Cardiac-related advances in imaging modalities such as CT, MR, PET/CT, SPECT and echocardiography have created a demand for cardiology PACS capabilities that offer individualized solutions to fit evolving image management and patient information management needs.
The cardiology PACS market is maturing toward a data revolution that has allowed for a continued decline in cardiac morbidity and mortality, says James E. Tcheng, MD, professor of medicine at Duke University in Durham, N.C. The American Heart Association says that since 2005, deaths from heart disease have dropped by 25.8 percent and deaths from stroke have fallen 24.4 percent.
Tcheng says that, considering that the major advances in cardiovascular medicine have been in the last 20 years to drive this reduction, he attributes the reduction to four things. “Statin therapy, new stent technology, a reduction in smoking, and imaging—which is one of the biggest reasons cardiovascular deaths have dropped,” he says. “With better imaging, comes better diagnosing—which means better care for patients.”
Tcheng says these advancements in imaging have enabled staff at Duke’s Heart Center to view multiple modalities in an integrated, web-accessible environment in the echocardiography lab through Xcelera cardiology PACS from Philips Healthcare.
They’re also in the process of linking Xcelera to the cardiac catheterization lab. “In the heart cath lab, we are obtaining images with intracardiac echo, intravascular ultrasound, and we want to be able to associate these studies so that if you are looking at the cath and you see an ultrasound probe in the coronary artery, you can simply pull up the ultrasound as well—Xcelera gives that capability,” he says.
Going from one hospital lab to three hospitals demanded a cardiology PACS with scalability, Tcheng says. “We needed an application that was more robust with the horsepower we needed to manage the flow of patient information and images in an efficient fashion,” he says. Moving to an enterprise SAN (storage area network) demanded a mature solution to handle the interfaces that had to be created. Tcheng says Duke is planning to develop into a multimodality, multi-vendor environment to bring up images from all cardiac-specific modalities.
Centralized image management
When the Cardiology Unit at the University of Rochester Medical Center decided to upgrade its echocardiography lab, including ultrasound and a server to a cardiology PACS, administrators went with a solution that would connect physicians from multiple departments and sites.
With PicomEnterprise from ScImage, which was already installed in the center’s cardiac catheterization lab, Cardiology IT Manager Martin E. Smith says he consolidated services under one global “cardiology umbrella. I needed one centralized image archive that could allow the physicians to work as a team.”
Smith says he has a back-end system with PicomEnterprise that can accept data from all cardiac modalities and send those images back to the user the same way they come in. “We now have a centralized image archive that nuclear, echo and cath can use,” he adds “and pediatric echo, OB/GYN and cardiac anesthesia are in the works.” Smith says a key benefit to the ScImage PACS is the ability to consolidate fragmented mini-cardiology PACS into one that is usable by everyone. “Our current cardiology PACS archive allows multiple modalities to choose an analysis/viewing package that best fits their needs, yet combining it in a centralized PACS archive that is easier to manage.”
Banner Health in Phoenix, Ariz., a nonprofit healthcare system serving seven states from Alaska to Arizona, also needed a centralized database for its echo and cath labs and found a solution with HeartLab, a cardiology PACS from Agfa HealthCare. (The system is now known as Impax Cardiology.) “We wanted to send both echo and cath imaging to the same regional database,” says Jon Pavlicek, biomedical engineering senior consultant at Banner. He says that the radiology PACS in use did not run cine loops cleanly and measurement tools were very poor, which he says did not allow for a refined report for cardiology.
Banner uses HeartLab as the main viewing software for staff and physicians to create reports for patient records. The system “talks” with a radiology PACS from Fujifilm Medical Systems through Bycast, a data management company that focuses on storage grids and management of the data that passes between the two PACS, says Pavlicek.