Feature | February 05, 2008| Mary Beth Massat

C-PACS Packs in More Images

C-PACS users want access to vascular ultrasound, interventional angiography images and data in addition to echocardiography.

Siemens' syngo CardioFusion is a unified platform for visualization of cardiac images from hybrid imaging technologies. It provides advanced VRT visualization to fuse anatomical and functional images of the heart.

Multimodality imaging is dramatically changing the landscape of cardiology PACS (C-PACS). To get a complete picture of the patient’s condition, clinicians want access to vascular ultrasound, angiography images and echocardiography and data.
When Peter Frommelt, M.D., director of the Pediatric Echocardiography Laboratory at Children’s Hospital of Wisconsin (Milwaukee), began practicing in the 1980s, echocardiographic data was stored on videotape and was difficult to access for other caregivers. “We were always dependent upon the one person who analyzed the data to make patient-care decisions,” he said, “because transferring that data was bulky and time consuming.”
Today, Dr. Frommelt uses Siemens Medical Solutions’ syngo Dynamics to review echocardiography and cardiac catheterization images. “PACS has revolutionized how we practice and share information,” he noted. “Surgeons, intensivists, anesthesiologists – they all have access to the images. We can collaborate to better understand all of the patient-care challenges in a more cohesive manner.”
A market in flux
Access to vascular ultrasound and interventional angiography images and data, in addition to echocardiography and diagnostic catheterization procedures, is one of the top demands among more than half of current C-PACS users surveyed by IMV according to Mary C. Patton, director, Market Research.
Interestingly, the demand for multimodality image review capabilities is particularly high among survey respondents who have yet to install C-PACS. “Of the respondents who plan to implement C-PACS in the next two years, over half consider CT Angiography to be absolutely necessary in the initial implementation of their C-PACS installation,” indicated the report.
The growth market for new C-PACS installs, notes Patton, is in hospitals under 200 beds. She also sees the dynamics of radiology and cardiology collaboration changing in this market segment. “Because smaller hospitals typically have fewer layers of management staff, I believe we’ll see more of a team effort between radiology and cardiology departments as it pertains to C-PACS installation. These sites may not have the budget for separate PACS managers to serve both departments,” she said.
Beyond the range of modalities, IMV’s data further suggests new installs are seeking capabilities beyond traditional imaging systems, such as structured reporting and integration with other information systems (IS). “New C-PACS adopters appear to be even more demanding with respect to additional capabilities,” Patton added.
C-PACS integrates enterprisewide
Enterprise imaging goes beyond the traditional radiology or cardiovascular modalities, says Bob Baumgartner, BSN, MBA, senior product manager for Horizon Cardiology at McKesson. “Other imaging devices within the institution are also vital to cardiologists, such as endoscopes and thorascopes.” He added that just as cardiologists aim to treat the whole patient, so too must C-PACS suppliers provide the integration for the entire imaging chain.
In fact, Baumgartner says McKesson’s high level integration view delves into devices that are not at the forefront of cardiology. An example of this is a patient with multivessel coronary artery disease with comorbid chronic obstructive pulmonary disease (COPD). To evaluate if the patient can successfully come off a ventilator after bypass surgery, the cardiologist would benefit from access to the bronchoscopy images.
Sai Raya, president, ScImage, notes that to “see the patient as a whole, we must also provide functionality to view, interpret and report diagnostic cardiology devices such as ECG and stress in addition to angiography, chest X-ray, echocardiography, CT and MR.” Historically, he says, ECG management has not been part of PACS, yet that data should be readily available to the cardiologist.
ScImage has developed a complete ECG management system inside of PicomEnterprise that takes the proprietary ECG data directly from the device and transforms it into DICOM. “Diagnostic procedures are part of the continuum and so cardiologists need to start there,” explained Raya. With this system, he says, cardiologists can perform measurements, compare prior ECGs and also place the ECG waveform data next to other imaging modalities for complete diagnostic capabilities.
With Emageon’s Vericis Cardiovascular Information System, Halifax Health Medical Center, Daytona Beach, FL, integrates ECG with echo and cath images on dedicated workstations, says Matthew Petkus, cath lab director. In each of the center’s three cardiovascular ORs, the cath lab control rooms, CCU and outpatient care recovery unit, “one workstation runs everything. Clinicians can connect to EKG and radiology modalities without retyping the patient information,” Petkus explained. This not only saves time but reduces the likelihood of committing errors.
Faster report turnaround times
Patient information and images must be accessible inside and outside the hospital. “We also extend images outside the hospital with a physician portal to other sites,” Petkus added. Pediatric cardiology images are often sent to specialists in Jacksonville for interpretation.
“Today, it is about data management and capturing all the patient information, not just image management,” said Petkus. “This is a powerful management tool.” He uses Vericis to submit data to the ACC-NCDR, ICD registry and for regional benchmarks with VHA and Novation.
For Dr. Frommelt, digital reporting tools have a tremendous impact on patient safety and physician satisfaction. Results are immediately available and sent to the EMR and automatically faxed to the referring physician. “Our median turnaround for reports has decreased from 24 hours using phone based transcription to a median of two hours using digital structured reporting,” he noted.
Dr. Frommelt is currently working with Siemens and several colleagues to improve pediatric cardiology echocardiography structured reporting by expanding the language/templated formats for DICOM SR (structured reporting). This would enable users to describe any form of congenital heart disease using drop-down menus and scripted phrasing as well as facilitate uniformity of reports and improve databasing capabilities. The team is also investigating the use of a universal language for coding congenital heart disease to facilitate both clinical and research-related communication between centers. Now in clinical testing, the new report templates should be available for use later this year.
Integration for a patient-centric approach
Although the lines of demarcation between cardiology and radiology are blurring, images and patient data must extend beyond these two departments. “There is an additional level of complexity because of the need to provide reports and images to the clinician, not just the radiologist or cardiologist,” said Baumgartner. “We are working to make these reports similar for the general practitioner and providing them the same GUI and toolsets.”
McKesson, he says, is also working to bring radiology and cardiology PACS together where appropriate. The solutions can share the same infrastructure, common hardware, utilities and short- and long-term archives, but McKesson’s solutions will continue to maintain the specialty toolsets and workflows critical to each department.
An integrated platform that implements a single archive for image management has its benefits, says Henri “Rik” Primo, director of Marketing and Strategic Relationships for Siemens Medical Solutions Image and Knowledge Management Division. “Storing all the meta data in one database allows the user to query the patient information with a Web-based browser and to pull all the images, such as echo, cath, CT and MR. The next integration step, explains Primo, is to integrate the other ‘ologies’ with the images so that all the information can be pulled by the referring physician together in one portal.
In fact, both Petkus and Dr. Frommelt note that the biggest challenge for patient care is integration of images and data into the EMR. Since patient information is contained in different databases and systems, “the amount of information collected on a patient depends mostly upon the ambition of the caregiver to find the data in three or four different places,” Dr. Frommelt said. “This can lead to gaps in the physician’s knowledge about the patient and has an impact on patient care and safety.”
“Most hospitals want a single EMR,” added Petkus, “but we all have different systems in each department.” Integration to the hospital information system (HIS) is “very challenging; we need more flexibility for the HIS to accept different types of patient data.”
Once systems are interoperable enterprisewide, streamlining images and data across cardiology PACS and radiology PACS, the EMR and all ‘ologies,’ not only will workflow become more expedient and accurate, but hopefully so will patient care.

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