Chesapeake Medical Imaging
Cost-Efficient DICOM Image Archiving and Viewing
A Better Look
Jackson has made liberal use of powerful open-source software and written some of his own. All the work with images on the three scanner-dedicated iMacs and the clinic’s other Mac desktop and laptop systems — viewing, rendering, and archiving — is done in OsiriX, which Jackson calls “the greatest free application in the world.” OsiriX enables any facility to move, read, and store DICOM images on Mac OS X.
CMI radiologists use OsiriX to view images on a Mac Pro with a 23-inch Apple Cinema Display — the clinic’s workhorse system. “With the Intel-based Macs, the system is faster and more stable,” says company CEO Mark Baganz. “We do great three-dimensional image manipulation with these very large files, and we also do four-dimensional time-sensitive evaluations such as virtual colonoscopies and cardiac work. We do a lot of 3D orthopedic and spine work. OsiriX does this all really well and very quickly. It’s as good as anything out there.
“Entry-level cost for a Windows-based radiology workstation, with the software licenses, ends up being well into six figures. With the new Intel-based Macs and open source software, you can get into it much less expensively. And you’re not giving up a thing where performance is concerned.”
“This system works. It’s costing us pennies on the dollar compared to other solutions. It’s stable. And I can look at any patient we’ve done in the last five years and pull the images up quickly, which is a really nice thing.”
Pennies on the Dollar
With the iMacs and OsiriX in place, the next need was archiving DICOM scan images to CMI’s Xserve RAID. Jackson installed Central Test Node (CTN), an open source archiving application, and used it to transfer all the earlier archived images from MODs to the Xserve, which stores them in a MySQL database. The Xserve currently puts 25,000 patient studies at the fingertips of CMI radiologists at any location.
“We had a Windows NT-based archiving product that filled up with a few thousand files,” says Baganz. “Other vendors are offering jukebox systems with MODs. There were other solutions that weren’t really online, and online systems that were prohibitively expensive. Now, with OsiriX and CTN, we have years of patient images online, just seconds away. And we haven’t touched the potential capacity of this system.
“We were having trouble finding a reliable solution in the marketplace. This system works. It’s costing us pennies on the dollar compared to other solutions. It’s stable. And I can look at any patient we’ve done in the last five years and pull the images up quickly, which is a really nice thing.”
“This Mac-based archive has been a tremendous resource for us,” says Jackson. “For about $12,000, we have solved a quarter-million-dollar problem.”
iRIS
CMI now had an elegant, low-cost archiving solution, but there remained the challenge of collecting patient information and linking it to the images.
“With six facilities and continuing growth, our practice required a web-based, Apple-friendly solution for patient scheduling, billing, and management,” says Jackson, “so we built our own.”
Jackson developed a Mac-based application called iRIS. iRIS has two components: iRIS Core, the patient management system, and iRIS Stream, which provides web access to images and reports for referring physicians. SecureRAD, a CMI company, will be marketing the full version of iRIS to other radiology facilities.
iRIS Core includes an OsiriX plug-in that gives physicians immediate access to the RIS from OsiriX. Clicking on a plug-in button pulls up all patient records, including images. Radiologists dictate their notes, which are typed and taken into iRIS in Mirth, an open source healthcare information standard. They can be printed or faxed from iRIS.
“We’ve done away with the manila envelope and the handwritten worksheet,” says Jackson. “iRIS dramatically reduces turnaround times and improves efficiency. It also reduces the possibility of errors.”
Meanwhile, iRIS Stream is expanding CMI’s geographic reach by making images and records accessible over broadband connections. Referring physicians can now log into iRIS and view streamed images from their offices.
“Having an IT system with a seamless, reliable architecture allows radiologists to deliver world class, cutting-edge service for these remote doctors,” says Jackson. “As always, better patient care is the bottom line.”