Detailed and Precise Measurement with Lesion Management

Larry Ray

Larry Ray, CTO R+I Volume Image Processing, Carestream Health

Precise lesion measurement is important for reliable evaluation of metastatic disease and faster assessment of the patient response to cancer treatment. For radiologists and oncologists, simple quantitative comparisons of historical exams – especially those imported from disparate PACS or modalities – have been a challenge in a traditional PACS, causing many to turn to costly dedicated workstations. Lesion Management is an embedded application tool in our Vue PACS that provides native oncology follow-up capabilities. The precision of the tool can help provide physicians with clearer and more detailed imaging exam results in less time, enhancing their productivity and efficiency to make a diagnosis.

There are several reasons oncology follow-ups are one of the most time consuming and challenging tasks for radiologists:

  • Relevant priors may not have been acquired by the same modality, thus making it difficult to compare as most PACS cannot correlate with different exam types
  • Identification, localization and measurements of lesions are often manual, time consuming and inconsistent
  • Often times lesion management and tracking is performed on a separate workstation or application, without integration to PACS

The lesion tool reduces the need for visual measurement by providing semi-automatic tracking and segmentation of lesions, which can help provide a faster and more consistent means of determining the size and estimating the overall volume of the lesion. The result has the potential to provide a better gauge of disease progression. Typically, when a radiologist first gets a case they mark the lesion and report on it before the data is stored. At a follow-up visit a second set of images with added lesions is read, often by a different radiologist. The lesion management software matches between the two reports and immediately generates a spreadsheet of the patient’s information. The data can be viewed and evaluated on a single exam basis, or a per lesion basis for comparison purposes.

 

When a patient is diagnosed with cancer it’s really a team effort between them and their care providers to choose the best possible treatment plan. Today, we have access to information almost immediately; questions get responses pretty quickly; we have better tools to fight these diseases. The lesion application is one of those tools. It allows for clearer, more meaningful communication and collaboration between radiologists, oncologists and referring physicians which is a vital step in providing the patient with the best care possible.

Editor’s Note:  The Lesion Management application, created by Larry Ray, Edward Gindele & Rick Simon, was a finalists for the Digital Rochester Great Awards in the Optic, Photonics and Imaging Technology category.

Learn more about Carestream’s Lesion Management application:

Highlights of AHRA 2013 with Marianne Matthews of Imaging Economics

Marianne Matthews, Editor in Chief of Imaging Economics, stopped by our booth on the last day of AHRA to wrap up the key topics of interest from the show. Matthews starts off by talking about quality and the real issues that surround it, such as how providers are going to be measured and meet the CMS mandates. Other key topics Matthews discussed were patient safety and the new tracking tools for radiation dose along with patient satisfaction and how that ties into the consumerization of imaging.

Matthews also offered insights on what she believed were to come for RSNA 2013. Not only does she see further expansion on these topics but we’ll also hear a lot about information technology (IT) and reimbursement.

Hear more of what Marianne Matthews had to say:

AHRA 2013: Gillette Children’s Specialty HC Provides Insight on Carestream Products

Jenny Severud, Lead Technologist of Out-Patient X-ray at Gillette Children’s Specialty HC, sat down with Don Thompson to discuss dose management and the use of the DRX-Revolution in her pediatric facility. In the video Severud discusses how Carestream’s cesium detectors allow technologists to use lower techniques to help lower dose, which is an important factor in medical imaging. She also talks about the new 2530C detector and commends the maneuverability of being able to efficiently get under the patient in a small, limited area.

Severud also discusses the fully automatic DRX-Evolution room at the Gillette facility and how the auto-centering and auto-positioning is her favorite feature.

AHRA 2013: Thoughts on the DRX-Revolution

In this video Anthony Aukes, Radiology Manager at Carle Foundation Hospital, reviews the Carestream DRX-Revolution Mobile X-ray System after seeing it at AHRA 2013. Aukes talks about how the life of any tech at an imaging facility is always fast paced and busy, but the built in features on the portable helps enhance their workflow and make their life much easier.

This year we showcased our new 2530C detector, which is something Aukes feels has a place in the hospitals’ NICU department. Being able to capture and review images quickly allows radiologists to show physicians what they’re looking for without any detrimental impact to patient care.

When discussing converting rooms to DR, Aukes emphasized the “do more with less” motto many healthcare facilities face today and how to stay on the leading edge of technology. The DRX-1 system allows them to upgrade exam rooms to newer technology with lower dose and better image quality without having the expense of replacing a whole room.

Key Trends in Healthcare from AHRA 2013: IT and Big Data

Opening day of AHRA 2013 focused a lot on IT and big data. We sat down with Cat Vasko, Editor of Digital Media at ImagingBiz, to discuss these and other key trends from throughout the day including does reduction and outcomes management.

In the video, Vasko discusses the need for advanced data analytics tools to move forward in radiology and medical imaging. She also talks dose reduction and how IT is necessary to do the cumulative dose tracking and analysis that is needed in the field to enhance patient safety. This is because technologists cannot achieve the same results from a chest CT and a chest X-ray without having the data to analyze.

Looking ahead to RSNA 2013, Vasko offers her predictions on key topics to be seen, placing emphasis on integration between different IT systems and modalities. She believes radiology departments can’t move forward and do the necessary analytical work without easy integration between all these systems.

Carestream goes to extremes…

Helen Titus

Helen Titus, Marketing Director, X-ray Solutions, Carestream

Over the Polar Ice.

Right now, Carestream is on a six-month trek across the frigid Antarctic continent. Well, none of our people are actually on the trip – but one of our flagship products is.

On March 21st, a small team of explorers set off on “The Coldest Journey.” They will attempt to conquer the last major challenge of polar exploration: to cross the Antarctic continent in winter. They’ll travel for six months, across 2,480 miles, at temperatures that can fall to –129F. During this perilous expedition, the team needs the ability to provide advanced medical care if needed – including diagnostic X-ray capabilities. The expedition’s doctor, Rob Lambert, knew that any X-ray system going on this journey would need to be exceptionally rugged, small, light and easy to operate. He chose the CARESTREAM DRX Transportable / Field Portable X-ray System.

The DRX-Transportable is a durable, all-in-one digital solution. It includes the DRX wireless detector, all electronics, a wireless access point and a tablet PC – all securely packed in a tough, protective case. Designed for easy portability, this is a system the expedition can depend on. Check out The Coldest Journey’s website.

Under the Desert Sun

The DRX-Transportable is even built to be rugged enough for military applications. This video* (also shown below) demonstrates how quickly the portable system can be deployed to evaluate serious battle injuries sustained by soldiers in desert combat – and in virtually any other environment as well.

The DRX-Transportable’s mobility and and wireless performance also make it ideal for disaster relief, EMT use, and travel to nursing homes and in-home care.

*Video is a bronze winner of the 34th Annual Telly Awards

Lean Manufacturing Produces Excellence across the Board

Ruud Vullers, Director, Global Manufacturing & Supply Chain, Carestream

Ruud Vullers, Director, Global Manufacturing & Supply Chain, Carestream

Excellence has always been a key characteristic of Carestream. From our people, to our products, right down the individual steps in our processes—we ensure excellence is weaved throughout our entire organization. We call this mantra eXceed and it defines the customer centric culture that has been created. The five components of this mission are as follows:

- Commitment to behaviors that create a customer centric culture
- Interviews to collect data on our customers’ experiences
- Analysis to identify and implement customer experience improvements across our organization
- Metrics to track our progress
- Recognition for employees that demonstrate customer focus, and eXceed customer expectations

When it comes to our manufacturing processes, we tackle analysis and metrics with the utmost importance so that we are able to create the best products for our customers in the most efficient way possible. Carestream owns and operates global manufacturing facilities so that products can be produced right where they are being sold. These logistics allow for faster speed of delivery and lower overall costs.

Manufacturing is involved in the earliest phases of the product design process so that cost is affordable and quality is built into the design. We have developed measurement methods for all key focus areas in manufacturing like incoming material quality and on-time delivery. This data is shared every month with our key suppliers to drive improvements. This allows us to live a life of lean manufacturing—a principle that depends on getting rid of all non-value added activities and keep only those that the customer is willing to pay for.

Our production system allows us to manufacture exactly what we need when we need it. Kanban (a proven lean manufacturing concept) allows for automatic replenishment of components.  Each day, inventory is communicated to our suppliers to minimize what is kept on-hand and improves quality since any quality problem is contained to a small number of components.

Morning briefings are held for each product line with a cross-function team so any areas of concern can be immediately assigned and addressed. Anyone on the manufacturing floor is empowered to initiate corrective processes and improvement, and feedback from customer installations are brought forward to the morning markets.

Ongoing quality improvement is built into every step of Carestream’s production process. The “Carestream Manufacturing Focus” video below provides some additional details.

Innovative Tools To Improve Clinical Quality: Montage Signal

At RSNA 2012 there was a subtle shift in emphasis from radiologist productivity to clinical quality, no doubt driven by greater quality reporting and pay-for-performance requirements.  Shown as a prototype in the Carestream booth, Montage Healthcare Solutions demonstrated Montage Signal™, a new software capability that flags report inconsistencies during radiology report dictation and identifies errors in real-time that can degrade clinical quality and reduce reimbursement.

Montage selected Carestream Vue Reporting as a proven radiologist workflow platform for demonstrating Signal. Signal is an extension of the Montage search-driven radiology business intelligence and clinical quality analytics tools that help practices understand and improve productivity and clinical quality. Visitors to the Carestream booth saw Montage Signal flag reports containing laterality and gender errors, critical test results and incomplete billing documentation—all before report finalization.

Montage search provides access to the unstructured clinical information in radiology reports, enabling radiologists to answer complex clinical questions without disrupting reading workflow. The result is clinical quality improvement and continuous learning because report creation can now occur in the context of prior clinical findings.

Woojin Kim, M.D.,  Interim Chief of Division of Musculoskeletel Imaging at the Hospital of the University of Pennsylvania and  Co-founder of Montage Healthcare Solutions, stopped by our social media broadcast lounge at RSNA to share his thoughts on the next step in clinical quality improvements and the importance of integrating tools into the reading workflow:

What other ways can we prevent errors before they come part of the clinical record?  What analytic innovations did you see at RSNA? 

Healthcare Reform Opens Doors for Mobile Screening Mammography Services

The 2012 RSNA meeting marked the 30th anniversary of the show from which Debora Wright’s mobile mammography screening business, Inner Images, was born. Three decades later, the current healthcare climate set a different at the meeting, but for Debora and Inner Images,  reform has opened doors and growth.

In this video, we speak with Debora from RSNA 2012 about how the move to digital mammography has helped her business’ productivity through this growth period.

Are you excited about the direction mammography is heading? What changes or benefits do you think we might see at next year’s RSNA?

Reflections on RSNA 2012 and the Progress in Intelligent Information Systems

On the last day of RSNA 2012, Dr. Eliot Siegel, Professor and Vice Chair University of Maryland School of Medicine Department of Diagnostic Radiology and Nuclear Medicine, and Chief of Imaging at VA Maryland Healthcare System in Baltimore, stopped by the Carestream booth to reflect on the focus on imaging informatics at this year’s event. Dr. Siegel comments on the opportunity to use information systems to empower and educate patients,  to make radiology more visible in patient care, and to drive the future of radiology.


What IT innovations caught your attention at RSNA?