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ADVANCEMENTS IN DIAGNOSTIC IMAGINGPAST MILESTONES TO FUTURE POSSIBILITIES

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TABLE OF CONTENTSIntroduction ........................................................................................ 3

Looking Back Erkan Akyuz .......................................................................................................... 5Joe Biegel .............................................................................................................. 6Travis Browning ................................................................................................... 7David Chou ........................................................................................................... 8Don Dennison .................................................................................................. 10Sue Johnson ..................................................................................................... 12Joseph Marion.................................................................................................. 13Giles Maskell ..................................................................................................... 14Jeffrey Mendel .................................................................................................. 15Patricia & Jason Salber .............................................................................. 17Leigh S Shuman ............................................................................................. 19

Moving Forward Erkan Akyuz ....................................................................................................... 21Joe Biegel ........................................................................................................... 22Travis Browning ................................................................................................ 24David Chou ........................................................................................................ 25Don Dennison .................................................................................................. 26Sue Johnson ..................................................................................................... 28Joseph Marion.................................................................................................. 29Giles Maskell ..................................................................................................... 30Jeffrey Mendel .................................................................................................. 31Patricia & Jason Salber .............................................................................. 33Leigh S Shuman ............................................................................................. 35

Learn More .................................................................................................. 36

Thank You ..................................................................................................... 38

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LOOKING BACK AND MOVING FORWARD

Innovation is the key to the future. It has been the driving force behind the advancements of our industry’s past, and continues to drive us toward better, more efficient, and more patient-centric healthcare practices. Excellence in diagnostic imaging can be the catalyst for providing truly life-changing care. The work done by radiology professionals improves quality of life and drives health systems forward. On the following pages, we share insights from the industry’s best and brightest, celebrating the progress of our past and looking ahead to the possibilities of our future. Read on to see what the experts have to say about where we’ve been and where we’re going.

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LOOKING BACK: REMEMBERING AND CELEBRATING PAST PROGRESS

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DICOM AND IHE STANDARDS DEVELOPMENTBeyond the inventions of the CT and MRI machines that create images, the development of DICOM and IHE standards are arguably among the most significant advancements in diagnostic imaging. Through standards we are able to open the lines of communication and collaboration by providing reliable protocols for the integration of imaging data from different devices and systems at both the technical and workflow level. These standards allow for various systems to be integrated in an efficient and repeatable way that is independent from the participating vendors. The DICOM and IHE standards really helped medical imaging lead the pack in the world of healthcare IT.

Erkan Akyuz

President Imaging and Workflow Solutions McKesson Technology Solutions

@ErkanAAkyuz

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ADAPTIVE IMAGE LOADING AND WORKFLOW IMPROVEMENTSSeveral major historical advancements come to mind. In 1994, at the RSNA annual conference, DICOM 3.0 proved that diagnostic images could be stored and transmitted independently of proprietary modality vendor barriers. Soon after, RIS/PACS workflow was dramatically improved with the advent of the Mitra Broker.

Support for high-volume, multi-slice CT data stressed early stage PACS architectures, but advances, such as adaptive image loading, enabled multimodality PACS to improve the level of diagnostic performance with any and all image data that was produced.

In more recent times, the integration of digital breast tomosynthesis into the core PACS environment serves as an example of how advanced visualization methods have become core to the PACS workflow.

Joe Biegel

Vice President Corporate Strategy and Business Development McKesson Technology Solutions

@JoeImaging

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APPLICATION AND SOFTWARE INTEGRATIONI believe the biggest advancement in PACS has been the ability to integrate with other applications: dictation software (efficiency and safety), post-processing applications (3-D and others), peer review software, and the EMR (a significant improvement in facilitating the radiologist to be in the chart while reading exams).Travis Browning, MD

Radiologist and Associate Professor UT Southwestern

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IMAGE EXCHANGE IMPROVEMENTSThe industry has come a long way in terms of interoperability. The ability to exchange images between various vendors is easier than before, but there are still some pain points since it is still not perfect. We will continue to see strides in this area, and the healthcare community is looking forward to full integration among all PACS vendors.

David Chou

Healthcare CIO

@dchou1107 “The ability to exchange images between various vendors

is easier than before.” TWEET THIS

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DIGITAL IMAGING IT TOOLSThe evolution of medical imaging, from the first x-ray to today’s advanced digital modalities, has contributed to enormous advances in medicine, saving millions of lives.

The advent of digital imaging IT tools, like PACS, delivered incredible productivity and accessibility. Results that took a week to deliver a generation ago are available in minutes. Images evolved from 2D projections to 3D volumes, along with multi-modality fusion and dynamic motion. Yesterday’s science fiction became science reality.

As diagnostic images are now digital, and are increasingly consolidated and indexed in large systems, like multi-facility PACS or VNA, and patient’s information is available in the EMR, new opportunities lie ahead.

Don Dennison

President Don K Dennison Solutions Inc.

@DonKDennison

“Yesterday’s science fiction became science reality.”

TWEET THIS

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USER FRIENDLY PACSI think back to our first PACS system and it was so difficult to use and difficult to sign in. It was nothing compared to what we have now. They’re now much more customer and user friendly. There’s always room for improvement, but a lot has been done to make it easier to find things, like measurement tools. Those, and other built-in features, have gotten so much better.

Sue Johnson

PACS Manager Mankato Clinic, Ltd.

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DIGITAL MODALITIES AND PACS ADVANCEMENTThe advent of digital modalities, led by CT, CR and ultrasound, were probably the major impetus to bring about the advancement of PACS. The early practice of converting digital images to film fit with the then-current infrastructure of film-based reading, but created a dichotomy in terms of managing images. Many facilities treated the film as the final image, and only kept the digital content for a fixed period of time.

Joseph Marion

Consultant & Principal Healthcare Integration Strategies LLC

@HCInformatics

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IMAGE MANIPULATION AND SHORTER ACQUISITION TIMESFrom the perspective of a clinical radiologist, the advances in radiology in the past 100 years have been astonishing with new imaging modalities, ever increasing image quality and shorter acquisition times.

The advent of digital imaging brought a revolution in our ability to manipulate, transmit and store medical images, and that revolution is still in progress. We still have a way to go in managing the balance between free transfer of images and proper information governance.

Giles Maskell, MD

President The Royal College of Radiologists

@RCRadiologists

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BROADSCALE INTEGRATION ACROSS FUNCTIONSIntegration in the broadest sense is the single best digital imaging achievement of the past, be it VR, 3D processing, EMR, etc. You can often sit in one place and perform every radiology function except procedures.

Jeffrey Mendel, MD

Radiologist and Radiologic Imaging Consultant Tufts

@jbmcan

“You can often sit in one place and perform every radiology

function except procedures.” TWEET THIS

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CT, MRI AND ULTRASOUNDThe three biggest game changers in radiology over the past 100 years have been CT, MRI and ultrasound. Prior to the introduction of CT, the best way to know what was going on inside the body was surgical exploration. MRI has allowed better soft tissue resolution, particularly of the brain, spine, and joints. Finally, ultrasound makes our list because of its ease of use, lack of radiation exposure, and its portability. Ultrasound is getting better, faster, cheaper, and that is a good thing.

Patricia Salber, MD

CEO Health Tech Hatch

@Docweighsin

Jason Salber, MD

Private Practice Radiologist St. Alphonsus Hospital

@JasonSalber

“Ultrasound is getting better, faster, cheaper, and that is a good thing.”

TWEET THIS

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PACS-EMR INTEGRATIONAs someone who has been fortunate enough to have PACS-EMR integration for four years, I feel this has been the most significant improvement in the interpretation of imaging studies since the coming of PACS. Being able to quickly get to the relevant clinical information (well, maybe not quickly, but at least having a shot at getting there) opens up the potential to actually be clinically relevant.

Gone are the days of wishing you could just see the chart to understand what is going on. Actually, those days aren’t gone, since a significant fraction of the patients we read images on have their clinical information somewhere other than on our EMR.

Leigh S. Shuman, MD

Radiologist Lancaster Radiology Associates

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MOVING FORWARD: CONSIDERING FUTURE POSSIBILITIES

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UNIVERSAL INTEROPERABILITYAs healthcare organizations continue to consolidate, sharing imaging data alongside clinical data within and between institutions will become commonplace. As we shift to person-centric care, the future holds the opportunity to achieve ubiquitous interoperability where physicians can tap into a nationwide network of hospitals and clinics providing real-time, broad access to all of an individual’s relevant clinical data.

The new standard of diagnostic care will be one based on value and dependent upon flexible quality and communication workflow, and an enterprise worklist driven by clinical and business logic. Widespread use of mobile platforms will make collaboration easier than ever. Clinicians will make faster and more accurate clinical decisions by integrating, analyzing, and filtering patient information from multiple sources and making it available in the radiologist cockpit.

Erkan Akyuz

President Imaging and Workflow Solutions McKesson Technology Solutions

@ErkanAAkyuz

“As we shift to person-centric care, the future holds the opportunity to achieve

ubiquitous interoperability.” TWEET THIS

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QUALITY WORKFLOW TOOLSOne area of significant near-term progress has been in deploying integrated quality workflow tools that have the potential to improve both quality and collaboration.

In the next few years, one area that is likely to see rapid advancement is the use of deep learning methods that enable predictive analytics to dramatically change the diagnostic process. The notion of having a data service “crawl” through volumes of clinical data to provide radiologists highly relevant collateral aids and specific protocol recommendations will become commonplace.

These methods will do many of the routine (error prone) tasks now performed by radiologists. This will not “replace the radiologist,” but will both reduce human error and enable radiologists to focus on higher level cognitive tasks that support diagnostic workflows.

Joe Biegel

Vice President Corporate Strategy and Business Development McKesson Technology Solutions

@JoeImaging

“Having a data service ‘crawl’ through volumes of clinical data…will become commonplace.”

TWEET THIS

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STRUCTURED REPORTINGI think the biggest advancement will be methodologies for structured reporting (either with traditional reports or structured annotation) which can facilitate electronic post-processing of the diagnostic interpretation for population management, clinical decision support, follow-up reminders, patient tracking, and evaluation of effectiveness of system process changes and other quality initiatives.

I believe that as integration between PACS and the EMR becomes more robust, we will approach a state where a third-party dictation client is unnecessary. The method of interacting with images will create the structured elements, either within the PACS (to create the report to feed the EMR) or through individual elements of information sent from the PACS (and assembled in the EMR).

Travis Browning, MD

Radiologist and Associate Professor UT Southwestern

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ENTERPRISE WEB VIEWERSThere are a lot of discussions in the market on creating an enterprise web viewer that can work with all images. I do believe we are due for this soon, and there are a lot of vendors working on this currently. Once we have an enterprise web viewer, I think we will see a shift in the market and it will be interesting to see what happens to the future of PACS.

David Chou

Healthcare CIO

@dchou1107

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AUTOMATION AND PREDICTIVE ALGORITHMSThe availability of clinical information to correlate with imaging information allows a more accurate diagnosis. Combined with evidence generated by traditional studies, or by analytics of large sets of clinical data, computers with sophisticated predictive algorithms will become increasingly capable of diagnosing conditions, predicting outcomes and recommending treatment for patients.

As image processing advances, automated characterization of findings within imaging data will also allow more rapidly available and consistent structured findings. Statistical evidence can be used to establish automated rules for additional appropriate testing to be conducted.

The more algorithms are tuned to deal with specific conditions and diseases, the more personalized the medicine will become.

Don Dennison

President Don K Dennison Solutions Inc.

@DonKDennison

“Predictive algorithms will become increasingly capable of diagnosing conditions.”

TWEET THIS

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ADVANCED IMAGE SHARINGIn the near future, I think the advancements will be in image sharing and the availability of images, all following HIPAA’s portability act. I also really feel PACS is going to start being the place where everyone’s images are stored. We’re starting to see this in our clinic already.

We’re going to be a one-stop-shop for images, and whether they’re jpeg or another file type won’t matter. I don’t know that it’s necessarily the best use of PACS, but I think it’s understandable because providers don’t want to sign-in to a separate application to get relevant information. This is going to be triggering a lot of similar changes.

Sue Johnson

PACS Manager Mankato Clinic, Ltd.

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ADVANCED VISUALIZATION AND STORAGEContinued advancement in advanced visualization will be a major driving force in diagnostic imaging and PACS. New imaging techniques will produce ever-increasing amounts of data, which may best be viewed as three-dimensional objects.

Advancements in computational and storage technology will enable better management of these larger data sets, as will the advent of cloud-based storage alternatives. Cloud-based storage will foster greater collaboration by providing better study accessibility.

Smarter consumers and the advent of alternative healthcare structures, such as the ACO (Accountable Care Organization), will place further pressure on study accessibility across entities and more personal control over study content by the patient.

Similarly, changing healthcare practices may mean greater integration of patient records. This may result in more applications of Health Information Exchanges (HIE), as well as further consolidation of information systems infrastructure.

The ability to access images today via smart phones or tablets will continue to trend with advancements in commercial technology.

Joseph Marion

Consultant & Principal Healthcare Integration Strategies LLC

@HCInformatics

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VOLUME OF DATA SOLUTIONS The next problem for us is the volume of data. Only a few years ago, a radiologist might have viewed a few hundred images in a day’s work, whereas that figure can now be into the tens of thousands. This trend will continue and we will only cope with it through the development of a sophisticated machine learning algorithms, which can present data to the human interpreter in a format which can be reviewed and analyzed in a more time-efficient way.

I don’t worry about computers taking over our jobs, but we must use the advances in artificial intelligence to enhance our ability to diagnose and manage disease, recognizing that we must use the available technology for the maximum benefit of patients.

Giles Maskell, MD

President The Royal College of Radiologists

@RCRadiologists

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INTELLIGENT INTEGRATIONNear future advances must be in intelligent integration. This may be in sophisticated analysis of EMR data via artificial intelligence, selection of relevant priors, preprocessing, or retrieval of remote (outside) studies.

It may also be in the more mundane (but perhaps more vital) integration of being able to easily control and assign data elements created by image processing, technologist measurements, and voice elements, to various outputs (reports, critical results, tabular data in PACS or other processing functions). Our struggle among the mouse, keyboard and microphone is the result of having to handle multiple interfaces and contexts to complete our work.

Jeffrey Mendel, MD

Radiologist and Radiologic Imaging Consultant Tufts

@jbmcan

“Near future advances must be in intelligent integration.”

TWEET THIS

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ARTIFICIAL INTELLIGENCE AND PATTERN RECOGNITIONSome futurists have predicted the demise of specialties based on pattern recognition, such as dermatology and radiology. But we think advances in artificial intelligence will change the practice of radiology.

Computer learning algorithms are being developed that will provide an initial interpretation of images. Images read as normal with a very high degree of certainty will not need a human over-read. Outliers, those images not considered normal by the algorithms, will be referred to radiologists for expert interpretation.

Sophisticated computers will integrate with PACS, EMRs, and other medical databases, so that pattern recognition can be correlated with prior clinical and pathological data almost instantaneously.

Radiologists and specialists in imaging will continue to be critical members of the medical team, with their exact role evolving as technology continues to advance.

Patricia Salber, MD

CEO Health Tech Hatch

@Docweighsin

Jason Salber, MD

Private Practice Radiologist St. Alphonsus Hospital

@JasonSalber “Pattern recognition will be correlated with prior clinical data almost instantaneously.”

TWEET THIS

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INSTANTANEOUS AND INTELLIGENT ACCESSI think the biggest advance for the future would be to have all clinical patient information on our EMR, so we have instant access to all the prior images, and intelligent access to all of the relevant prior clinical information. That would really be something to write home about.

Leigh S. Shuman, MD

Radiologist Lancaster Radiology Associates

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BRINGING THE FUTURE INTO FOCUSWith the Conserus™ suite of solutions, the future is in focus. Conserus offers a range of products that help orchestrate interoperability among existing systems and specialists while helping simplify the transition from volume- to value-based care. With comprehensive solutions like Image Repository, Clinical Data Exchange, Workflow Intelligence, Enterprise Worklists and Quality Workflows, we can help you connect your entire enterprise, putting valuable information in the right hands, in the right place, at the right time.

Visit conserus.com for more information.

YOUR JOURNEY TO VALUE-BASED CARE IS UNIQUE. WHY SHOULD YOUR SOLUTIONS BE ANYTHING BUT? Regardless of the path you take to value-based care, McKesson can help make your journey as seamless as possible. Our diagnostic imaging solutions support the specific needs for radiology, mammography and cardiology departments. Our vendor-agnostic solutions can help optimize your PACS and CVIS investments and improve interoperability among existing systems, helping you connect your entire enterprise and putting valuable imaging information in the right hands, in the right place, at the right time.

Visit mckesson.com/medicalimaging for more information or request a meeting or demo at mckesson.com/connectedenterprise.

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THANK YOUThank you to the healthcare leaders who contributed to this eBook. The sharing of their knowledge and expertise is an example of how, together, healthcare industry leaders can collaborate and support each other as we look toward a future of increasingly excellent patient care.

GET MORE INSIGHTAs healthcare leaders face the challenges and advancements ahead, there are resources available to help. For the latest medical

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