A pair of commercial, off-the-shelf software packages has addressed limitations in PACS implementation by providing the capability for real-time consultation and collaboration between radiologists and oncologists at disparate healthcare sites in England.

“Many oncologists have had no specific training in these newer imaging modalities (MRI and PET), and so the advice of an appropriate radiologist in the interpretation of these images is highly beneficial,” wrote the authors of an article about the remote collaboration in the British Journal of Radiology.

The authors noted that even CT images, in some instances, may be difficult for oncologists to interpret for purposes of target volume determination in radiotherapy. Recognizing this, the Royal College of Radiologists issued a recommendation that clinical oncologists and radiologists should collaborate closely on gross tumor volume delineation in complex cases.

However, for practical purposes this best-practice type of collaboration may be challenging to achieve, the authors noted. Scheduling, workload and clinical professionals who practice at differing locations compound the difficulties in achieving the goal of interactive consultation.

The Nottingham University Hospitals NHS Trust sought a healthcare IT solution to overcome these practical issues. The facility first looked to its PACS, which included a conferencing capability for diagnostic images.

Unfortunately, according to the authors, the system does not support tumor outlining or provide image fusion capabilities. In addition, there were workflow concerns with the radiotherapy planning CT images.

“The dedicated radiotherapy CT scanner is not scheduled using the radiology information system, but via the dedicated radiotherapy resource scheduler,” the authors wrote. “This means that it is not straightforward to put radiotherapy planning CT images on PACS, even if PACS had the required functionality.”

The Nottingham team found one part of their healthcare IT solution bundled with the Microsoft Windows operating system deployed on many desktops in the facility, NetMeeting. The remote desktop tool is part of the standard Windows package, and allows two or more users to share applications and data and to videoconference across a network connection.

A PC-based virtual simulation application, ProSoma from the Shrewsbury, U.K.-based Oncology Systems Limited (OSL), provided the remaining piece to the collaboration solution. According to the authors, the ProSoma package has the functionality required by the facility’s radiologists and oncologists for target-volume delineation consultations.
To conduct a remote outlining session, an oncologist runs NetMeeting on the same workstation with ProSoma, while a radiologist opens the NetMeeting applet on their PC. Once the connection is established between the two, the oncologist shares their desktop with the radiologist—creating a virtual space where both clinicians have full access to the radiotherapy virtual simulation package.

The authors reported that their solution is practical in routine clinical use and extremely low cost, as NetMeeting utilization required no expenditure on software licensing. In addition, they noted that it has increased interaction between the clinical specialties, which ultimately results in a higher quality of patient care.

“Over the six months that we have been using NetMeeting and ProSoma, our specialist head and neck oncologists and radiologists have been working together on planning CTs approximately once a month on difficult cases,” the authors wrote. “Prior to this, there was no routine radiological input into target volume delineation on planning CTs.”