Inside the February 2009 print
edition of Canadian Healthcare Technology:
reading services launched in Canada
A new tele-radiology reading service, called Real Time Radiology
Canada, has been launched in Canada to provide expert reading of
diagnostic images to hospitals and clinics.
Innovations abound at
annual radiology show
At the latest Radiological Society of North America conference, held
last December in Chicago, they introduced innovations in
ultrasound, MR and CT, along with PET scanning and intra-operative
READ THE STORY
DI research institute
A new research centre for medical imaging informatics has been
launched at McMaster University in Hamilton. The institute aims at
advancing DI via collaborations involving different academic and
clinical disciplines, along with corporate partners.
The Hospital for Sick Children, in Toronto, and Dapasoft, have
devised a system that automates the collection of EMS patient data
at the point-of-care. Using the web, they can share the data in
real-time with remote physicians and allied health professionals.
READ THE STORY ONLINE
Last autumn’s annual gathering of the Canadian Society of Telehealth,
held in Ottawa, was the biggest ever. CST member Nancy Gabor reports
on highlights from the meeting.
A device that offers CT-like imaging right in the operating room is
being marketed by Medtronic. Called the O-arm, the system makes it
easier for surgeons to check their work as they operate.
PLUS news stories, analysis, and features and more.
Tele-radiology reading services launched in Canada
A new tele-radiology reading service, called Real Time Radiology Canada,
has been launched in Canada to provide expert reading of diagnostic
images to hospitals and clinics.
The service is a response to the dire shortage of radiologists in some
areas of the country – which has resulted in reading and reporting
delays of days or even weeks. In turn, that has meant delayed decisions
and treatment for many patients, particularly in rural areas of Canada.
The company has been two years in the making and started with the
working name of CanadaRAD. That name was recently changed to avoid
confusion with a similar-sounding service. And while Real Time Radiology
was slated to officially start in January of this year, demand for its
services was already so great that it started work in December,
completing its ‘go live’ ahead of schedule.
“This is the first, Canadian-driven, national teleradiology initiative
in the country,” commented Ian Maynard, CEO of Real Time Radiology,
formerly of GE Healthcare and a twelve-year veteran of the Picture
Archiving and Communication System (PACS) marketplace.
Already, 20 radiologists have signed on with Real Time Radiology,
“making it the largest independent group of licensed Canadian
radiologists practicing teleradiology in Canada,” said Maynard.
The company expects the number will increase to 50 in two to three
months. Maynard says the business plan calls for bringing on as many as
500 radiologists within five years. “This will provide on-site
radiologists in every region, province and territory with better and
broader options for backup coverage from colleagues licensed to practice
in their jurisdiction.”
Typically, small hospitals and clinics must incur large costs to augment
their radiology capacity. They must attract and equip additional staff
with the necessary IT infrastructure, or pay the associated travel,
living and accommodation costs to fly in additional radiologists to
serve their community.
Flying in a radiologist is often expensive, inconvenient and an
inefficient use of the radiologist’s time.
Use of Real Time Radiology, says Maynard, will result in improved
medical care for patients across the country. “We’re providing improved
access to care and equalization of service, especially for patients in
remote communities,” he said. Maynard noted there are some regions where
a radiologist only visits every couple of weeks, and referring
physicians and patients must wait for their studies to be reported.
Other regions simply don’t have as many radiologists as they need, which
is also a problem. When these radiologists leave for the day, go on
vacation or get sick, referring physicians and their patients simply
have to wait – and the level of medical care suffers.
However, using this secure teleradiology service, images can be
transmitted to Real Time Radiology’s data centre where they are routed
for reading to credentialed radiologists. What’s more, the system allows
the radiologists to work from any part of the country, at any time of
the day or night and even from their homes.
“The goal is that no exam goes unread for any significant period of
time,” said Maynard.
The radiologists maintain their affiliations with their own
organizations, such as hospitals and independent imaging centres, and
provide interpretations in off-hours, evenings and weekends. A
subscribing Real Time radiologist is paid for every exam read.
“Radiologists are able to practice on their own terms,” said Maynard.
“Many have told us that they welcome the opportunity to be paid for
exactly what they read in their off hours, thereby supplementing their
income. It’s one of the reasons we’ve seen such a high pre-launch and
pre-advertising subscription rate.”
One may wonder, given the longstanding shortage of radiologists in many
Canadian communities, why a service of this sort hasn’t been launched
The answer, said Maynard, is that it required the creation of a service
and technical infra-structure on a national scale. Most teleradiology
companies are regional 2-5 person operations with limited capacity.
And while point-to-point teleradiology has occurred in Canada before –
typically involving a hospital and a specific radiology group – no one
in Canada has ever created a system that allows any number of hospitals
and clinics to interact with a large number of radiologists licensed to
practice in their jurisdiction.
Real Time Radiology has created its own workload management, coverage
request and response system. “It includes automatic routing of exams
based on the applicable jurisdictional credentials of the radiologist,
their capabilities and subspecialties, along with their scheduled
availability,” said Maynard. “The system can also respond to
unanticipated on-demand requests, providing radiologists and the
institutions they serve, with an unprecedented real time resource.” The
creation of this system constitutes a significant innovation on the part
of Real Time Radiology.
“We can have 50 different senders, generating studies at all hours of
the day and night,” said Maynard. “We have the capacity to handle this
because of the scale of the service”.
The compensation model is also new for Canadian teleradiology. Other
services typically require radiologists to leave their current place of
work and commit to a full-time position.
At Real Time Radiology, radiologists can continue to serve their current
institution and provide services on a per exam basis.
Real Time Radiology was launched by a team that includes Mr. Ian
Maynard, as well as radiologists Dr. David Koff, Dr. Nadine Koff and Dr.
The company recently announced a multi-year, multi-site contract win to
provide evening, night, weekend and on-demand coverage to the Huron
Perth Healthcare Alliance.
In addition to providing teleradiology services across Canada,
international hospitals have requested the company’s services.
“Canadian radiologists enjoy outstanding reputations internationally and
are thought of as providing uncompromising quality and good value,” said
Hybrid imaging the talk of the town at RSNA
conference in Chicago
CHICAGO – Much of the buzz at the Radiological Society of North America
(RSNA) conference – held here last December with some 58,000 attendees –
was about the fast-developing field of hybrid imaging. These innovative
systems combine different types of imaging – for example, they mix
ultrasound with CT or MR, and nuclear medicine with CT.
The benefit? In an instant, hybrid systems are delivering
multi-dimensional information to radiologists and physicians about the
anatomy of their patients – enabling them to make faster, more accurate
diagnoses and to more effectively conduct interventional procedures.
Of course, hybrid imaging systems are also demanding new skills from the
technologists and physicians who are running the machines, as well as
from radiologists reading the exams.
As just one indication of the surging importance of hybrid technologies,
the Canadian Association of Medical Radiation Technologists (CAMRT),
based in Ottawa, is now conducting a ‘gap analysis’, to find out which
cross-modality skills its members have and those which they may be
lacking. The information will be used to create new training programs to
make sure that techs are up to speed with these new hybrid systems,
which are taking the medical world by storm.
“Hybrid imaging is having a big impact on our profession, and we’re
taking steps to address the trend,” commented Fiona Mitchell, president
of CAMRT. She said that radiation technologists are facing similar
challenges in the United States, the United Kingdom and Australia, but
these countries haven’t yet conducted a study of the impact of hybrid
systems on technologists. “They’re very interested in what we’re doing
and they’re eager to see our results,” said Mitchell, adding that a
paper based on the survey should be ready next spring.
Not only does hybrid imaging provide physicians with high-quality
information, but it also boosts patient satisfaction and throughput in
the hospital system, she observed. “When you can provide two exams at
the same time, you’re providing a form of one-stop shopping for the
patient,” said Mitchell, who is the provincial professional practice
leader with the British Columbia Cancer Agency, in Vancouver, as well as
serving as president of the CAMRT.
The RSNA is held annually, right after the American Thanksgiving holiday
in late November. It’s said to be the largest medical meeting of the
year in the United States. In addition to the busy seminar and lecture
schedule, the trade show component is a much awaited annual event, as
it’s the place where global DI suppliers show off their latest
developments – and this year there were plenty. On the hybrid side, they
included a new ultrasound system from GE Healthcare that can display and
merge live U/S with CT and MR images; a SPECT camera from Philips that
adds CT in a compact design; and new PET/CT systems from Siemens, GE and
Philips that conduct scans in five minutes – instead of the conventional
As well, several of the leading vendors showed off improvements in their
CT systems, with a key development being the reduction of X-ray doses to
patients – Siemens, in particular, announced its new Somatom Definition
Flash CT, a dual-tube system that combines fast imaging with very low
A major advance was also announced for MR, with Philips introducing a
system that provides clear imaging of the body using 3.0T MR. This had
been a difficult task in the past, and as a result, MR has been mostly
used for brain and musculoskeletal imaging; now, it can be used to
obtain high-quality images of the heart, liver and lungs.
Companies also demoed exciting systems for the operating room – in
particular, Medtronic showed off a low-field, 0.15T MR system for
intra-operative imaging during neurosurgery, and a mini-CT-like system
for orthopedic and general surgery that provides quick, 3D scans in the
operating suite. In greater detail:
Ultrasound: GE Healthcare announced an innovative new ultrasound
system – the Logiq E9, which can display images from other modalities,
such as CT and MR, directly beside live ultrasound images during the
examination of a patient. What’s more, the imported images can be fused
with the real-time ultrasound, giving the ultrasonographer a greater
amount of information to work with.
Image fusion is achieved by marking a common point on two images – the
live ultrasound image, and, say, the imported CT image. A GPS-like
technology then keeps the images in synchronization. The images can even
be overlaid, with one on top of the other.
It’s among the first systems of its kind – merging live ultrasound
images with pictures from other modalities. “This helps address the
biggest challenge in ultrasound radiology and vascular care – how to
leverage clinical images from previous diagnostic imaging studies for
interventional or diagnostic procedures,” said Terri Bresenham, GE’s
vice president of diagnostic ultrasound and information technology. “We
worked closely with a global team of radiologists and sonographers to
develop this new ultrasound architecture, giving clinicians the
advantages of imaging modalities – MR, CT and PET – and it is already
reigniting the imagination of the ultrasound industry.”
As her team demonstrated the Logiq E9 at the massive GE Healthcare
booth, Ms. Bresenham noted that it will be especially helpful to
physicians conducting biopsies and ablations. It will also be useful for
verification of lesions and to track various conditions over time,
giving physicians more comprehensive views of the patient’s anatomy as
they conduct exams or interventional procedures.
On a related front, Toronto-based Traxtal Inc. demonstrated a similar
system at the RSNA – an ultrasound workstation that can import CT and
other types of images, and then merge the pictures so that sonographers
and physicians gain a more complete view of the patient’s anatomy.
Traxtal’s PercuNav system, which it calls a computer assisted,
image-guided diagnostic and interventional system, has been cleared by
the FDA in the U.S. for all imaging modalities. Interestingly, it also
features a broad range of flexible and rigid “tip-tracked” instruments.
Using minute electro-magnetic sensors embedded in the tips of these
instruments, the software superimposes the precise, real-time location
and orientation of the instruments on pre-operative and live images of
Neil Glossop, PhD, company founder and president, explained that the
PercuNav system is designed for soft tissue navigation using tracked
instrumentation. As such, the system is optimized for accurately
conducting biopsies and ablations, inserting lines, and conducting other
“CT and MR images provide physicians with terrific tools for identifying
areas of interest, but are often impractical for navigation purposes,”
said Dr. Glossop. “Ultrasound is a great live imaging modality, but
images can be difficult to interpret. We set out to combine all
available imaging data with real time tracking of the tips of flexible
instruments on one screen to allow the physician to accurately target
and navigate directly to areas of interest with confidence. We are
delighted with the extremely positive physician response to the PercuNav.”
The PercuNav system consists of the Traxtal Tx mobile system cart,
PercuNav software, and a wide range of instruments, including flexible
needles, biopsy devices and RFA introducers. The system also
incorporates advanced techniques for compensating for patient motion and
respiration. Overall, it acts like a GPS system for medical instruments,
and according to the company, it is the only such product available that
allows accurate tracking of flexible instrument tips inside a patient’s
The company will start shipping units with the capability to import and
manipulate CT, MR and other images to customers in the U.S. in the first
quarter of 2009.
Traxtal is currently seeking Canadian approval for the system from
Health Canada; meanwhile, several Toronto-area hospitals have expressed
interest in testing the unit once it is ready for use in Canada, said
Nuclear Medicine: At the mammoth Philips booth, the Dutch-based
company was showing off a hybrid innovation of its own – a SPECT/CT
system that combines images from these two modalities. “It’s a new kind
of hybrid,” commented Dominic Smith, VP of global marketing for nuclear
medicine. “Others use CT and add SPECT,” he said. “This takes SPECT and
adds CT panels.”
The result is a much smaller system – and a much less expensive hybrid
solution. Smith explained the cost of the new device, called the
BrightView XCT, will be on the order of US$600,000 to $750,000. That
contrasts with the much higher price of a CT device which adds nuclear
imaging, since the price of a 64-slice CT machine typically starts at $1
The combination of price and the power of SPECT/CT imaging may be a
winner for the Canadian market, which is seeking innovative imaging
solutions but is strapped for cash. Moreover, higher-energy PET/CT
hasn’t yet made major inroads in the Canadian marketplace, largely
because of cost constraints and the reluctance of jurisdictions such as
Ontario to reimburse physicians for the exams. As such, SPECT/CT may be
an ideal solution for Canada. Smith noted the system is aimed at such
nuclear medicine applications as cardiac exams, bone implants, and
checking for infection. “It’s a good, multiple purpose system,” said
On the PET/CT front, there was lots of excitement – it’s clearly a field
that’s undergoing rapid development. And while the market in Canada has
been flat of late, for the reasons cited above, many observers feel that
will change in the years to come. That’s because PET/CT is becoming the
‘gold standard’ in oncology imaging, and as care is shown to improve in
other countries as a result of PET/CT, the pressure will mount in Canada
to adopt such solutions.
Siemens showed its new Biograph mCT, a PET/CT scanner that can take
whole body scans in five minutes. It can be outfitted using a 40, 60 or
128-slice CT scanner. It has a 78 cm bore – quite large, and ideal for
imaging larger patients or those with tubes and equipment attached, such
as oncology patients.
For its part, Philips was touting a new PET/CT scanner with an 85 cm
opening; it too, is capable of five-minutes scans.
GE Healthcare also announced a new PET/CT scanner that images in less
than five minutes. At a pavilion where GE discusses technologies under
development, the company also discussed some work in progress concerning
In particular, it’s doing a great deal of research on ‘4D’ PET/CT, which
accounts for the motion of the heart and lungs while the patient is in
the scanner for five minutes or more. Jean-Luc VanderHeyden, PhD, global
molecular imaging leader, explained that because the scan time is much
longer than in other modalities, there’s a challenge in obtaining clear
images of lesions in moving organs such as the heart and lung.
“If the tumour is small, and it’s moving, it will be lost in the image –
it won’t be detected,” said Dr. VanderHeyden. Alternatively, it may not
be accurately positioned, and during radiation treatment, “you end up
treating normal tissue.”
“In PET, motion management is the biggest challenge,” he said. As such,
GE Healthcare is investigating methods of ‘phase management’, so that
imaging is done during rest stages, resulting in clearer and more
Magnetic Resonance Imaging: Aside from the new hybrid
technologies, progress is also being made in more traditional imaging
modalities, such as MR and CT.
For its part, Philips Healthcare announced a new 3T MR scanner and an
innovation for MRI that dramatically improves the way 3T MR machines can
According to spokesmen from the company, the new technology eliminates
the image problems that 3.0T systems have experienced in the past when
scanning the body. As a result, the company believes that 3.0T systems
will achieve even greater acceptance in the marketplace and that they
will become the de facto standard for MR imaging. Currently, 1.5T
scanners are the workhorse systems in hospitals and clinics.
In the past, 3.0T imaging has been challenging for certain clinical
procedures due to dielectric shading effects and local specific
absorption rates (SAR). Philips’ new, proprietary, MultiTransmit
technology addresses these issues at the source with multiple RF
transmission signals that automatically adapt to each patient’s unique
anatomy. As a result, the new Philips MRI scanner delivers clear
diagnostic images for even the most demanding high field applications
such as breast and liver imaging, the company said.
“3T as a modality has not been embraced by the larger [imaging]
community,” commented Stephen Mitchell, senior director, MR, for Philips
Healthcare in North America. “This innovation moves MR into broader
applications, such as breast imaging, liver and cardiology.”
And at the RSNA, amid a good deal of fanfare at their booth, Philips
unveiled its new 3.0T MRI scanner that incorporates the new
MultiTransmit technology. According to the company, the Achieva 3.0T TX
enhances image quality, provides up to 40 percent greater scanning speed
and helps ensure fewer retakes through increased image uniformity.
MR is, of course, an extremely useful imaging technique and many
hospitals wish to acquire a scanner – or additional machines, if they’ve
already got one. However, finding space in the hospital for an MR
scanner can often be a problem.
A solution was offered at the RSNA by MedBuild, a division of Modular
Space Corp. The company designs and constructs pre-fab imaging buildings
that can be trucked to a site – say, next door to a hospital – where a
unit can be lowered into place. It then becomes an extension of the
In 2009, MedBuild plans to start offering this solution to Canadian
hospitals. “It’s designed for centres that have run out of space, and
for organizations that discover renovating an existing space is too
expensive,” said Jim Gabriel, director of business development.
The company took visitors on tours through a 14’ x 50’ prototype
building right on the floor of the RSNA trade show. The building has all
the requisite shielding needed for MRI suites. Gabriel says the company
aims to provide a turnkey solution to Canadian hospitals in 2009 for
less than US$400,000.
CT: Siemens festooned a CT scanner with fruits and flowers, to
signify the life-affirming features of its new Somatom Definition Flash
CT. In particular, the new unit generates very low X-ray doses while
providing very fast and clear imaging – all to the benefit of the
patient. It was quite a sight in halls that are typically filled with
cold, hard metal and plastic equipment.
Essentially an improved version of Siemens’ previous high-end CT
machine, the Somatom Definition Flash is a dual-source CT featuring two
X-ray tubes that simultaneously revolve around the patient’s body.
According to the company, it offers the fastest scanning speed in CT
(i.e., 43 cm/s) and a temporal resolution of 75 ms, enabling, for
example complete scans of the entire chest region in just 0.6 seconds.
The speed of imaging has important implications for patient care.
Perhaps most importantly, the system operates at an extremely reduced
radiation dose. For example, a spiral heart scan can be performed with
less than 1 millisievert (mSv) of radiation, whereas the average
effective dose required for this purpose usually ranges from 8 mSv to 40
mSv. And the scanning is so fast, patients no longer have to hold their
breaths, as they did with CT in the past or on slower machines.
X-ray dose has become a huge issue in healthcare. Significantly, in the
United States, the Alliance for Radiation Safety in Pediatric Imaging
has launched a campaign called ‘Image Gently’, which provides protocols
for delivering the lowest doses when imaging children. The Canadian
Association of Radiologists is a backer of the movement, and the
Canadian Association of Medical Radiation Technologists is climbing
aboard soon. (More information is available at:
Of course, a good deal of innovation has been occurring in the CT sector
– in 2007, Philips announced a 256-slice scanner, while Toshiba
announced a scanner that acquires 320 slices in a single rotation of the
gantry. These scanners also significantly reduce the time needed to
conduct a CT exam, and they, too, reduce the X-ray dosage to patients.
How have they fared in the market?
For its part, Philips has sold 50 of its 256-slice scanners worldwide
since the announcement, with two sales so far in Canada – one has
already been installed at the Centre hospitalier de l’Université de
Montréal (CHUM), while another will be delivered shortly to the Rouge
Valley Health System, just east of Toronto.
“It’s been a successful launch,” commented Brent Shafer, president and
CEO of Philips Healthcare, North America. Shafer noted that the CT
market in general declined about 14 percent in 2008 from a year earlier,
but the outlook appears good for 2009, despite the worldwide economic
downturn. “We’re looking for a recovery in CT in 2009,” said Shafer.
Joe Robinson, senior vice president of sales and marketing for Philips
in North America, pointed out that imaging speed and technical
capabilities in CT are only half of the equation for hospitals. “It’s
all about workflow,” he said, pointing out there must be software tools
to smooth the flow of information from the imaging suite to the
radiologist and then on to the referring physician. “It doesn’t matter
if you’re doing 256 slices or 320, you really need these workflow
Surgical imaging: Medtronic showed a fascinating pair of systems
designed for intra-operative imaging. The company, perhaps best known as
a maker of cardiac pacemakers and defibrillators, is offering an
innovative O-arm, which provides CT-like imaging using a ‘telescoping’
gantry – it looks like a big C when open, and gives physicians access to
the patient while conducting operations. When imaging, the C closes,
forming a ring around the patient – hence the term O-arm.
The surgeon or interventional radiologist is able to quickly check his
or her work using the system, which offers 2D and 3D imaging. It’s said
to be advance over traditional C-arms in the operating room, which may
not provide 3D imaging. It also has advantages over an intra-operative
CT, which doesn’t allow easy access to the patient.
And while a standard CT will cost on the order of $1 million or more,
and typically requires siting in a dedicated room, the O-arm is selling
for approximately US$700,000 and can be positioned right in the OR.
Worldwide, 100 of Medtronic’s O-arms are now being used, including two
in Canada – they’re at the QE II Health Sciences Centre, in Halifax. Top
applications for the system include spine, neuro and orthopaedics.
“Typically, in the OR, they use C-arms, but you can obtain better 3D
with the O-arm,” commented Leslie McConnon, marketing manager for
Medtronic’s Navigation business unit. She said it takes 13 seconds to
perform a scan, and 10 seconds for the 3D reconstruction.
Medtronic also displayed its Polestar iMRI Navigation Suite –
essentially a mini-MR system for intra-operative imaging. Whereas
standard hospital MR scanners use a field strength of 1.5 Tesla, the
Polestar generates a field of 0.15T.
And instead of the big doughnut-style design used by traditional MRs,
the Polestar makes use of two large disks – the patient’s head fits
inside, allowing for ease of access by the surgeon.
Due to the low field strength, “The image quality isn’t as good as a
standard MRI scanner, but it’s excellent for surgeons in the operating
room,” said Bruce Leggett, who handles marketing of the Polestar for
He explained that the brain is a gelatinous mass that can move around
during neurosurgery. If surgeons are navigating using only pre-op
images, they might miss parts of a tumour as it shifts during the actual
operation. Using the Polestar, they can constantly check during the
procedure to see if they’ve excised the entire lesion.
The system is selling for US$1.6 million, and the company has sold 50
worldwide – including 27 in the United States. A system was recently
sold to the QE II Health Sciences Centre, in Halifax, where surgeons
starting using it last November.
New medical imaging research centre at McMaster University
By David Koff, MD
HAMILTON, ONT. – An innovative initiative at McMaster University is
coming to life, combining medical imaging with a range of disciplines
such as medicine, medical physics, biomedical engineering, computer
science, nuclear medicine, e-health, statistics, and psychology.
The Medical Imaging Informatics Research Centre at McMaster University (MIIRC@M)
is the result of the efforts of the radiologists at Hamilton Health
Sciences, and researchers and scientists at McMaster University and the
University of Waterloo, along with other prestigious Canadian and
At the practical level, we have secured funding for our initiative for
two years, plus office space, from McMaster University’s Faculty of
Health Sciences. This funding has allowed us to recruit a manager with
invaluable experience in computer sciences, medical sciences, and
The team is moving into offices at the McMaster Innovation Park in
February. Also Agfa, a leading PACS vendor, has generously agreed to
donate a licence for their web-deployable image and information
management solution (IMPAX 6) for our research purposes.
Why a Medical Imaging Informatics Centre?: The idea of creating a Centre
came from many years of partnership with engineers on a number of
research projects. During this partnership it became apparent that
computer scientists have brilliant ideas plus the time and resources to
build exciting research projects, but they lack a clinical background
and the validation and guidance from physicians.
While the physicians involved would be very enthusiastic about
participating in more research and turning their ideas into real
applications, they are overwhelmed by the amount of day to day clinical
work. Added to which they have very limited academic time, and don’t
always know where to find the appropriate partners and resources to
build successful projects. This disconnect helps to explain the low
number of research grants generated by many radiology departments.
MIIRC@M development and goals: The mission of MIIRC@M is to create an
environment to bring together these groups and use their skills to
create and implement a support infrastructure and develop the necessary
tools. The physicians will benefit from the computational and analytical
skills from the scientists involved, and the scientists will receive
guidance and validation as well as access to clinical data from the
Both groups will collaborate when it comes to writing grant applications
and publications. As an example, one of the tools we plan to build is a
resource database of relevant anonymized medical images, which will be
created by archiving diagnostic images of disease conditions using
various modalities (e.g., CT, Ultrasound, and MRI). This image library
will be accessible by modality, pathology, and type of image under
approved research protocols. The images may be licensed for use as a
learning resource for the MD and residency training programs.
Paramount among the goals of the Centre is the development of successful
projects, and the list of potential topics is long:
• Advanced image processing; image segmentation; image registration;
• Human-computer interface; visualization; workflow; image compression.
• Quality Assurance; Quality Control.
• Data mining and neural networks; content-based image retrieval;
evidence-based guidelines; cross-modality visualization of disease
entities; report-driven image understanding.
• Psychophysics and reading environment.
We have already begun work on a number of projects involving different
skills; image compression with the Mathematics Department, and body
compression with the Kinesiology Department, both at the University of
Waterloo; and a joint project with Agfa on radiation safety.
Conclusion: While MIIRC@M has been created to foster research and
education in Medical Imaging Informatics, and to create new
opportunities for talented people, we hope to achieve this in a spirit
of collaboration with other specialties who are also image producers and
who may wish to participate; such as cardiology and pathology.
We are of course always looking for more research and partnership
opportunities, especially those that help solve medical imaging-related
issues or which create innovative and original ways to approach imaging.
Dr. David Koff is Chief, Department of Diagnostic Imaging, Hamilton
Health Sciences and Chair, Department of Radiology, Faculty of Health
Sciences, McMaster University.
Innovative system collects and transfers patient data during EMS
By Dianne Daniel
Does electronic access to information save lives? Absolutely. Can it
enhance patient outcomes? Without a doubt. And, as two recent IT efforts
related to emergency services in Toronto indicate – one at the
Sunnybrook-Osler Center for Prehospital Care (SOCPC) and the other by
The Hospital for Sick Children’s (SickKids) Acute Care Transport
Services (ACTS) team – electronic access to information can also enhance
decision making, reduce room for error, and provide a vital
communication link at times when paper-based information just isn’t good
In September, 2008, the transport team at SickKids, which only deals
with emergent cases and handles roughly 800 inter-facility neonatal
transports each year, launched Transport Remote Access Care (TRAC), an
electronic information gathering system that provides portable
telehealth capabilities. The goal was to extend the process of
electronic bedside monitoring out into the field so that paper-based
charting during transport could be eliminated, and patient information
could easily be shared between a referring and receiving facility.
“We wanted to start the process of electronic data gathering as soon as
we made patient contact in the community hospital and continue that
process throughout stabilization, and on follow-up in the admission
process here,” explains Dr. Hilary Whyte, neonatologist and medical
director, ACTS. “We were maintaining a paper record for patients during
resuscitation and stabilization, including documenting vital signs, and
it was a lot of work when you only have two people there and,
invariably, a sick, fragile baby.”
Partnering with Dapasoft Inc. of Toronto, a provider of custom
healthcare solutions, and consulting with clinical staff, the hospital
undertook to develop TRAC, a system that mirrors bedside electronic
patient monitoring in the field, automatically downloads patient
information from a referring hospital, and incorporates a web camera
(webcam) to provide enhanced communication with receiving physicians.
“Everybody recognizes that for patient safety and quality of care, we
need a system that provides an automatic data dump so that we’re not
transcribing information,” says Whyte. “Also, when you want
physiological data, you want it particularly around the time of an acute
deterioration in patient condition and that’s the very time you can’t
The hardware component of the TRAC system consists of an OQO
minicomputer running a full version of Microsoft XP and a Microsoft
webcam, both of which are installed on the neonatal transport deck. The
software component, developed by Dapasoft, is an HL7-based integration
engine that collects physiological data such as temperature, heart rate,
blood pressure and oxygen levels from the patient monitor, stores it on
the OQO and feeds into hospital-based electronic charting systems. The
system is also designed to work over a wireless network.
“Since not all hospital sites are WiFi-enabled, we took the unorthodox
stance of saying, ‘If we don’t have WiFi available to us, we’ll bring it
with us,’” notes SickKids systems manager Loreto Lecce. As Lecce
explains, the transport team is equipped with a WiFi access point that
it connects to a receiving hospital in order to establish a secure VPN
tunnel back to SickKids. Referring physicians can then access the most
current patient information from a web portal, whether at the hospital,
at home or in their office, and can also view images of the infant using
the web cam.
Another example of an emergency services team that has found an
innovative way to deal with paper is the Sunnybrook-Osler Center for
Prehospital Care. As the quality assurance arm for the Emergency Health
Services Branch of the Ontario Ministry of Health, the SOCPC provides
medical oversight and clinical direction to roughly 1,800 paramedics
operating across a 12,000 square-kilometre region near Toronto. A large
part of that responsibility relies on the auditing of Ambulance Call
Reports (ACRs) to look for protocol violations and determine whether
intervention or training is required.
The challenge is that the majority of ACRs in Ontario are still
paper-based. To fulfill its requirement to the Ministry, the SOCPC used
to maintain a carbonless paper copy of each report and perform random
audits on a representative sample size, using off-duty paramedics to
search for protocol violations.
To improve efficiency and ensure that every ACR would be involved in its
auditing process, the SOCPC developed a Data Abstraction System that
relies on an SQL database. Important patient data such as history, chief
complaint and EMS response is stored in the database and predetermined
filters are then used to automatically search the information for
variations in medical protocols. For example, nitro-glycerine is an
appropriate medical act for a chest pain complaint, but it shouldn’t be
administered when a patient’s blood pressure is below 100.
The SOCPC turned to Scarborough, Ont.-based INOFAS Integrated Systems
Inc. to perform the necessary data entry into the Data Abstraction
System. However, whenever a “variant” report was flagged by the
electronic filters, auditors still had to search through boxes and boxes
of stored paper to retrieve the original copy.
That’s when the SOCPC made the decision to scan the paper-based reports
and maintain the scanned images in an Alchemy fixed content repository
from Captaris Inc. In addition to performing data entry, INOFAS provides
the scanning service, using a Fujitsu fi-5650C sheet-fed scanner and
Kofax Virtual ReScan (VRS) software, and hosts the images on a server in
a secure data centre. A key requirement, says INOFAS president Mike
Harrison, was to find a scanner that would deliver clear electronic
images given the poor quality of the ACR, which is a four-part
carbonless form completed by hand. It also had to accommodate
“At first we thought the VRS would slow us down; now we wouldn’t live
without it,” says Harrison, noting that the VRS software detects and
stops a poor image, enabling scanners to adjust the quality at the point
of scanning. “Our images are better than the paper,” he says.
“When you’re getting 500 to 700 sheets every day, filing them and
retrieving them was a nightmare,” says Bryan Pett, SOCPC director,
corporate development and strategic planning. “Now the retrieval is
instantaneous and foolproof.” By providing electronic access to ACRs,
the SOCPC has reduced the cost of auditing by 80 percent, he adds, and
is addressing potential violations up to 85 percent faster. “Under the
old system it could be weeks or months before calls were audited, which
was very problematic,” says Pett. “Now, rather than spending a lot of
time and money searching through the haystack for the needle, we have
this big magnet that we can lower onto the haystack and it pulls up the
needle for us.”