Peering Into Radiology 2012

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Radiology is evolving at breakneck pace with clinical needs, demographic realities and IT development converging to create change. Looking into radiology’s crystal ball is never an exact science. “We are in a period of time when healthcare is being rewritten and re-defined,” states John Desch, vice president for sales and marketing at Philips Medical Systems. Vendors and healthcare providers alike are in a state of flux as the feds try to slow overutilization of imaging technologies through legislation and reimbursement cuts.

Insiders, however, do have some clear indications about radiology’s needs and what they mean for the radiology department of the future. Perhaps after touring the halls of McCormick Place at RSNA last month, and before making clear plans about the next steps for the department, consider the experts’ take on Radiology 2012.

RIS/PACS: The challenges ahead

RIS/PACS is the driver of digital radiology. Over the next five years, the current trend toward integration will solidify. The best new systems will be universal, enterprise-capable and integrated. Paul Chang, MD, vice chairman radiology informatics at University of Chicago, points to five trends driving RIS/PACS development.

Enterprise digital image management will continue to gain traction. That is, facilities will leverage their investment in PACS and seek an integrated infrastructure to handle all digital imaging including all the ‘ologies’ and visible light images. Hospitals will need a DICOM wrapper or DICOM translation box for non-DICOM data like visible light images.

The twin challenges presented by systems integration and interoperability will persist. Service Oriented Architecture (SOA) and web services go beyond Integrating the Healthcare Enterprise (IHE) and support complex radiology workflow and provide necessary interoperability, says Chang.

Challenge number three stems from hefty datasets. Conventional wisdom might peg storage as the primary problem, but the price of mass storage will continue to plummet, says Chang. “The problem is transmission of data from the server or archive to the web client or workstation,” he says. The solution is server side manipulation, which eliminates the need to transmit large datasets. Datasets can be stored on a hard drive augmented with a dedicated graphics processing unit; results are streamed to the end user, minimizing the transmission burden.

Vijay Tanjore, senior marketing manager, Americas, Imaging Solutions Business for GE Healthcare, foresees storage challenges as RIS/PACS migrates through the enterprise. “There will be a storage crunch because of the size of pathology and endoscopy datasets, and people will run out of storage.” A single pathology image, for example, can range up to 60 to 80 megabytes compared to 0.5 megabytes for a CT or MR image. Sites will be forced to invest in additional storage or transition to an ASP model that minimizes concerns about  obsolescence and capital investments, says Tanjore.

Chang foresees a blurring of the distinction between PACS and the EMR. “We’ll see fewer standalone PACS,” predicts Chang, “PACS will become the multi-media component of the EMR.” The EMR will be customized for the workflow of various end-users. “Every PACS will need to play well with EMRs,” adds Tanjore.

The final issue in the RIS/PACS market of 2012 centers on radiologists. Will PACS make radiologists obsolete, asks Chang? Because clinicians can view images instantly, radiologists need to demonstrate their value to their customers—referring physicians and specialists across the street, across town and across the world. PACS can help radiologists demonstrate their value by enhancing virtual collaboration and communication with end-users.

“The radiologist will be the central diagnostic imaging consultant in the future,” counters Philips’ Desch. New IT solutions will take radiologists beyond image viewing and enable them to see and consolidate health data and use it to predict disease and consult with referring physicians in the primary-care office, surgical suite and across the world.

Jay Moskovitz, radiology informatics manager at Cincinnati Children’s Hospital, recommends sites investing in PACS go beyond the basic questions about DICOM, IHE and HL7 as they invest in the next generation of systems and ask potential vendors:

  • Does the PACS facilitate paperless radiology?
  • Does the system improve documentation and communication among radiologists and with clinicians?
  • How does the PACS