Radiologist start-up offers low-cost PACS solution

If you build a better image management system, will the worldbeat a path to your door? That question is facing two radiologistswho have set out on their own to market a low-cost picture archivingand communications system.

Dominator Radiology Systems was formed last year by Dr. MurrayA. Reicher and Dr. Evan K. Fram. Reicher is director of MercyMagnetic Imaging Center in San Diego, while Fram is a neuroradiologistat Barrow Neurological Institute in Phoenix. Reicher is also presidentof Radiology Medical Group in San Diego. Dominator has headquartersin both cities.

Reicher and Fram began working on an image management systemout of dissatisfaction with PACS offerings on the market.

"We're frustrated radiologists who were disappointed inthe products that industry was providing to us because they werevery costly or very slow or seemed to miss the mark," Reichersaid. "We finally reached the point where we needed a systemso badly for our own practices that we decided to build one ourselves."

What Reicher and Fram have built is a PC-based image managementsystem with an emphasis on speed, cost-effectiveness and easeof use.

The company offers a modular approach to image management anddisplay, and its products range from teleradiology links to multimodalitynetworks with archiving and printing capabilities.

Dominator serves as a systems integrator, uniting hardwarefrom OEMs and linking it to software the company has developed.The arrangement frees Dominator from being tied to a particularpiece of hardware if it becomes obsolete.

"We've purposely constructed the software so that we canmigrate to other devices as the technology improves," Reichersaid. "We are going to use the best technology availableto integrate into the system."

The system features five components:

• Dominator, a physician-operated multimonitor imagereview station that runs on a 486 computer. Dominator has a keystroke-and-trackballinterface and uses 1600 x 1200 pixel monitors displaying 256 shadesof gray. The workstation can be preprogrammed to accommodate displaypreferences of both the radiologist and referring physician.

• Catapult, a technologist-operated image capture stationthat uses a video frame grabber, allowing technologists to format,window and level images before radiologists read them. This processmore closely resembles the standard film formatting process thanPAC systems that directly transfer image data from the digitalscanner to the viewing station, according to Fram.

• Guardian, a long-term optical disk archive subsystem.Guardian uses CD-ROM technology, making it an affordable alternativeto more complex systems. Dominator is planning to integrate aCD jukebox-style long-term storage device into its product line.

• Opti-Miser, a high-resolution (256 pixels per inch,256 shades of gray) laser imager that prints on photographic-qualitypaper.

• Ambassador, a remote viewing station designed for usein a radiologist's home, a referring physician's office, or anyward, clinic or surgical suite.

Dominator has Food and Drug Administration 510(k) marketingclearance for all of its products.

Dominator systems interface with all digital imaging modalities.Despite their enthusiasm for filmless imaging, Reicher and Framare not completely sold on computed radiography in its currentform.

"I don't think I would be comfortable reading a digitizedplain film to look for a cervical spine fracture. I haven't seenan article or study that demonstrates that it's accurate,"Fram said. "But that doesn't mean it's not. When the technologymatures a little, we'll do the experiment."

Dominator has two systems installed, one at Mercy MagneticImaging Center and one at Fitzsimmons Army Hospital near Denver.Future sites include George Washington University in Washington,DC, and the University of Utah in Salt Lake City.

Installation costs for the system in place at Mercy totaledabout $200,000. Dominator claims that its system can save users$100,000 to $200,000 in film costs alone in the first year ofoperation.

In addition to film savings, users can cut expenses associatedwith chemicals, personnel costs, printers and service contracts,and ancillary film costs, Fram said.

The company is not intimidated by its competition in the PACSarena, which includes some of the heaviest hitters in medicalimaging. The fact that Dominator is headed by radiologists whohave an intimate knowledge of the needs of physicians is the company'ssecret weapon, according to Reicher.

"The types of talent that are needed to develop theselargely software products are the types of talent that residein medical companies, not technical companies," Reicher said."Let's not fool ourselves--these are software products we'retalking about."

Dominator has not ruled out a strategic alliance with a largerpartner, however, and is in discussions with major companies inthe telecommunications and computer industries.

"Our goal is to get out eight or 10 systems by the endof the year, have a large number of happy customers by the (RadiologicalSociety of North America meeting), then roll out from a salespoint of view in a big way," Fram said. "We're planningto be a large company."