Report from RSNA III: Agfa Impax 6.4

I spent an hour or so with my old friends from Agfa, and they didn't seem to have any weapons in sight, either. My paranoia may be overstated, or at least misplaced.

We had the chance to look over some of the new stuff going into Impax 6.4, which we should receive at the end of January, 2008. There are some nice interval tweaks and fixes, which will improve the Impax experience. First and foremost is a marked improvement in the CT/MR multiplanar navigation. This will include auto-linking, and active targeting. This eliminates a significant complaint we had with 6.2, where triangulation was trying at best. Window/level and zoom parameters can also be linked. Version 6.4 will support Vista, but only if you don't have any Barco monitors. Likely a driver issue at this point. Comments, Barco? The simple search function is tweaked, and is now a bit more customizable, and usable overall. A glitch in deployment of Voxar 3D has been fixed, and I will no longer accidentally activate Voxar 39 times during the course of my reading. There is also a nice new toy, Smart seek web access. This appears as a tab or tabs in the study information are of the information screen. Basically, it is a smart browser, connecting one to various search engines such as Google or MyPACS. It is set to search on the body part or history, or what-have-you of the case up on the viewer. Could be a time saver in practice.

Agfa is working on an EMR display, called the Impax Clinical Module (we were assured that the button labeled ICM could be renamed), which requires a server box called the Enterprise Clinical Dashboard. No, I don't know how much that might cost.

A rather important new option is the incorporation of Vocada's Veriphy critical result reporting program. What Vocada (now owned by Nuance/Dictaphone) lacks in spelling ability, they make up in usefulness of their product. Veriphy is an automated system that will follow pre-set rules to notify our illustrious referring clinicians of a critical result. One can set the system to send a text with a phone number to call to get a voice clip, for example, or even send an email. This step is documented, as is the clinician's response, so the JCAHO requirement for an audit trail is fulfilled. Since this is about the only way to graft such a system (including voice clips) onto Impax, I was impressed. There are similarities to Amicas' RadStream, which the Vocada salesman poo-pooed, but in some ways RadStream works better, as it reprioritizes cases based on pre-test criteria. But you can't get RadStream for any other PACS at the moment, so it is somewhat of a moot point. Anyway, while Veriphy is a separate program, Impax will automatically log you into it upon startup.

We were also shown Works In Progress, many of which looked quite promising. Dr. K, one of our finest MSK rads (all of our rads are fine, by the way) was quite intrigued with ORTHOGON, a wizard based orthopedic measurement program. Basically, one selects the measurement to be taken, say a Cobb angle, and the program shows via a big red dot where to put the cursor next. It's easy enough for a caveman Nuclear Radiologist to use. "Follow the bouncing red dot" was the watchword.

Agfa is developing its own PET/CT and Virtual Colonography programs, and both look very promising. The PET/CT will perform autoalignment, and should work with any two datasets, no matter their modality. There is a very nice method of growing a volume of interest about a lesion, which seemed to work quite well for SUV's, as well as volume measurements. There is a report generator module as well. I have two complaints about their implementation, though. First, the blending control involves clicking over the word "Blending" at the bottom of the viewport, then dragging to control. Give us a button or a slider, please. Secondly, they are using hot-spots, areas on the viewport that will control various functions. Again, I prefer buttons. I need to see where I'm going.

The Virtual Colon piece is nicely done too, incorporating features that I have seen in some high-end products like Viatronix. In particular, there is an indication of what parts of the colon you have seen, and what you haven't, which could be critical.

AND......coming in 6.5......spine labelling! We saw a brief video of how it will work, and it will be OK, rather similar to Amicas' version, but not quite there. I asked why it has taken several years to reach this point, and was told that it took a great deal of programming to detect interspaces and such. Which is funny, because most other spine labelling programs just interpolate. Don't overthink things, guys.

So, there are many improvements coming for us Impax users. We're still toggling, though....