PACS Gain Tools to Speed Reading and Diagnosis
PACS vendors' expanding portfolios outside of radiology into other 'ologies' - including cardiology, orthopedics and even pathology - was clear at last week's meeting of the Radiological Society of North America. Vendors also highlighted advanced visualization tools to help radiologists manage the ever-increasing amount of data and "image pollution" funneling into their workstations. New PACS optimized for the complex world of breast imaging are hitting the streets, too. New system features enable user-friendly hanging protocols and advanced visualization to ease the integration of mammography into the digital image mix. And finally, small hospitals and imaging centers are gaining some attention with new systems geared to their specific workflow and IT needs.

Overall, excitement for PACS was very high as facilities large and small seek to upgrade older systems or look to embark on digital image management for the first time. RSNA-goers were asking serious, practical questions on PACS - with little tire-kicking and more actual buying this year.

(Note: companies appear in alphabetical order.)

Agfa Corp. launched three new systems - Impax Web1000 5.0, Impax RIS/PACS for Imaging Centers and MediWeb RIS/PACS. New Impax Web features facilitate report distribution times and improve clinician workflow. Data Currency allows continuous synchronization of patient data from the Impax server to Web1000. MPEG integration offers improved stability, compatibility and control, enabling access within or beyond hospital firewalls, and a conference mode function allows authorized users to work interactively with each other and use instant messaging for real-time communication.

Impax RIS/PACS for imaging centers is tailored for the workflow, integration and implementation needs of single and multi-site centers and integrates RIS, PACS, speech, document management, billing and practice analysis. Impax RIS/PACS provides referring practices with Web access to reports and images.

Agfa announced the successful release in Europe, Australia and South America of MediWeb, a thin-client solution for radiology order communication and results distribution. With MediWeb, exams performed in the radiology department can be ordered and followed up from any desktop, and reports and images generated in the radiology department are available to any authorized user inside and outside of the hospital via a web browser.

The company also introduced the enhancement of its Impax ES for Orthopaedics toolset with an Orthopaedics Spine module, which is a works in progress. The new module provides tools to digitally plan spinal surgeries and digitally calculate scoliosis, vertebral rotation and estimate skeletal maturity, compared to normal values. The workstation includes planning tools for hip and knee replacement, biometry, osteotomy, coxometry and trauma.

Agfa also announced its planned acquisition of GWI, a European HIS and EPR vendor. The deal is expected to close in early 2005. (For details, see story at:

AMICAS, the radiology division of VitalWorks Inc., showcased its Vision Series family of products at RSNA. The company demonstrated its full, end-to-end product suite, including Vision Series RIS, Vision Series PACS, Vision Series Financials and Vision Series Document Management. AMICAS Vision Series 4.1 with AMICAS RealTime worklist connects all enterprise users and integrates RIS, cardiology, PACS, orthopedic templates, document imaging, 3D and dictation.

The company showcased integration of Vision Series PACS with the Heartlab Encompass Cardiology PACS via the AMICAS RealTime Worklist to provide on-demand access to cardiology and radiology images across the enterprise without user query. Other new features for the Lightbeam Diagnostics Workstation and RealTime Worklist include study display without accession numbers to enable personalized worklists for radiologists and their customers, integrated 3D cropping with targeted review and AMICAS ThinView, a dynamic means of accessing images and reports starting from minimal information and expanding to full viewing.

Also new from AMICAS is its Insight Services client-centered professional and consulting services to execute the transition to digital.

The company shared plans to release a new acute-care software package with cardiology, orthopedic and 3D tools prior to the Healthcare Information Management and Systems Society (HIMSS) meeting in February. Stay tuned.

Brit Systems highlighted its custom, modular turn-key systems for PACS and teleradiology. The company's DICOM server and archive for image storage options include the Capture Workbench mini-server and Roentgen Files.

The Capture Workbench mini-server contains a DICOM module of DICOM storage and JPEG compression syntaxes for teleradiology. The Roentgen Files provide a scalable DICOM server, archive and web server for high availability and high security. Viewing solutions include The Radiology Workbench - UNIX or NT based workstations for primary interpretation, The Review Workbench - UNIX-based workstation for hospital use and The Referral Workbench - a Web-enabled Windows-based viewer for home and office use. Data acquisition options include The Capture Workbench frame grab system for digital modalities, The Scanning Workbench for Lumisys-based film digitizers, The ACR2000 Lumisys CR system and The QC Workbench for quality control and modality worklist functions.

Cedara Software Corp. showcased a full line of PACS-enabled clinical tools, including OrthoWorks Spine Analyzer, I-Store, I-SoftView and I-Reach.

The newly launched OrthoWorks Spine Analyzer detects the bone contours and measurements of the spinal vertebrae for cervical, lumbar, postural and frontal analysis in a few mouse-clicks. The system's semi-automated spinal vertebra anatomy detection feature simplifies planning and allows rapid standard spinal measurements. Spine Analyzer integrates with Cedara OrthoWorks Care Manager, which automatically populates data fields into a central repository so clinical data can be data mined, organized, and shared and exchanged remotely. OrthoWorks Spine Analyzer also shares data with Cedara's OrthoWorks planning module, which is used to load and review images, as well as plan surgical procedures such as rod, screw and implant sizes.

I-Store image management and archiving system is a software-only option that provides hardware flexibility. The scalable distributed architecture allows customers to grow the archive as image volume expands.

I-SoftView provides a 3D volume rendering option, and I-Reach provides web-based report and image viewing.

Cerner Corp. used RSNA as the launching pad for the MultiMedia Foundation enterprise-wide imaging and distribution solution. MultiMedia Foundation takes both DICOM and non-DICOM images like photographs and pathology images and places them in an enterprise-wide archive for web-distribution, linking both DICOM and non-DICOM images to the EMR. The system can be used with Cerner and other vendor's PACS products.  

CoActiv Medical Business Solutions highlighted new features for its Exam-PACS modular PACS. The features include unlimited installation of clinical viewing software throughout facilities at one price. The Exam-Sender, Exam-File and Exam-Vault modules are now compatible with other PACS and function directly from other modalities. New functions include open database searches in Exam-Sender with restrictions determined by facility for referring physicians and robotic capabilities for Exam-Filer.

DatCard Systems showcased its PacsCube DICOM distribution system, a CD-R/DVD-R publication device that provides an automated alternative to laser film. PacsCube takes DICOM images and records them onto a CD/DVD to enable distribution of digital images to patients, referring physicians and institutions. Models include the Express 100X, configured with a single recorder and the Express 200X with two recorders for larger sites. Both models feature one click patient de-identification, Remote Server Query Retrieve, a Web-based interface, OEM DICOM viewer support, batch archive processing, multi-facility capability and multi-language support.  

DeJarnette Research Systems highlighted the PACSware Migration Gateway 2.0 at RSNA. The software provides basic migration functionality, including complete migration lists via SQL or a series of connected DICOM queries, database tracking and error handling. Migration Gateway 2.0 also offers a verification tool to compare legacy and target archives. Optional features include a pre-fetch migration tool and store and forward tool.

DeJarnette also showcased its dyseCT product. DyseCT identifies multiple procedures studies and modifies the DICOM modality worklist to replace multiple procedures, automatically associates images with a specific anatomical region and separates images in a multiple procedure study and links them with orders.

DR Systems highlighted DR Systems PACS/RIS Release 7. The new technology incorporates cardiology tools; "auto pull" of cases and reports; improved RIS interfaces and expanded mammography reading. New features include integrated cardiology PACS, pathology image distribution and smart client technology. Smart-client technology uses web services to enable automatic updating of software applications, provide full functionality of the local computer on Web-sourced data, avoid network bottlenecks and facilitate data exchanges, the company said.

DR Systems also highlighted FDA clearance for diagnostic reading of digital mammography on its PACS, which will enable integration of digital mammography into the RIS/PACS workflow to achieve efficiencies in automated reporting, storage, archiving and web-based distribution. The capability is available via DR Systems Release 6 software using the Dominator Diagnostic Workstation and offers the ability to view, archive and retrieve digitized mammograms and scan prior mammograms for comparison. Other features include comparison to ultrasound, MRI and other modalities, automated reporting and CD, internet and web distribution of images, audio and reports.

Dynamic Imaging launched new clinical applications, fault tolerant architecture and 3D management tools on its IntegradWeb PACS. The new Fault Tolerant Grid Architecture enables sites to continue to function independently in the event of network failure in multi-site PACS deployments. Its Orthopedic Package provides a comprehensive template library. 3D tools include a Configurable Slice-Thickness Reformatting engine that automates image formatting to minimize storage space requirements following image post-processing and reconstruction. A Slab Scroll Tool creates on-the-fly in-plane reformatting with adjustable slice thickness, and a Configurable Data Compression Utility automates lossy image compression over time to create increasingly smaller file sizes as studies age. Automatic Results Notification automatically emails referring physicians a link to online studies when diagnostic results are available. Other new features are a Key Images Template and Hanging Protocols based on Scanning Techniques and Orientation.

Eastman Kodak Company debuted its enhanced RIS/PACS suite and introduced a mammography upgrade for DirectView PACS System 5. Kodak RIS/PACS supports native applications such as 3D volume rendering and improves customization of display protocols based on workstation image layout and functionality, so each type of study is displayed according to preferences. It enables referring physicians to receive information in emails or embedded in an electronic medical record -with the option to view the entire imaging study via secure web-based access. Referring physicians can also order and schedule radiology exams and view patient status and history. Other enhancements include an improved graphic user interface, streamlined exam reporting capabilities, an advanced report search engine, improved diagnostic reading and 3D viewing with associated imaging studies on a single workstation. Clinical tools include MPR/MIP tissue definition and vessel tracking functionality. The suite includes KODAK DIRECTVIEW Versatile Intelligent Patient Archive (VIParchive) software for control of PACS-related image and information storage. Kodak RIS/PACS will be available in early 2005.

Kodak also introduced a mammography upgrade for DirectView PACS System 5. The upgrade allows users to integrate digital mammography with general radiology workflow and allows users to review and store ultrasound, MRI and other digital modality images. It includes a Mammography Workstation with multi-modality, multi-vendor support. The Mammography Upgrade and Mammography Workstation will be available in the first quarter of 2005.

The company also highlighted its new pricing for Professional Services and expanded availability of Remote Monitoring Services.

Eclipsys highlighted its upcoming acquisition of eSys Medical Systems, announced plans to launch a new product family - Eclipsys Diagnostic Imaging Solutions - and showcased Sunrise PACS.

The Eclipsys Diagnostic Imaging Solutions line will include Sunrise PACS and Sunrise RIS and provide integration with Sunrise Clinical Manager HIS to enable clinicians to view patient records, images and reports in real time from anywhere at any time, the company said.

Sunrise PACS, powered by Sectra, links radiology and other specialized diagnostic imaging capabilities - including cardiology, mammography and endoscopy - to the clinical workflow of the organization. Sunrise PACS provides streamlined access to digital radiology images to help reduce delays in care, such as report turnaround times and image re-takes. The system delivers imaging data as an integrated part of the overall patient record by providing image access at the point of care on any Sunrise-enabled device; automates access to medication history, lab data and other clinical information for radiology personnel review and enables radiology and cardiology image management with one system.

Emageon rolled out its 2004-R6 product release. New features include integration with Dictaphone PowerScribe voice recognition, UltraVisual Technologist featuring web-based administration tools and paperless workflow, a mammography workstation, OpenGL high performance graphics, multi-specialty tools and multi-institutional support.

Emageon also highlighted Intelligent Visual Medical System (IVMS), an enterprise advanced visualization and infrastructure solution that allows physicians and healthcare professionals to manage, access and visualize medical content using multi-specialty tools through a dynamic user interface.

Finally, Emageon highlighted October 2004 FDA clearance for softcopy viewing of digital mammography for its UltraVisual advanced visualization software used in conjunction with FDA-approved display hardware. Now, presentation-quality mammography images and prior digitized mammography film images can be displayed using features native to Emageon's software. Standard tools include real-time pan/zoom with zoom presets; intuitive selection of current and prior images with customizable hanging protocols; fully configurable magnifying glass; comprehensive grayscale support with window/level presets; arbitrary image rotation; image filtering; key image creation for communicating with other physicians, and multiple display support. All settings are configurable and follow the user throughout the enterprise.

eMed Technologies showcased its eMed Matrix. The PACS is built with Microsoft's .NET smart client architecture to combine the power of the PC and reach of the web. The system features a new platform, redesigned user interface and peer-to-peer communication and collaboration tools. The company also highlighted the direct integration between Dictaphone PowerScribe Workstation and eMed Matrix. Version 2 of Matrix offers teaching files, MIP, MPR and reconstruction tools and will be available in the first quarter of 2005. (eMed is in the process of being acquired by Cedara Software.)

eRAD/Image Medical Corp. showcased eRAD standards based, web-centric PACS and Practice Builder 1-2-3 next-generation PACS. eRAD uses existing LAN/WAN infrastructure to provide secure, enterprise access to studies and reports on high-definition workstations or PCs.  Practice Builder 1-2-3 offers MPR, 3D and orthopedic templating. It includes a native interface to the EMR, RIS or HIS and supports DICOM structured reporting. PracticeBuilder 1-2-3 is designed to work on the existing network using TCP/IP to enable the same functionality over a WAN or the Internet.  

Evolved showed its web-based, fully managed RIS/PACS and Evolved PACS. RIS/PACS features include integrated workflow, online dictation/transcription, secure off-site archiving, patient data and scheduling and interfacing. The company provides implementation support with a managed service approach to RIS-PACS.

Evolved also highlighted Evolved PACS, which combines radiology and cardiology on one platform. Features include high-resolution 3D viewing, access by workflow or patient record, diagnostic review and enterprise wide clinical viewing, automatic pre-fetching and vendor neutral software.

Ferrania Imaging Technologies showcased its LifeWeb RIS/PACS, a brokerless solution. The enterprise-level, web-based system manages images and workflow, supports speech recognition and allows remote access.

Fujifilm Medical Systems introduced the latest version of its flagship PACS, Synapse 3.1 as well as showing its expanded vision to address RIS and PACS. The new 3.1 release offers advances in CT image processing, extended dictation support and multi-vendor operation capabilities. Enhancements to Fuji's patent-pending Reading Protocol technology automate the presentation of documents, image processing parameters and results in Synapse. Clinical Conferencing and Series Renaming are now available in Reading Protocols. Synapse Web Administration Tools (SWAT) Enhancements 3.1 expands reporting capabilities with workflow analysis tools including cycle time quantification, study tracking and measurement of time from acquisition to dictation. Controlled Deployment allows administrators to push Synapse installation to users. Clinically, Dynamic Range Control and Image Sharpening are available for CT images. DICOM SCU allows Synapse users in multi-site facilities with different PACS to access images on other PACS. And Dictation Support provides users with a choicer of dictation systems. Options include G2 Speech, Lanier Serial Port, PowerScribe, Provox, Quadrat Speech Technology and Talk Technology. Synapse 3.1 is expected to be commercially available in the first quarter of 2005.

Fuji also announced its expanded vision for Synapse PACS to address the blurring of the RIS and PACS market categories. The company will develop a brand new market category of information systems called "knowledge management" systems. The new development direction, coined Comprehension by Fuji, aims to deal with the spectrum of clinical and business processes as a single, complete, intelligent system that can embrace all evolving requirements of the radiology domain. Fuji demonstrated a "task-oriented" workflow that allows users to quickly navigate to the work that needs to get done, without the need for complex queries. The task-oriented workflow allows users to navigate to and explore through all information, so they can quickly identify and work with information and events pertaining to their role.

Further, Fuji announced a partnership with Silicon Graphics to bring Silicon Graphics Prism visualization platform to Synapse PACS.

GE Healthcare used RSNA as the launching pad for Centricity AW Suite, Centricity PACS SE and Centricity Digital Hardcopy.

Centricity AW Suite fuses modality and PACS technologies and incorporates advanced tools, allowing users to acquire, manage, store, review, analyze and report on information from a single workstation. Centricity modules include results review, CPOE, flowsheets with monitor capture, progress notes and census boards that combine to create a filmless, wireless and predominantly paperless care environment for a faster, more comprehensive information flow. Similar to the Centricity PACS Enterprise Edition, Centricity PACS SE utilizes powerful imaging applications, including Centricity RA 1000 radiology application, Centricity AW Suite for visualization for large data sets of PET/CT, CT, MR and XR, and Centricity Enterprise Web for image and information distribution.

Centricity PACS SE, which is integrated with the EMC Clariion AX100 storage system and Intel-based server hardware, is a plug-and-play PACS designed to meet the workflow needs and IT constraints of smaller hospitals (100-400 beds) and busy imaging centers. The modular, "all images online' system scales Centricity PACS for smaller sites to create a fully filmless work process, with fast storage and complete RIS integration. Installations began this fall.

Also new from GE is Centricity Digital Hardcopy. The multifunction solution simplifies file room processes by burning and labeling CDs or DVDs for image and report distribution in DICOM format; each CD or DVD includes a copy of the browser-based Centricity DICOM viewer, allowing the user to view the images and reports contained on the disk on most standard PCs with Internet access.

The company highlighted several works-in-progress including an ergonomic workstation with voice and hand-controlled Centricity software and a wireless surgical Centricity OR prototype with motion recognition, voice commands and an infrared keyboard.

GE also announced new reading room design services.

GlobalCare Solutions launched its Amalga NoCompromise RIS/PACS. The enterprise system includes an online permanent archive, dictation/transcription, voice recognition, teaching folders, 3D imaging, document scanning and enterprise web delivery.

Guardian Healthcare Systems at RSNA rolled out an integrated RIS-PACS called FlowPoint. FlowPoint lets healthcare enterprises combine a patient's medical radiology data and images into one digital record, the company said. The integrated RIS/PACS aligns information technologies with radiology to optimize business and clinical results, employs web services architecture to provides enterprise interoperability and pathways to new enhancements and provides a single application architecture to eliminates integration problems between RIS and PACS. FlowPoint PACS, a set of web services embedded in the RIS, provides radiology patient information, image management and web-based imaging capabilities, and information distribution to healthcare enterprises, including small- and medium-sized hospitals, physician offices and medical imaging centers. It enables enterprise-wide scheduling to optimize radiology equipment and facilities.

IDX Systems Corp. at RSNA highlighted its acquisition of PointDx, a developer of structured medical reporting technology and introduced the re-engineered ImageCast RIS/PACS. (See related story,

PointDx technology will be directly integrated into the IDX Imagecast RIS/PACS, IDX said. Structured reporting in RIS/PACS is expected to improve revenue cycle management and efficiency among clinical staff, reduce medical errors and facilitate delivery of a high-quality report to referring providers. ImageCast with structured reporting will enable a structured report with common medical vocabulary and key images, which can be used to electronically launch the full image set. Additionally, the improved report is designed to enable improved outcomes monitoring and better position the referring provider to deliver enhanced care. Finally, ImageCast with structured reporting will help automate or remove steps in the coding and billing process to yield shorter turnaround times and improve the revenue cycle. ImageCast with integrated image analysis and reporting capabilities will be available by mid 2005.

The company also showcased the rearchitecture of ImageCast. The reengineered product offers specific workflow tools to meet the needs of both radiology and cardiology. ImageCast for cardiology will be launched at ACC 2005.

IDX and Stentor also announced the renewal and extension of their technology partnership for the delivery of integrated PACS until 2015.    

Imco Technologies highlighted Imco-WirelessPLUS wireless solution for enterprise image access. The wireless solution includes wireless image/report viewing software, a wireless image/report server software and image/report control software on radiologist workstations. The system allows radiologists to send data using wireless devices including tablet PCs and PDAs. The wireless software display resolution can be zoomed several times and provides pan and window/level control. Imco-WirelessPLUS will be released in the first quarter 2005, Imco said.

The company also introduced new Imco-view features, including customizable hanging protocols and a third-party monitor for worklist viewing. Imco-ortho is now available as a software option integrated into Imco-view. Also new is QuickClick, which offers 16 programmable function keys for the most common individual users functions.    

Integrated Modular Systems Inc. highlighted Radin web-based image management system. Radin/IMSI Ortho.PACS provides a digital environment to assist in the assessment of geometrical changes of lower extremities and perform filmless surgical planning. The open system interfaces with multiple systems and features HIP biomechanics and coxometry modules, templating and stitching capabilities. New web-based 3D and on and off-site redundancy archiving are now available. The company also showed its web-based integrated RIS-PACS and

Intelerad Medical Systems Inc. showcased several new features to IntelePACS InteleViewer at RSNA. New features include linked stacking, configurable overlay information, cine, teaching file module and print, email and fax of reports and key images. The new InteleViewer Teaching File module enables tagging and indexing of images using CPT codes and other parameters to streamline search and display of teaching cases. Intelerad's Reporting Worklist software addresses IHE management issues. The software will be demonstrated at the IHE 2005 Connectathan in January.

The company also highlighted third-party integrations with TraumaCad orthopedic templating, Voxar 3D MIP, MPR and 3D color volume rendering and AquariusNET Server for advanced 3D viewing and distribution. MPR was shown as a work in progress on Inteleviewer and will be available by summer 2005.

Intelerad also featured its 24-hour call center support and new remote monitoring tools. The new service allows customers to reach a trained technical service specialist directly at any time of the day or night.

Marotech Inc. showcased its full line of PACS solutions including Marosis Enterprise full PACS for large sites, Marosis Workgroup for small and mid-sized facilities and Marosis Stand Alone miniPACS. The company also highlighted integration with Lucion for advanced 3D tools, StructuRAD for structure reporting and Orthocrat's TraumaCAD orthopedic templating and planning software.

McKesson Corp. at RSNA launched Horizon Rad Station and showed Horizon Medical Imaging and Horizon Radiology Manager workflow management system.

Rad Station features adaptive image loading to optimize image display and navigation; virtual image management to support advanced, multi-slice and high-data volume modalities and clinical series mapping that enables common display protocols for vendor-specific DICOM implementations.

Horizon Radiology, McKesson's web-based integrated RIS/PACS solution provides seamless management of images and information for gains in workflow productivity from order entry to report distribution. Horizon Medical Imaging (PACS) and Horizon Radiology Manager (RIS) are available as an integrated RIS/PACS, or standalone RIS or PACS using standards-based methods and the IHE framework to interface with other systems. Features include integrated billing, claims optimization, necessity checking, distribution and reporting functionality. Horizon Radiology provides cost-effective scalable solutions for the workflow needs of imaging and outpatient centers, as well as small hospitals or mid to large multi-site, enterprise facilities, the company said.

McKesson also showed off new Horizon Medical Imaging features including a web-based single viewer workstation for efficient distribution and access to all studies from any clinical department across the enterprise. The workstation provides new viewing options and the ability to handle very large volumes of data for storage and display to meet the needs of CT and MR scanners. Enhanced integrated tools for nuclear medicine, PET/fusion images, orthopedic templating and 3D imaging from everyday to high-end options improve workflow support and productivity.

Meditech highlighted its PACS integration suite at RSNA. The suite links information systems and PACS into a clinical system for radiologist access to patient data and clinician viewing of diagnostic images, exam information and interpretation through an online medi