Saturday, May 23, 2015

A Note To GE PACS Service

Image courtesy


I don't believe I've had the opportunity to meet any of you, but I am one of the radiologists who provide imaging interpretation at a site using GE PACS. I have some familiarity with PACS in general as well, and so I wanted to touch base with you on the issues we are having with the Universal Viewer. I was very disappointed to learn that GE would not have someone on site today; we had rearranged the schedule so I could be here to work with you. Since that is the case, I wanted to outline some of the difficulties we are facing with the new UV software in lieu of a personal meeting,   While UV represents a significant improvement over the old Centricity PACS/RA-600, we have encountered several problems with the software, some with severe enough impact upon patient care that we must request a patch on an emergency basis.

The most serious problem we face is the inability to save annotations (measurements, etc.) placed on an image. In the clinical oncology setting, it is absolutely critical that we have the ability to follow a lesion from scan to scan, and if the measurements are not preserved, the lesion on a comparison study must be remeasured, taking additional time and leading to possible inaccuracies.

An equally serious defect leads to one or more slices of a CT series simply dropping out, leaving a blank screen within the viewport showing only the text "0% loaded". Closing and reopening the study may reveal the missing slice, but usually this requires multiple attempts and sometimes causes other slices to disappear. Clearly, we cannot interpret what we cannot see.

At least one of us is experiencing intermittent zooming of slices when scrolling through a CT series. This is an unnecessary distraction at best which could lead to inability to visualize structures beyond the aberrant field of view.

On at least one occasion, and probably several others, a prior study does not appear to have been properly retrieved. I believe the most glaring case has been submitted to GE. The report from the prior study (multiple priors in this particular case) refer to images that are not present. Is there some reslicing taking place on the stored prior exams, particularly if they were performed on the old CT's which have since been replaced?

There are other lesser but still annoying and potentially dangerous glitches in UV. Scrolling though the prior report with the mouse wheel is disabled once the user clicks back into a viewport. The report can still be scrolled with the left mouse button using the cursor to drag the side-bar control. The Navigator window is hidden initially by the exam information window. To retrieve it, we must press "N" twice. I suspect both of these are state problems stemming from the use of Internet Explorer intermixed with your ActiveX viewer. Perhaps this legacy from Dynamic Imaging isn't playing well with the newer code?

We had high hopes of using UV for reading PET/CT scans. As it stands today, this cannot be done. Synchronization is not possible (at least on some patients) between the PET and a prior CT only exam. Perhaps this could be fixed with a new hanging protocol, but I haven't been able to make this work consistently. We are unable to get SUV readings, without which we cannot interpret a PET exam. In addition, the fusion function does not work correctly. Proper PET/CT fusion requires an "alpha" control which varies the contribution of the PET and the CT slice to the fused image. The only control you have on the fusion pane is for PET intensity, and this does not yield a usable image. This is properly executed on our old Advantage Workstation, and I would refer you to this display to see how fusion should work.

Finally, the search function of the worklist perpetuates the rather annoying requirement that ONLY GE has insisted upon for years and years, the placement of a space after the comma when searching for a patient by name. Yours is the only software out there that does not simply parse the input for the comma. Yes, it's a minor thing, but for those of us who have to bounce back and forth between multiple PACS systems, this uniqueness is really not appreciated.

I should add that the new Zero Footprint Viewer does work much better than the old Centricity Web client, which was truly one of the worst pieces of PACS software ever created. I had anticipated being able to utilize the full UV client remotely; I had thought it to be a zero-footprint product itself rather than an ActiveX app. I assume UV could be used remotely, but apparently our site is not allowing it to be distributed beyond the DMZ as we are doing elsewhere with Merge and Agfa clients. But that's another topic for another day.

The problems above that affect the display of the images, particularly the image drop-out and the inability to save annotations, represent impediments to patient care. I would urge GE to patch these as quickly as possible.

Thank you.




Stacey Gordon said...

And none of this was tested prior to release? Of course not. No one that works in testing has any clinical clue.

Dalai said...

From an anonymous reader:

Now that I've finished laughing over your comments on the newest GE PACS I feel honor bound to point out a few things. I didn't post this trying to stay out of trouble, so here I go. CT skipping images? AGFA fixed that a while back. Annotations not staying? Could that be due to some bizarre privilege that wasn't given to Radiogists? Zero viewer requires active X? I'm not surprised since we had to have desktop load add ons for their Web and even CD's. When are these guys going to figure out that most Facilities do not allow the standard user the ability to install anything and really make a Zero footprint viewer?
Several of the other annoyances seem vaguely familiar, but at least AGFA listens when you "throw the patient care card".
Have a Great Day!