AuntMinnie.com: What are the key PACS usage trends you're seeing (i.e. thin-client workstations, storage area networks, progressive image transmission etc, flat-panel displays, speech recognition, 3-D software, etc.)?
Caren Mason, eMed: Although accepted by many over the past four years, lossy compression is nearing complete acceptance due to a number of factors. Data volumes are increasing, and managing lossless compressed data is just too expensive in terms of raw storage requirements and network bandwidth requirements. In addition, DICOM is (finally) adopting a compression standard that offers high quality and meaningful compression ratios.
SAN/network-attached storage (NAS) combined with off-site archiving is an ideal solution to have all "relevant" data on a hard disk. To date, this storage model has been too costly, which has led to the use of tiered storage and hierarchical storage management (HSM) technology. In addition, past technology has not allowed the configuration of large disk/RAID farms without the use of high-end host computers -- again, an extreme expense. SAN/NAS solves this problem by allowing low cost host computers to manage a large farm of disk/RAID.
A few issues still hold back the widespread deployment of SAN/NAS, however, including its cost. SAN/NAS technology is still very expensive for the scale of operation typical of small and mid-sized facilities. You still have to deal with the cost and management of redundant image data storage, although off-site archiving will solve this problem.
In other trends, all applications will eventually become Web-based. This is a must due to the significant reduction in costs and administration complexities when using Web technology.
Vishal Wanchoo, GE: The biggest trend is the integration of PACS with different systems, whether it’s 3-D, speech recognition, or orthopedic templates for orthopedic surgeons. We’re seeing the integration with RIS, disease management, and other information all on one desktop, getting away from multiple points of contact.
With deployment across the enterprise, thin-client workstations are key. And that’s part of an unmet need. Thin-client technology is not where it needs to be today. You need to address every segment of the physician population with robust and specialty-specific viewing capabilities and hanging protocols. We see these thin-client workstations moving closer and closer to the capabilities of the diagnostic workstation.
Gary Larson, Kodak: All of the technologies you’ve mentioned. Thinner client workstations are attractive for their ease of deployment and support, as well as lower-cost hardware. We've seen a lot of interest in SANs because of the ability to make information instantly available to high numbers of users in a larger enterprise, sharing storage devices in the process.
Progressive image transmission is of particular interest in situations where images must be transmitted over wide area networks to low-resolution monitor workstations. Although the attractiveness of flat panel displays is obvious, the cost-performance ratio, especially for high quality diagnostic workstations, still places these technologies out of reach of the everyday user.
Richard Hullihen, Marconi: Workstation performance continues to escalate; we’re seeing faster and faster machines with more and more memory. Workstations are quite powerful. This has allowed us to incorporate technology such as speech recognition, advanced image visualization, and flat-panel displays -- as well as study group concepts and natural workgroup concepts, which some people like to call storage area networks.
All of these technologies are coming into a complete platform for PACS. In the past, these problems would have been solved by bringing more computers into the department. If you walk into some of the early-stage PACS departments, you’ll see a workstation console, keyboard, and display. You’ll see a RIS console, keyboard, and display, a transcription system, keyboard, console, and display, and an illuminator all being defined as a work environment for a radiologist. We’re very quickly headed into the domain where that’s a single console.
Rik Primo, Siemens: Thin client is becoming the favorite model for Web-based distribution of images and reports. Storage area networks (SAN) allow hospitals to achieve economies of scale for the storage of all data, not just PACS. Further, network-attached storage (NAS) and SAN eliminate the creation of "departmental data buckets." By having all storage in the IT department, data management is more efficient (think about backup procedures, hardware/software maintenance, disaster recovery procedures).
Progressive image transmission is a very promising and powerful technology that is currently still hampered by the many proprietary implementations. We are looking to the DICOM standards to provide a universal, vendor-independent algorithm.
With the increasing performance and reliability of these systems, speech recognition could become the preferred way to shorten the transcription process, which still introduces unacceptable delays in the availability of the radiology report.
Multislice CT and volume MR acquisitions have upgraded 3-D soft-copy reading to the status of a required tool. 2-D displays of slices in 3-D MR or multi-slice CT acquisitions have become an essential tool in soft-copy reading. Viewing 1,000 images on 25 sheets of film is no longer a viable option. Furthermore, 3-D software is making strong inroads in applications such as virtual endoscopy (made possible by 3-D or multislice data acquisition techniques in CT and MR).
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