Big Data and the Future of Radiology Informatics.

Rapid growth in the amount of data that is electronically recorded as part of routine clinical operations has generated great interest in the use of Big Data methodologies to address clinical and research questions. These methods can efficiently analyze and deliver insights from high-volume, high-variety, and high-growth rate datasets generated across the continuum of care, thereby forgoing the time, cost, and effort of more focused and controlled hypothesis-driven research. By virtue of an existing robust information technology infrastructure and years of archived digital data, radiology departments are particularly well positioned to take advantage of emerging Big Data techniques. In this review, we describe four areas in which Big Data is poised to have an immediate impact on radiology practice, research, and operations. In addition, we provide an overview of the Big Data adoption cycle and describe how academic radiology departments can promote Big Data development.

Putting image-sharing in the patient's hands .

A new digital technology has been developed by researchers at Wake Forest School of Medicine to allow unaffiliated institutions to transfer medical images, thus avoiding the hassle of CDs. Could the PCARE system offer a model for others to follow?

Meaningful use in radiology.

With an estimated $1.5 billion in potential stimulus bonus payments for radiologist professionals at stake, and penalties looming farther down the road, radiologists would be wise to study and respond to recent federal regulations related to meaningful use of complete certified ambulatory electronic health records and their equivalents. Many radiologists mistakenly believe that they were "left out" of the meaningful use rewards or that compliance is technically impractical. With diligent preparation, including the adoption of new technology and workflows, the vast majority of radiologists can qualify before October 2012 to capture the full available rewards and avoid later penalties.

Detectors for the future of X-ray imaging.

In recent decades, developments in detectors for X-ray imaging have improved dose efficiency. This has been accomplished with for example, structured scintillators such as columnar CsI, or with direct detectors where the X rays are converted to electric charge carriers in a semiconductor. Scattered radiation remains a major noise source, and fairly inefficient anti-scatter grids are still a gold standard. Hence, any future development should include improved scatter rejection. In recent years, photon-counting detectors have generated significant interest by several companies as well as academic research groups. This method eliminates electronic noise, which is an advantage in low-dose applications. Moreover, energy-sensitive photon-counting detectors allow for further improvements by optimising the signal-to-quantum-noise ratio, anatomical background subtraction or quantitative analysis of object constituents. This paper reviews state-of-the-art photon-counting detectors, scatter control and their application in diagnostic X-ray medical imaging. In particular, spectral imaging with photon-counting detectors, pitfalls such as charge sharing and high rates and various proposals for mitigation are discussed.

Picture, archiving and communication system in the Italian NHS: a primer on diffusion and evaluation analysis.

This contribution focuses on picture archiving and communication systems (PACS) in the Italian National Healthcare System (NHS). It finally aims to test the Chiefs Radiology Department's perceptions about PACS along the main evaluation dimensions emerging from the literature. First, a brief review of the main literature concerning PACS evaluation leads the authors to classify the different approaches undertaken and highlight the main variables of investigation. Second, the evidence emerging from a survey is presented and discussed in the light of the literature review. The survey aims to: (a) map out the degree of PACSs diffusion and their main features in the Italian NHS; (b) verify whether and how PACS impact the dimensions analyzed in many evaluation studies carried out to date; (c) test the relationship between some measured impacts and specific PACS features.

OpenSourcePACS: an extensible infrastructure for medical image management.

The development of comprehensive picture archive and communication systems (PACS) has mainly been limited to proprietary developments by vendors, though a number of freely available software projects have addressed specific image management tasks. The openSourcePACS project aims to provide an open source, common foundation upon which not only can a basic PACS be readily implemented, but to also support the evolution of new PACS functionality through the development of novel imaging applications and services. openSourcePACS consists of four main software modules: 1) image order entry, which enables the ordering and tracking of structured image requisitions; 2) an agent-based image server framework that coordinates distributed image services including routing, image processing, and querying beyond the present digital image and communications in medicine (DICOM) capabilities; 3) an image viewer, supporting standard display and image manipulation tools, DICOM presentation states, and structured reporting; and 4) reporting and result dissemination, supplying web-based widgets for creating integrated reports. All components are implemented using Java to encourage cross-platform deployment. To demonstrate the usage of openSourcePACS, a preliminary application supporting primary care/specialist communication was developed and is described herein. Ultimately, the goal of openSourcePACS is to promote the wide-scale development and usage of PACS and imaging applications within academic and research communities.

"Distributed proton radiation therapy"--a new concept for advanced competence support.

The increased interest in high precision radiation therapy is to a large extent driven by the potential of modern imaging technology. The aim of this project was to analyse how an expensive proton facility best could support a multi-centre health care system. We have developed a model for distributed expert collaboration where all clinical experts will work close to their patients in regional centres. Patients who are candidates for proton therapy will be examined and dose-planned at their regional clinic, discussed in a fully information supported video conference and digitally made available at the proton treatment facility. The proton facility itself will be placed near a communication centre easily reached by all patients where they will be treated under full responsibility of their own physician at the home clinic. This concept has been analysed in detail both with respect to the overall functionality and with respect to possible weaknesses. It was found that the concept of distributed radiation therapy, as proposed here, will offer a stable clinical solution for advanced radiation therapy. It will support the spread of knowledge, serve as a fully developed backup system and the concept will further serve as an efficient base for clinical research.

Multislice CT: 64 slices and beyond.

Since the first introduction of 4-slice multislice computed tomography (MSCT) more than 6 years ago, MSCT imaging has achieved widespread acceptance and became a standard of care in routine clinical practice by offering high-speed, non-invasive, thin-slice diagnostic scanning for a wide range of clinical applications in radiology and cardiology. In the past year, the industry has witnessed an explosive increase in the amount of data obtained by MSCT and in the number at acquired slices to 32 and 64. While some experts have argued that a 16-slice system is sufficient from a practical standpoint, a closer examination of 32- and 64-slice systems offers new and superior clinical benefits over and above 16-slice technology, especially in imaging of the coronary arteries and in multiphase and functional studies. With the introduction of 32-slice computed tomography (CT) systems, the routinely acquired slice thicknesses have been reduced to 0.5 mm and 1 mm. At these slice thickness levels, it is possible to acquire isotropic volume data sets in all CT scans. Recently, diagnosis based on isotropic volume data has become the standard in CT imaging as it offers far greater clinical benefits than previous 16-slice CT technology. While many of the clinical benefits of a 64-slice CT system center around imaging the heart, there are several distinct areas in the radiology practice that benefit as well. One key area is in the field of interventional neuroradiology and the ability to separate venous from arterial flow using computed tomography angiography (CTA). The evolution of MSCT has opened up new frontiers in diagnostic imaging that were unimaginable just a few years ago.

Current status and issues of concern in diagnostic radiology.

I have tried to give a little history, discuss some current topics: PACS, inappropriate image utilization, CT screening, Night Hawk, molecular imaging, sonoscope, CAD, and LBBH. I hope these issues are more familiar to you now. The articles that follow from the faculty of the University of Missouri-Kansas City School of Medicine and Saint Luke's Hospital will bring you up to date regarding the current status of CT, MRI, ultrasound, nuclear medicine, mammography, and interventional radiology.

MRI: are you playing your system like a fiddle or a Stradivarius? Where we are headed and how to keep up.

Dr. Raymond Damadian performed the first human magnetic resonance imaging (MRI) scan in 1977. Unveiled from behind the research curtain, MRI technology was introduced to the clinical environment by the mid 1980s. Most academic and largehospitals lined up right away and purchased their first scanners as soon as they became available. The race began, and the MRI learning process at radiology departments all over the world started. As with any growing technology, came a surge of competition--manufacturers as well as imaging facilities. MRI technology flooded the medical community, since it provided enormous benefits for patients and doctors. It was like a rocket launching with scientists and original equipment manufacturers (OEMs) researching, creating and contributing to the advancement of clinical science and forever improved diagnoses. Radiologists at UCLA predict that most of today's procedures currently falling under research will flourish in the clinical setting within the next 5 years. The rise of PET technology and the ability to fuse metabolic images with an anatomical MRI map will undoubtedly prove invaluable for staging of pathology, treatment planning and tracking, especially when the disease is present within soft tissue, like the brain. Another sign that MRI is a healthy addition to medical imaging is the increasing number of MRI reimbursement codes. However, Medicare, Medicaid and private insurance companies are also scrutinizing more and paying less today than they did yesterday. There will always be certain myths about how bigger is always better. That's not to say system enhancements and advancements are not essential to medical imaging, but the needs and budgets differ for each facility. Regardless of site needs or budget, it is imperative that all facilities utilize the equipment they have to their maximum potential. The new "bells and whistles" might not be needed to stay competitive. Innovative technology continues to be available as long as there is a need. However, buying bigger and better doesn't always mean you will utilize what's been bought to its full potential.

Taking digital imaging to the next level: challenges and opportunities.

New medical imaging technology, such as multi-detector computed tomography (CT) scanners and positron emission tomography (PET) scanners, are creating new possibilities for non-invasive diagnosis that are leading providers to invest heavily in these new technologies. The volume of data produced by such technology is so large that it cannot be "read" using traditional film-based methods, and once in digital form, it creates a massive data integration and archiving challenge. Despite the benefits of digital imaging and archiving, there are several key challenges that healthcare organizations should consider in planning, selecting, and implementing the information technology (IT) infrastructure to support digital imaging. Decisions about storage and image distribution are essentially questions of "where" and "how fast." When planning the digital archiving infrastructure, organizations should think about where they want to store and distribute their images. This is similar to decisions that organizations have to make in regard to physical film storage and distribution, except the portability of images is even greater in a digital environment. The principle of "network effects" seems like a simple concept, yet the effect is not always considered when implementing a technology plan. To fully realize the benefits of digital imaging, the radiology department must integrate the archiving solutions throughout the department and, ultimately, with applications across other departments and enterprises. Medical institutions can derive a number of benefits from implementing digital imaging and archiving solutions like PACS. Hospitals and imaging centers can use the transition from film-based imaging as a foundational opportunity to reduce costs, increase competitive advantage, attract talent, and improve service to patients. The key factors in achieving these goals include attention to the means of data storage, distribution and protection.