North York General to install new PACS,
chooses Algotec’s ImagiNet

Canadian Healthcare Technology

June/July 1999

By: Jerry Zeidenberg

TORONTO – While many hospitals are installing picture archiving and communication systems (PACS) developed by giant, multinational companies, North York General Hospital has opted for an image management system devised by a small but innovative company – Algotec Systems Ltd., of Israel. It’s the first Canadian installation of a PACS for the Israeli company, which also has a U.S. office n Duluth, GA.

“We believe it’s the best solution available,” said Dr. Raziel Gershater, chief of diagnostic imaging for North York General. The hospital performs some 90.000 diagnostic imaging exams a year, and as a result of restructuring, is absorbing the nearby North York Branson Hospital, which conducts another 90,000 exams.

Dr. Gershater has been developing PACS at North York General sine the early 1990s, focusing on the integration of images from CT, MR and digital flourography. Despite the advantages of storing and routing medical images using the older systems, there were some serious limitations that will be overcome with Algotec’s technology, called ImagiNet.

North York General previously used a patchwork of imaging systems that was developed over the years and cobbled together by several companies. The software required regular tweaking and maintenance. By contrast, the new system will single-handedly tie together all of the hospital’s computerized imaging modalities, resulting in greater reliability and ease of use. “We’ll have as system that’s not made up of bits and pieces from a variety of vendors, we’ll have one that’s seamless and totally integrated,” said Dr. Gershater.

The hospital will extend its current soft-copy access to include nuclear medicine and ultrasound, all integrated with computerized, radiological reports.

The medical center also has the go-ahead to acquire two MRI machines – one high-field, 1.5 Tesla magnet, the other an open, low-field system. Moreover, in approximately two years, the hospital plans to add Computed Radiography (CR) and Direct Radiography (DR), as well. Ultimately, computerized pictures from all these modalities will be available on the PACS network.

The Algotec ImagiNet system is strong on workflow management, something the previous PACS didn’t offer, commented Dr. Gershater. Workflow components in the software automatically transmit a variety of tasks and information to radiologists and technologists throughout the diagnostic imaging department.

For example, radiologists will only have to power-up their workstations to discover the day’s worklist waiting for them; similarly, technologists working with CTs and other modalities need only to log-on to their systems to obtain their own list of tasks for the day.

The new software also has pre-fetching abilities and auto-routing of images to the appropriate radiologist. This means that the software not only provides the radiologist with images from recent exams, but it will also call up previous pictures from a 180 gigabyte short-term RAID archive and a 2 terabyte, long-term archive that uses digital linear tapes (DLT). “It pulls up all of the pertinent studies for a patient,” said Dr. Gershater, who explained that the radiologist benefits by comparing images and spotting changes in various structures over time.

The ImagiNet system uses the HL-7 standard for interfacing to the hospital’s new Cerner information system. This will enable radiologists to obtain a wealth of data from computerized medical records. “Looking at a case, I want to see the pathology report, lab results, blood count, the drugs that a patient is taking – so I know what procedures to recommend,” said Dr. Gershater, commenting that the connection to the hospital information system will be extremely useful.

At the same time, physicians outside the radiology department will have access to diagnostic images by using a component of the ImagiNet system called MediSurf. It’s a Web browser – the first FDA-approved Java-based Web browser for radiology – and North York General has been using it for about three years.

MediSurf is one of the building blocks of the modular, ImagiNet system, and its use will be extended inside and outside the hospital.

Clinicians anywhere in the hospital can gain access to diagnostic images ad reports simply by hitting a MediSurf button on their Cerner interfaces. Files will be distributed in this way over the hospital’s internal Intranet, making the data available to any physician who wants it.

They’re even able to do this from home. Because the system is integrated with the HIS, they can also obtain other types of medical information from patient records.

“They could even order tests from home, if they see a problem for the patient on the chart,” said Dr. Gershater. This could mean huge productivity gains for the hospital, faster and higher quality of care for patients, and greater convenience for doctors.

He noted that the system provides encryption for date security and that the hospital also has its own firewalls for protecting computerized patient information.

ImagiNet itself uses a decentralized processing model, meaning that the information is processed on several CPUs, not just one. If one system goes down, other are ready and able to continue the work.

The president of Algotec, Menashe Benjamin, PhD, commented that the ImagiNet PACS has an “architecture that assures the system will never quit, unless there is a hospital-wide network failure. If for whatever reason some parts of the system fail, the other parts will take over.”

Powerful workstations are also part of the ImagiNet configuration. The hospital’s DI department has already been using 10 ProVision stations for post-processing of images. Using these stations, radiologists can analyze images using multi-planar reformatting (MPR), image fusion and volume rendering techniques, maximum and minimum intensity projections (MIPs), shaded surface 3-D displays and virtual endoscopy.

However, most of the day-to-day readings will be done on newly acquired NT-based MediPrime stations, which offer user-defined protocols and can support one to four screens. This is where the radiologists will view current and previous exams; at the same time, they will also have powerful tools such as MPR available.

All in all, the ImagiNet system coupled with the new, Cerner hospital information system should put North York General on the road to building an extensive electronic patient record. It will give clinicians access both to text and images. And for the radiologists, it will provide greater efficiency and effectiveness through the analytic tools at their disposal, along with the workflow management features. “Most PACS are weak on workflow management,” said Dr. Gershater. “But this one is impressive. It really appeals to us.”