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"Big Data" comes to medical imaging

by Brendon Nafziger, DOTmed News Associate Editor | June 27, 2013
From the June 2013 issue of HealthCare Business News magazine

Tomo troubles
Breast tomosynthesis is a 3-D digital mammography technology that uses an X-ray scanner to spin in an arc over the breast, taking multiple images that it reconstructs into a 3-D image. Only one tomosynthesis unit, Hologic’s Selenia Dimensions, is on the market, having been cleared by the Food and Drug Administration in February 2011, but other manufacturers have released tomosynthesis devices in Europe and will probably bring them over to the U.S.

When they do, and should the tomosynthesis market take off (right now it is not reimbursed by Medicare, which somewhat limits its appeal), it could be an even bigger data archiving burden for imaging centers and hospitals.
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Dr. David Clunie, an imaging informaticist, is even helping organize a talk at the Society for Imaging Informatics in Medicine’s 2013 conference this summer on how breast tomosynthesis could “kill” traditional PACS, in part because of the size of its files. Even a compressed, four-view tomo study would be roughly 350 MB — larger than even most CT chest and abdomen scans, he said.

“That is quite a lot of data to transmit and store, particularly when one considers the relatively high throughput of a dedicated screening facility,” he wrote in a March article on Aunt Minnie. “It is certainly a nontrivial amount of data to include in one’s consideration of capacity and cost of the archival distribution infrastructure.”

Tomo’s big file size also has knock-on effects, by requiring faster network speeds to shuttle tomo data across and beefier specs for viewing workstations, according to Steve Deaton, vice president of sales with Vitzek, a company that recently added a tomo viewing feature to its mammography PACS.

“The DBT size causes a ripple that will not only require more investments in IT infrastructure between the server and the radiologists' eyes, but it will also change the workflow models,” Deaton, who’s sitting on the tomo SIIM panel with Clunie, told DOTmed News by e-mail. “We have seen more radiologists reading from locations remote to the actual acquisition location, and this usually involves transmitting data over the Internet. Internet speeds usually are a fraction of what local networks are, so it will be increasingly difficult for radiologists to maintain their current distributed location model.”

Keep in mind, too, that diagnostic imaging isn’t the only discipline pumping up imaging volumes. Cardiology is a big contributor here, Daher says, and there’s already an established market for cardiology PACS. But possibly, the lion in the road is pathology. If CT or MR studies average 50 to 100 MB per study, digitized pathology studies start at over 1 gigabyte, Iron Mountain’s Leonard says.

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