvpub.com/rtblog/?p=357
2. http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=63163CE5901A4CB79222387325054E18&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=C8375DC8E424464191DA5850D736C91C
3. http://www.diagnosticimaging.com/imaging-trends-advances/pacsweb/pacs/article/113619/1492383
4. http://www.healthimaging.com/index.php?option=com_articles&view=article&id=19525:swearingen-releases-updated-ris-suite

A flexible program, the OmniVue system allows you to view both CR and DR digital images as well as network with workstations and PACS systems. Offering superior image display, annotation, image processing, file management, communication, optional capture and print solutions, medical facilities both large and small experience the benefits that come from using this adaptable system.

Image display provided by these dicom viewers allows the viewing of one, two three and five MP resolutions. Experience the power of separate worklist display, hanging display options and presets, multiple exam and thumbnail display. You can synchronize CT and MRI viewing, and utilize cine view for CT, MRI and ultrasound modalities.

User-friendly solutions are offered by this software system for the image processing and file management of CR and DR images. DR masking is enabled, and you can flip, rotate or arbitrarily rotate, zoom, pan and invert digital medical images easily and quickly. After you have manipulated the images, you can import and export Dicom images, even import by batches. You can convert non-dicom images to the medical digital format, and backup through the use of multiple patients CD and DVD burning capabilities. Reports to go with your digital medical images can also be conveniently saved as dicom files. E-mailing digital images is also possible with this dicom web viewer.

It is recommended that certain hardware is utilized with this powerful dicom web viewer in order to achieve maximum results from the software. You will want to have in place a Pentium processor, two gigabytes of RAM memory, and at least a one hundred and sixty gigabyte hard drive. The display resolution should be a least 1280 X 1024 and the software needs the Microsoft Windows XP Professional, Vista or 7 operating systems.

Dicom Solutions offers the OmniView software system for use with CR and DR digital images at prices affordable for small and mid-sized medical facilities. Call toll-free at (800) 377-2617 for more information.

Rad rooms can be enhanced with a DR system in place. Digital systems provide some of the fastest capture times of medical imaging options currently available, offer the highest quality resolution in digital medical imaging, and use less radiation than other types of digital imaging systems. The speed that comes with digital imaging technology allows your medical office to streamline workflow while offering improved patient care.

The Neo DR unit is one such system in place in both large and small medical offices. This system allows you to retrofit your existing radiology equipment at a fraction of the cost of purchasing an entire new suite of gear. Another benefit is that your staff already knows how to operate your current system, so there is reduced time needed for learning how to operate new equipment.

The Neo digital radiography system is unique in its class in that it is a wireless unit that uses cassettes to capture the medical images. It conveniently works in conjunction with your existing wall stand and table bucky, saving you costly equipment replacement and room modification costs. A lightweight system, weighing in at only eight and a half pounds, it is also flexible, allowing its use at any location in your examination rooms. Immediate review of digital images is possible through the wireless technology, which transmits the digital images to your console.

The CareStream DR system is another wireless system that allows you to retrofit your current equipment. The system can be used whether patients sit or stand, adding an additional flexibility factor. Installation of this unit takes only one day of downtime. Because of its speed in delivering quality digital images, it works well when time is of the essence, such as in a trauma department or emergency room environment.

DR imaging solutions from Dicom offers even small medical facilities the ability to move up to quality digital imaging for a fraction of the cost of other imaging options.

Doing More With Less

Due to the nature of the profit-driven health care system in the U.S. and the incredible expenses and debt burden incurred by medical students, fewer and fewer doctors are going into less well-paying specialties such as radiology; while the demand for qualified radiologists is increasing by approximately 15% a year, the annual number of such specialists is growing by only 2% .

Teleradiology is simply the ability to send medical images to remote locations over the World Wide Web. Through teleradiology, a mammography imaging center can transfer such images to any other clinic in the world.

In addition, teleradiology capability will allow multiple viewers to study an image at the same time, facilitating consultation and faster, more accurate diagnoses.

Another benefit of teleradiology is that it enables the clinic to easily archive images in a remote location, making backup and disaster recovery much easier should the unthinkable happen.

Is It Customizable?

Another feature one should consider in a mammography viewer is the ability of the user(s) to customize its image retrieval functions. Every center has different needs and methods; when images can be searched and retrieved based on user-defined parameters, the result is a more efficient workflow and faster turnaround time.

User-Friendly?

It goes without saying that a mammography viewer that is easy to use will result in cost savings. A more complex system may run faster, but if it is necessary for staff to spend an inordinate amount of time dealing with a steep learning curve, it will cause cost more in the long run.

Although PET-CT imaging has revolutionized diagnostic medicine, cost and logistics have proven to be problematic; not only is the combined system quite expensive, the radioactive drugs required for this type of imaging are also costly and have a short shelf-life. The DICOM format and teleradiology has mitigated these issues somewhat, making it possible to disseminate such images over an intranet as well as the World Wide Web.

Basic Features

Ideally, a PET-CT viewer allows for display of the fused image while allowing the user to control blending and create a three-dimensional reconstruction of the subject. Flexibility is also important. In addition to a full set of image editing and manipulation software tools and and various import/export options, the viewer should be compatible with legacy systems, including non-DICOM protocols and file formats. Some of the tools to look for include:

• angle
• line
• cine
• point location
• triangulation

User friendliness is another important factor to consider. Drag-and-drop function as well as set-up wizards can greatly cut down on the amount of time required to learn a new system.

Security

Because patient confidentiality is an important issue, the PET-CT viewer should have strong security features as well. In addition to password login and authentication, the system should include:

• web page timeout
• anonymizer feature
• privilege and query parameters
• SSL security (at least 128-bit)

This list of features is by no means exhaustive; because such a system represents a considerable investment, some due diligence is required. PET-CT viewers are manufactured by several different companies, and not all of them offer the same tools and features. It will be up to you to determine which PET-CT Viewers will best serve the needs of your particular health care operation.

Teleradiology is made possible by today’s Internet technologies, and promises to reduce costs by making better use of resources.

What Is Teleradiology?

Simply defined, teleradiology is the transmission of medical images over the World Wide Web and Local Area Networks. This allows for consultation with qualified radiologists in remote locations, allowing them to provide services without having to be on-site with the patient. It is also vital for hospitals and clinics in smaller, under-served communities who need the services of rare specialists such as neuropathology, pediatric medicine and osteology during off-hours, making it an excellent tool for telemammography.

How It Works

In the early days, teleradiology was quite limited, depending on telephone lines for transmission. With the event of high-speed Internet service and fiber-optic cable, hundreds of large images can be sent virtually instantaneously. Image-compression software make this even more efficient, while new security technologies such as voice-recognition and 128-bit encryption insures that such images are delivered only to those medical professionals authorized to receive and view them.

VRN – The Next Generation

The Virtual Radiology Network facilitates teleradiology services by collecting digital imaging studies from all over the World Wide Web and delivering them to the appropriate specialists. This is of great help to radiologists in managing workflow, providing these professionals with a variety of Web and network-based management tools.

• Computed Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Ultrasound

Finding the images or studies you need has never been easier, with new protocols that make it fast and simple to retrieve large studies. The new IG MammoViewer also allows for the viewing of multiple studies at once for purposes of comparison.

Once your study is complete, the appliance will create a report based on user definitions and parameters.

New And Useful Tools

The IG MammoViewer comes with a complete set of advanced software tools that can make it easier to:

• rotate, zoom or pan across the image
• take measurements
• create annotations

It now also offers full CAD support.

Security

Patient privacy is an important issue, and you’ll be glad to know that the new IG MammoViewer is fully HIPAA compliant. Protocols and authorizations are set by the network administrator on the appliance itself; there is virtually no chance that an unauthorized party can get access to sensitive patient files.

Join The Industry

Today, the Candelis ImageGridTM Mammography Web Viewer is in use by over 200 hospitals and image centers. Your clinic or hospital can can one in place and operating within three weeks of your order; every purchase of a ImageGrid Mammography Web Viewer includes full technical support. You will no longer require the services of an outside consultant in order to operate your PAC systems.

About The Company

Candelis Inc. is a major innovator in the field of medical imaging and diagnostic equipment, located in Irvine, California.

History

You may be surprised to learn that mobile x-ray machines have been around almost as long as x-ray equipment itself. What is even more interesting is that neither the stationary x-ray machine nor its portable counterpart were developed by medical scientists. X-rays were first discovered in 1895 by a German physicist named Wilhelm Röntgen, who was experimenting with cathode rays. The first portable x-ray machine was an American innovation, developed by a building engineer just after the First World War.

These early portable x-rays were nonetheless heavy and difficult to carry. Furthermore, they required portable dark room facilities.

Modern X-Ray Machines

Today’s modern portable x-ray solutions are compact and relatively lightweight (under 90 pounds). Furthermore, thanks to modern wireless technology and digital imaging techniques, x-ray images can be transmitted from and to any centralized location using DICOM 3.0 protocols. They can also be stored on the device itself, then enhanced and printed out at any clinical workstation or DICOM viewer.

Who Can Benefit

In addition to mobile clinics, veterinarians in rural areas who specialize in the care of livestock and large animals will find that mobile x-ray equipment can make the job easier. Military services such as MASH units and medical facilities aboard smaller Naval vessels will also benefit from having portable x-ray units.

In addition to medical applications, portable x-ray machines have found uses by law enforcement agencies. They have been successfully used to detect hidden explosives, concealed weapons and general contraband.

Medical and law enforcement professionals will find a number of different models and configurations from which to choose when it comes to portable x-ray machinery.

• price
• compatibility
• ease of use
• hardware requirements

What follows are brief reviews of some of the more popular commercial DICOM viewers.

eFilm Workstation

Produced by Merge Healthcare Inc., eFilm is one of the more common DICOM applications among health care professionals. Version 3.1, which was released in March 2009, now supports the Windows Vista operating system. Reports from users in the medical community state that this latest version is faster and makes it easier to view multiple images at a higher resolution by adjusting the viewing protocols. The licensing fee also includes one year of unlimited technical support at no additional cost. A free 30-trial of the software is available at the Merge corporate website.

Recommended System Requirements:

 Pentium 4 processor
 2 GB RAM
 4 GB of hard disk space
 32-bit video card

Manufacturer’s Price:

$950.00 for one year, $2500.00 for perpetual license

Voxar 3D Workstation

The Voxar 3D Workstation is published by the Advanced Visualization Imaging System Division of Barco NV, which was taken over by Toshiba Medical Systems early in 2009. It can be licensed on three levels:

• core application (basic)
• advanced tools (including “fly-through” imaging capability)
• clinical applications (full functionality)

The latest version of this software, 6.3.2, was released in June 2009. This software is designed for easy integration into any existing PAC system and is compatible with the Windows Vista operating system.
Recommended System Requirements:

Contact manufacturer

Manufacturer’s Price:

Contact vendor

PACSImage-Vue

This software package complies with all FDA standards and is fully compatible with all DICOM functions. Published by PACS-Image Inc., this is also one of the more economical DICOM viewers available commercially. The company offers a limited-time free trial.

Recommended System Requirements:

 Dual Core processor or better
 2 GB RAM (XP); 3 GB RAM for Vista OS
 160 GB of hard disk space
 1280 x 1024 resolution monitor

Manufacturer’s Price:

Contact publisher

One of the primary challenges is consistency, particularly when it comes to grayscale images such as x-rays. Typical computer monitors, even high-end ones, lack complete consistency when it comes to their grayscale characteristics. This variation may even occur between monitors of the same model.

The DICOM Part 14 imaging protocol is rapidly becoming the standard of grayscale adjustment among the different monitors that are being used throughout the industry; any monitor that is chosen should be compliant with this standard.

Area and Aspect Ratio

It goes without saying that when it comes to monitors, bigger is in fact better – and this is particularly true when it comes to medical images. It’s about pixels; different modalities produce images of different sizes in terms of area. The greater the area, the more detail that can be seen. In addition, images such as x-rays become “stretched” on smaller monitors, causing some distortion of the information and loss of image quality – not a good thing when it comes to accurate diagnoses.

A monitor of at least 3 megapixels (MP) with a screen size of 1536 by 2048 pixels will serve quite well for most image viewing needs.

The LCD Advantage

Aside from the fact that CRT monitors are largely obsolete, the liquid crystal display (LCD) monitor provides much better picture quality, a larger viewing area and a smaller footprint. In addition, they provide a brighter picture.

Graphics Card

Unlike most commercial monitors, medical monitors have specific requirements; therefore, most companies bundle these monitors with graphics cards that are specifically designed to work with them. If you must purchase a graphics card separately, keep in mind that such a card should support portrait orientation as well as monitor calibration (most commercial models do not).