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Archive through April 09, 200809-04-08  12:44 amJonathan Rex20
 
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 Link to this message Neelam Dugar  posted on Sunday, April 20, 2008 - 05:33 pm Edit Post Delete Post Print Post
PACS suppliers are increasingly improving their software to improve capabilities including
1. 3D as standard application available throughout the enterprise (Agfa Impax 6, Fuji Synapse etc etc)
2. PET-CT fusion will in time also become part of a standard PACS software application. Smaller companies like Pukka-J are providing PET-CT fusion as standard application. Osirix (A FREE! PACS workstation software for MAC users-Thanks Peng!, has PET-CT fusion as standard http://www.apple.com/downloads/macosx/imaging_3d/osirix.html

Those PACS suppliers who do not improve their software to provide PET-CT functionality as standard will find it difficult to compete in the global PACS market. This blog made interesting reading with predictions of the future of PACS and PET-CT software.
"But I think the best option for PET/CT viewing might well come from the PACS vendors. At RSNA, I saw some preliminary versions of PET/CT reading modules from Intelerad, Agfa, Dynamic Imaging (GE!), and Amicas.But PET/CT doesn't really require quite the level of processing we see in some 3D renderings of the beating heart, and I suspect we will see more and more PACS programs that can handle it readily, and as well (or better) than the big ol' workstation."

Let us take some of the mystique out of PET-CT viewing and reporting within the NHS. It is no big deal. Reporting PET-CT does require training (in the same way as MRI, CT or any other modality).

Jonathon--I understand from your profile you work with Inhealth which is an Independent Sector provider for PET-CT including reporting to the NHS.
 Link to this message Chris Bull  posted on Sunday, April 20, 2008 - 06:24 pm Edit Post Delete Post Print Post
This is where the specialised thin client applications like Visage and TeraRecon can provide the necessary solutions for 3D, cardiology and PET/CT when linked with the PACS providers workstations. The application must also provide critical SUV values for PET/CT which are difficult to provide as different manufactures provide these different ways. I would be concerned with the free applications that the necessary research has not been carried out to confirm the accuracy of the reported values from the different manufactures.
 Link to this message Jonathan Rex  posted on Sunday, April 27, 2008 - 03:41 pm Edit Post Delete Post Print Post
<Quote="Neelam Dugar">Jonathon--I understand from your profile you work with Inhealth which is an Independent Sector provider for PET-CT including reporting to the NHS.</Quote>

Neelam - Before you go suggesting that my comments are coloured by a desire to keep PET/CT reporting as a closed shop, be aware that whilst my company has the contract to provide the examinations, we actually have no stake in the partner company who do the reporting.

My concerns are purely professional, and are based on a concern over the lack of techinical knowledge of Nuclear Medicine in general and PET/CT specifically by a lot of Radiologists and the wider clinicial community in general.

Evidence the frequent disagreements between Nuclear Medicine Physicians and their Radiological collegues over all things Nuclear Medicine.

That is not to say you can't learn, but everyone can't be an expert.
 Link to this message Neelam Dugar  posted on Monday, April 28, 2008 - 02:13 pm Edit Post Delete Post Print Post
Royal College of radiologists has issued new guidance on PET-CT training for existing NHS radiologists and Nuclear Medicine Physicians. This is no longer numbers based but competency based. This will indeed improve PET-CT usage and reporting within NHS, and will allow for radiologists to demonstrate PET-CT within MDTs where patient management decisions are taken.

There is a move towards having at least 1 reporter from each referring NHS Trust.

NHS Trusts will need to consider getting a PET-CT reporting software for this. I agree with Chris that there maybe a role for specialist 3rd party applications like Visage, Terarecon, Voxar etc for integration into PACS to provide a PET-CT reporting software (unless LSP PACS can provide the functionality).
 Link to this message Neelam Dugar  posted on Tuesday, April 29, 2008 - 12:36 pm Edit Post Delete Post Print Post
The Royal College of Radiologists has issued guidance for NHS radiologists to be trained in reporting and demonstrating PET-CT in MDTs. This will allow NHS patients to get a good standard of care from a PET-CT perspective.

Requirements for PET-CT reporting was not identified on the initial OBS for PACS from LSP, as the OBS predates the PET-CT contract. However, if the NHS radiologists are to provide a good PET-CT reporting service to NHS, it is vital we are supported by a good PET-CT software application through the LSP PACS suppliers. Considering that LSPs are largely responsible for PACS provision within England, it is vital that we take a national view on this.

To enable best practice for PET-CT within NHS, and to improve radiologists efficiency in reporting PET-CT within NHS, the following are the requirements:
Either
1. LSP PACS suppliers provide dedicated PET-CT reporting software
or
2. LSP PACS supplier provides desk-top integration with a 3rd party dedicated PET-CT reporting software application (this 3rd party application could be bought nationally/cluster wide/individual Trusts) with a fixed price charge for desk-top integration for each Trust/Cluster by the LSP.

PET-CT reporting software should be available on ALL PACS reporting workstations (on a concurrent user licence model) in order to improve NHS radiologist reporting efficiency.
 Link to this message Peng Hui Lee  posted on Wednesday, April 30, 2008 - 04:56 pm Edit Post Delete Post Print Post
Osirix can be downloaded from this site: www.osirix-viewer.com
It's free unless you want the 64-bit version for which there is a small charge.
It only runs on Macs.

Hardware depends on expected usage. Full 3D functionality with large PET-CT datasets will require more computing power. Recommended specs here:
http://www.apple.com/science/solutions/medicalimaging_config.html

You can work out the total cost in the UK here:
http://store.apple.com/uk
and compare that with the cost of buying something from the usual vendors.

Note: you don't need to use Apple monitors. In fact grey-scale Totoku monitors are supported.

Peng
 Link to this message Jonathan Rex  posted on Wednesday, April 30, 2008 - 08:43 pm Edit Post Delete Post Print Post
[quote]Note: you don't need to use Apple monitors. In fact grey-scale Totoku monitors are supported.[/quote]

Umm... has anyone addressed or considered the issue that:-

Plain radiographs or any grey scale images are always best displayed on a monochrome monitor.

and PET/CT would always need to be viewed like many Nuc Med images (such as cardiac) in colour.
 Link to this message Neelam Dugar  posted on Thursday, May 01, 2008 - 02:02 pm Edit Post Delete Post Print Post
PACS workstations come with 3 monitors (usually 2 greyscale and 1 colour). RIS and other applications that need colour like PET-CT should be able to be viewed on the 3rd colour monitor.
 Link to this message Peng Hui Lee  posted on Thursday, May 01, 2008 - 06:42 pm Edit Post Delete Post Print Post
Sorry, I realise this is getting off-topic...

Barco produce high luminance Coronis colour displays which are alleged to be suitable for grey-scale applications.
http://www.barco.com/medical/en/products/product.asp?gennr=1650
Thee cannot be used with Macs.

Apparently it is possible to calibrate Apple 30" cinema displays so that they meet the minimum German requirements for grey scale applications e.g. reading chest x-rays.
http://images.apple.com/science/pdf/Radiology_White_Paper20070814.pdf
 Link to this message Roger Rawlings  posted on Sunday, May 04, 2008 - 05:50 pm Edit Post Delete Post Print Post
I think you will find the new EIZO Colour display - RX211 - fit's the bill perfectly for colour and greyscale reporting! I posted some time ago regarding teleradiology and we knew that PET CT images would be in the mix. That is why we have already converted to Colour Diagnostic displays - without having to buy Apple Macs.

I think the NIPACS preferred solution is an interesting one - making sure the colour information screen on a greyscale workstation is suitable for reporting a colour image and also for viewing 3D etc.. And the QA is the same as for a monochrome.

And I don't think a 17" Dell or HP would be considered a suitable display for this purpose???

 
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