SIIM 2010 Starts With a Great Kick-Off

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Dr. Bradley Erickson from the Mayo clinic,  Chair of SIIM, kicked off the annual meeting  in Minneapolis, with a slogan "Value innovation through imaging informatics", i.e. how to get additional information from images, such as "buried" inside the image pixels and/or metadata.

He also added “Buying CT, MR is like dating, buying a PACS/RIS is like getting Married” and therefore, to know exactly what your requirements are and making sure a vendor meets your needs is critical.  As a matter of fact, divorcing a vendor is even more painful than just replacing a modality. Therefore, the emphasis of SIIM has changed recently from covering RIS –PACS to include 3-D, CAD, but most importantly business analytics, i.e., how to run business well. These topics are important to understand to makes sure that one can select the proper partners.

Dr. Raymond  Geis discussed politics and business intelligence. Against the political background of the cost of healthcare in the US being unsustainable (quote from Obama), increasing  national and global competition for radiology contracts, the  FDA being more pro-active in reviewing imaging and PACS systems, there is a major investment going to be made. The ARRA will invest $27B in healthcare IT to reform healthcare. Money is already being spent right now as 52% of the US hospitals increased HIT budgets. Now, there is still a lot of confusion about the so-called "meaningful use" criteria that systems have to meet to be candidate for any ARRA money, and also, the implementations are still less than 10%, for example, CPOE with decision support is only implemented in 7.4% of the institutions right now.

Business analytics is different than data collection: Data describes what is happening. If you have a lot of data, data is going to decide for you how to model what is going on and see new paths, which is where the analytics part comes in.  There is no question that future business analytics, i.e. innovations that increase value will be strongly rewarded.

Dr. Bradley Erickson (Mayo Clinic)  discussed advanced image visualization and 3-D. The main innovation this past year is that "thin clients are starting to act fat", i.e. 3-D applications are starting to have more of the fat client functionality. In addition,  ipads, laptops are now able to run these applications and also now work on high latency networks and low bandwidth.

There is more workflow support in the applications: simple mouse clicks will support going through the steps of the processing. Unfortunately, these tools still do not integrate well with RIS (Radiology Information System) : it is not known what studies are in process, reported, completed etc. There is more reporting capability within 3-D, especially in structured format such as  direct information about a stenosis to report. More and more of these applications run on mainstream hardware, it is not required to have specialized hardware processors anymore. Outsourcing as part of Teleradiology providers is becoming more popular as well.

Dr. Keith Dryer (Mass General) gave a presentation about cloud computing. The question of the computing is whether it is on the ground or in the sky? We see applications moving from client based, to server based, and now cloud (internet based). The advantage of cloud computing is definitely to allow far better cross enterprise communication, while needing a lower capital investment and have immediate upgrades, automatic remote access. However, as he mentioned, the forecast is still partly cloudy which means that a lot of work needs to be done still.

Dr. Anthony Seibert from UCDavis discussed DR changes. Many vendors now offer portable wireless detectors which allow for "POS" or Point Of Service imaging  for the OR (Operating Room), ER (Emergency Room) and bedsides. It is easy now to retrofit existing radiology rooms. Detectors are now providing capabilities and is going beyond static to provide fluoro, and digital tomosynthesis.  Another upcoming modality is CT cone beam acquisition. The trend is getting more images, increasingly complicated hanging protocols, and last but not least in many cases higher patient dose.

The public is demanding information about the dose. An important development is the definition of standardized dose index for DR/CR: instead of the S number, EI, etc. ,AAPM is proposing a new standard, unified among different vendors. This will allow technologists better manage and control the exposures. In addition to the emphasis on CT and fluoro dose, there is also a major initiative for pediatric imaging: Image gently: to have kid-size exposure factors, and for adults: the Image wisely campaign. AN important development is the IHE REM profile (Radiation Exposure Monitoring) which defines how modalities can accurately report the dose to reporting systems using new DICOM objects.

Dr. David Weiss discussed: multimedia reporting, in particular, how the operation can become "reporting centric". The reporting system should connect with the information system, combine information with CAD and RIS. Radiologists spend sometimes up to 50% of their time  on report and not where they should spend the time, i.e. the interpretation of images. Critical result reporting has to be fast, time efficient, and require a multilevel security and audit trail support. This needs multivendor cooperation and communication, which is still a major challenge.

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