Saturday, January 29, 2005

My SCAR 2003 Review

Posted on June, 2003....

Many of us are in the PACS market, either to replace an existing system, or to dive in for the the first time. Hopefully, many of us went to the SCAR meeting, which provided a great forum for discussion and comparison of the various products out there. I want to compare observations. The purchase of a full PACS system represents a multimillion dollar investment, and we all want to find the best possible solution. Therefore, I shall post my own observations and I BEG you all to do the same.
General Observations:
1. Everyone is headed to "web based" architecture. This means for most that each image has its own URL. Some are already there, some are getting there, some are planning to be there someday.
2. MPR/Volume rendering on the PACS workstation is the up and coming thing. Most vendors use either some limited proprietary method, or bundle the Voxar 3D product in some form. See below.
3. The three monitor set-up is just about universal now. This entails two high res monochrome monitors (generally 3-5MP) with a small color monitor for the worklist and maybe some 3D stuff. EVERYONE had flat panels, usually Barco's for the high res. The vast majority used Dell workstations.

Company Specific (far from complete....):

AGFA: The grandfather of PACS..seems to have lost a tremendous share of the US market. Their client is very good. Sadly, their underlying architecture seems to be similar to the original (distributed databases, routing, etc.). The good: new product in the works... The bad: no one knows when it's coming.

Algotec: A good front end as it stands. The completely new client was not ready in time for SCAR. It is said to offer much 3D capability. Architecture is a little unclear; rep emphasized the "modular" capability of the, when expanding or upgrading, one box can be reconfigured or redesignated or reloaded to do the work of another box, thus preserving your investment.

Amicas: To me, this was the "sleeper" of the whole show. My personal opinion is that they have the best combination of client, worklist, 3D integration (with the Voxar engine), and web-based architecture. I would have placed my order then and there, but they do not have any installs as large as mine would be, and I have learned not to volunteer for beta testing. Frankly, I'm hoping they can convince me they CAN handle such a large project. They say that what they were showing was what they were shipping NOW, a nice change.
Fuji: Probably has the strongest web-based design. EMC reps felt that Fuji was best able to use their storage products for greatest speed and efficiency of all the PACS vendors. Again, a personal opinion, but I HATE their front end. The web/folder model is cute, but I find it much harder to work with than most of the others. Voxar 3d is thrown in as a free standing program, integration is promised, but wasn't demonstrated. They too say that what they show today is what they are shipping today. In speaking with other users, the general opinion is that Fuji delivers what is in the contract, AND NO MORE, so negotiate wisely. They are very price conscious, and make it clear that you will pay for what you get. Hopefully, you get what you pay for, too.

GE: Ah, the General! What can you say? They will probably supply more systems than any other company simply because they are GE. Centricity has a very usable front end, better if you have their VERY expensive RIS to go with it. Looks like their hanging protocols are great once you go through a rather lengthy set up process. I had a hard time pinning them down as to what ships when. Apparently, Centricity 2.0 will NOT SHIP UNTIL 12/03. They are flailing around with umpteen 3D solutions... I think the TerraRecon server box option will be available to ship with Centricity 2.0. They also showed their Advantage Workstation (AW) in a similar configuration (ANOTHER server box plugged into the network with "thin client" operation from the PACS workstation) which actually worked well, but won't be available for you and me until 12/04 (maybe). The 3D module of Centricity itself is a joke. I had heard something about a software port of AW to the Centricity platform, but all they had was an old AW package that didn't work too well. Underlying architecture is NOT web-based in the individual URL sense. They do however use centralized database structure, though it is two-tiered. Still should be functional and expandible. They do use UNIX in the central components...may be good or may be bad depending on your point of view. Personally, I still have some love for UNIX; I can't get it to crash anywhere near as often as I can Windows of any flavor. The General has acquired a reputation for running roughshod over us users about price. One big rumor abounds concerning a big academic install where GE was yanked out in the middle of the process and Siemens brought in. I had the opportunity to talk to one of the principals, and the truth apparently is that GE upped its price by several million and the institution decided to go with a cheaper alternative. I don't know if the institution changed its requirements or some such thing in the middle of the negotiations. I am anxiously awaiting comments from my GE reps....

Philips: Fairly good front end, most of the bells and whistles are included. I don't think they are web-based. Most of their main components appear to be from Sectra.

Siemens: Good client, but elderly architecture due for complete replacement in18-24 months.
Obviously, I didn't get to every last vendor. Please, please, please everyone, fill in the gaps and tell us what YOU think!

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