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www.totoku.eu Color Display Megapixel C M Y CM MY CY CMY K EuHos_Dec15.pdf 1 11.12.2015 10:53:42 EUROPEAN HOSPITAL  Vol 24 Issue 6/15 16 RADIOLOGY Developing digital public healthcare services in Andalucía Competing with multi-slice CT without the cost Europe’s largest PACS project Re-engineered cone beam sharpens MSK views Accenture and Carestream are current- ly implementing a joint project in Andalucia, framed within the bilat- eral cooperation agreement between the Andalucian Health Service and the Ministry of Industry, Energy and Tourism, through Red.es for the devel- opment of digital public services in Andalucia’s Public Health System. PACS is an electronic, community- wide system that is used to capture, view, store and distribute medical imaging digitally rather than printing images onto film. The new system will allow clini- cians to manage and share diagnostic imaging data across all Andalucia’s 1,600 healthcare facilities by the end of 2015. Equipment and systems will be installed in two data centres capa- ble of storing 1.4 petabytes each, Although a few 3-D mini-scanners are available for a deeper view of bone joints or sports injuries, uptake has been slow, according to Andrew Hartmann, Vice President and General Manager at Carestream for Ultrasound & CT Solutions. For difficult cases, he explained, a physician might turn to full-body CT, which is not optimised for extremity exams and not able to look at one elbow or knee. ‘The implementations for ortho- paedic imaging that we’ve seen so far have not met clinicians require- ments, whether for imaging per- formance, costs or ease-of-use,’ he explained. ‘The big CTs are simply not designed to do these focused examinations. In addition, weight- bearing exams are not possible. There is additional information to be gained of the knee, ankle and feet if a 3-D image can be taken under natural load.’ Taking a fresh approach to muscu- loskeletal (MSK) imaging, Hartmann pointed out that Carestream has turned to a core expertise for focused-field, cone beam CT. The company offers the CS 9000 Extraoral Imaging System, used primarily for dental imaging, but the firm recently added the CS 9300 System with panoramic imaging, also used by ear-nose-throat specialists. For a new musculoskeletal scan- ner, Carestream began collabora- tion in 2011 with Johns Hopkins University, in Baltimore, to build the first prototype of an extremity 3-D cone beam CT system from the ground up, to validate its perfor- mance with patient studies, and then to refine the system as a second- generation prototype. A third-generation working model was installed at the University at Buffalo, New York for extensive clin- ical trialling by John Marzo MD, and the orthopaedics and sports medi- cine department. The first European installation is scheduled for a clinic in Finland. Smaller than the bore on a con- ventional CT, the opening of the prototype system is large enough to accommodate a wide range of patient sizes and obtain a reasonable volume to acquire the specific area of interest. Carestream also opened the bore with an access door, to create a way for patients to easily step into and out of the scanner. ‘If I have a bad knee, the last thing I want to do is climb into a tunnel, or to sit in a chair and slide my leg into a hole, because that way I’ve lost the advantage of a weight-bearing image, which is the whole point for this kind of exam,’ Hartmann pointed out. Mounted on three axes, the bore can be rotated to suit a patient posi- tion whether standing, seated or horizontal. The prototype system has a high frame rate for exposures, and a low-dose, flat panel detector so that, rather than doing hundreds of revolutions, it needs only a single 240-degree rotation to acquire a full-field imager in one exposure, Hartmann explained. ‘We put a lot of effort into improv- ing workflow,’ he said, pointing to the simplified display for the user interface, and an additional patient- facing display to enhance the inter- action with the system operator during an exam and to ensure a friendlier experience. Despite its size, the OnSight 3-D can be rolled to another posi- tion, has minimal radiation shield- ing requirements, and needs only a standard electrical outlet to operate. ‘We say this system is on target, on budget and on time because it provides imaging specifically where a physician wants to look, competes with multi -slice CTs without the cost, and lets them schedule four patients an hour while keeping the revenue stream in-house,’ he said.. A prototype of this system was first introduced at the Radiological Society of North America’s (RSNA) meeting in Chicago this year. After regulatory approvals, it will be branded as the Carestream OnSight 3-D Extremity System. The firm plans to demonstrate this at ECR 2016 next March equivalent to 11,000 personal com- puters of 250 gigabytes. This horse- power will enable radiologists and physicians from any health facility in Andalucía to instantly access, secure and manage medical imaging studies, radiology reports and patient imaging, explained Santos Lopez, Carestream Spain Director for Healthcare IT: ‘Any user anywhere can immediately access any study performed at any facility in the region. They don’t need to wait at all and can access the system from their tablets and mobile phones – both IOS and Android Galaxy. This is a real progress, as doctors will be able to complement their results with patient’s record and check beyond their own hospital or primary assis- tance centre.’ Andalucía is a giant in terms of size and population; its nearly 9 million inhabitants, about 15% of Spain’s pop- ulation, are spread over almost 90,000 km². The joint Carestream-Accenture initiative is expected to manage as many as eight million imaging studies, from X-ray, CT, MRI, ultrasound or any another modality, per year. ‘To this day, this is the most impor- tant PACS project in all of Europe,’ Lopez pointed out. ‘We dare not say the whole world, but even this could be possible.’ The system will use an updated ver- sion of the Carestream Vue software, which enables image and volume reconstruction to be performed at any workstation without having to install any costly add-ons. Radiologists will be able to carry out multi-planar reconstruction and visualise any plan (coronal, sagittal, axial) independently from how or where the image was captured. Another novelty is the introduction of the lesion management function, which allows users to identify, seg- ment and track a lesion in the system, to follow and monitor its evolution over time. Carestream will also be responsible for system maintenance until late 2017. Accenture, for its part, will provide the architecture of the system and its implementation, as well as user training. Up to this day, Andalucía was equipped with a series of local PACS. Using the same image digitisation system will benefit patients and professionals, and save money for the healthcare system, according to Pablo Sánchez Cassinello, Accenture Health Spain Managing Director: ‘With the new PACS, maintenance costs will be reduced by 35%.’ Investment in the project amounts to more than €6.7 million and is based on the previous agreement of the Ministry of Industry, Energy and Tourism, through the pub- lic corporation Red.es, with Andalucía Health Service to fulfil the objectives of the Digital Agenda for Spain within the Digital Public Services Plan and the Health and Welfare Programme. ‘The initiative will be funded at 80% by Red.es, through the Regional European Development Fund (FEDER) of the European Commission, and the other 20% by the Junta of Andalucía,’ Sánchez Cassinello added. Accenture has been present in Spain for 50 years and has over 10,000 employees in the peninsula. It has worked with the Andalucía Health Service since 1998, and employs about 500 people in Malaga alone. Carestream has over 20 years experi- ence in PACS and has been present in Spain for over 12 years. It has con- ducted implementations with Seville’s Virgen del Rocío, the second largest institution in the country, and four health systems in Andalucía since 2005. The deal with Andalucía Health Service helped Carestream Spain to secure financial growth in 2014. However, with the general elections in October, investment has slowed down. ‘We don’t expect any big public competition this year,’ Lopez said. Economic considerations have pre- vailed in the country’s public health sector over the past few years and companies have had to adapt their prices to the situation. However the worst is over, Lopez thinks: ‘When you hit rock bottom the only way is up.’ Investment in health has been paralysed in the peninsula for the past few years, but Spain will soon have the largest picture archiving and communications system (PACS) in Europe, Mélisande Rouger reports Pablo Sánchez Cassinello, Accenture Health Spain Managing Director Andrew Hartmann, Vice President and General Manager at Carestream for Ultrasound & CT Solutions PACS supports the surgeons work in the OR Cone beam CT, a new approach to musculoskeletal (MSK) imaging Santos Lopez, Carestream’s Spain Director for Healthcare IT EuHos_Dec15.pdf 111.12.201510:53:42

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