Imaging start-ups exploit native Internet environment

Internet-based technologies have fundamentally changed the way data are exchanged. In addition to becoming a communications backbone for "everyman," the World Wide Web has taken multimedia out of the esoteric and into the everyday.

This evolution is having a dramatic effect on medical imaging. In the last few years, a number of new vendors have made their mark by developing compression and data-streaming products that work within existing bandwidth and image resolution limitations to provide high-quality images over public networks using standard communication protocols and platform-independent Web-native programming.

Added benefits of these next-generation products are the inherent enterprise-distribution capabilities found in the "anywhere, anytime" nature of the Web. The lower cost associated with standard Internet transmission cannot help but shift the focus of image management away from the pictures and onto the communication and workflow potential. In fact, the ability to stream images quickly and efficiently on demand expands the use of images (and the usability of PACS) into the diagnostic, collaborative realm. PACS is no longer a static image archive but a communication system for real-time evaluation of patient data across the enterprise.

Established PACS firms are acknowledging the importance of these new technologies by partnering with Internet-savvy multimedia software developers to gain access to image-streaming techniques. After introducing its iPACS product at the 1999 RSNA meeting, RealTimeImage has gained partnerships with Kodak and InSite One. RTI will integrate its pixels-on-demand image-streaming technology into Kodak's Distributed Medical Imaging (DMI) systems and into InSite One's InDex digital image storage and retrieval service. RTI's proprietary technology uses a wavelet-based processing algorithm to generate partial spatial transforms of areas of interest in an image, enabling remote users to view and manipulate images in real-time.

The debut of iPACS Portable has also moved RTI into the wireless market. iPACS Portable is designed to enable point-to-point streaming of medical images from a lightweight server to an individual reviewer over any wireless or wired Internet connection. Using iPACS Portable in conjunction with a portable ultrasound, CR, or other image-acquisition system, a physician at a hospital or other location can view and interpret diagnostic-quality images streamed from a wireless-enabled PC or laptop server in the field. Images are available to the physician on the receiving end via a unique IP address assigned to the remote computer. The physician can access the images from a PC or workstation via the Internet and view the images in real-time, even providing real-time consultation over a separate phone line.

According to Gene Rubel, vice president of RTI's medical imaging, the firm is in talks with other medical equipment vendors. RTI is also looking at developing streaming techniques for ultrasound cine.

Similarly, IDX has tapped Stentor for a joint technology development partnership. IDX says Stentor's iSyntax wavelet compression-based streaming technology is important because it adds enterprise image access capabilities to the IDX RIS. The firms debuted several joint products as works-in-progress at the 2000 RSNA show, including a perpetual archive and a diagnostic workstation that uses a touchscreen interface.

Image Medical's PracticeBuilder image distribution system is now the property of Avreo (formerly Riptide Technologies) following Avreo's acquisition of Image Medical, which was announced at the RSNA meeting. The predictive streaming wavelet technology built into PracticeBuilder allows standard PCs outside the radiology department to perform as quickly as high-end workstations and to push large amounts of data through a network at dial-up speed. As with the Web-based imaging technologies developed by Stentor and RTI, it takes only seconds for low-resolution versions of a study to appear. Avreo will integrate PracticeBuilder into its Web-native ARIIS (advanced radiology integrated Internet solution) to provide end-to-end image and data distribution to all healthcare stakeholders, including consumers. Avreo is also working to integrate other parts of the healthcare management chain, including scheduling, claims processing, and e-commerce capabilities, into its offerings.

After its debut in healthcare two years ago at the SCAR conference, LizardTech has been slow in getting its MrSid imaging technology into the medical market. Originally developed at Los Alamos National Laboratory to transfer images via satellite uplink, MrSid uses selective decompression technology to provide end users with only the pixels that they select to view, reducing file sizes and increasing download speeds. As a user pans and zooms into areas of an image, MrSid streams the additional pixels necessary to view that area. The firm is working on MrSid generation three, which will provide support for contrast brightness, increase the quality of compression, and extend the ability to manipulate compressed images.

LizardTech also showed DjVu, licensed from AT&T Labs, which converts scanned documents containing both text and images into small files (compared with the size of the same document in PDF format). DjVu also has an editor program, which enables users to add hyperlinks and annotations. Mirroring RTI and Stentor, LizardTech is seeking strategic partnerships among vendors who are looking to expand data transfer capabilities in low-bandwidth networks.

Algotec introduced enhancements to its Web-native ImagiNet product line, including 3-D capabilities for MediSurf. Version four allows users to view 3-D images at multiple angles and orientations over the Web. The firm is also offering its ImagiNet products via ASP.

The battle over image streaming is far from over. New techniques are constantly being developed to squeeze more capabilities out of the existing technology environments. For example, Foresight Imaging and Lead Technologies introduced software to enable video from various modalities to be streamed into a standard DICOM file. The companies are starting to ship the program in December.

© 2000 Miller Freeman Inc.
12/13/00, Issue # 118, page 4.