Radman targets PACS with database connection

Radiologists may lose their image if they depend on a picturearchiving and communication system (PACS) without adequate patientdatabase controls, according to Dr. Richard Turkanis, presidentand CEO of Radiology Management Systems (Radman).

Radman, a three-year-old radiology information systems supplierin Santa Monica, CA, has integrated PACS with its RIS. The resultis better image tracking, Turkanis said. The firm introduced itsRadman image management system at the 1991 Radiological Societyof North America meeting in Chicago.

Demand for remote radiology diagnosis is on the rise, he said.More third-party payers will require subspecialty interpretationof images from MR, CT and other advanced imaging systems overthe next several years. The American College of Radiology is consideringsubspecialty certification requirements similar to those in usealready for mammography.

"If you have a big (radiology) group, and there is onlyone neuroradiologist covering two hospitals, how is he going toreview other cases? You have to start decentralizing (physically)and centralizing electronically," Turkanis said.

The first Radman IMS was installed last year at Cottage CommunityMagnetic Resonance Center in Santa Barbara, CA. This center usesthe image transmission and display system to read cases sent infrom a second MRI site 150 miles away, he said.

The firm's second PACS installation will connect four imagingsites for a Beverly Hills radiology group using T1 phone lines.The dedicated digital lines are provided in partnership with U.S.Sprint. Ten outlying systems will eventually be hooked up to threecentral reading stations, he said.

Sprint has targeted medical imaging transmission applicationsfor use of its nationwide fiber-optic telephone network (SCAN5/23/90). The firm has partnerships with other PACS firms as well,including Advanced Video Products.

Radman maintained a measured pace in the development of itsPACS product. The firm first introduced a clinical database systemand then added an accounts receivable package before introducingan image data capability, Turkanis said.

"The basis of everything in radiology is the patient clinicaldatabase. We treat images as only another form of patient data,"Turkanis said.

A RADIOLOGY BUSINESS has three primary outputs: the radiologyreport, the bill and the images. Image information is classifiedas non-volatile data; in other words, it is permanent and unchanging.

Most PAC systems input image identification in a way that isnot tied to the volatile clinical database. This can create problemswhen the image identification is input incorrectly or patientdemographics change, Turkanis said.

"If the patient gets married a few times and comes inunder several different names, the system has to know when shecomes in again that there are several images or sets of images.The only way to know that is to have error checking, with theclinical information system controlling and feeding the imageinformation," he said.

Demographic information in the patient database--such as age,social security number, maiden name and addresses--is cross-checkedin the Radman system to ensure that the full patient image fileis accessed, he said.

Apart from the need to integrate images with an RIS, a PACsystem must be cost-effective and quick to turn a profit, he said.

"A product needs to show payback in 18 months or two yearsmaximum. The problem with larger scale systems that show paybackin five or seven years is that the technology at that point isoutdated," Turkanis said.

While Radman's system sports 2000 x 2000-pixel resolution monitors,this does not provide the company with a competitive advantage.All PACS and RIS vendors have access to high-quality hardwarefrom outside suppliers, he said.

"The only thing that distinguishes one vendor from anotheris software. The technology that is available to do primary interpretation(on screen) is available to everybody," Turkanis said.

Transmission and on-screen diagnosis of digitized x-rays isnot as cost-effective as working with digital images from MR,CT, ultrasound and nuclear medicine scanners, he said. Users shouldstart with only what they need and can afford, and implement theirown digital image management systems in a stepwise fashion, hesaid.