Wednesday, November 23, 2011

Another Shoot-Out,
Or, A Requiem For Advanced Imaging

Shoot-Out at the OK Corral
The word has gotten out to some of our potential vendors, so I might as well go public. We're having another shoot-out, and it should be quite interesting.

Our larger hospital system seems to have found some funding for an advanced imaging product of some sort, and somehow your friend Doctor Dalai has become the point-man in the decision. Initially, we were going to go with a bundled solution, as we need a few CT scanners, not to mention my beloved SPECT/CT scanner. Sadly (for the vendor in question), some of the initial prices ("good only for the next 10 days!") were way out of line, and so we are unbundling the purchase. I am thus free to pursue the best-in-breed of Advanced Imaging and SPECT/CT.  Someone else gets to worry about CT.

There are only a few choices when it comes to SPECT/CT, and I've reviewed them before. But advanced imaging is another story.

To create the atmosphere for a fair and balanced decision with respect to advanced imaging software, we will arrange a "shoot out" between some of the major vendors and their products.  I say "some" because we don't have enough room or time to showcase every possibility, so we are limiting the scope to a few programs that seem to have potential to accomplish what we need to do. A side-by-side comparison seems much more efficacious than the series of 20-minute demos we've been enduring. Plus, some of the vendors have been, shall we say, a teeny bit aggressive about placing their product for a prolonged demo, to the point that we were to accommodate about a half-a-dozen servers and 5 IP addresses. That might be the next step, but we need to be absolutely certain that our needs will be met before we start opening up rack-space in the data center.

The format will be similar to the Stanford PET/CT competition I wrote about a while back, with the vendors processing data we provide on a real-time basis. We will give them a script to follow, so we can see the same things done on the different machines, and then of course there will be some time for the vendors to do their own thing.

The script is still in flux, but I have a number of things that we need to see, and a few that we would like to see. In no particular order, here's what's on the list so far:
  • One-button processing, or as near to this ideal as possible. Of course, there must be a way to go back and manually alter anything that needs altering.
  • To the greatest degree possible, the system must be operable/viewable from anywhere, and any platform (PACS station, laptop, iPhone, iPad, Android phone or tablet, and whatever else comes up in the near future.)
  • There must be complete and total integration with IMPAX 6.5 and beyond, our illustrious PACS.
  • Procedures will include (but certainly not be limited to):
    • Brain perfusion
    • PET/CT viewing
    • Full cardiac/coronary work-up
    • Virtual colonography
    • Bone subtraction/transparent/translucent rendering
    • AVI creation
Suggestions for other items are welcome, although vendors need to be circumspect on this.

In addition, we have been tempted by "dose reduction" or "denoising"software, which is included in some of the advanced packages. I've discussed the concept earlier, and frankly, I still don't like the idea of dropping the quality of a scan in hopes of rescuing it later. So, to me anyway, this will not be a critical component. If it comes with, fine, if it doesn't, also fine.

The tentative schedule for the shoot-out is set for early January. Ambulances will be at the ready for the fallen.

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