The CIO Perspective: Issues in Image Management

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It is taxing enough for radiology and IT decision makers to contend with the image-management consequences of multidetector CT, high–field-strength MRI, 3D reconstructions, and various recent other trends responsible for a rising tide of diagnostic data. Added to this are the burdens created by other disciplines across the enterprise when they use imaging systems of their own and send the output to a common archive in an environment where the goal is universal access, not just from one corner of the organization to the other, but bidirectionally from multiple points of contact.

It’s not surprising, then, that the departments of radiology and IT at a growing number of institutions are working together more cohesively these days. The challenges that they face are held in common, rising from a customer base that is larger and broader than ever.

The Medical University of South Carolina (MUSC) in Charleston has an exceptionally big imaging environment (with at least 89 separate buildings on a 76-acre parcel) and a growing number of disciplines across the enterprise (including cardiology, oncology, pathology, rheumatology, and orthopedics) that want to get in on imaging.

To address this expanding customer base, the first concern of Frank C. Clark, PhD, MUSC’s vice president of IT and CIO, is ensuring that the enterprise has adequate archival capacity. “We have a SAN storage solution built up now to almost 500 terabytes,” he says. “Because of the explosion of imaging here, we’re adding to that storage capacity at the rate of about 15% annually.”

imageFrank Clark, PhD, CIO

Even at that, MUSC has found it necessary to tier the archive to facilitate efficient retrieval of images and help hold the line on costs. “Basically, the newest or most important images are placed on fiber channel, older or less important ones go to a SATA archive, and the oldest or least important are archived further down the performance chain,” Clark says.

The catch is that image users are permitted to define the tier where they want their images to be stored. Since the natural impulse is to want image retrieval to be nearly instantaneous, most users automatically load everything onto the fiber channel. “That, of course, is unrealistic,” Clark acknowledges, “so we try to help users make better choices by providing education about which types of images should be placed where, ideally, among the tiers.”

The help that Clark describes is delivered through a governance process that, among other things, encourages each clinical user to articulate his or her image needs. “We use a suite of automated tools that constantly monitors the different storage tiers to measure frequency of use and also storage growth within specific applications and segments over a protracted period of time. These not only help us identify and track the largest archive consumers, but also help us home in on what it is each user is actually trying to accomplish, so that he or she doesn’t make tier-selection choices in a vacuum,” Clark says. “We believe this is key to being able to effectuate significant savings.”

Related to image-retrieval speed is bandwidth, and MUSC has been working to improve that as well. “Our radiologist workstations operate on at least a gigabyte of bandwidth; we’re attempting to provide as close to that same amount as possible out at all the desktop-based viewers used by the clinicians across the enterprise,” Clark explains, adding that it helps to have a thin-client PACS viewing application. “This is allowing us to extrapolate PACS very economically across the enterprise,” he says.

Still, the shift to thin-client PACS is not without a price. “We have 10,000 or so desktops to maintain and upgrade, rather than a handful of high-end workstations confined just to the radiology reading rooms,” Clark says. “The good news is that most of our viewers are managed using a thin-client model, which allows us to push out software upgrades remotely from a central point. This saves us from having to go out and physically touch each desktop in order to implement the changes. We still must send out IT personnel, however, any time hardware is due for replacement, or if we want to expand the device’s storage, so there still are logistical issues to be dealt with here.”

Images acquired from modalities throughout MUSC are ultimately funneled into a centralized clinical data repository, where they then are aggregated with each patient’s laboratory results, chart, and other