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).

The new bone densitometer, called MetriScan, can identify osteoporosis, monitor patients’ response to osteoporosis treatment as well as test for their risk for fractures. The bone densitometer also allows physicians, after reviewing patients’ personal and family medical history, to perform bone density tests or bone mass measurements in-house.

Key features of the MetriScan bone densitometer include very short processing time for test results. Getting test results takes only one minute, and if you wish to print out the results, one additional minute is all it takes. The test itself is performed by the bone densitometer in less than one second.

Other features include automatic calibration checks for a very low clinical precision error rate. Patients require no preparation for the test and the test itself is painless. Radiation levels for the test are lower than five percent of that used in acquiring a dental x-ray.

The most common uses for the bone densitometer are for small or mid-sized medical facilities, especially those with primary care physicians. Patient care improves because at-risk patients can be tested for bone mineral density more often as a part of their routine examinations, and the testing is covered by Medicare for senior patients.

The TIMS DICOM system is a software and hardware system that allows for the conversion of non-Dicom equipment to dicom modality. The digital medical images that can be created via the TIMS DICOM allows you to utilize them with a PACS system, as well as burning the images to CD or DVD, and it lets you print the digital images to paper or film.

Hospitals and medical facilities can also purchase the Dicom gateway software by itself. This software allows you to convert your digital medical images to dicom images. The software lets you print the images or save the images to disc, and it allows you to receive dicom images from other dicom-based equipment. The Dicom gateway TIMS software does not need the TIMS hardware to function, and in this way you can save money by only purchasing what you need. By adding the TIMS hardware component to the system, you will also be able to connect to non-dicom modalities to acquire medical images.

The entire TIMS DICOM system suite saves your medical facility mone