Remote control allows offsite experts to run MR applications

Expert-i promises the ultimate expression of teleradiology: the control of MR scans being performed rather than simply the ability to read the results after the fact.

Dr. Paul Finn has used the software for the past year to conduct cardiovascular exams remotely. He takes control of scanners spread across the University of California, Los Angeles campus and changes imaging planes, inputs pulse sequences, and saves protocols.

Pending clearance by the FDA, the software will be released later this year by Siemens Medical Solutions as an option on its syngo package. Finn, a professor of radiology and medicine at UCLA, says it might be used to extend the clinical reach of MR to unfamiliar turf, such as cardiac MR.

"You can log onto a site where techs have never done a cardiac MR scan, and you could end up with as good a study as if it were done on your own system," said Finn, who is affiliated with UCLA's Cardiovascular Research Laboratory.

The software is an evolutionary step beyond Siemens' Phoenix technology. Phoenix, which is widely available to the Siemens installed base, allows users to download and execute on their scanners clinical protocols developed by experts. Expert-i turns PCs into virtual MR consoles, affording the opportunity for expert collaborations on challenging examinations.

"It is the other side of the teleradiology coin," Finn said. "Instead of just interpreting images, we are interactively running the scanner."

Last November, he orchestrated RSNA demonstrations of Expert-i from his computer at UCLA. Visitors to the Siemens booth witnessed Expert-i in action twice daily in demonstrations featuring real-time scans run by Finn but performed at Northwestern University. Siemens framed the technology as "a second opinion in seconds." But it may go far beyond that.

Luminaries anywhere in the world might use Expert-i to follow a procedure, advising staff at the site by phone how to take corrective action. They might even take control of the distant scanner, operating the console remotely.

The process is fairly straightforward, according to Finn. PCs loaded with Expert-i are assigned the appropriate password and plugged into a local network. The networking software to enable the hookup-VNC (virtual network computing)-is readily available on the Internet.

VNC software allows a computer operator connected to the Internet to view and interact with any other computer on the network. VNC works across platforms and among different types of computers.

Expert-i translates this capability into MR. Once in place and enabled by a high-speed network, Siemens's software displays on a PC the same full-screen view shown on the remote MR console. Mouse clicks on the PC terminal are mirrored in the remote MR console.

With Expert-i, specialists trained in advanced MR techniques need not be physically present to instruct local staff, who are assured that help is literally standing by if they run into trouble. The concept could be extended to serve as a safety net for inexperienced users, who might call on remote experts to step in and scan.

Initially, however, the results may be more localized, as at UCLA. Teaching institutions often spread MR scanners miles apart, making it difficult, if not impossible, to provide expert guidance at each. UCLA concentrates its expertise in one area served by two MR scanners, one operating at 1.5T and the other at 3T. This is where Finn and the most skilled MR technologists at UCLA spend the majority of their time, conducting studies and reading data. Demanding techniques, such as those addressing cardiac MR, might be limited to sites with the expert staff needed to perform them, if not for Expert-i.

Finn began using Expert-i as part of a pilot research project in early 2005. His objective was to define the clinical value of the software and describe for Siemens his findings. Today Finn uses the software routinely to perform challenging scans and instruct staff at any of the 10 MR sites spread across the UCLA campus.

"It is something I would find hard to do without now, and that is a tribute to the software, because it means it works," he said. "But the exciting part is that there is no reason why this couldn't ultimately work across the state or country or globe."

Jeffrey M. Bundy, Ph.D., Siemens' director of MR R&D, described the potential of Expert-i as very broad.

Its actual use, however, is still largely undefined.

"We are in the early days of looking at how Expert-i might be applied," Bundy said.

The primary applications will come from imaging providers, but a subtle twist on this potential turns Expert-i into a sales tool. The software could be framed as providing an extra measure of comfort to prospective customers considering the purchase of a system for applications beyond their grasp.

Just as Expert-i might be harnessed for a range of uses, so might the concept be used by other vendors.

"I think we need to push the vendors-not just Siemens, but the other guys-to push the envelope," Finn said. "In principle, all this is possible."