Nuclear Medicine & Image Management: A World Apart

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hiit040603As PACS has evolved over the last two decades, the technology has advanced to meet the needs of most - but not all - imaging modalities. General radiology PACS tend to focus on anatomical modalities like CT and MR. The primary reason for the cold shoulder? Nuclear medicine represents a different species with specific and unique needs.

"General radiology PACS don't provide the display functionality to support nuclear medicine studies. In addition, some PACS don't fully support DICOM for nuclear medicine for easy storage and retrieval of nuclear medicine studies," explains Bill Erwin, PhD, senior medical physicist with MD Anderson Cancer Center in Houston.

In some cases, frustrated nuclear medicine departments have cobbled together their own homegrown product to serve as the image management solution. In others, the department continues to rely on less than state-of-art solutions like storing images on CDs and magneto-optical (MO) drives. But some nuclear medicine departments have tapped into one of the few commercial solutions on the market - with promising results.

Several niche companies have developed nuclear medicine image management solutions geared to the unique needs of the specialty. Deploying such a solution can bring a number of benefits including complete soft-copy image management, improved workflow and access to nuclear medicine DICOM translation tools to facilitate a heterogeneous scanner environment. The hitch is to understand the facility's needs and the potential and limits of nuclear medicine image management solutions. In addition, smart departments also keep one eye on the future as the PET/CT explosion is driving changes across the nuclear medicine field.

The needs: At a glance

While most imaging modalities focus on anatomical representation, nuclear medicine displays images in many different ways. Static display does not suffice for dynamic nuclear medicine studies, planar gated studies, SPECT, PET or PET/CT, says Mike Georgiou, PhD, director of basic science operations-nuclear medicine at the University of Miami Hospital in Florida.  Nuclear medicine requires very specific display capabilities; the system must display grayscale or color, functional, quantitative and fusion data. For example, PET/CT image review is a complex process that entails viewing of transaxial, coronal and sagittal and maximum intensity projection (MIP) images. In addition, the physician should be able to easily triangulate the area of interest, obtain standard uptake values (SUVs) to determine metabolic uptake and change the display to PET and CT alone or both in a fused fashion.

Although nuclear medicine modality workstations provide processing and analysis tools for soft-copy interpretation and quantitative analysis, they can not store nuclear medicine images for the long-term. A nuclear medicine image management solution can provide that central archive. In addition, many systems incorporate DICOM translation tools to help hospitals integrate heterogeneous scanner environments.

Beyond the modality workstation

One of the primary reasons for turning to a nuclear medicine image management solution is to overcome the constraints of multiple modality workstations. "Modality workstations provide necessary processing and display tools, but they don't meet nuclear medicine image management needs beyond the modality," says Georgiou. That is, the workstations do not interact efficiently with the radiology PACS to provide networking integration, remote access to images or appropriate long-term data archiving.

Two years ago, University of Miami Hospital turned to Thinking Systems Corp.'s ThinkingPACS to meet the broader image management needs of its nuclear medicine department. "ThinkingPACS provides display and review flexibility, a departmental archive and remote access through its web-service capability," sums Georgiou.

The transition to soft-copy nuclear medicine image management has resulted in workflow gains as physicians no longer need to return to individual modality workstations to interpret studies. Thinking Systems provides the nuclear medicine processing packages of modality workstation, which facilitates one-stop reading.

Multi-purpose image management

MD Anderson Cancer Center has relied on Numa Inc.'s NumaStore as its nuclear medicine image management solution for more than 10 years; however, the system transcends the basic archive role. The unfortunate reality of DICOM-compliance is DICOM is not a strict standard.