RSNA—A Retrospective Wrap

I don't know how you feel, but I spent more time reading RSNA pre-show, in-show and post-show coverage this year, way beyond what my eye doctor recommends. And this reading was piled on top of the usual spate of press releases, press conferences, keynote presentations, gold medal ceremonies, IHE demos, exhibitor meetings in the South Building and North Building, Starbucks, bus rides, taxi rides, corporate receptions, breakfasts and dinners.

But this was not a waste of time by any measure—there were plenty of developments worth noting this year, and some even worthy of parting with tough-to-get budget dollars or Euros to obtain for your hospital or imaging center. And as a few articles have reported, there were more than a few non-radiologists shopping for the imaging tools they need to stay on top of the latest diagnostic techniques and equipment.

PACS/RIS/HIS/EHR

So much progress, still so far to go. More than 100 vendors advertised and demonstrated PACS and related products. I didn't see them all, but I came pretty close. I'm sure you saw the same jargon on every booth—workflow, enterprise, 3D, on-line archive, voice recognition, reporting, web-based, web-enabled. But amidst all the clutter, I spotted the early signs of fourth-generation systems coming to market. These are built on open networks containing transactional workflow tools and databases appropriate for all professionals involved in a patient's diagnostic imaging exam. These systems address workflow well beyond the radiology department, even advising referring physicians on the proper procedure to order.

Third-generation systems were on every street corner, providing total radiology department solutions—that is, integrated or open network RIS/PACS connected to all the imaging systems and the HIS for seamless import and export of patient data, images and reports. While these systems may rapidly become a commodity, they are today's workhorse products that deliver huge value. You can buy a good one or a great one and there are many solid vendors to choose from, so the challenge is deciding which flavor to choose. My advice - buy for the near-term, and plan on buying another in three years. Trust me, everything will be better by then, though the prices won't change much. You'll just get more functions for the money. Negotiate for upgrades, but don't plan on them being installed by the due dates—promiseware is the word here.

A few schizophrenic vendors showcased orthopedic, cardiology and laboratory applications for the growing handful of non-radiologists in attendance. Reality is setting in.

Some new major players arrived to enter this market, utilizing expertise developed in other clinical department workflow systems. Radiology is starting to look like a factory, at least to the IT experts who build workflow systems for corporations, physician groups and other hospital departments.

And some new items were some of the simplest - CD burn and print workstations, scanners for document import and conversion to DICOM formats and software that assists referring physicians in ordering the correct imaging procedure.

And did I mention IHE? The demonstrations area of InfoRad showcased even more IHE developments and real-world experiences. If you do not understand Scheduled Workflow at this point, you are officially a PACS novice. IHE = Interoperability = Plug and Play Networks.

CAD

Good deeds are their own reward, and I counted 17 vendors with CAD at RSNA this year. Move over mammography, here comes CAD for lung CT and x-ray, colon CT, breast MRI and fMRI. This trend is only getting started, as radiologists need these software tools to help them plow through the images that spew from the latest imaging systems. I expect this class of software to broaden beyond detection and incorporate image fusion from multiple modalities (already seen in a few booths).

Big Island Territory

If you've seen one 3T, 64-slice, PET/CT/MRI multi-modality, digital x-ray, CAD, and 3D/4D workstation, then you know that there is not enough money in your budget to buy every imaging tool that is currently on the market. How much can one little community hospital absorb? Well, don't be surprised if you can have it all for no money down. Just sign this service contract, and drive it on home today. Honest.

My advice—never go to these booths alone, there is safety in numbers. Many of the middle aisles look like ambush territory straight from the Wild West days.

But seriously, you have no choice but to buy from the big 4 if you need a new 64-slice CT scanner. And every one of these mainstream imaging systems are well advanced in productivity when compared with the three-year-old or older systems you presently own. I don't think you can afford to wait another year, your competition is upgrading as we speak.

And finally, the burning question of the year - do radiologists own imaging anymore? Don't even think this while you are within the city limits of Chicago, it truly is a dangerous thought. But check almost any other medical trade show, and sure enough the imaging vendors are all there, whether it is cardiology, orthopedics, surgery, oncology, gastroenterology—you get the point.

Anyway, my cowboy boots and I are soon headed for some warm-weather interoperability training and healthcare IT at HIMSS 2005 in Big D - yeehaw!

Douglas F. Orr is principal of J&M Group. Send Trend Tracker questions and comments to dforr@aol.com.