Chesapeake Medical Imaging

Cost-Efficient DICOM Image Archiving and Viewing

By Grant Ellis

“I’ve always had a Mac bias from my personal work with photography, so I was ready for a Mac-based system,” says Mark Baganz.

Three years ago, Mark Baganz, medical director and CEO of Chesapeake Medical Imaging (CMI), gave Phillip Jackson, an engineer who worked for a company that provided Internet services to CMI, a mission: create a Mac-based system that integrates and streamlines the storage and retrieval of medical records and images — at a cost below that of the solutions being offered by vendors.

“The companies that make scanners offered solutions for archiving images and managing patient records, but none of them were without flaws,” says Baganz. “And with third-party solution providers, it can cost you a quarter of a million dollars just to start the conversation. I’ve always had a Mac bias from my personal work with photography, so I was ready for a Mac-based system.

“Should we buy a $250,000 archiving solution, or should we get creative? We decided to get creative. And who better to get creative with than Apple?”

“Then OsiriX appeared — a superb Mac-based open-source medical imaging software package. Now we could have a Mac-Based platform that could excel in image viewing and interpretation. We thought, ‘Let’s see if we can integrate OsiriX into an efficient patient-records workflow and create an easier and more affordable way to tie our whole enterprise together — images, patient records, and billing — in a single efficient workflow.’”

Getting Creative with iMacs

CMI opened its new Annapolis, Maryland, corporate office and imaging center in January, 2006, with three new Siemens scanners in place. Two other CMI radiology clinics in nearby Chestertown and Glen Burnie and two affiliated imaging centers in Delaware were already equipped with Phillips, Siemens, and Toshiba scanners.

CMI wanted an archiving and radiology information system (RIS) that would handle its rapidly growing volume of images, insurance forms, radiology worklists, billing documents, and appointment records. “We wanted to cover all our bases with one great solution,” says Jackson. “Above all, we needed these tools to provide the best patient care available.”

CMI staff members had been archiving DICOM images to magneto-optical disks (MODs), CD-ROMs, and DVDs. What CMI wanted was a way to make archived images and patient records available online to staff members and referring physicians. Archiving solutions were available from major vendors, but the cost would have run into hundreds of thousands of dollars.

“A facility like ours could afford solutions like that,” says Jackson. “But there are a lot of great things you can do for a lot less. Should we buy a $250,000 archiving solution, or should we get creative? We decided to get creative. And who better to get creative with than Apple?”

When CMI moved into its new offices, Jackson put a 17-inch Intel-based iMac beside each of its new scanners instead of the workstations normally purchased with the scanners. Technologists use the iMacs daily for archiving the images from each day’s scans to DVD. Radiologists use them for “wet reads” — initial, on-the-fly assessments of images. CMI staff members also use them to do 3D rendering, to access the clinic’s RIS, and to collaborate using iChat. “They’re great tools,” says Jackson. “We just do it all with one workstation.”

When a CMI technologist has completed a patient study, the images move automatically from the scanner console to the nearby iMac and are archived to DVD. They also move automatically to a gateway, a desktop image router that sends them to a secure third-party archive in Philadelphia as backup for disaster recovery. The gateway also archives images on a local Xserve RAID controlled by a Power Mac G4. CMI typically archives about 80 multi-scan patient studies every day, which corresponds roughly to 3GB of data per day and a terabyte per year.

“The Xserve RAID archive is the cornerstone of the services we provide,” says Jackson. “It enables our radiologists to read images and turn over a patient report to the referring physician within 24 hours. In fact we turn a report around in less than six hours. Our absolute goal is to have all reports from today’s scans out by noon tomorrow. I know of no other imaging center that can accomplish that.”

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