RSNA 2010: Carestream and Sectra

Being a Personality in the PACS field (I doubt this is a goal to which many folks aspire) has significant advantages, one of which is the opportunity to be friends with some great people.  As Doctor Dalai, I'm in mild demand to come have a look at this product or that.  So far this trip, I've demo'ed Sectra and Carestream, the former at the request of Mike Cannavo, the One and Only PACSMan, and the latter at the request of Garn, our once and former AMICAS salesman.  (Actually, I go way back with Garn's family...his father and sister sold my group its first Image Data PhotoPhone system back in 1989.)

Let's start with Carestream.  Personally, the first thing that comes to mind when I hear that name is some sort of urological appliance, but I guess I'm the only one who has that problem.  In case you didn't know, Carestream was once Kodak's health imaging division, since bought out by Onex, a big venture-cap firm.  The software is written by Algotec, an Israeli firm with which I also have history, as they wrote the viewing software for our old Elscint CT's.    

The latest and greatest version of Carestream's RIS/PACS 11.1, bears only slight resemblance to the Algotec product I remember from SCAR (now SiiM) 2003.  This is a .NET program, which is self-deployed via web browser, like most of what's out there these days.  

The Archive Explorer is Carestream's flavor of worklist, and it is folder-based, somewhat like the Synapse approach.  The worklist disappears when a study is brought up on the viewer.  While the worklist is adequate, it doesn't give the real-time color feedback as I have come to know and love with AMICAS.  

The viewer itself has some similarities to the newer versions of Microsoft Office, with tabs and tools much like Word or Excel.  The toolbar and right-click menu can be customized.  When the viewer is active, a "mini archive" appears on the left-most screen, which includes priors although multiple filters can be applied to this display.  The thumbnail images can be dragged to a miniature representation of the monitor set-up for display.  

Display protocols are automatically launched based on study attributes.  Advanced visualization can be included in the arrangement.  

Carestream has included one rather spectacular function, that of automatic registration of a study of any cross-sectional modality to one of the same or any other modality.  Thus, an old and a new CT could be registered to one another, facilitating comparison.  A PET and a CT, or a CT and an MRI could be similarly linked.  The algorithm doesn't deform the comparison, but it will convert it to an MPR which might allow for a little closer match.  This is something I've only seen in advanced visualization programs, and it would be very nice to have.  

The system can bring up multiple old comparisons, but there is no clear flag or signal to let you instantly realize which is the current exam and which is the old one, and that could be problematic.

There is a rather complete vessel segmentation program that will identify the major blood vessels all by itself, and this works for coronaries as well.

There is a native report generator which is templated based on the study, and there is speech recognition with AutoText (precanned reports).

Carestream has a solution for enterprise viewing called SuperPACS, which essentially places a layer on top of disparate systems at multiple sites.  An "agent" wraps around the local system and builds an index, and Carestream's unified/integrated reporting allows easier distribution of the dictation back to where it belongs.

The Cloud is big at Carestream.  The company owns ten data centers around the world, and is the largest supplier of cloud solutions.  

There is the now-obligatory iPad app with a zero-foot-print viewer.  It is patient based, and displays in HTML 5, since Flash won't work on the 'Pad.  

Sectra, made in Sweden, was once the supplier of Philips PACS.  Philips sadly dumped them for Stentor iSite, and Sectra had to go it alone in this country under its own name.  It recovered from the experience well, and to its great credit, never once (at least publicly) acted the part of jilted lover toward Philips.

Sectra started the demo with a view of its prototype Visualization Table, a huge screen embedded in glass or plastic, designed for, you guessed it, autopsies!  I tried to get Mike to lay his head down over the image of the spinning skull (the screen uses multi-touch type gestures to manipulate 3D images), but for some reason he declined.  

We then saw Sectra's obligatory iPad app, which was a little more robust than some, and was able to stream the image for instant display gratification.  We also saw the latest app for Windows Phone, which was actually rather more powerful, having a limited but still pretty good subset of the main worklist available at your fingertips.

And on to PACS.  There were several Mikes present in the booth, and the Mike that ran the demo did a great job.  It was only after he was done and I was sliding off my stool (no comments) that one of the other Mikes told him who I was.  He did recover well, but that brief flash of panic made me wonder just what my reputation has become out there in the big bad world of PACS.

Sectra has done something either very good or very bad, depending on your point of view, placing a fourth monitor on the right of the usual three for a RIS display.  Of course, you don't have to use it, and the workflow can be driven by either RIS or PACS.  

The left-most monitor usually contains the information window, which is mostly similar to the last incarnation of Sectra PACS I saw a few years ago.  Basically, it consists of customizable panels which include the list of worklists, the worklist itself, a patient history panel, and a document/order and report panel.  This is a very busy screen.  Worklists are highly customizable, and can search across an enterprise, even tapping other connected PACS.  A little eye icon appears on the worklist in front of patients that are being read by someone else.  The worklist does not use color other than that little green eye, and the background of the entire Information window is a little bright...how about darkening it a bit so as not to dazzle my green eyes?

Filters can be applied to worklists for searches, and there is a nice big banner that comes up to tell you that filters are in place.  This may not sound like a big deal, but when you have some entry in the far right field of a search window that you forgot about, and you can't get any search results, you realize that such a warning might be a darn good idea.  Here that, Centricity?

Sectra does clearly mark the studies as to current and prior.  

The cursor wraps around the screen, which helps limit mouse movement.  (Believe me, it works.)  

Hanging protocols have improved somewhat from the old version.  There is an unusual combination of text and dragging windows around to create a hanging protocol.  It is still a bit harder than AMICAS' version, but much better than Agfa's (which doesn't work at all).  Staged hanging protocols are available.

High-level visualization, including PET/CT fusion and comparison, is accomplished through outside programs, with Mirada 7D recommended for PET in particular.  

For those who are allowed to import CD's, there is a "temporary merge" function that will let you treat two patients as one.  Very powerful option, but I do advise extreme caution when using it!

There is an optional Image Central which can be used to import non-DICOM studies into the PACS, thus serving the 'ologies other than Radiology.

Sectra uses off-the-shelf graphics cards to drive the high-res color monitors on its workstations.  

So, here we have another tale of two systems, and this time both are worthy of praise.  Neither is perfect, but I would be content to use either one.  In my always humble opinion, both could use a few tweaks, and I've mentioned a few of them above, but both companies seem to be interested in satisfying their users, which they appear to have done.

I'm not really sure why neither has had great penetration into the US market.  These are worthy contenders, and perhaps with a bit more (OK, a LOT more) publicity, they could be right up there with some of the larGEr vendors.  

Stay tuned.  More to come.