SCAR meeting highlights need to bring images to desktop, bedside

SCAR meeting highlights need to bring images to desktop, bedside

Debates over risks of compression resurface

Will radiologists and referring physicians one day use personal digital assistants (PDAs) to review images and update reports while at a patient's bedside or rushing through an airport to catch a plane? That is the vision of Dr. Ronald Arenson, chairman of radiology at the University of California, San Francisco, and keynote speaker at the annual meeting of the Society for Computer Applications in Radiology (SCAR), held in Philadelphia earlier this month.

Arenson, a PACs pioneer, spoke on the evolution of PACS, including his involvement with early efforts to develop the technology and improve the delivery of care. He concluded with a discussion of emerging technologies, such as speech recognition and PDAs, that he believes will have a major impact on the way radiology is practiced today.

"Radiologists are in the information business, and we should be the drivers of this business in medicine," he said. "(In the future), the radiologist will be the one guiding medical care, both diagnostic and therapeutic processes, and will have much more patient contact and more involvement in the delivery of care."

As an example, Arenson displayed a handheld Casiopea with a chest image that he noted showed "remarkable clarity"; the user can also access and update related reports and other medical data. UCSF is working with LizardTech to refine this Windows CE application of LizardTech's wavelet-based image compression software, which debuted at last year's SCAR meeting (PNN 6/99). Similar to Stentor's dynamic transfer syntax (DTS) technology, LizardTech's software allows users to initially receive a low-resolution version of the image and then zoom in on regions of interest at higher resolution.

But the more things change, the more they stay the same. As PACS begins to make inroads into smaller hospitals and imaging centers—thanks in part to the hot new ASP trend (see related story, p. 1) but also to the wave of miniPACS launched at last year's RSNA meeting—debates over certain aspects of the technology have been rekindled. One of the best-attended sessions at SCAR was a point-counterpoint on image compression. The heated debate centered around whether the faster transmission speeds and enhanced storage capabilities made possible by image compression outweigh the risks (see Data Byte, this page).

"Compression algorithms represent a very significant technological accomplishment, but radiologists cannot exchange definite data degradation for questionable performance benefit," said Dr. Donald Schomer, assistant professor of radiology at M.D. Anderson Cancer Center in Houston. "It is a risk-benefit ratio, and there is very little benefit and unquantifiable risk."

According to Schomer, while compression made sense a decade ago, high-speed digital subscriber lines and cable modems have made it unnecessary to compress images. He stressed the need for better image compression validation studies.

Not surprisingly, proponents of image compression said that the benefits far outweigh the risks. In fact, there is no legal precedent for a physician being sued because of image degradation caused by compression, according to Dr. Thurman Gillespy, associate professor of radiology at the University of Washington in Seattle.

"There is very little loss of image quality in compression, which is probably less than routine degradation caused by everyday factors," Gillespy said. "In most cases, even an expert may not be able to tell the difference between a compressed image and one that has not been compressed."

On the show floor

Several new PACS products and services were introduced at this year's SCAR meeting, surprising for a conference that has long been considered primarily scientific. But there was a significant jump in exhibitor attendance, with nearly 100 companies on hand. It is still a relatively small show, however, particularly in comparison with the RSNA meeting, so there was plenty of time and room for the deal-making that currently characterizes this industry.

In addition to the numerous ASPs announced at the meeting, many of the new products on display carry price points that will surprise competitors in several market niches:

—The Clarity 3-megapixel flat-panel display from Dome Imaging Systems, a 1.5K x 2K integrated 21-inch display system (monitor and adapter) that lists for $16,995 and under $29,000 for a dual-screen configuration;

—Dynamic Corporation's digital radiography receptor, which recently received FDA clearance and sells for less than $100,000;

—A new low-cost, moderate throughput computed radiography system from Fuji that sells for around $60,000;

—InFlite, an introductory server-based product from InSite One designed as a free "trial run" of InSite's ASP-based InDex image archiving service (PNN 2/00);

—Lernout & Hauspie's PACS/RIS Extension Partner program, designed to support the integration of L&H PowerScribe for Radiology speech recognition system with PACS and RIS applications; current partners include Agfa, Cemax-Icon, Marconi, Siemens, GE, IDX, Cerner, and SMS;

—The addition of new DVD and AIT technologies, Vidar digitizers, and Dome's Clarity flat panels to Marconi Medical's PACS and archiving product lines, plus new "reading area network" capabilities (similar to storage area networks [HNN, 4/19/00]);

—North American Imaging's distribution agreement with Samsung, which adds Samsung's Raypax PACS product to NAI's growing line of image management products (PNN 2/00);

—The commercial launch of Stentor's iSyntax Web-based enterprise image distribution software, following completion of beta testing at 14 U.S. sites (PNN 11/99);

—Wuestec's new DR system, complete with workstation, for under $200,000.