Hartford Hospital Stroke Clinic

Using Apple technology to bridge a medical imaging gap

Physicians Gary Spiegel and Stephen Ohki examine a patient with the Siemens imaging system in the Stroke Center’s angiography suite.

The basic problem was sheer data. Each stored frame from the Artis is 1024x1024x16 bits. Spiegel may record several 100-frame bursts during a single examination, and the Center may examine as many as six patients in a 24-hour period. An average day produces about 15GB of data.

The leading manufacturers of angiography systems – Siemens, Philips, and GE – offer archiving solutions, but they tend to be costly, slow, and not well suited to angiography. Hartford Hospital serves its Radiology Department with a multimillion-dollar Philips-Sectra Picture Archive & Communication System (PACS), but the big files generated at the Stroke Center overwhelmed the Sectra server. Katen used Apple technology to create something totally different.

In the angiography suite, Katen routes images from the Siemens Leonardo workstation through a Gigabit Ethernet connection to a dual quad-core Mac Pro and a 10.5TB Xserve RAID rack-mounted under the counter in the suite. The Xserve RAID easily stores and retrieves the largest images generated by the angiography system. A 30-inch Apple Cinema Display sits next to the monitors of the Leonardo and the Artis.

The Mac runs OsiriX, an open source software system for processing, viewing and archiving 3D medical images. The system easily outperforms the Sectra because of its faster processors, its local RAID, and its ability to hold large images in memory. The Sectra PACS, like most PACS systems, is not optimized for archiving large numbers of images, nor can it display or manipulate the digital subtraction (bone deletion) images used in angiography. OsiriX on the Mac Pro easily handles both these requirements and also serves as a full 3D workstation and PACS node for retrieval and review of a patient’s CT and MR studies. Spiegel, however, asked for two more features.

“I wanted backup redundancy for the image archive, and fast image review capability in my office so I could review cases in real time with my colleagues,” he says.

Katen installed an identical system in Spiegel’s office and added a software routine to OsiriX for fast automatic mirroring. Cases imported or sent to the suite’s Xserve RAID are automatically mirrored on the office’s Xserve RAID over a point-to-point 10 Gigabit Ethernet connection using Myricom cards. There is also a separate gigabit point-to-point connection between the suite and the office for additional redundancy.

Consolidating A Deskful of Hardware

“An unexpected but highly desirable bonus for me is hardware consolidation,” says Spiegel.

“Before Roger installed this system, I had a Leonardo in my office with its monitor, plus the hospital PACS system with two Dome monitors and a 15-inch side display, plus a standard hospital computer with another standard Dell screen – five monitors and three CPUs. Now all I have is an eight-processor Mac Pro and two 30-inch Apple Cinema Displays that give me fantastic quality – at least as good as the Dome monitors.

“Additionally, using VMWare Fusion virtualization software to run Windows in Mac OS X, I’m running all the hospital’s software – an unexpected benefit. The Sectra PACS actually runs much faster in VMWare than on the hospital’s systems. OsiriX is essentially a DICOM viewer, but it serves as a PACS workstation. The system costs less than half the price of one hospital PACS workstation, with far superior performance.”

“When Gary’s dictating a case in his office on the Mac Pro, he’s using OsiriX and voice-activated Nuance PowerScribe,” says Katen. “He has Eclipsys Sunrise, the hospital’s information system, open in VMWare, monitoring his inpatients’ care. He can also have the hospital PACS open in VMWare at the same time.

“If he’s away from the hospital, he uses Apple Remote Desktop on his laptop to pull up a case from the system, contact his colleagues, and plan a surgery for the morning.”

The Ultimate Reason for Mac: Great ROI

In the Stroke Clinic, two buildings away from the angiography suite, a multidisciplinary surgical team meets with patients in a Mac-equipped conference room that includes an Xserve RAID and a quad-core Mac Pro running OsiriX, which is used as a PACS server and can display patient CDs created on virtually any PACS system. Katen designed the system and wrote a Mac-based program that manages patient flow through the clinic. The system was really a test platform for the OsiriX-based PACS solution in the angiography suite, and it performed flawlessly with 100% uptime.

In the end, however, a great ROI argument opened the door for the archiving solution that Spiegel wanted.

“Our Mac-based solution enabled us to eliminate filming,” says Spiegel, “and the savings from filming enabled us to purchase the system. The IT department had nothing that could touch it financially. A Windows-based 6TB RAID alone, purchased through the hospital’s distributors, would have cost $80,000. The total Mac hardware cost for the whole archiving system, including the twin redundant system in my office with duplicated 10TB Xserve RAID, was $62,000, and its performance is clearly superior.”

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