IT Matters – Which of today’s universal clinical viewers have the potential to be tomorrow’s radiology diagnostic viewers?

April 03, 2015
From the April 2015 issue of HealthCare Business News magazine

Another important feature of many UniViewer solutions is the range of options it has for querying and retrieving medical image data. Most department PACS solutions only support a DICOM interface with external devices, requiring the UniViewer to pre-stage months of image studies on a working cache to meet performance expectations.

The cost of a few terabytes of storage is not the issue. The existence of two separate databases of image data, the original images on the PACS and the copy of the images on the UniViewer cache, creates a synchronization problem. Having to guarantee that the UniViewer is always delivering the most recent version of the image study to the physicians is an undesirable complication.

Most Vendor Neutral Archive (VNA) solutions support the much faster web services interfaces like Web Access of DICOM Objects – using Restful Services (WADO-RS) and Medical Imaging Network Transport (MINT).

A UniViewer and a VNA connected by a web services interface allows the UniViewer to draw image data directly from the VNA. This precludes the need for that pre-staging cache, improves performance, and eliminates the need to synchronize disparate databases. The pairing of UniViewer and VNA using a web services interface has the potential to be much more than a clinical viewer for the EMR physicians.

What if the UniViewer offered a richer set of display features and functions, well beyond what is considered ”clinical” functionality and included hanging protocols? In fact, such an advanced UniViewer paired with a a next generation PACS solution. The only piece missing is the workflow application.

Hold that thought for a moment longer. As expected with any display application, the range of features and functions undergoes constant change. The basic flavor of the earliest UniViewer often did not satisfy the needs of the true image users in the physician community. Ideally, the clinical viewer should provide display tools nearly identical to those available to the radiologists and cardiologists interpreting the studies. Naturally there is now considerable interest in how far UniViewer vendors will expand their feature/functionality suite. The line extending from “clinical” display applications to “diagnostic” display applications is something of a continuum representing the ever-increasing demands of users for more and better tools.

There are, of course, technology requirements associated with the more advanced tools required for diagnostic interpretation, but the hope is that zero or near-zero clients paired with server-side rendering technology can support all of the tools currently included in the most advanced diagnostic workstations used in the organization’s imaging departments, and provide a substantial boost in performance, finally supporting at home diagnostic interpretation. Therefore, it is my contention that UniViewers should be evaluated based on where they sit along this continuum, how far along the continuum toward “diagnostic” a vendor plans to take its product, and how soon.

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