eRad PACS

Mark Twain once received a telegram from his publisher stating:

NEED TWO-PAGE SHORT STORY TWO DAYS.

Twain responded,

NO CAN DO TWO PAGES TWO DAYS. CAN DO THIRTY PAGES TWO DAYS. NEED THIRTY DAYS TO DO TWO PAGES.

In the same vein, Dorothy Parker, an American poet and writer once said to then-Vice President Calvin Coolidge, "Mr. Coolidge, I've made a bet against a fellow who said it was impossible to get more than two words out of you." His famous reply: "You lose." (Ms. Parker stated upon learning of Coolidge's death many years later, "How can they tell?")

Those of you who have followed my attempts at writing over the years know that I am far from the Calvin Coolidge of blogging; I can yammer on and on for pages, and sometimes not say very much in the process. However, when it comes to PACS, I think Mr. Coolidge would have agreed with my minimalist philosophy, probably best outlined in my old post, Feature Fatigue and Lego PACS. There is such a thing as too many words, too many adjustments, and too many features, even if they are all relevant, useful, and powerful. And to pervert the spirit of Mark Twain somewhat, it is far more difficult to produce something with fewer features than a product with lots of them.

The folks from eRad gave me the keys to a web-demo, and then made the trip down to my average little town in the South from their average little town in the South to do a proper demonstration. In spite of my long lead-up, this is a powerful program with a bright future. However, you can guess where we're going with this in the end.

eRad's mission statement unifies one's view of their approach:

The Mission of eRad® is to unify diagnostic imaging processes and operations by:

• Applying unique technology which will present patient images, diagnostic reports and medical records to Physicians, Technologists and Clinicians from a single unified data base.
• Delivering images and information both error free and with high availability across a unified infrastructure.
• Enhancing patient care and reducing costs through improved immediate and long-term access to unified imaging information.
• Improving productivity through unified workflow.
• Delivering high value, scalable, cost effective unified diagnostic imaging solutions.

We invite you to look carefully at our product, its features and functions. This web site presents much of what a prospective user or institution may need to understand our solutions. In addition to a detailed description of the eRAD PACS® product line, you will find descriptions of the hardware components we use, demonstrations of our product, profiles of our staff and much, much more.

We recognize that a web site is no substitute for an informed account executive or service representative and invite you to contact us at any time by telephone or e-mail to open a dialog with eRAD. We are eager to assist you and look forward to the opportunity to do so.

Actually, these are lofty, admirable, and ultimately achievable goals. This is certainly in stark contrast to some companies out there with a mission statement of "Sure it works, sort of..."

One thing eRad can unify is an enterprise, or even a collection of disparate PACS systems. Uniting a (mostly) homogeneous enterprise shouldn't be that hard, but it certainly can be. eRad's approach. . .

is similar to most, with a server at each site feeding into the central server. Others call the peripheral computers spoke servers, and the effect is the same. At least they don't call for a separate computer for each scanner, like some systems are wont to do.

Trying to tie several different PACS together is a larger pain in the neck (or lower), but eRad has a better plan for this than most:

This is the sort of thing the VA has done with ScImage. Basically, it involves grafting their system over "legacy PACS" such as GE, Siemens, Sectra, and Agfa. This would really come in handy in an environment such as ours where our nighttime readers have to contend with two worklists from our Agfa system (even though it's one PACS, the two hospital worklists resident cannot be, well, united), one unified list from the Amicas dual hospital system, and others coming in on the group-owned Amicas. One single worklist would be a lifesaver. Of course, we would then have to come up with a way for the dictations to be routed to their proper site and so on. I'm not sure that one has been solved as yet. Still, the fact that eRad recognizes the need for such an umbrella is certainly important.

For me as a radiologist, the business-end of a PACS is its user interface. The web-demo as well as the live session gave me a good glimpse into eRad's GUI. I'm not going to do the features justice, but I'll try to give you a feel of what we have. Keep in mind that there are a lot of nice features. A LOT of them. Here is a screen-capture of their worklist:

and here is a snapshot of their viewer:

Clicking on the pictures above will expand them, and this is necessary to see what I'm going to talk about.

The worklist is customizable, and sortable on any column head. There is an indicator as to whether a study is locked, and there are various controls for batch reading, demographic editing, and for creating custom filters. ANY part of the DICOM header can be made a part of the worklist and subsequently a filter or search:

If one paid for PACS by the number of GUI features, eRad would be very expensive indeed. Here are just the extra modules that can be added when you first download the program:

These add some significant higher-level visualization to the package. Look at the viewer itself. The first thing that strikes me is the sheer number of buttons. The layout can be changed, by dragging the bars as you might with Microsoft Word. There are separate buttons for the major permutations of image and series layout. Most everyone else does this with popup menus and only one or two buttons. Many of the remaining functions have separate buttons as well. Notice that the buttons take up a lot of real estate that might otherwise go to the image viewports themselves.

There are good implementations of triangulation, linking, etc., and the ever-important mark-as-read-go-to-the-next-study button. When you click said button, there are various options as to how to leave the study status, or this can be determined from preset instruction. Window and level can be set from presets, slider controls, or the usual up/down/left/right drag. The series tray has a little indicator that tells if you have viewed all images. You don't want to miss the lesion on the last slice, now do you? There are separate buttons to reset image info, window/level, zoom, etc. There is a very nice report view that allows importing of key images. There is a pretty good spine-labelling module.

When going through the demo, I hinted at my discomfort with the multiple buttons and controls. My friends from eRad reassured me that there is a default configuration supplied out of the box that will get most rads up and running. But if you want to get in and change things, there is a way to do that. Oh, boy, is there a way to do that... Here are just a few of the 14 tabbed control panels for customization:

Oh, and the right-click menu brings up something like this:

This is where I have to say, "Whoa!" There is really a tremendous amount of power here, and in some respects, there is too much power. I have called this approach to a GUI the "Lego PACS", because of the high level of customization. As I've said before, this is to some degree a term of endearment, as Lego was my absolute favorite toy as a child, and it is still hard to resist when I go past a toy store or especially the Lego Store at the Mall of America. But I still prefer a simple, clean streamlined interface. Yes, the eRad default might give me that, but then there is the temptation that is hard to resist to go in and "tweak". OK, that's personal problem, and not eRad's fault, but still. . .

This is a program with great potential, one to watch closely. I think personally that the GUI needs a little smoothing and seasoning, but it is certainly usable. eRad has addressed a number of issues that are close to my heart, and some that the "big boys" haven't even solved as yet. I will expect to see great things from them in the future. In the meantime, if you ask me to say three words about eRad, I would say, "Pretty good."