Highlights from the MDCT 2014 Workstation Face-off

Menashe Benjamin.gif

Menashe Benjamin, Vice President, HCIS, Carestream

This year marked the 12th annual International Society for Computed Tomography’s (ISCT) Workstation Face-off at Multidtector-row CT (MDCT) 2014. Doctors representing four vendors (Siemens, Phillips, TeraRecon and Carestream) worked on four different cases with the vendor’s workstation to put each system to the test in terms of speed and accuracy of diagnosis. Once again, Carestream was the only vendor that used a PACS workstation to complete all the cases, while the other vendors used highly specialized, dedicated 3D workstations.

All cases were complex and required advanced and fast image processing, measurement and reporting capabilities. The cases included:

  • Following a lesion in the abdominal wall across four time points based on two PET-CT and two CT studies;
  • Segmenting two lesions in the liver and segmenting the whole liver into nine segments according to the Bismuth classification;
  • Providing a set of measurements from a CT scan to plan a transcatheter aortic valve replacement; and
  • Highlighting multiple rib fractures of a severely injured man following a motor vehicle accident.

Dr. Michalle Soudack, Head of Pediatric Radiology at the Safra Children’s Hospital in Israel, was our experienced representative on the Carestream Vue PACS system. As always, she demonstrated the various applications in a clear, concise and precise manner, all within the allotted time.

Three areas that stood out in this year’s face-off:

  1. Polling. These were not scientific, official polls, but questions were posed to the audience and they could text in their answers.  The questions and results are below and these findings, while not conclusive, are interesting in terms of the audience makeup at MDCT 2014. For instance, the first poll question, 11 respondents say they have never been asked to measure liver volume and, surprisingly, 10 respondents answered “Yes” to the fourth poll question. This is a promising sign that collaboration and cooperation are gaining ground in the medical imaging space.MDCT
  2. The case results. These differed widely among the vendors in the second case, where the competitors were asked to measure the whole liver volume and the tumor burden per liver segment.


While the judges did not provide an official answer on which vendor was the most accurate, they did comment that validating the reproducibility and accuracy of automatic measurement results is an important factor in assessing workstation segmentation performance.

3. New product and application. During the presentation of the fourth case, Dr. Soudack was able to provide a look at two of Carestream’s newest technologies for radiology IT.

 a. The first was a work-in-progress called radial view. Dr. Soudack worked through a case focused on rib fractures and showed a new view that more clearly depicts the fractures, as can be seen below:

MDCT Radial View

Radial View is a special form of MIP (Maximum Intensity Projection) showing the ribs spread out as if they were looked upon from inside the body.

b. The second and more important new technology demonstrated by Dr. Soudack was a complete workflow highlighting Vue Reporting as a key tool for communicating findings and promoting collaboration between all radiology stakeholders. Vue Reporting brings radiology reporting into the rich, multimedia and interactive world. This new technology allows radiologists to couple findings and images into a single interactive report, as well as to inject into the report measurements and calculations created during image interpretation, thus helping to minimize chances for errors. Dr. Soudack demonstrated features such as live hyperlinks that enable instant access to live images and complete patient portfolios from the web, including validated mobile devices such as iPad and iPhone (for which Carestream has FDA clearance).


As always, the workstation face-off was a thrill to watch because we were not only able to see expert radiologists maneuver throughout the different platforms, but we were able to see how the workstation technologies and applications are evolving. These advances are being made with the purpose of helping create a more efficient and error-free work environment for the radiologist, which can in turn provide better care to patients. The unique design of Carestream Vue PACS, with its unified backend and data model, strives to expand this environment to ALL radiology stakeholders, addressing the needs of referring physicians, administrators, and patients as well.

Where do you see PACS workstations in the future? Are there applications you hope to see added to your system down the road?

Q&A: What to Include in Your PACS RFP

Eddie Moore, HCIS Digital Solutions Architect, Carestream Health

Eddie Moore, HCIS Digital Solutions Architect, Carestream Health

What are the top five things to include in a RFP to best understand a vendor’s options?

  1. Know what you want. Clearly define the scope of the project before you begin writing and making requests.
  2. Be clear and concise. Keep the RFP as short as possible while still being inclusive of your requirements. You’ll receive better responses with clearly defined questions and specifications as opposed to long, rambling documents that leave too much to the interpretation of the responder.
  3. Rank and weight. Try to stick with 5 – 7 categories and relevant sets of questions, making sure they’re ranked and weighted appropriately. You want to ensure all relevant groups/departments are equally represented in the request so that one department doesn’t override or exclude another.
  4.  Understand and communicate. Provide an executive summary at the beginning of the document that includes where you are and clearly defines where you want to be at the conclusion of the process.  Don’t require a scope of features and functions that exceeds the actual needs of the project you’re quoting.
  5.  Include all relevant criteria.  Don’t exclude any specific features or functions unless there is a valid, documented business reason.  Allow the vendors to tailor their solutions to the full scope of the RFP.

What do most purchasers forget to ask in their RFP?

I find that a lot of RFP’s don’t ask questions. What they provide is just a long document of statements without any real questions in there.

I also believe that too many people jump right into RFPs and bypass the RFI (Request for Information). You get responses from everybody, big and small, when you only send out an RFP. It can be very confusing and distracting to sort thru a large number of vendor responses that may, or may not be relevant to the original request.  The RFI can be extremely helpful during the pre-selection process as it allows you to narrow down the potential list of vendors to your specific situation and weeds out the inferior vendors.

When dealing with PACS systems it’s very easy to overlook and miss things. Creating an executive summary equipped with detailed diagrams of your current and future state is critical to ensure you receive appropriate responses.  It acts as a guide by easily separating vendors that don’t suit your needs from ones that match your documented criteria.

What is the best way to evaluate products from different vendors?

I would say there are really three important factors to evaluate before selecting a vendor-of-choice:

  1. Compare apples-to-apples. Don’t let a supposedly unique feature make your decision for you. Make sure you evaluate each vendor equally based on your needs.
  2. Be objective and critical. Rank and weight the responses based on tangible, measurable results.
  3. Be proactive. Don’t make a decision solely based off of a piece of paper. Conduct on-site interviews of each vendor’s proposal.

Lastly, choose a vendor!  This can either be a blatantly obvious choice from your review of the RFP submissions, or require you to do a more in-depth evaluation in a head-to-head environment.  Either way, following these guidelines can provide you with the necessary assistance to select the best suited vendor.

Below is a sample template of a RFP, which can be downloaded here.

This post previously published on Everything Rad provides additional information about tender bids that can help the process.

Why User Groups Are Necessary for Technology End-Users

By Jim Travitz, Senior Imaging Analyst, Trinity Health, Holy Cross Hospital, and President, Carestream VIBE User Group

When becoming an end-user of a particular piece of technology, one way to ensure you are able to get the most out of that technology is to join a user group, if the company has set one up. By joining a user group, customers are essentially creating a line of communication between not only themselves and the company, but with like-minded customers like themselves as well—and that is where some of the most important benefits exist.

Collaboration is the name of the game when it comes to user groups. The ultimate goal is for customers to discuss issues and solutions among each other, allowing the company to chime in when necessary. As an example, I am currently the president of Carestream’s VIBE User Group for its HCIS products, and am currently corralling more Carestream customers to join the group because of the benefits it offers. In addition to learning about the latest PACS, RIS, and other HCIS updates, there are several other initiatives in the works for VIBE:

How-to guides for users: We want users to have knowledge and informational materials available at their fingertips when joining the group. This is made possible by creating channels for users to reach out to one another, as well as Carestream delivering on providing the information we need to learn about its technologies.

Bring clarity to the user group:  As a group, we have the ability to decide what are the most important ideas/issues that need to be addressed. Collaborating to decide this is able to give Carestream a better idea on how to develop its products so it can meet our needs. Being from diverse organizations, we are going to have different needs we want addressed, so it becomes up to the group to deliberate on what the most universal needs are that can be focused on.

Sharing content: The best source of content in a user group tends to be the users themselves. Coming across an article or research, and then sharing it with the group is one of the best resources available. The best user groups are those that are the most educated and participate often, so by sharing content, users are contributing to improving the education of the group.

Education from Carestream about new features: If users are to experience the benefits from Carestream’s technologies, then education will be needed on its part to educate users about new features. Be it in the form of webinars, demo videos, or downloadable guides, education about these features is a must, and one the company is looking forward to providing.

Regarding the future of VIBE, I am currently working to fill a couple positions in the user group. I am looking for a PACS Knowledge Manager and a RIS Knowledge Manager. These two positions will be tasked with organizing all of the content that is shared among the PACS and RIS sections of the group, and ensuring that this information is accessible for all members.

Additionally, I recently attended RSNA in December and was able to talk with other members of VIBE about what they are looking from joining the group. The two biggest needs users are looking for from the group are consistent user collaboration and webinars from current VIBE members. With these features being put into place, it is our plan than as VIBE evolves, so will the members of the group. That will be the most beneficial end-game for all of those involved.

If you are a Carestream HCIS user and are interested in joining the VIBE user group, you can click the link to sign up.

Below is an interview I conducted at RSNA about VIBE, what changes are currently taking place in the user group, and what improvements users can expect in the future.

Vue PACS Enables Image Sharing Among 11 UK Trusts

The Cheshire and Merseyside NHS Consortium covers 11 trusts in the UK and chose Carestream to be their new PACS supplier after their existing contracts for PACS and RIS systems, delivered through the National Program for Information Technology (NPfIT), expired. When selecting a new provider, the consortium was aiming to get the most cost effective and feature-rich system to meet their needs. One feature that came equipped with their chosen system was the advanced features of CT reconstruction. Taking steps to be cost effective has allowed Cheshire and Merseyside to pay 40 percent less than their previous national contract.

Cheshire and Merseyside is unusual in that there are multiple trusts in a small geographic area with a number of specialist hospitals. Royal Liverpool University Hospital is one hospital in the trust and for them it has been a challenge between patients moving around to hospitals and keeping images with the patient. The PACS system makes it easy for images to be acquired at one site and reported at another, a high priority for the trusts. When reporting, radiologists have access to previous studies where they can report right then and there, which is a big advantage. Roughly 1.5 to 2 million exams are conducted each year across the consortium and the more studies that are done, the faster the amount of data being transferred increases. Royal Liverpool has greatly decreased their amount of data transfers from about 250 studies per week to around 180 and is looking forward to that number dropping even further than 100 studies per week. This provides lead image transfer teams with more resources to do other things instead of importing such a large amount of studies.

Detailed and Precise Measurement with Lesion Management

Larry Ray

Larry Ray, CTO R+I Volume Image Processing, Carestream Health

Precise lesion measurement is important for reliable evaluation of metastatic disease and faster assessment of the patient response to cancer treatment. For radiologists and oncologists, simple quantitative comparisons of historical exams – especially those imported from disparate PACS or modalities – have been a challenge in a traditional PACS, causing many to turn to costly dedicated workstations. Lesion Management is an embedded application tool in our Vue PACS that provides native oncology follow-up capabilities. The precision of the tool can help provide physicians with clearer and more detailed imaging exam results in less time, enhancing their productivity and efficiency to make a diagnosis.

There are several reasons oncology follow-ups are one of the most time consuming and challenging tasks for radiologists:

  • Relevant priors may not have been acquired by the same modality, thus making it difficult to compare as most PACS cannot correlate with different exam types
  • Identification, localization and measurements of lesions are often manual, time consuming and inconsistent
  • Often times lesion management and tracking is performed on a separate workstation or application, without integration to PACS

The lesion tool reduces the need for visual measurement by providing semi-automatic tracking and segmentation of lesions, which can help provide a faster and more consistent means of determining the size and estimating the overall volume of the lesion. The result has the potential to provide a better gauge of disease progression. Typically, when a radiologist first gets a case they mark the lesion and report on it before the data is stored. At a follow-up visit a second set of images with added lesions is read, often by a different radiologist. The lesion management software matches between the two reports and immediately generates a spreadsheet of the patient’s information. The data can be viewed and evaluated on a single exam basis, or a per lesion basis for comparison purposes.


When a patient is diagnosed with cancer it’s really a team effort between them and their care providers to choose the best possible treatment plan. Today, we have access to information almost immediately; questions get responses pretty quickly; we have better tools to fight these diseases. The lesion application is one of those tools. It allows for clearer, more meaningful communication and collaboration between radiologists, oncologists and referring physicians which is a vital step in providing the patient with the best care possible.

Editor’s Note:  The Lesion Management application, created by Larry Ray, Edward Gindele & Rick Simon, was a finalists for the Digital Rochester Great Awards in the Optic, Photonics and Imaging Technology category.

Learn more about Carestream’s Lesion Management application:

Doing MORE with Health IT Through Applications

Saskia Groeneveld, Wordwide Marketing Manager, HCIS, Carestream

Saskia Groeneveld, Wordwide Marketing Manager, HCIS, Carestream

Picture archiving communication systems (PACS) are a norm when it comes to uniting the needs of medical imaging and healthcare IT.

An important idea to keep in mind is that the complete capabilities of a PACS do not stop upon installation. To effectively provide the best service and functionality, healthcare facilities with a system must be up-to-date with upgrades and applications offered.

Carestream is currently offering our customers MORE when it comes to using our Vue platform of PACS applications. The upgrades and applications being offered include:

The latest version of Vue PACS: Provides new tools to help radiologists speed through 3-D volumetric studies, CT, PET, ultrasound and more. This upgrade can also allow access to new embedded clinical applications, reporting tools, Vue Motion, MyVue, Vue Beyond and archive expansion.

Powerful processing tools: All-in-one clinical workstation housing a suite of powerful processing tools lead by the PowerViewer. These applications reduce the reporting cycle without compromising the quality of the diagnosis.

Diagnostic confidence: New, embedded clinical applications like Lesion Management are diagnostic tools designed to improve productivity and diagnostic confidence. Precise lesion measurement is critical for reliable evaluation of metastatic disease and faster assessment of the patient response to cancer treatment. This upgrade introduces the capability as a native PACS application, helping to eliminate the cost and delays of a dedicated workstation, and enhancing assessment of oncology patients.IB_X_medium_RGB

Digital Breast Tomosynthesis (DBT): Allows the ability to read traditional Mammograms, Breast Ultrasound, Breast MRI, General Radiology or Digital Breast Tomosynthesis (DBT) exams from a single desktop. We can also securely archive DBT exams to allow access from any Vue PACS Mammo Workstation.

Reporting – Vue Reporting: This tool delivers native digital dictation or voice recognition, enabling much faster dictation. Radiologists no longer have to handle multiple log-ons or erratic integration, or lose time inputting clinical context such as measurements or DICOM metadata.

Patient empowerment – MyVue: This application allows patients to access, share and manage their own images and exam data. A secure portal, MyVue allows real-time sharing and collaboration between patients and healthcare providers, helping to eliminate the need for duplicate exams and the production of CDs, DVDs or films. This means potentially significant savings in both time and money.

Accurate, timely delivery of information – Vue Beyond: This tool for PACS and Archive is a web-based dashboard that provides real-time access to the departmental performance indicators.

Consolidation: Clinicians need access to the entire patient portfolio to make sound critical decisions. Vue Archive offers a multi-tier repository for data stored using XDS, XDS-i, DICOM, and HL-7 standards as well as other non-DICOM objects. Paired with the Vue Motion universal viewer (which can access and display many types of clinical data) it provides a vendor-neutral repository that is safe, manageable, and flexible. Moreover, it protects users from technology obsolescence, and enables continuous adaptations for evolving IT needs.

While this post provides an overview for many of the Carestream applications that allow you to do more with Vue PACS, it does not cover everything. Click on the link to learn more about the applications and add-ons you can use to create a PACS setup that offers the most to your facility and to your patients.

Moving Forward in Carestream PACS Upgrades

We have an eXceed corporate commitment to our customers at Carestream that promises them that “our focus is your success.” One of the four components in this commitment is outstanding. This refers to delivering to outstanding performance to our customers–both through our service and through our products.

Innovation is vital to providing this outstanding performance. We must be sure that out products are addressing our customers’ need and allowing them to provide the best care possible to patients.

With our PACS, the next phase of our upgrade will include 64-bit computing. Over the last couple of years, some impressive improvements have been made to scanners that have created large volumes of images that need to be processed online. To address this, Carestream has made the decision to migrate our workstation platform and the server platform into full 64-bit support, allowing our customers to handle those larger data sets seamlessly.

Our director of R&D for PACS, Seffi Markov, explains more in the video below.

[youtube http://www.youtube.com/watch?v=6kTvIhawmUw]

Information Technology (“IT”) Trends – Predictions Through 2015.

Diana Nole, Carestream Health

Diana L. Nole, President, Digital Medical Solutions

In a recent webinar, Gartner, the information-technology research and advisory firm, outlined the 10 trends they believe will have the greatest impact on IT through 2015. While some of their predictions struck me as less-than-revelatory – citing trends already self-evident in the industry – some of their other speculations are both interesting and insightful.

In any case, this forecast is a great jumping-off point for further thought and discussion. Below, I’ve condensed Gartner’s major points into an easy-to-scan overview. What do you think of their analysis and predictions?   I encourage you to share your responses. If you want to dig deeper, you can view Gartner’s presentation, as published in Health Data Management’s  online magazine.

1) Consumerization and the Tablet

The growing use of tablets by customers will require companies to intensify their focus on security issues, use profiles, and planned integration.

2) The Infinite Data Center

Data centers will achieve “logical growth without physical growth” – handling more data with far less infrastructure.

3) Resource Management

Organizations’ energy consumption and management will become an “enterprise-level discipline.”

4)   Mobility

A growing mobile focus will drive an IT paradigm shift, security will be a greater concern, and creating portals for myriad devices will be a serious challenge.

5) Hybrid Clouds

Businesses will transition form their current cloud-based solutions to reap the benefits of private and hybrid clouds.

6) Fabric Data Centers

The integration of disparate IT elements via fabric data centers will help optimize workflows. Fabric-based computers will follow, offering pooled global resources.

7) IT Complexity

As every 25% gain in functionality drives a 100% increase in system complexity, companies will have to squeeze every cent from their IT dollars.

8) Big Data — Big Problems

The challenges of managing and using immense quantities of data will increase – making virtualized storage, de-duplication, and prioritizing of data crucial.

9) The End of Service Desks

Users’ demand for immediate, real-time support will grow, and service desks will become inadequate – transitioning into business productivity teams.

10) Virtual- and Software-Defined Networks

Increased automation, hardware/software separation, simplified design and other factors will change the interactions between systems, humans and one another.

Having contemplated these predictions, I believe that there’s an overarching trend that encompasses them all –– a trend accelerating at an exponential rate. Bill Gates articulated it well when he said: “Information technology and business are becoming inextricably interwoven. I don’t think anybody can talk meaningfully about one without talking about the other.”

Nowhere is this more relevant than in the business of medical imaging. Clinician productivity, diagnostic speed and accuracy, patient satisfaction, the quality of care we provide – all of these can grow and improve only as fast as our ability to effectively manage healthcare information.

You can explore some of Carestream’s leading-edge imaging IT solutions here.

Innovative Tools To Improve Clinical Quality: Montage Signal

At RSNA 2012 there was a subtle shift in emphasis from radiologist productivity to clinical quality, no doubt driven by greater quality reporting and pay-for-performance requirements.  Shown as a prototype in the Carestream booth, Montage Healthcare Solutions demonstrated Montage Signal™, a new software capability that flags report inconsistencies during radiology report dictation and identifies errors in real-time that can degrade clinical quality and reduce reimbursement.

Montage selected Carestream Vue Reporting as a proven radiologist workflow platform for demonstrating Signal. Signal is an extension of the Montage search-driven radiology business intelligence and clinical quality analytics tools that help practices understand and improve productivity and clinical quality. Visitors to the Carestream booth saw Montage Signal flag reports containing laterality and gender errors, critical test results and incomplete billing documentation—all before report finalization.

Montage search provides access to the unstructured clinical information in radiology reports, enabling radiologists to answer complex clinical questions without disrupting reading workflow. The result is clinical quality improvement and continuous learning because report creation can now occur in the context of prior clinical findings.

Woojin Kim, M.D.,  Interim Chief of Division of Musculoskeletel Imaging at the Hospital of the University of Pennsylvania and  Co-founder of Montage Healthcare Solutions, stopped by our social media broadcast lounge at RSNA to share his thoughts on the next step in clinical quality improvements and the importance of integrating tools into the reading workflow:

What other ways can we prevent errors before they come part of the clinical record?  What analytic innovations did you see at RSNA? 

RSNA 2012 PACS Conversation with the University of Pennsylvania Health System

Kim Chan, Director of Radiology IT at the University of Pennsylvania Health System, talks to us at RSNA 2012 about the workflow challenges of radiologists reading reports from a variety of different hospitals with disparate PACS systems.  Chan shares why the University of Pennsylvania Health System is upgrading their picture archiving communication system to CARESTREAM Vue PACS, which will allow radiologists to read from multiple hospitals on a single PACS workstation.