Agfa Impax 6.x…The Saga Continues

I’m not the only one who has noticed some gaps or glitches in Impax 5.2 and even 6.0. One Agfa user mentions these problems (rewritten for clarity) on APUG (the Agfa user’s group) with reading MRI under 5.2:

1. Triangulation - the localization tool in Impax 5.2 doesn’t work as well as some of the more simply designed tools in eFilm or Amicas. With the latter two, you just click on a point, and all other windows lock on to the same level. With Impax, the corresponding tool does work, but not on images that are linked by position to other windows. Good, but not quite there. As with lots of other tools, you have to click it again (actually twice) to turn it off. The soon-to-be-famous Agfa toggle.

2. Speaking of linked sequences, it is possible to link a bunch of sequences together. We even have a wizard button that will sync all the planes of an MRI together. Unfortunately they all scroll at the same time, and you can’t just click one button and link everything together. Amicas links the planes individually and intuitively, as do others, and with one button.

3. There is no easy way to display location of a slice on every other orthogonal plane, and have it update as you scroll through slices, without a "scout" window, nor is there a way to show the first and last image on other planes. The scout scroll tool in Impax is by contrast extremely cumbersome and finicky. Amicas and others do this with a single button.

4. Measurement tools - dragging across an object, clicking to get a measurement, then moving the number aside to measure the perpendicular dimension (to avoid the numbers overlapping right in the middle of the lesion being measured) is simply too many steps for what should be a much simpler process.

5. Too many functions in 5.2 require several mouse clicks, which is frustrating for many rads who are used to the functionality of tools which require a single mouse click.

6.What passes for a spine-labeling tool and hanging protocols are essentially impossible to use in 5.2.

The list ended with this: “One wonders how much end user (i.e. radiologist) input was sought at the time of development.” Someone else comments, “Perhaps enough voices will together prompt the necessary improvements in functionality. It is apparent that no working radiologists were involved in the development of the initial product.” Now, I was told that there were 12 radiologists on the Agfa advisory panel that approved Impax 6.0, and yes, they had experience with other systems. Still, given that Impax 6.0 does things in very similar fashion to Impax 5.2, I have to wonder a little bit about that. The majority of these difficulties persist into 6.0, which has a viewing component that is very similar under the hood to what we have with 5.2. Keep in mind for CT triangulation and whatnot that the "simple MPR" tool has been removed, but it may be replaced at your option with Voxar 3D.

The good news is that at least some of these things are to be fixed by RSNA 2006, or so we hear. That would be nice.

A friend of mine on the other coast has been having a world of trouble with his 6.x installation and migration from another vendor. “The doctors’ workstations crash all the time, AGFA applies a patch and says this will fix it and in a couple of days the stations are crashing again. The rads say AGFA sucks! Even so, they do all agree that we are in a better place than we were with the old vendor.”

Obviously, Agfa needs to work on a few things.

I am probably a bigger fan of Agfa's than they are of mine. I do believe I got several of their execs rather upset with some of my blog posts on Impax 6.0, but I'll stand by most of what I posted, and I corrected the areas that were inaccurate.

Agfa's big push with Impax 6.0 was the migration to the .NET architecture, a laudable goal. The "front end" to the interface was completely revamped from Impax 4.x-5.x. The new interface is very different overall, for those of you who have not sampled it. There is a great deal of "toggling" between screens of information. I liken it to a control panel on the Enterprise (the starship, that is) where a wave of the hand would load in a different set of options. Having used Impax 6.0 as a web-appendage for call purposes over the last several months, I still find this quite disorienting. I like having a worklist constantly visible on the third (or fourth or fifth) monitor. (As an aside, we are having to add a fifth monitor to our four high-res monitor stations to accommodate the eventual migration to Impax 6.0 from 5.2.)

While the main interface was revamped, the Impax 6.0 viewing component is really a re-skinned port of the viewer from Impax 5.2 with all its good and bad points. The main deficiency I find (beyond the lack of usable tools as others have outlined) is the persistence of the clone-window concept. With other systems (and Amicas I think does this quite well), one can drag any sequence to any viewport or window. I like to view my CT's with multiple window settings, for example. Now this can be done, and I even have a wizard to do it, but it requires spawning a clone window to do so. I want to be able to do this within the main viewer itself. I could go on, but you get the idea.

As I mentioned above, Agfa told us last RSNA that "12 radiologists" were on their panel for approval of Impax 6.0, and they ultimately agreed on the final release. I suggested at the time that these radiologists must have been exclusive Agfa users, because of the stasis of the viewer; I was told that was not the case. Having sat on advisory boards of other vendors, I can attest to the difficulty in getting more than two radiologists to agree on anything, so I can see how things might have gone in the Agfa meetings. Still, now is the time to fix and revamp Impax 6.0, before it gets entrenched as it stands. We can only hope that Agfa can fix some of these problems by RSNA, or I’m going to be “toggled” to death.