Cardiovascular Business - May/June 2008 - (Page 24)

TeChnology UpdaTe M-mode examination of the mitral valve demonstrating classic late systolic bileaflet mitral valve prolapse (arrows), obtained from the parasternal long axis view. Because of dependence on the ultrasound beam, prolapse can be missed or overdiagnosed with M-mode echocardiography alone. therefore, the diagnosis needs to be confirmed by two or three dimensional methods. (source: Judy Mangion, MD, Brigham and Women’s Hospital) on a server. All echo data are available for review, analysis and comparison, and can be accessed enterprisewide by referring physicians. Although other cardiac modalities like MRI and CT are stored on a separate PACS, physicians can retrieve all images at any hospital computer. The PACS and dedicated echo server can be accessed through the web for universal enterprise review by referring physicians. Similarly, St. Francis Hospital stores echo and cardiac images on Agfa HealthCare’s IMPAX CV and on an EMC Corporation Centera storage solution. The PACS holds seven years of cardiac imaging data, and a web viewer makes it possible for physicians to view studies offsite or for several users to view or post-process data concurrently. Because echo produces fairly large datasets, images are compressed at 20:1, a ratio that does not compromise diagnostic quality, says Katz. The digital archive delivers critical advantages over tape. “It’s unwieldy to view or compare echo studies on tape. With digital storage, cardiologists don’t need to rewind the tape to look at a specific lesion or review wall motion,” shares Katz. The digital platform saves time and improves clinical decision-making and treatment. EMC’s CLARiiON NAS (network attached storage) serves as the short-term repository for echo data at St. Francis Hospital. Raw data are stored on the NAS; however, cardiologists must use vendor workstations to re-manipulate the raw data. Other models promise to eliminate the need to trek to vendor workstations to interact with raw data. TomTec Imaging Systems’ Image-Arena Software interacts with most vendors’ non-DICOM data to provide a universal platform for image review and minimize dependence on multi-vendor workstations. The software is available on other platforms such as McKesson Horizon Cardiology. Arizona Heart Institute in Phoenix deployed Horizon Cardiology in 2006 and selected echo as the first modality to place on the PACS platform because it represents a large volume of data. Integrating echo data into PACS delivers financial, productivity and clinical benefits, says COO Rick Roth. Cardiologists no longer chase CDs or DVDs to review prior echoes, and clinical decision-making and treatment are accelerated because physicians can access and view studies immediately after acquisition. More dimensions, more challenges 3D echo brings additional challenges, says Kort. It requires a separate platform and generates large, non-DICOM datasets, essentially magnifying the issues of integrated echo image management. Currently, 3D datasets require offline quantitative analysis to quantify parameters like ejection fraction; however, evolutions in 3D technology and a close-to-prime-time DICOM standard should deliver improvements. Many sites rely on unrefined 3D echo image management strategies. At Stony Brook University Medical Center, for example, a committee is charged with developing guidelines. “The goal is to determine the best way to archive the data without archiving the entire dataset,” explains Kort. At the macro level, the American Society of Echocardiography (ASE) aims to lend a helping hand. The society is working toward streamlined archive guidelines to ensure greater uniformity among institutions. ASE is in the final stages of approving a 3D DICOM standard, which will make it possible to interact with 3D datasets on the PACS workstation, says Mangion. What’s more, “smart” 3D technology will automatically calculate parameters like left ventricular volume and ejection fraction to improve sonographers’ workflow and reduce the time requirements of 3D echo. Digital days are here It is time for cardiology to integrate echo into the digital image management strategy. The benefits are clear and cover multiple 24 Cardiovascular Business May/June 2008

Table of Contents Feed for the Digital Edition of Cardiovascular Business - May/June 2008

Cardiovascular Business - May/June 2008 Contents First Word Cover Story - Coronary CTA: Drafting the Strategic Plan Financing New Technologies: Early Adopters, Lease vs. Purchase, and Joint Ventures Clinical Study Digest: ACE or ARB: It's Your Choice Can Off-Hour D2B Times Be Reduced Without Breaking the Bank? Digital Image Management Primer: Integrating Echo SPECT/CT for Cardiac Disease Detection: An Economic Conundrum Integrating the Healthcare Enterprise Connects IT Systems News & Views Calendar Reader's Resources The Back Page

Cardiovascular Business - May/June 2008

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