Inside the March 2005 print
edition of Canadian Healthcare Technology:
Feature Report: Wireless and mobile solutions
64-slice CT revolutionizes diagnostic imaging
The University Health Network (UHN) and Mount
Sinai Hospital, in Toronto, are among the first medical centres in
Canada to acquire 64-slice CT scanners.
McGill hospitals select iCongo for e-supply chain
When it comes to e-commerce applications such as
electronic ordering and invoice handling, Quebec hospitals are
poised to become the most advanced in the country.
READ THE STORY
New methods of e-Learning
Mount Sinai Hospital, in Toronto, has created a
new model for e-Learning, one that combines computerized self-study
with additional education in a classroom setting. The system has led
to dramatic improvements at the hospital.
Improved Open MRI
Open MRI systems have always been more
patient-friendly than closed-bore systems. Now, physicians in
Calgary are set to show that new mid-field machines produce clinical
results that rival those of high-field systems.
READ THE STORY
RFID gains ground in Canada
Radio-frequency ID appears to be taking off in Canada as a way of
tracking patients, visitors, medical equipment - and even babies.
Many new applications are in the works in medical centres.
Orillia Soldiers’ Memorial Hospital, in Ontario,
has developed an innovative system for reducing the administrative
burden shouldered by clinicians and staff when working with diabetes
patients. Soldiers’ will soon offer a version of the system to other
PLUS news stories, analysis, and features and more.
UHN and Mount Sinai become trailblazers in 64-slice CT scanning
By Jerry Zeidenberg
TORONTO – The University Health Network (UHN) and
Mount Sinai Hospital (MSH) are among the first medical centers in Canada
to acquire 64-slice Computed Tomography (CT) scanners. According to
diagnostic imaging experts, the 64-slice technology provides remarkable
improvements in imaging speed and performance, resulting in significant
benefits for radiologists and patients.
The Department of Medical Imaging at UHN (made up of
the Toronto General, Toronto Western and Princess Margaret hospitals),
and working in conjunction with MSH, recently purchased four multi-slice
Aquilion 64 scanners from Toshiba Canada. One of the machines, located
at the Toronto Western Hospital site, is dedicated to neuro abdominal
and orthopedic applications, while the systems at the Toronto General
campus will be used primarily for cardiac imaging.
The CT devices are capable of acquiring 64 images (or
‘slices’) every rotation (0.4 seconds), so that approximately 140 (512 x
512) full resolution pictures are acquired every second. As a result of
the fast acquisition of images, exams can now be performed in a matter
of seconds, rather than minutes or hours. “We can now image the head in
five seconds,” commented Dr. Karel terBrugge, Chief of Neuroradiology at
the Toronto Western Hospital.
Commenting on how far CT scanning has progressed, he
said, “When I first started using CT in the 1970s, there were three
scanners in the world, one of them in Montreal. Back then, it took us 45
minutes to do a CT scan of the head.”
Moreover, with Toshiba’s latest 64-slice system,
special software automatically reconstructs the slices into 3D images of
the brain, heart and other organs, and sends them on to radiologists – a
major advance in workflow and a big time-saver.
The speed of the latest system produces other major
• Scanning is so fast that clear CT pictures can be
taken of the beating heart – previously, blurring usually occurred when
radiologists used CT to image the heart;
• CT imaging of the arteries can be performed,
instead of catheter angiography, resulting in less contamination of the
• The shorter exams are better for children, since
little or no sedation is required;
• With faster studies, lower doses of X-rays are
given to patients;
• Automated 3D reconstruction software gives
radiologists new and often better ways of looking for abnormalities in
the human body than previous, 2D formats.
• Quicker imaging means that physicians can start
treatment sooner. This may have particular importance for trauma and
stroke patients, where it’s important to start therapies as soon as
Dr. Patrice Bret, Chief Radiologist at the UHN and
Mount Sinai Hospital, said the upgrade to 64-slice imaging results in
qualitative improvements that amount to a turning-point in diagnostic
imaging. It’s a change that goes far beyond what the numerical jump from
4 or 8 slices to 64 might signify.
“This is a major leap,” said Dr. Bret. “It’s the
first time you can do 3D in CT with real speed.” He explained that the
shift to 3D imaging improves not only the pace but also the quality of
the work performed by radiologists. Viewing data in three-dimensions
enables radiologists to see structures from many angles and planes, both
inside and outside, with the assistance of a variety of computerized
“With everything done so quickly, it means that
viewing in 3D will now become what’s normal, not 2D,” said Dr. Bret.
He noted that for some years, the thinking at UHN and
MSH has been to convert to CT not just for sophisticated brain and heart
scans, but for a number of indications of general radiography, which
still account for about 70 percent of the imaging studies performed.
General radiography includes common exams like chest
X-rays and imaging of broken bones, and has traditionally used
two-dimensional X-ray imaging.
Dr. Bret asserted that it’s far better to look at
images in three-dimensions, using low-dose CT for better views, and to
glean more information, than to continue using flat X-ray images. As the
power of CT continues to increase, he said, costs will plummet, making
it viable to replace X-ray machines with CT scanners. Because of the
three-dimensional capabilities, it appears that CT may be preferable to
investments in direct radiography, a computerized upgrade for film-based
Already, four-slice CT scanners can be obtained for
$250,000 apiece – half the cost of the Digital Radiography machines.
Asked about the role of Magnetic Resonance (MR)
imaging in this scenario, Dr. Bret responded that magnetic resonance
imaging will only grow in usage, as it’s a contrast resolution
technique, while CT is best for spatial resolution. “MR has a huge
future, especially, in functional imaging, where it can tell me if a
lesion is active and functioning,” he said.
While CT is valuable for pinpointing the location of
structures and anatomical changes in the body, unlike MRI it’s not able
to detect changes in function or metabolism. As such, both modalities
will be needed in the future.
Mr. Toshihiro Rifu, General Manager, CT Systems
Division for Toshiba Medical Systems Corp., of Tokyo, attended an
educational event at the UHN and commented that the Aquilions installed
at the hospital are among 30 that the company has delivered worldwide.
He forecasted that by the end of March, Toshiba will have shipped 130
units with 32 or 64-slice capabilities.
Toshiba is already working on the next generation of
its CT scanners, which will be able to acquire 256 slices in a single
gantry rotation. Several test units are already in use in Tokyo. Mr.
Rifu noted that the industry is producing new generations of equipment
in two-year cycles, and that it won’t be long before Toshiba begins
commercial shipments of the 256-slice machines. “Every two years, we’re
stepping up to the next technology,” he said.
As a result of the shift to 64-slice and higher
performance machines, the benefits to radiologists and patients will
only continue, said Behram Engineer, Vice President of the Medical
Systems Group for Toshiba of Canada. “A major advantage will be the
reduction of invasive procedures,” said Mr. Engineer. “You’ll also keep
patients on the table for far less time, which is a big savings for
McGill hospitals select iCongo for e-supply chain
By Jerry Zeidenberg
MONTREAL – When it comes to e-commerce applications
such as electronic ordering and invoice handling, Quebec hospitals are
poised to become the most advanced in the country.
Major medical centres in Quebec are now implementing
e-commerce solutions from providers such as GHX and iCongo. They’re
converting transactions with medical supply companies from paper and
telephone communication to more automated computerized systems – a much
more efficient way of working.
In January, the McGill University Hospital Centre,
consisting of five teaching hospitals, signed an agreement to implement
iCongo’s MediChain system as a pilot project, in conjunction with Source
Medical, a large distributor of medical supplies.
If all goes well with the test, 45 other suppliers
will be encouraged to come on board in the following weeks, enabling
purchasing managers and staff members to streamline the ordering,
invoicing and reconciliation process for an estimated 80 percent of the
organization’s annual purchasing.
The MediChain solution will be offered to 75 other
hospitals that make up the Association Quebecoise de la Logistique et de
l’Approvisionnement du Sectueur de la Sante (AQLASS) – enabling a large
group of hospital professionals across the province to computerize their
supply chain processes.
“Until now, almost all orders exchanged between
Quebec hospitals and their suppliers have been paper-based,” said Carole
Duhamel, Director of Materials Management Services for the McGill
“All transactions have been manual – from printing
out purchase orders, faxing them to suppliers and calling the companies
to check on whether the documents have been received and entered in
their systems. All of this is very time-consuming. And when the invoice
doesn’t match the price on the original order, even if it’s out by just
a penny, the whole process is rejected and must start over again.
“We expect to see major savings when all of this is
done electronically and automatically,” said Duhamel. Theoretically at
least, all of the supply chain procedures she mentioned can be done at
lightning speed through computerized routines. With fewer person-hours
needed for the ordering and checking process, the participants expect to
see major benefits.
“We think the system will reduce their operating
costs by 50 percent,” said iCongo president Irwin Kramer, citing
statistics from successful implementations in other industries. For its
part, iCongo (www.icongo.com) is a specialist in enterprise portals,
catalog and e-procurement systems, on-line trading exchanges and other
It counts among its large-scale installations such
customers as Industry Canada, the Canadian Apparel Federation and the
National Hockey League.
Kramer said it takes $50 to $75 to process a purchase
order manually, largely as a result of the staff hours needed for order
entry, paper handling, checking and reconciliations. For its part, the
MUHC puts through some 50,000 to 60,000 purchase orders each year. The
annual cost is in the neighborhood of $3 million, using a figure of $60
for processing each P.O. If MediChain and iCongo can bring this down by
half, as suggested, the McGill hospitals could be looking at a savings
of $1.5 million yearly. Similar improvements are anticipated at other
Quebec hospitals that intend to implement the system. “Quebec’s
hospitals will save tens of millions of dollars a year,” said Kramer.
Duhamel noted the McGill hospitals and AQLASS
evaluated six different e-commerce solutions before choosing iCongo’s
“It was the best in terms of supplying us with a
turnkey solution that would require little customization,” said Duhamel.
“It also was the easiest to use. It has the ability to send any kind of
document to any type of system.
The others that we looked at weren’t as
She explained that while Quebec hospitals considered
e-commerce in the past, until now the systems seemed difficult to
implement. As a result, “we’ve got close to zero electronic transactions
between provincial hospitals and their suppliers.”
She asserted that the situation will rapidly change
this year as the MediChain technology fans out through the provincial
According to iCongo, its MediChain solution is a
document exchange and e-procurement platform that makes use of
middleware to connect the systems of hospitals and suppliers over the
Steven Kramer, the company’s Director of Business
Development, said the solution has two major components. First, it uses
a document exchange server that delivers purchase orders to suppliers,
sends back P.O. acknowledgements, advance shipping notices and invoices
– all electronically. What’s more, the system is integrated right into
the financial systems of the users.
Secondly, MediChain includes a catalog system that’s
constantly refreshed with updated product and pricing information.
Duhamel said the catalog will be extremely beneficial to MUHC, easing
the ordering process and enabling staff members to stay on top of
changes. “We’ll quickly be able to order different products from
vendors, and to accept, reject or re-negotiate changes.”
On the technological side, the MediChain platform
receives documents in a variety of file formats from suppliers and
buyers, and sends them securely to their destinations in the required
This is done using a series of web forms, which
permit the online visualization of all transaction types (i.e., EDI 850,
e-mail, XML and others.)
When it comes to communications, the system supports
HTTP, HTTPS, FTP, secured FTP, VPN, EDI-INT, AS2 and AS1.
Data formats include XML (in different flavours, such
as SOAP), EDI, text, Excel and any other file format. Real-time
integrations are conducted, according to the company, using web services
or direct ODBC or JDBC connections.
“There’s no limitation on formats,” said Steven
Kramer. “We can do any format to any other, and we can handle any type
of communication protocol.”
E-Learning improves computer application training at Toronto’s Mount
By Neil Zeidenberg
TORONTO – New computer applications are introduced to
hospital staff on a regular basis, usually leaving clinicians and staff
members scrambling to master them.
To speed-up the learning curve, a Toronto teaching
hospital has initiated a two-step e-Learning program that lets doctors
and nurses become familiar with new information on their own, before
completing a learning module in a classroom setting.
“Sinai e-Learning combines computer-based training
with classroom education, and ensures everyone is at the same level of
understanding when entering the class,” explained Marilyn Sanli, manager
of information systems and education, Mount Sinai Hospital.
Typically, new applications are learned in a
traditional classroom environment with an instructor – a
one-size-fits-all approach that doesn’t always work, since some
clinicians learn very quickly and want to move on, while others require
more time to understand the application.
Sinai e-Learning is a big help to those who require
more time to become familiar with new materials. It also allows
clinicians and staff members to choose what they want to learn, and
“The residents and interns love the flexibility of
the program,” said Sanli. “The learning tutorial can be done at home, in
the staff lounge, on the web or in the computer lab.”
After completing the on-line tutorial, clinicians
book a convenient time in the classroom with a qualified instructor.
Classes are held between 8 am and noon, Monday through Friday.
“Students come into the classroom with their peers
and discuss the material with an instructor,” said Sanli. “There they
discuss scenarios that apply to their specific rotations. For example,
the use of computers in general medicine – the scenario is based on a
day in the life of a resident on the general medicine floor.”
The class ends with a competency test. Clinicians
must score at least 80 percent in order to use the application on the
hospital floor. This ensures that all clinicians with access to a
computerized application have proven their ability to use it.
Since January 2004, more than 840 clinicians have
learned new applications via Sinai e-Learning – a tool created
completely in-house without any technology partners.
These applications include Results Review and
Electronic Clinical Documentation, which went live in November 2004.
“We’re also developing a similar program to Physician
Order Entry, called Clinician Order Entry. That’s expected to go live in
March 2005. And an application called MAR, a medication administration
tool, is set to go live in April.”
Because new clinical applications are expected to
come into use on a regular basis, Mount Sinai has hired two full-time
staff members to train people to use them.
Sanli said that Sinai e-Learning has also made a big
impact in school nursing programs. About 1,000 nursing students come
through Mount Sinai’s doors every year, and training them to use
computerized applications means a huge commitment of time and resources.
Now all nursing students view the learning tutorial before entering the
hospital and then book time in the computer lab for phase II. “We wanted
them to be competent before they started using the system, and now we
can incorporate that,” said Sanli. “Previously, we were forced to allow
them to use the system without any training, or have someone else do it
“This allows clinicians to spend more time on the
floor where it matters most, with patients.”
New and improved Open MRIs make headway in the clinic market
By Andy Shaw
Whether it runs under the Rockies, or chunnels its
way to Paris, or performs magnetic resonance imaging (MRI) on our body
parts, there’s something unnerving about entering a tunnel. If it
weren’t so darn quick or so important to our health, many of us would
rather get there by some other route. Especially trying is the
experience of slowly passing through the 60-centimetre-narrow,
thumpingly noisy tunnel of a traditional MRI scanner.
But soon, patients won’t have to suffer that
claustrophobia at the MYK Diagnostic Imaging clinic in Calgary. That’s
where Dr. Deepak Kaura, a young but well-schooled paediatric
radiologist, and his two partners are setting out to prove that today’s
“open MR” systems are as good if not better than the regular closed-bore
“Lying on our new, open MR scanner, you’ll look to
your left and look to your right, and all you will see are the walls of
the clinic,” says Dr. Kaura.
What’s more, when the MYK clinic installs its Hitachi
Altaire 0.7 Tesla open MR scanner early this spring, it will be:
• the first its kind and strength in the country;
• joining four low-power open MR systems in Montreal
• the opening sale in what Hitachi Canada Ltd. hopes
will be a shift in Canadian MRI buying patterns;
• a litmus test of public-private healthcare.
More about all this later, but first some background.
In November last year, Hitachi Canada announced it
was entering the Canadian MRI market with two new machines that had
already proven a hit south of the border and elsewhere: the Altaire
“high field performance” Open MR system and the “advanced mid-field” .3
Tesla AIRIS Elite.
They are the latest in open MRI machines that have
helped Hitachi gain an estimated 60 percent share of the U.S. open MRI
market. In all, the company has sold over 1,350 open systems to American
buyers and more than 3,000 worldwide. But none in Canada until now.
“In the U.S., it was the private clinics that first
started open MR sales going,” explains Doug Ragan, general manager of
medical solutions for Hitachi Canada. “They were far cheaper than closed
systems, but could do the basic head and spine examinations well.”
As their use grew, so did their popularity with
patients. In a traditional MRI encounter, the patient must lie
dead-still for up to 30 minutes or more. Examinations are limited to
body parts that can be put at the centre of the focus of the magnet and
to patients who fit through the donut-hole opening. Fidgety children
under six years of age usually have to be sedated beforehand.
But an open MRI has far fewer physical restrictions:
• injuries to shoulders, or knees, or feet or other
awkward parts can be targeted simply by shifting the patient;
• large and obese patients weighing up to 500 pounds
can be accommodated;
• parents can lie alongside their children to provide
comfort during the examination.
“It was patients asking for open MRI exams that gave
the next boost to sales,” says Ragan.
Then came a 1995 U.S. study that further heightened
demand – and quieted the doubting Thomases in the American radiology
“The knock against open MRI systems has always been
their comparatively low field strength,” explains Ragan. “But a group of
doctors and physicists did a double-blind study of field strength using
two closed systems, a 1.5 Tesla system (the power of today’s standard
closed models) and a .5 Tesla.
“They concluded that even though there was a
difference in image quality, it had no real impact on the ability of
physicians to make an accurate diagnosis,” says Ragan. “And even 0.3
Tesla open systems are fine for most imaging tasks.”
This is no marketing hype from Hitachi. Ragan knows
of what he speaks, holding a Ph.D. from the University of Western
Ontario in medical imaging.
Still, Ragan admits, the stigma of being low field,
low cost, and therefore second-class equipment has stuck with open
systems, especially in Canada.
“Also, radiologists in Canadian hospitals have had no
real incentive to buy an open system,” says Ragan. “They knew that with
a closed system they would have no trouble filling up their schedule.
Also, there were no private clinics for a long time, so the profit
motive wasn’t there either.”
That is until the likes of Quebec, British Columbia,
and Alberta came along to challenge dictums against private imaging
clinics and their supposed threat to universal healthcare. And
especially after one freshly minted radiologist from the University of
Manitoba and the Alberta Children’s Hospital did specialist training at
Thomas Jefferson University in Philadelphia. There Dr. Kaura saw
first-hand the patient advantages, especially for children, of open MRI.
And when he first saw the image quality and what the
.7 Tesla Altaire could do he says, “I nearly fell off my chair. They’ve
optimized the magnet’s sub-systems to make a .7 Tesla give you the same
image quality as a 1.5. It is very impressive.”
Hitachi’s VOSI (vo-sigh) sub-system technology
improves on the holy trinity of image quality:
Signal-to-noise ratio – distinguishing better between
detected and random signals. Hitachi has made the vertical field magnet
of an open system as effective in reducing unwanted image clutter as the
conventional horizontal magnet of a closed system – by means of coil,
receiver bandwidth, and pre-amplifier innovations.
Spatial resolution – discerning more clearly the
small distances between separate details in the image.
The key piece here is the scanner’s gradient
sub-system and its “slew rate”. In effect, Hitachi has strengthened the
gradient and sped the slew rate up to unprecedented levels for an open
Contrast resolution – making sharper the contrasts
between different tissue types. Of note here is Hitachi’s unique FatSep
pulse sequencing which effectively helps make obscuring fat disappear
from the image.
“The .7 Altaire can do the same as a closed 1.5 Tesla
with the exception of functional MRI imaging and spectroscopy,” says
Dr. Kaura also thinks sophisticated cardiac imaging
should be left to the closed systems.
Despite these minor limitations, Ragan and Dr. Kaura
think open MRs are now set to revolutionize diagnostic imaging in Canada
– if and when the word gets out.
Though his Calgary clinic and its equipment is
privately owned, the service it renders to patients will still be billed
to Alberta’s public health system. A formula the rest of the country –
caught up in the private versus public debate about imaging clinics –
should be watching with interest. What will make the MYK clinic
profitable, Dr. Kaura firmly believes, will be patient demand and
referring physician awareness.