Tuesday, June 17, 2008

(MIM)Vistas of New Orleans

The annual meeting of the Society of Nuclear Medicine is held in various cities, including New Orleans, San Antonio, Philadelphia, Orlando, and Toronto. This year's meeting is rather poignant, as this is the first time the SNM has returned to New Orleans since Hurricane Katrina. The Morial Convention Center is in great shape; you would never know of the tragedies that occured within its walls and nearby. However, within a few miles of the convention center, and only a mile or so from the French Quarter, lies the Ninth Ward, and there we found that all is not well with New Orleans. Much destruction remains, and rebuilding is slow and patchy. Further north, near Lake Ponchatrain, there is even more devastation, and three years after Katrina, little has been fixed. Locals tell us that over 60,000 people left New Orleans, never to return, and their homes will sit barren for the foreseeable future, testaments to a complete failure of government at all levels, especially local.

Bourbon Street is as lively as ever, perhaps slightly cleaner than it was on my last visit several years ago. Alcohol flows freely, and the strip clubs dominate the landscape. My fourteen-year-old son (who looks fourteen) was offered Jello-shots, among other things, which he wisely declined, as Mrs. Dalai and I were looking on. One of the street hawkers asked me if I wanted to buy my son his first lap-dance. I smiled and didn't respond, but I reviewed the possible answers: "No, he's only fourteen." Or, "No, but when do I get my first lap-dance?" Or, "Let him buy his own!" Mrs. Dalai was not amused. She was even less amused when a stripper outside a club called to her, "Hey, I'll play with you too, baby-doll!" There is no place like Bourbon Street. I like to come here every five to ten years just to remind myself why I don't want to come here any more often than that.

I'm somewhat surprised that this city exists at all, let alone the fact that it survived the one-two punch from Katrina and Rita. There's a joke around these parts: "Look up. What do you see? Sea level." Yes, New Orleans sits anywhere from 1 to 15 feet below sea-level. Minor problem, eh? But, the spirit here is strong, the levees and pumps have been repaired, and the rebuilding goes on. Eventually, I predict New Orleans will return to its former grandeur.

But now, back to things medical.

I had the chance to speak with several folks from MIMVista, including the fellow that wrote the software for the iPhone 3G application. The company was kind enough to give me the link to the presentation at WWDC08 in San Fransisco:

As it turns out, the iPhone app cannot be demo'ed at this point due to some pesky NDA's MIMVista signed with Apple. But as per the last post, the software should launch with the iPhone 3G itself.

The real news here is the core MIMVista software itself. For us PET/CT readers, what they offer is nothing short of revolutionary. To understand this, you have to realize what it is I do when I read PET's. If I'm looking at a new study, I try to find the "hot spots," and determine if they are physiological or pathological. If the latter, I need to determine how hot they are, a measurement called SUV, or Standard Uptake Value, which is a ratio that tells us how hot the lesion is relative to the total distributed dose. A somewhat arbitrary value of 2.5 has been assigned to badness; in other words, if a lesion is 2.5 or more times hotter than the "average" activity in the body, we should worry that it is malignant, or at least infectious or inflammatory.

MIMVista's software won't actually find the hot spots for you (no doubt they are working on that) but once you locate them, MIM does the rest. Simply focus in on the lesion, and let the PET edge tool take over. It will find the contour of the lesion in three dimensions, and report back all the needed statistics such as minimum and maximum SUV, HU's (density from the CT component), and the volume of the lesion. MIMVista uses a unique, proprietary edge detection system that uses a gradient-based algorithm as opposed to the constant threshold algorithm used by everyone else in the business. See this paper if you want the details.

This would be adequate in and of itself. But as Apple's Steve Jobs himself says, "Oh, and one more thing...." The bane of my existence as a PET/CT reader is the comparison of the current study to one or more priors. MIMVista has attacked this problem, and has the only real solution I have encountered. This is multi-faceted, and very, very well thought-out. The system will automatically match the old study to the new. Voxar told me years ago that they were working on this, but they have yet to deliver it. In addition, the system will propagate the contours around the lesions from the prior study to the lesions on the current study. That may not sound like much, but trust me, this could be an absolute miracle for us readers. The lesion contours can be transferred rigidly, or can be deformed, and will automatically adjust to the new pattern of the finding. This is what the clinicians (and sometimes the patients themselves) want to see. Tell me the progression of the SUV and the size of the lesion. Measuring all of this manually for every lesion for every study is incredibly tedious and prone to error. I'll take every bit of help I can get, and MIM is offering me a heck of a lot of assistance.

MIMVista's system is made up of modules,

which as I understand it can be used separately, or together, with or without the "PACS" storage server. The "viewer" is a thin client, but supposedly not for diagnosis. However, the "thick" fusion module should work on all workstations with a fairly open license agreement. As of now, there is no integration to Agfa, which I would need for reading PETs done at my Agfa. Let's get to work on this, Agfa and MIM. Quickly. I really, really want to get my hands on this software.

I looked briefly at the Cardiac package, which would be great for those doing multimodality PET perfusion/CCTA scans. At the moment, it doesn't have the high-level CCTA angiographic controls and so forth that we need for readout of CCTA alone.

I didn't demo the Neuro package, but I have been told by other docs that it is quite advanced.

I was asked not to mention numbers, but I can say that the value for the price is absolutely phenomenal. This is a bargain folks, and I don't say that often. PET/CT readers, have a look. You'll be glad you did.

Disclosure statement: The folks at MIM gave me a UniBall pen, worth approximately $1.


Anonymous said...

Our hospital just purchased MedView as it's PET/CT diagnostic software solution. We had the option to use MIMVista for free, but we didn't like it as much as MedView. Our radiologists use both MedView and MIMVista as they float between two hospitals. So far, they have all said they like the MedView better.

However, the idea of the auto-comparison of old studies really has my attention...that would be awesome. Hopefully, MedImage (the company that makes MedView) will get on the ball with that capability so as not to lose customers.

Our MedView also comes with a separate, yet integrated program, called 4DM-SPECT for reading our cardiac nuclear medicine studies. The beauty of all this is that it is all interfaced through an API plugin to our PACS, Philips iSite. So it is all seamlessly done from any PACS workstation in our network. The MedView licenses are floated between concurrent users.

I'm curious, have you used MedView? Does MIMVista have advantages over it that I should be bugging our vendor about?

Anonymous said...

Ryan, you may want to look into MIMvista's ability to integrate as a PACS plugin as well. We have concurrent licenses setup at several of our institutions on our PACS workstations and they work beautifully. Moreover we have used Medview before, and our doctors specifically requested a switch to MIMvista. Maybe the Dalai can explain why.