Digital Medical Imaging for Pets

Needed: A Scalable PACS Archive

OsiriX user interface showing a 2D multiplanar reformat of an English Bulldog with multiple spinal anomalies.

With AVMI’s success came swelling archives of space-hungry DICOM images. Broome tried Picture Archive Communication System (PACS) solutions from two vendors, but their capacity was limited, and he was repeatedly running out of storage. He wanted a scalable PACS that didn’t have the high price tag of proprietary systems.

Through the OsiriX User Group, Broome contacted Phil Jackson of SecureRad, whose specialty is Mac-based solutions for medical imaging data. Jackson installed a SecureRad SecureVault PACS solution built around a Mac Xserve RAID with 5.5 terabyte capacity and a clear path for expansion. The cost was appealing.

“We ended up spending a fraction of the amount we could have spent on vendors’ hardware and software,” says Broome. “It was amazingly inexpensive to put in a SecureRad PACS system with this power and growth potential. With a Windows-based system, we’d have to pay for a software license for each exam room. That’s why most facilities buy licenses for one or two rooms, creating workflow bottlenecks. We use the same Macs to view images and to run our practice management software.”

When SecureRAD arrived, Broome’s downtime troubles ended. When his previous PACS system failed, he had to pack it up, ship it back to the factory, and wait a week to get operational again. With SecureRad, he simply hot-swaps a new disk drive for the failed one – although that hasn’t happened yet. “We chose Xserve RAID for SecureRad because of its robustness,” says Jackson.

SecureRad makes AVMI’s workflow a marvel of simplicity. New DICOM images go to all workstations and are archived in the PACS. The metadata for each image goes to a MySQL database on the Xserve RAID. Broome and his colleagues can download studies from anywhere on the network.

Broome has the luxury of accessing the PACS from his home using Apple Remote Desktop over a T1 WAN that also connects the LA facility. All studies also go to a radiologist at Washington State University for review. DVMax, a practice management and billing software system from Sneaker Software, also runs on AVMI’s iMac viewing stations.

Digital Radiography: OsiriX and the Mac Change the Economics

Broome is often called upon to speak to veterinary associations about the merits of digital imaging technology. He estimates that 90 percent of U.S. veterinary clinics still use traditional film X-ray systems with their chemical processing. Digital radiography (DR) systems, on the other hand, expose X-rays onto a metal plate connected to a computer, providing near-instantaneous viewing of the images. Although the price of these systems has dropped from $200,000 to around $100,000, vets who can buy a traditional X-ray system for $5000 are reluctant to make the upgrade. Broome fights this reluctance with logic and economic realities, including the cost-effectiveness of Apple technology.

“To take an X-ray the old-fashioned way,” says Broome, “you position the patient on the table, make your settings, and click the exposure. Then you have to take the film cassette into the darkroom, take the film out of the cassette, and run it through a processor. Then you look at the film and say, he’s rotated, this isn’t what we wanted, and start all over. These are the X-ray workflow limitations we’ve all been working with for 100 years.

“With DR, the whole experience takes three or four seconds. If you need to adjust the image, you do it immediately with minimal stress to the patient. The quality of the images is better and more diagnostic.” Computed radiography (CR), a less costly alternative, exposes X-rays onto a phosphor plate, which is inserted into a desktop device for extraction of a digital image.

“All these solutions are running on PCs,” says Broome, “and all provide viewing software. None are as robust or as flexible or as ideal to work with as OsiriX. The nice thing is that all the images they generate adhere to the DICOM standard, and can be viewed on any platform, including the Mac.

“We originally paid $180,000 for a vendor’s DR system that included a PC and viewing software from a third-party company. A lifetime license for the software runs about $3000, and you don’t get upgrades and new features. Two or three years down the road, you have a product that’s limited compared to current versions. What you can do instead is save the cost of the workstation, buy a Mac and put OsiriX on it, and have what is probably the best viewing station out there. That’s what we did.”

“Most veterinary practices have a digital imaging device,” says SecureRad’s Jackson. “To be able to put in a PACS and an iMac and engage OsiriX for their reading station – the cost savings are phenomenal.

The Case of the Gray and White Cat

The story of AVMI’s success would not be complete without a success story and a happy ending. Broome has taken pictures of animals that belong to the rich and famous, but he remembers more fondly the married couple whose cat was suffering seizures. They arrived for their imaging appointment, not with a thousand-dollar Sphinx or Ocicat, but an ordinary gray-and-white domestic shorthair.

An MRI series, viewed by a radiologist on an Apple Cinema Display and by the owners on an exam-room iMac, clearly showed a benign meningioma – the tumor made famous by Elizabeth Taylor – that was amenable to surgical resection (i.e.: it could be surgically removed).

“We have the luxury of having two veterinary neurologists who work within the practice,” says Mike Broome. “The couple elected to have the tumor removed. The cat went right into surgery and is doing fine after a year. The MRI, the SecureRad PACS, and the Mac technology helped us produce a happy ending.”

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