April 2003 Telemedicine Systems, Radiology Purpose Teleradiology systems electronically transmit radi- ologic images and consultative text from one location to another. Designed to facilitate rapid diagnosis and consultation by imaging specialists, teleradiology sys- tems link hospital departments to other departments, other hospitals, physicians’ homes, or clinics by means of telephone lines, digital networks, and/or microwave or satellite transmission. Because image data can be transmitted thousands of miles, hospitals and remote emergency medical centers that do not have an in- house radiologist can transmit images to a radiologist at a larger hospital for review and interpretation. Teleradiology allows two-way online consultation and enables a radiologist to serve several freestanding radiologic clinics or mobile centers without leaving the hospital’s radiology department. Teleradiology is also used by the military during warfare and by emergency medical personnel during natural disasters to improve emergency diagnosis and treatment. Principles of operation Teleradiology systems are configured to exchange data between the transmitting and receiving sites, frequently by means of the Internet or World Wide Web. The complexity of a teleradiology system depends largely on user needs, and most display stations and networks can be customized to include such features as multiple viewing monitors, permanent (archival) image storage, and image data manipulation. A typical teleradiology system consists of an image capture station and a receiving station. The image capture station includes a personal computer (PC) with a high-speed modem, a high-resolution display 197008 424-010 Scope of this Product Comparison This Product Comparison covers dedicated tel- eradiology systems, as well as those that are expandable to picture archiving and communica- tion systems (PACS). For more information on image transmission, networking, and storage, see the Product Comparison titled PICTURE AR- CHIVING AND COMMUNICATION SYSTEMS (PACS), RADIOLOGY. These systems are also called: teleradiology systems UMDNS information This Product Comparison covers the following de- vice term and product code as listed in ECRI’s Universal Medical Device Nomenclature System™ (UMDNS™): • Information Systems, Telemedicine, Radiology [16-994] 5200 Butler Pike, Plymouth Meeting, PA 19462-1298, USA Telephone +1 (610) 825-6000 ● Fax +1 (610) 834-1275 ● E-mail [email protected]
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April 2003
Telemedicine Systems, Radiology
Purpose
Teleradiology systems electronically transmit radi-ologic images and consultative text from one locationto another. Designed to facilitate rapid diagnosis andconsultation by imaging specialists, teleradiology sys-tems link hospital departments to other departments,other hospitals, physicians’ homes, or clinics by meansof telephone lines, digital networks, and/or microwaveor satellite transmission. Because image data can betransmitted thousands of miles, hospitals and remoteemergency medical centers that do not have an in-house radiologist can transmit images to a radiologist
at a larger hospital for review and interpretation.Teleradiology allows two-way online consultation andenables a radiologist to serve several freestandingradiologic clinics or mobile centers without leaving thehospital’s radiology department. Teleradiology is alsoused by the military during warfare and by emergencymedical personnel during natural disasters to improveemergency diagnosis and treatment.
Principles of operationTeleradiology systems are configured to exchange
data between the transmitting and receiving sites,frequently by means of the Internet or World WideWeb. The complexity of a teleradiology system dependslargely on user needs, and most display stations andnetworks can be customized to include such featuresas multiple viewing monitors, permanent (archival)image storage, and image data manipulation.
A typical teleradiology system consists of an imagecapture station and a receiving station. The imagecapture station includes a personal computer (PC)with a high-speed modem, a high-resolution display
197008424-010
Scope of this Product ComparisonThis Product Comparison covers dedicated tel-eradiology systems, as well as those that areexpandable to picture archiving and communica-tion systems (PACS). For more information onimage transmission, networking, and storage,see the Product Comparison titled PICTURE AR-CHIVING AND COMMUNICATION SYSTEMS (PACS),RADIOLOGY.
These systems are also called: teleradiologysystems
UMDNS informationThis Product Comparison covers the following de-vice term and product code as listed in ECRI’sUniversal Medical Device Nomenclature System™(UMDNS™):
• Information Systems, Telemedicine, Radiology[16-994]
card, a viewing monitor, and an image capture device.Before it can be stored or transmitted, the film imagemust be digitized (converted into a series of numbers)by the capture device, which electronically divides theimage into rectangular areas called picture elements(pixels); the sequence of pixel values representing theimage can then be stored, processed, and transmitteddigitally.
There are several capture devices available for dig-itizing film images. The most basic device uses aclosed-circuit television (TV) camera focused on a lightbox and linked by a video cable to a capture card insidethe PC. The film to be transmitted is laid on the lightbox, and the camera is focused on the film until adesirable image is observed on the video monitor. Thisimage is freeze-framed, stored as a digital file, and sentover a modem to the receiving station. Because digit-izing in this manner results in a low-resolution image,low-contrast chest radiographs requiring higher reso-lution should not be digitized using this method. Othermethods of digitizing include the use of a charge-coupled device scanner to digitize film images line byline. Certain scanners provide significantly high reso-lution, optimize optical density, and can scan all sizesand types of radiographic film. See the Product Com-parison on FILM DIGITIZERS for more information.
In direct image capture (DICAP), images from digi-tal modalities such as computed tomography (CT),magnetic resonance imaging (MRI), and ultrasound(US) are acquired before the multiformat film is made.Referred to as video capture cards, DICAP interfacestap directly into the video signals produced as thepatient is being scanned, converting these analog sig-nals into digital signals for storage and transmission.
The pixel size and the number of gray levels for eachpixel determine the image resolution. Spatial resolu-tion improves as pixel size decreases, and contrastresolution improves as bit depth increases. For 64shades of gray, 6 bits are required for each pixel en-coded; for 256 shades of gray, 8 bits are needed. TheAmerican College of Radiology (ACR) recommendsthat display systems for CT, MRI, US, nuclear medi-cine, and digital fluorography have resolutions of512 × 492 × 8 bits or more. Likewise, systems fordigitized radiographic films, computed radiography(CR), and digital radiography (DR) should have reso-lutions of 2048 × 2048 × 8 bits or more. Because of theamount of information that must be transmitted foreach pixel, digital transmission is almost alwaysslower than analog transmission. To compensate, digi-tal systems usually use sophisticated high-speedtransmission modems, resulting in a slightly highercost.
The modem converts the digital data from the PCinto an analog signal for transmission over standardtelephone lines, digital subscriber lines (DSL), cablemodems, or dial-up high-speed modems.
Another modem at the receiving station then con-verts the incoming analog signal into digital data forthe display computer. Modem speed is measured inbits per second (bps) of data transmitted or received,and speeds can range from 13,000 to 28,800 bps.Speeds greater than 28,800 bps can be achieved overleased lines dedicated to data transmission. Unlikeanalog transmission, digital transmission is not af-fected by background noise or other audio interferencebecause there is a sufficiently wide difference betweenthe frequencies of the digital signal to avoid encodingerrors.
Images are stored in the computer memory or a diskdrive; the number of images saved is limited by the sizeof the computer memory and the capacity of the diskdrive. Short-term storage of data can be accomplishedusing a redundant array of inexpensive disks (RAID).For archival (i.e., permanent) storage, suppliers offermagneto-optical disks (MODs), recordable compactdiscs (CD-Rs), digital linear tapes (DLTs), and digitalvideo (or versatile) discs (DVDs). Jukeboxes — archi-val library systems that accommodate several differ-ent types of storage media and are expandable toseveral hundred terabytes — are also available.
Some suppliers have established relationships withapplication service providers (ASPs) to enhance theirofferings. The mainframe computers or distributedservers managing the files and databases reside at aremote location on the ASP’s technological infrastruc-ture. Only the workstations and a limited selection ofcommunications equipment are physically present inthe hospital. The ASP server is linked to the hospitalover a wide area network (WAN) using the Internet, avirtual private network (VPN), or a private line. Thehospital rents the application from the ASP on a per-user, per-transaction, or per-month basis. An ASPprogram is designed to resemble a local area network(LAN) system, although all the operations are con-ducted using an Internet browser or a thin-client front-end application and are transmitted over a WAN.Maintenance and upgrades are performed according tothe ASP’s schedule, and the level of customization isoften less than that for an in-house installation be-cause the ASP will try to standardize its proceduresfor many customers.
After image capture and/or conversion, the imagesare then transmitted to a remote location for viewing.The computer system controls the acquisition, display,
manipulation, and transmission of image data. Work-stations at each site are used for interactively review-ing digitized radiologic images before and aftertransmission, for archiving digital images, and forcontrolling the capture devices and printers.
Several image enhancement features are availablewith many teleradiology systems. Software can beused to enhance contrast, improve edge delineation, ormagnify an area of interest. Most systems havepan/zoom, scrolling, and brightness/contrast controlfunctions. Some also offer selectable window width andlevels, color, grayscale adjustment, and text integra-tion. By altering the image contrast through adjust-ment of the grayscale, the radiologist can evaluate bothsoft and radiopaque tissue from the same radiograph.This is particularly useful in the evaluation of chestpathology or trauma.
Image transmission and networks
A teleradiology system is usually configured as aLAN and therefore can be interfaced with larger PACSor other computer systems (e.g., radiology, hospital,laboratory). Most teleradiology systems can also beintegrated into a wider network, encompassing multi-ple hospitals, clinics, and/or other healthcare facilities.
Computer workstations and peripheral devices areconnected with file servers or a central host computerby coaxial, twisted-pair, and/or fiberoptic cable to forma LAN that allows communication between devices.Coaxial and fiberoptic cables offer greater electronictransmission capacity but are costly and relativelydifficult to install in existing buildings. Twisted-paircable, consisting of one or more pairs of insulated wiretwisted together, is often already in place for telephonesystems.
Various network architectures are available, de-pending on the supplier. In a centralized network, alarge central computer (host) houses all programs,files, and other data available for users connected tothe network; the host computer also controls networkoperations. Since all of the processing and storagehardware is in a central location, environmental secu-rity (e.g., personnel access, fire control) is simplified.Although control of a centralized network is straight-forward, expansion beyond a certain number of termi-nals or a certain amount of data storage can requirecostly hardware upgrades such as added terminal con-trol units, larger central processing units (CPUs) tohandle the increased workload, and additional diskdrives to handle increased storage. In addition, if thecentral host computer fails, the terminals connected toit cannot be used.
In a distributed network, each user on the LAN hasa PC that can function independently from the net-work, as well as access shared files and programs fromthe file server(s). If the LAN should fail, users can stilluse their PCs; however, some central functions maynot be accessible. Expanding this type of networkusually requires adding another computer to the net-work and updating the system’s software.
In a client/server network, PCs, microprocessor-based laboratory instruments, and other workstationsare client devices with stand-alone processing anduser-interface capabilities. The clients are connectedto dedicated servers — larger PCs, file servers, orminicomputers — that provide applications softwareprograms, storage, database management programs,and other utilities upon request from the client device.Adding additional PCs usually does not affect theprocessing power of other clients.
In a peer-to-peer network, all computers are on thesame communications level; that is, each computer canact as a server on the network, capable of initiating andterminating sessions, exchanging data and files, andprocessing information. A peer-to-peer network archi-tecture is typically used for smaller LANs because it isrelatively simple to install and manage. For largerLANs,dedicated multiple servers are usually used to accom-modate a greater number of users and operations.
The LAN, which connects users within a limitedarea (e.g., a building or building complex), can beintegrated into a larger network encompassing multi-ple hospitals, clinics, and other healthcare facilities. Ametropolitan area network (MAN) serves users in ageographic region (e.g., city, suburb); a WAN covershundreds or thousands of miles. Several LANs can belinked together to form a MAN or WAN using tele-phone lines or microwave, satellite, fiberoptic, or ra-dio-frequency devices for real-time data, voice, orimage transmission.
Recently, the Internet and World Wide Web havebecome important in the transmission of patient re-ports and diagnostic images. Some facilities have de-vised innovative ways to transmit and access imagesover hospital intranets. PCs are located in patientrooms and radiologist offices so that patients and phy-sicians can view images and reports. The intranetprovides image distribution over a standard Ethernetnetwork. Many suppliers are now offering image ac-cess using the Internet or Web-based technologies.Images can now be accessed at remote sites using aWeb browser (e.g., Microsoft Internet Explorer,Netscape Navigator) over DSL, cable modems, or dial-up high-speed modems. Some suppliers use Web-based
technologies for both intranet and Internet imagedistribution.
With Web servers included with the system, manysuppliers allow full 12-bit images to be delivered.Studies have been conducted to verify the diagnosticquality of the transmitted images. In one study, radi-ologists reported no significant loss of image accuracyfor CT systems. Additionally, a telemedicine project atone rural hospital provided a practical, cost-effectivealternative to transporting patients to the nearestfacility, which was more than 50 miles away. Somesystems may allow remote-to-remote diagnostics inwhich the physicians are at separate locations, bothseparate from the facility.
Bandwidth (the amount of data that can be trans-mitted), transmission speed, and communicationscosts vary with the type of transmission media avail-able. Newer high-speed transmission media may notbe available in some rural areas. Plain old telephoneservice (POTS), also called public switched telephonenetwork, allows transmission speeds of 1.2 to 28.8 Kbpsfor voice or modem data; switched-56, a digital service,allows transmission speeds of 56 or 64 Kbps for videoand data (no voice).
Integrated Services Digital Network (ISDN), astandard for digital connection between the networkand user, allows transmission speeds of 64 Kbps to 1.5Mbps for voice, data, full-motion video, and images.With ISDN, there are two interfaces: Basic Rate Inter-face (BRI) and Primary Rate Interface (PRI). SwitchedMultimegabit Data Service allows transmissionspeeds of 56 Kbps to 100 Mbps for data, images, voice,and video. Dedicated (fixed) circuit networks (e.g., T-1,T-3) allow transmission speeds from 384 Kbps to 45Mbps for data and voice, but transmission is restrictedto users on the network.
Frame relay, a digital network, allows transmissionspeeds of 56 Kbps to 1.54 Mbps for data. However,frame relay is not a dial-up service; the user must bepart of the dedicated frame-relay network to transmitand receive data.
Microwave and satellite transmission can also beused for telemedicine. Microwave hookups are rela-tively expensive compared to standard telephone lines,and they have a limited range of 5 to 10 miles. Systemswith a 20-mile range are available at a higher cost. Inaddition, an unobstructed line of sight must be main-tained for microwave transmission to work. In theUnited States, a Federal Communications Commis-sion license is required to operate microwave transmis-sion equipment. Satellite transmission is a moreexpensive method of data transmission because it
requires the purchase of additional equipment, includ-ing the satellite transmitter (uplink) and the receiver(downlink). The major disadvantage of the satellitesystem is its high cost. Also, in some countries, the useof satellite communications may be restricted or mayrequire the use of a special license.
Data compression
Another factor affecting transmission time is thedegree of data compression. Digital images are com-pressed (i.e., pieces of information are dropped) so thatthe image occupies less space and can be transmittedfaster. Compression is expressed as a ratio; a ratio of10:1 means that for each piece of information in thetransmitted matrix, 10 have been dropped from theoriginal before transmission. Lossless compression(2.5:1 to 4:1) is a nondestructive algorithm that com-presses data with no accompanying change in pixelvalues or grayscale range; it is most commonly usedfor transmitting low-contrast chest or bone x-rays.Lossy (destructive) compression, which uses ratiosranging from 5:1 to 100:1, changes pixel values slightlyand is used for high-contrast images, such as thoseobtained from CT and MRI, which can withstand ahigher degree of compression without a noticeablevisual difference. Some manufacturers offer selectablecompression ratios so that the operator can regulateimage detail and transmission speed for each imagetransmittal.
Other algorithms for data compression can be hard-wired into the modem or the computer or be incorpo-rated into the software. One algorithm, for example,is suppression of repeated characters, which evaluateseach individual pixel and, when the same value isrepeated for several adjacent pixels, assigns a code forthe pixel intensity and a value for the number of timesthis intensity is repeated. Strings of leading zeros ortrailing blanks can be eliminated by data compaction.Systems can combine several data-compression anddata-compaction algorithms to achieve maximum re-dundancy reduction. Once compressed data is trans-mitted, an algorithm at the receiving end is used toreconstruct the data to form an image as close aspossible to the original.
The most common compression algorithms cur-rently used are based on the Joint PhotographicExperts Group (JPEG) standard for still-image com-pression. Other algorithms increasing in use includewavelet compression, which compresses the image asa whole, allowing more data to be compressed whilestill maintaining image quality. This technique is be-ing used to compress large image files such as chestx-rays for transmission.
Data-compression use is a debatable issue, andsome have questioned whether images constructedfrom a compression ratio greater than 3:1 are accept-able. However, proponents of high-ratio data compres-sion claim that if correctly used, it does not result inany appreciable degradation in the quality of the trans-mitted image.
Whenever data-compression techniques or high-speed transmission devices are used, the probability ofimage degradation or destruction increases, and somesort of error-checking procedure is necessary. Error-checking algorithms can be hardwired into the high-speed modems or into the computer. Error-checkingsoftware functions can be updated periodically withnewer algorithms. In one simple form of error check-ing, the length of each data line transmitted is re-viewed, and lines that are too short are rejected andautomatically retransmitted. Error-checking algo-rithms should have zero error tolerance to ensurefidelity in image transmission. Certain error-checkingalgorithms can increase transmission time.
Security
The patient’s right to privacy makes system securitya major consideration: computer access to patient filesmust be controlled. Most suppliers use multilevel userpasswords and user identification codes to limit per-sonnel access to information required for their particu-lar job. System design should mask the password fromthe screen during entry to prevent unauthorized peo-ple from seeing it. Also, systems now offer audit trailsas well as automatic logoff if a terminal is left idle fortoo long to prevent unauthorized access to data.
Confidentiality, driven in the United States by theHealth Insurance Portability and Accountability Act of1996 (HIPAA), is a major concern when purchasing aradiology telemedicine system. In addition to usinguser-unique passwords and user IDs, facilities shouldconsider adjusting monitor positions so that onlyauthorized personnel can view the screen, having re-pair technicians sign a confidentiality waiver, refrain-ing from using e-mail as a means of transferringpatient data, performing random audits, putting upfirewalls (only necessary if connected to outside net-works), and using access restriction and encryption.The administrative simplification provisions of HIPAAcall for the standardization of electronic health infor-mation transactions. Also included are standards forkeeping health information secure, for giving patientscontrol over the disclosure of their health records, andfor establishing unique identifiers for healthcare provid-ers, health plans, employers, and individuals. Compli-ance is only required for electronic health information;
paper record compliance is voluntary. Compliance re-quirements vary for each part of HIPAA and are alsodifferent depending on the facility’s size. For moreinformation on HIPAA, see the Health Devices articlecited below.
Reported problemsSome computer components are sensitive to vari-
ations in temperature, humidity, and line voltage. Likeany other large electrical device, these computers gen-erate considerable heat during operation, which candamage components such as drives and microprocessorchips. Depending on the system, temperatures mayneed to be restricted to within a few degrees of 20° to23°C. Although these restrictions typically apply tomainframe computers, users should be aware that PCsand minicomputers may be adversely affected by tem-peratures outside this range. Humidity must be lowenough to prevent condensation but high enough toeliminate static electricity. Lint and dust from carpetsand paper, as well as chemical fumes that affect elec-tronics and storage media, may necessitate the use ofan air-filtering system.
Electrical fluctuations can damage computer com-ponents, impair performance, disrupt program opera-tion, and destroy data. Preventive measures includeinstalling an online uninterruptible power supply. Al-though a dedicated line isolated for the CPU may notcompensate for voltage variations, it may be useful toreduce signal noise. Copying disks at regular intervalsprotects stored information. Damage can also resultfrom component failure or user abuse.
To reduce the downtime due to system failures, mostcomputers offer redundant fault tolerance, whereby aduplicate set of main components (e.g., processors,drives) serves as a backup. A less expensive option in-volves the use of disk mirroring (storing data in dupli-cate) to provide backup if one disk becomes inoperable.
No software is without programming errors, whichmay affect the proper functioning of the software. Attimes, these errors are discovered only after the soft-ware has been installed and is in use. Suppliers shouldprovide quick resolution of programming errors oncethey are found.
Teleradiology equipment should be tested on a regu-lar basis; a thorough quality-assurance programshould be established. Overall system performanceshould be tested weekly, and components such as laserdigitizers, monitors, and video framegrabbers shouldbe tested monthly or quarterly.
Data-compression techniques and other methodsdesigned to shorten transmission periods have re-sulted in errors. Although high-ratio data compres-sion remains one of the most controversial issuessurrounding teleradiology, the use of error-correctioncircuitry and software and improvements in the qual-ity of transmission methods have greatly increased theoverall accuracy of radiographic diagnosis by teleradi-ology. Hospitals should develop a policy concerning themaximum amount of compression permitted to ensureaccurate transmission of diagnostically useful images.
There have also been legal concerns about usingdigital images for diagnosis, including safe storage andlength of storage, access to information, disseminationof stored information, and unauthorized access to re-cords. In addition, as the use of teleradiology for remotediagnosis increases, more questions about physicianliability and licensure have arisen. The new standardestablished by ACR for teleradiology addresses physi-cian licensure and credentialing issues related toteleradiology.
Purchase considerationsThe following should be considered before purchas-
ing a teleradiology system:
• Availability of a direct connection to CT, MRI, US,and other imaging modalities
• The need for a film digitizer to digitize plain films
• Image acquisition and transmission times
• Maximum image matrix size that can be acquiredand transmitted
• Multitasking capabilities (The system should beable to simultaneously digitize one image whiletransmitting another.)
• Availability of cost-effective WAN transmission(e.g., ISDN, DSL, cable modem)
• User-friendliness of the computer system
• Physician adaptability to image interpretation us-ing a computer monitor rather than a traditionalfilm viewer
• Image and data storage needed
• The use of portable systems for on-call radiologists
• Hardware and software requirements for integrat-ing with other information systems in the facility orinterfacing with PACS or other information systems
• System upgradability
• Multiple-site networking capabilities for integra-tion with a MAN or WAN
• Service providers for both hardware and softwaremaintenance and the location and availability ofservice representatives
• Financial stability of the supplier
Applications of the teleradiology system should alsobe considered. Real-time review by consulting physi-cians at different sites requires high-resolution imagesand rapid transmission by either ISDN or satellite forpoint-to-point transmission or by dedicated coaxialcable, DSL, or cable modems for LAN transmission.Image transmission to on-call radiologists at homerequires transmission over telephone lines; each radi-ologist should have a high-resolution computer moni-tor at home, and the department should have aportable modem, CPU, and hard disk that the radiolo-gist can carry home when on-call. If hard-copy reviewis desired, the department should invest in a laserimager.
If the teleradiology system is to be integrated witha PACS, compatibility with communications stand-ards should be considered. An international standardfor network architectures, called Open System Inter-connect (OSI), was developed under the guidance of theInternational Organization for Standardization (ISO).ACR and the National Electrical Manufacturers Asso-ciation (NEMA) have established the ACR/NEMADigital Imaging and Communications standard (DI-COM 3.0), which ensures data exchange among imag-ing devices, regardless of the brand or image formatused. The standard sets minimum requirements forhardware, data-link service, networking, messagepresentation, and applications. DICOM 3.0 was de-vised so that several devices meeting the standardcould be organized into a system without customizedinterfaces.
Supplier-specific network architectures are beingreplaced by open architectures that comply withACR/NEMA and ISO/OSI standards. The adoption ofan industrywide standard will allow hospitals to in-stall multisupplier systems and should reduce theexpenses of implementing a totally digital department.To facilitate networking, any new equipment pur-chased should be DICOM compatible.
A facility should choose a system that provides theresolution and performance characteristics that bestsuit its needs. Obtaining a list of users from the manu-facturer and talking with experienced teleradiologistsbefore purchasing a system may prove helpful.
Cost containment
The most critical consideration in purchasing a tel-eradiology system is cost-effectiveness. Teleradiology
is cost-effective only if it reduces a hospital’s expenseswithout adversely affecting patient diagnoses andtreatment or if it improves patient care to a greaterextent than it increases expenses.
Using hardware already in the department can re-duce initial expenditures. In addition, for buyers thatlack the initial capital necessary to purchase an entiresystem, leasing the hardware can be an attractiveoption.
The initial acquisition cost does not accurately re-flect the total cost of owning and operating a teleradi-ology system. Operating costs include hardware/software maintenance, telecommunications and net-working, and upgrade costs. These costs may be offset,however, by reductions in patient transfer and physi-cian travel costs, time savings, and improved qualityof care. On-call teleradiology systems are available forapproximately $15,000 to $20,000; systems used foroverread networks can be purchased for $60,000 to$80,000.
DICOM 3.0 specifies CD-Rs as standard storagemedia. At a cost of less than $1.00/CD-R, using CD-Rscan reduce film costs and the need for film storagespace. Compact disc (CD)-writable drives are availablefor $100 to $500, and CD jukeboxes that hold close to100 GB of data are available for approximately $9,000.
ECRI recommends that, to maximize bargainingleverage, hospitals negotiate pricing for maintenancefees for software and hardware before the system ispurchased. Buyers should also negotiate for a nonob-solescence clause or access to a growth path. Buyersshould also make sure that applications training isincluded in the purchase price of the system. Somesuppliers do offer more extensive on-site or off-sitetraining programs for an additional cost.
In response to the need for integration of teleradiol-ogy systems with existing devices (e.g., imaging equip-ment, PACS), several suppliers have emerged as“systems integrators,” offering computer hardware,specialized software interfaces, medical peripherals,and other interfacing solutions to integrate existingequipment and new teleradiology equipment in thehealthcare organization. In addition, ECRI’s HealthSystems Group can assist in the planning and instal-lation of a teleradiology system.
Stage of developmentAlthough telemedicine was first used in the 1960s,
teleradiology systems were not widely used until the1980s. Early systems used slow-scan TV technology,producing analog signals that required several minutes
for transmission over telephone lines. Digital systemsnow dominate the teleradiology market, and advancesin microcomputers and film-scanning technology allowhigh-speed digitization of film images, lossless datacompression, automatic transmission, and image en-hancement. Teleradiology has benefited from the in-creased availability of relatively inexpensive, powerfulPCs with high-resolution monitors, as well as from theincreased use of digital imaging technologies such asMRI and CT. Installation of teleradiology systems inmobile imaging centers that provide MRI and CT isalso increasing.
Continued improvements in telecommunicationstechnology, microcomputers, compression algorithms,interactive workstations, and digitizing technology, aswell as the demand for faster and more convenientinformation transfer within the medical community,will increase the demand for teleradiology systems anddigital data transmission. The future growth of a na-tional and international telecommunications infra-structure will also facilitate the installation and use ofteleradiology systems. Image and data transmissionvia cable modem is a faster and more cost-effectivealternative to ISDN and T-1 lines. With transmissionrates of 1.5 Mbps, this cable service uses coaxial net-works rather than phone lines. Progressive wavelettechnologies allow rapid access of images over slower-speed lines or via real-time display stations.
Currently, teleradiology systems are most fre-quently used for subspecialty consultations and foroff-site reading of images by on-call radiologists. Theemphasis on managed care, integrated healthcare de-livery networks, and the computer-based patient re-cord has increased the interest in expandingteleradiology applications and the market for teleradi-ology systems. Independent radiologist groups arepartnering with radiology departments at researchinstitutions, teleradiology equipment suppliers, and/ortelecommunications companies to provide specializeddiagnostic services and, in some cases, teleradiologyplatforms and communications services, via overreadnetworks. These networks, which are rapidly growingin response to managed care, typically consist of mul-tiple remote sites that transmit images to facilitieswith fully staffed radiology departments or to radiolo-gist groups.
Most recently, telemedicine — the delivery of medi-cal care to patients worldwide through telecommuni-cations technologies and multimedia applications —has emerged as a new method of healthcare deliveryin Europe, the United States, the Middle East, andother regions. By combining teleconferencing, tele-phone consultations, teleradiology, telepathology, and
other technologies and applications, telemedicine may,in the future, help decrease healthcare costs world-wide, as well as improve the quality of care in somecountries. (See the Product Comparison titled VIDEO-CONFERENCING SYSTEMS, TELEMEDICINE for moreinformation.)
The escalating interest in telemedicine and the suc-cess of ongoing telemedicine projects suggest that themarket for this technology will increase dramaticallyover the next decade, as will the number of programsavailable. Future clinical applications are predicted toinclude mentoring of surgeons, home monitoring ofcritically ill patients, remote control of robotically as-sisted surgery, and advanced healthcare delivery tomore rural areas.
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Hostetler S. How to set up a rural teleradiology net-work. Diagn Imaging 1994 Mar;16(3):75, 79.
Intelligent solutions for radiology data managementand storage. Health Manage Tech 2002 Nov;23(11):20-3.
Orphanoudukis SC, Kaldoudi E, Tsiknakis M. Techno-logical advances in teleradiology. Eur J Radiol 1996Jun;22(3):205-17.
Pauly A. Telemedicine permits long-distance diagno-sis. Diagn Imaging 1993 Feb;15(2):57-9.
Ridley EL, ed. PACS and teleradiology: analysis ofindustry trends and purchasing patterns [strategicplanning report]. Diagn Imaging 1996 Summer.
Sarasohn-Kahn J. Europe AIMs at telemedicine.Healthc Inform 1993 Apr;10(4):62-4.
Society for Computer Applications in Radiology. Un-derstanding teleradiology. Harrisburg (PA): Societyfor Computer Applications in Radiology; 1994.
Stark DD, Crues JV 3rd. Remote diagnosis raisesefficiency of radiology. Diagn Imaging 1993 Nov;15(11):91-104, 179.
Williams OL, Singh SK. Teleradiology: opportunities,problems, implementation. Radiol Manage 1996Jan-Feb;18(1):33-9.
Standards and guidelines
Note: Although every effort is made to ensure that thefollowing list is comprehensive, please note that otherapplicable standards may exist.
American College of Radiology. Standard for teleradi-ology. 1994 (revised 2002).
American College of Radiology/National ElectricalManufacturers Association. Digital imaging andcommunications in medicine (DICOM) part 1: intro-duction and overview [standard]. 1999 (revised2000).
Digital imaging and communications in medicine(DICOM) part 2: conformance [standard]. 1999 (re-vised 2000).
Digital imaging and communications in medicine(DICOM) part 3: information object definitions[standard]. 1999 (revised 2000).
Digital imaging and communications in medicine(DICOM) part 4: service class specifications [stan-dard]. 1999 (revised 2000).
Digital imaging and communications in medicine(DICOM) part 5: data structure and semantics[standard]. 1999 (revised 2000).
Digital imaging and communications in medicine(DICOM) part 6: data dictionary [standard]. 1999(revised 2000).
Digital imaging and communications in medicine(DICOM) part 7: message exchange [standard].1999 (revised 2000).
Digital imaging and communications in medicine(DICOM) part 8: network communication supportfor message exchange [standard]. 1999 (revised2000).
Digital imaging and communications in medicine(DICOM) part 9: point to point communication sup-port for message exchange [standard]. 1999 (revised2000).
Digital imaging and communications in medicine(DICOM) part 10: media storage and file format formedia interchange [standard]. 1999 (revised 2000).
Digital imaging and communications in medicine(DICOM) part 11: media storage application profiles[standard]. 1999 (revised 2000).
Digital imaging and communications in medicine(DICOM) part 12: media formats and physical me-dia for media interchange. [standard]. 1999 (revised2000).
Digital imaging and communications in medicine(DICOM) part 13: print management point-to-pointcommunication [standard]. 1999 (revised 2000).
Digital imaging and communications in medicine(DICOM) part 14: grayscale standard display func-tion [standard]. 1999 (revised 2000).
American Health Information Management Associa-tion. Patient photography, videotaping, and otherimaging [guideline]. 1995 (updated 2001).
Canadian Association of Radiologists. CAR standardfor communication: diagnostic radiology. 1997 (re-viewed 2001).
Center for Devices and Radiological Health. Guidancedocument for the preparation of premarket notifica-tion [501(k)] applications for communications systems
(powered and non-powered environmental controlsystems) [guidance article]. 1995.
Institute of Medicine. Telemedicine: a guide to assess-ing telecommunications in health care. [report].1996.
International Electrotechnical Commission. Guide-lines for implementation of DICOM in radiotherapy[standard]. 2002.
Medical electrical equipment — part 1: general re-quirements for safety [standard]. IEC 60601-1(1988-12). 1988.
Medical electrical equipment — part 1: general re-quirements for safety. Amendment 1 [standard].IEC 60601-1-am1 (1991-11). 1991.
Medical electrical equipment — part 1: general re-quirements for safety. Amendment 2 [standard].IEC 60601-1-am2 (1995-03). 1995.
Medical electrical equipment — part 1: general re-quirements for safety. Section 1. Collateral stan-dard: safety requirements for medical electricalsystems. IEC 60601-1-1 (1992-06). 1992.
Medical electrical equipment — part 1: general re-quirements for safety. Section 1. Collateral stan-dard: safety requirements for medical electricalsystems. Amendment 1. IEC 60601-1-1-am1 (1995-11). 1995.
Medical electrical equipment — part 1: general re-quirements for safety. Section 2. Collateral stan-dard: electromagnetic compatibility — requirementsand tests. IEC 60601-1-2 (2001-09). 2001.
Physician Insurers Association of America. Tele-medicine: an overview of applications and barriers[report]. 1996.
Royal Australian and New Zealand College of Radiolo-gists. Position on teleradiology. 2001.
Royal College of Radiologists. Guide to informationtechnology in radiology, teleradiology, and PACS.2000.
Society for Computer Applications in Radiology. Un-derstanding teleradiology [recommendation]. 1994.
Citations from other ECRI publicationsHealth Devices
Learning about telemedicine services: where to begin?1997 Apr;26(4):178-9.
Telecommunications in healthcare. 1997 Jul;26(7):263-85.
Agfa-Gevaert Ltd (UK) [324525]27 Great West RoadBrentford, Middlesex TW8 9AXEnglandPhone: 44 (20) 82314517Fax: 44 (20) 82314951E-mail: [email protected]: http://www.agfa.co.uk
Agfa Hong Kong Ltd [193770]Cavendish Centre 14/Fl23 Yip Hing StreetWong Chuk HangHong Kong SARPeople’s Republic of ChinaPhone: 852 25559421Fax: 852 28736172E-mail: [email protected]: http://www.medical.agfa.com.hk
BRIT Systems [183017]1909 Hi Line Dr Suite ADallas TX 75207-3322Phone: (214) 630-0636, (800) 230-7227Fax: (214) 630-1638E-mail: [email protected]: http://www.brit.com
DeJarnette Research Systems Inc [155951]401 Washington Ave Suite 1010Towson MD 21204-4821Phone: (410) 583-0680Fax: (410) 583-0696E-mail: [email protected]: http://www.dejarnette.com
DR Systems
DR Systems Inc [187974]9369 Carroll Park Dr Suite BSan Diego CA 92121-3264Phone: (858) 625-3344, (800) 794-5955Fax: (858) 625-3335E-mail: [email protected]: http://www.dominator.com
GE Medical Systems Asia (Japan) [300443]4-7-127 AsahigaokaHino-shiTokyo 191-8503JapanPhone: 81 (3) 425826820Fax: 81 (3) 425826830E-mail: [email protected]: http://www.gemedical.co.jp
GE Medical Systems Europe [171319]283 rue de la Miniereboite postale 34F-78533 Buc CedexFrancePhone: 33 (1) 30704040Fax: 33 (1) 30709855E-mail: [email protected]: http://www.gemedicalsystems.com
Line Imaging Systems [155958]240 Townsend Sq111 South StOyster Bay NY 11771Phone: (516) 624-7400, (800) 330-5463Fax: (516) 624-2049E-mail: [email protected]: http://www.lineimaging.com
McKesson
McKesson Medical Imaging Group [410524]10711 Cambie Rd Suite 130Richmond BC V6X 3G5CanadaPhone: (604) 279-5422, (800) 661-5885Fax: (604) 279-5468E-mail: [email protected]: http://www.mig.mckesson.com
Medasys
Medasys Japan K K [362142]Grand Verger 1012120-6 HigashinaganumaTokyo 206-0808JapanPhone: 81 (42) 3706421Fax: 81 (42) 3706422E-mail: [email protected]: http://www.medasys.co.jp
Medasys SA [202262]Espace Technologique de Saint-AubinImmeuble Le MercuryF-91193 Gif-Sur-Yvette CedexFrancePhone: 33 (1) 69337300Fax: 33 (1) 69337301E-mail: [email protected]: http://www.medasys.com
Merge Technologies Inc [233833]1126 S 70th StMilwaukee WI 53214-3151Phone: (414) 977-4000, (877) 446-3743Fax: (414) 977-4200E-mail: [email protected]: http://www.merge.com
Philips
Philips Medical Systems Asia [188101]30/Fl Hopewell Centre17 Kennedy RoadWanchaiHong Kong SARPeople’s Republic of ChinaPhone: 852 28215888Fax: 852 25276727E-mail: [email protected]: http://www.medical.philips.com
Philips Medical Systems North America [102120]22100 Bothell Everett HwyPO Box 3003Bothell WA 98041-3003Phone: (425) 487-7000, (800) 526-4963Fax: (425) 485-6080E-mail: [email protected]: http://www.medical.philips.com
Philips Nederland bv Medical Systems [152365]Postbus 90050NL-5600 PB EindhovenThe NetherlandsPhone: 31 (40) 2782559Fax: 31 (40) 2780160E-mail: [email protected]: http://www.medical.philips.com
RADIN
RADIN Group GmbHDiv SOHARD AG [407310]Wuerzburger Strasse 197D-90766 FuerthGermanyPhone: 49 (911) 97341270Fax: 49 (911) 97341299E-mail: [email protected]: http://www.radin.de
RamSoft
RamSoft Inc [250071]16 Four Seasons Pl Suite 215Toronto ON M9W 6E5CanadaPhone: (416) 674-1347, (888) 343-9146Fax: (416) 674-7147E-mail: [email protected]: http://www.ramsoft.biz
ViTel Net (Visual Telecommunications NetworkInc) [335217]8201 Greensboro Dr Suite 820McLean VA 22102Phone: (703) 448-0999Fax: (703) 749-9559E-mail: [email protected]: http://www.vitelnet.com
About the chart specificationsThe following terms are used in the chart:
Multimodality: The imaging modalities from which theteleradiology system can acquire, digitize, and/ortransmit images.
Compression ratios: A measure of the degree to whichimage data is compressed to reduce image transmis-sion times and/or data storage requirements. Thehigher the ratio, the more the data is compressed.
Maximum matrix size transmitted: The maximum pixelmatrix size that the system can transmit.
Transmission time for maximum matrix: Transmissiontimes vary depending on the size of the image ma-trix, the type of compression and compression ratio,and the transmission method.
ROI magnification: The ability to demarcate and mag-nify a region of interest in the image.
List price, std configuration: The prices that appear inthe charts represent a wide range of system configu-rations. Prices vary depending on user-selected op-tions and customizations. Some of the pricinginformation in this chart has been derived from listprices reported on a supplier’s Web site or to ECRI’sin-house information services by healthcare institu-tions and by suppliers. A footnote identifies theseprices. In these instances, suppliers have declined toprovide HPCS directly with prices and may not haveconfirmed the information. These prices are estimatesand may or may not reflect discounts, options, spe-cial packages, and multiple-unit sales. They areprovided for the convenience of our readers.
Abbreviations:
ACR — American College of Radiology
ARO — After receipt of order
ATM — Asynchronous transfer mode
B/W — Black and white
CCD — Charge-coupled device
CD-R — Recordable compact disc
CE mark — Conformite Europeene mark
CR — Computed radiography
CRT — Cathode ray tube
CT — Computed tomography
DAT — Digital audiotape
DHCP — Dynamic Host Configuration Protocol
DICOM 3.0 — Digital Imaging and Communica-tions in Medicine Standard
DR — Digital radiography
DSA — Digital subtraction angiography
DSL — Digital subscriber line
EN — European Norm
FDA — U.S. Food and Drug Administration
FDDI — Fiber Distributed Data Interface
FTP — File transfer protocol
GS — Gepruefte Sicherheit
GUI — Graphical user interface
HIS — Hospital information system
HL7 — Health Level 7
HW — Hardware
IEEE — Institute of Electrical and Electronics Engi-neers
ISDN — Integrated Services Digital Network
ISO — International Organization for Standardiza-tion
JPEG — Joint Photographic Experts Group; a datacompression standard
SCU/SCP — DICOM Service Class User/ServiceClass Provider
SECAM — Sequential Couleur avec Memoire; color-television standard of 625 scan lines and 25 in-terlaced frames per second
SVGA — Super Video Graphics Array
SW — Software
TCP/IP — Transmission Control Protocol/InternetProtocol
UPS — Uninterruptible power supply
US — Ultrasound
VAC — Volts of alternating current
VPN — Virtual private network
WAN — Wide area network
WIP — Work in progress
XA — X-ray angiography
Note: The data in the charts derive from suppli-ers’ specifications and have not been verified throughindependent testing by ECRI or any other agency.Because test methods vary, different products’ specifi-cations are not always comparable. Moreover, prod-ucts and specifications are subject to frequent changes.ECRI is not responsible for the quality or validity ofthe information presented or for any adverse conse-quences of acting on such information.
When reading the charts, keep in mind that, unlessotherwise noted, the list price does not reflect supplierdiscounts. And although we try to indicate whichfeatures and characteristics are standard and whichare not, some may be optional, at additional cost.
For those models whose prices were supplied to usin currencies other than U.S. dollars, we have alsolisted the conversion to U.S. dollars to facilitate com-parison among models. However, keep in mind thatexchange rates change often.
Need to know more?For further information about the contents of this
Product Comparison, contact the HPCS Hotline at +1(610) 825-6000, ext. 5265; +1 (610) 834-1275 (fax); [email protected] (e-mail).
IMPAX Web 1000 RadWorks 6.0 WebViewer 5.1 Radiology Workbench
WHERE MARKETED Worldwide Worldwide Worldwide USA
FDA CLEARANCE Yes Yes Yes Yes
CE MARK (MDD) Yes Yes Yes No
MULTIMODALITY All modalities CT, MRI, US, CR, CR, CT, MR, US, NM, All DICOMx-ray, DR, NM, DX, XA, RF, DR, DX, MG,PT, VL, PR, SR, KO IO
IMAGE CAPTURELight box Not specified No NA No
Size, cm (in) Not specified NA NA NAVideo framegrabber Not specified Yes NA High resolution
Resolution Not specified All resolutions NA 1024 x 1024,512 x 512
Direct digitalimage capture Not specified Yes NA Yes
Film digitizer(s) Yes Canon, Lumisys, How- NA Kodak Lumiscan,tek, Vidar, Array, VidarTWAIN compliant
Scan speed, sec 45 for 2K x 2K Digitizer dependent NA 30, 6-20Shades of gray 4,096 Digitizer dependent NA 4,096 (3584 x 4352)
MODEM SPEEDS, Kbps 28.8, 56, ISDN, DSL, All speeds for ana- All speeds for ana- 14.4, 19.2, 28.8,cable modem log, ISDN, ATM, T-1 log, ISDN, ATM, T-1 ISDN/T-1/ATM *
IMAGE TRANSMISSIONSending computer PC server Intel Intel Intel, Windows based **
Compression ratios User selectable, 3:1 lossless, user- Client-side select- User selectable;wavelet, lossy or selectable lossy able lossy wavelet gradual transmissionlossless wavelet and JPEG and JPEG available
Maximum matrix sizetransmitted 4K x 4K No maximum Connection/compres- 2560 x 2048;
sion dependent 4K x 4K ***Transmission time
for maximum matrix Depends on compres- Connection dependent Connection dependent Connection dependentsion & transmission
HL7 COMPLIANT Yes Not specified Not specified Optional
Colons separate data on similar models of a device. This is the first of* Also 33.6 Kbps, 56 Kbps, cable modems, and DSL. three pages covering** Also RS/6000 with appropriate network adapter card. the above model(s).*** 4K x 4K with optional 50-micron spot-size laser. These specifications
OPTIONS Cardiology display Multiple background None specified RAID (fast-accesstools, integration synchronous, send/ disk), voice dicta-into 3rd-party receive, unlimited tion, waveletproducts such as EPR sites, reports on compression, voice
all actions of send- transcriptionand-receive sites,view as arrive
Colons separate data on similar models of a device. This is the second of* Also RS/6000 with appropriate network adapter card. three pages covering** Also shutters, image-enhancement filters, key images/frames, hanging protocols. the above model(s).
IMPAX Web 1000 RadWorks 6.0 WebViewer 5.1 Radiology Workbench
SYSTEM SECURITY Password w/auto ex- Group and individual Windows NT authenti- User ID, group,piration, auto log- user IDs, U.S. Dept. cation, SSL for data firewalls availableoff, password- of Defense transfer, query re-assigned privileges * C2-level security strictions, data log
POWER REQUIREMENTS 110-240 VAC, PC dependent PC dependent 120 VAC, 60 Hz50-60 Hz
PLANNING & PURCHASEList price,
std configuration $45,000-180,000 $15,357 Not specified $10,000+
Warranty 1 year 1 year 1 year 1 year
Delivery time, ARO 45-60 days <4 weeks <4 weeks 2 weeks, SW; 1 monthLumisys scanner
depends on config per year per yearSoftware Contract available, 10% purchase price 10% purchase price 12% purchase price
depends on config per year per year per yearTraining w/purchase Demo disk available Custom Custom Not specified
Telephone support 24 hr, toll-free Optional remote Yes 24 hr, toll-freenumber maintenance by phone hotline, Internet
Year first sold 1994 1994 1998 1994
Number installed >300 worldwide >9,000 >75 ~120
Last softwareupdate November 2002 December 2001 July 2000 December 2001
Fiscal year January to December January to December January to December January to December
OTHER SPECIFICATIONS DICOM compatible; 24-bit true-color Image enhancement None specified.upgradable, images; stand-alone, also includes multi-scalable store and forward, frame display, user-architecture; workgroup configura- selectable compres-PC-based viewing and tions possible; Web sion, modality-basedWeb viewer viewer and archive compression qualityavailable. available. GMP and factor, user
ISO 9001 conformance profiles, and userstatements permissions.available.
Colons separate data on similar models of a device.* Also data access controls, 3rd-party user authentication, comprehensive audit trail, 128-bit SSL encryption of DICOM header
Colons separate data on similar models of a device. This is the first of* Specifications current as of March 2002. three pages covering** Also RAW and Sun Raster. the above model(s).*** 2-5:1 lossless to 100:1 lossy wavelet, selectable : 2:1 lossless, 3:1 JPEG lossless, 7:1 lossy, lossy wavelet selectable. These specifications
Colons separate data on similar models of a device. This is the second of* Specifications current as of March 2002. three pages covering** Depends on configuration. the above model(s).
Delivery time, ARO 1-2 weeks 90 days 120 days 90 days
Monthly maintenanceHardware Based on Not specified 16% of purchase Service contract
configuration price for 100% HW availableSoftware Based on Not specified Upgrade coverage Maintenance contract
configuration availableTraining w/purchase 40 hr on-site, Tailored to customer 2-7 days, based on On-site
customizable needs installation sizeTelephone support Toll-free hotline, 24 hr service 24 hr, toll-free 24 hr, 7-day, toll-
Web support, upgrade support hotline free help deskYear first sold 1994 1991 1992 1993
Number installed Not specified Thousands 165 >7,800
Last softwareupdate November 2000 Twice annually or as March 2003 September 2002
neededFiscal year January to December January to December January to December January to December
OTHER SPECIFICATIONS Software only; ACR-NEMA 2.0 CCOW compliant; full Scalable design todistributed and conformant; protocol PACS available. enterprise PACS;supported with conversion from image-distributionrecommended minimum various proprietary networks; flexibleconfiguration. manufacturers. DICOM-transfer or
WHERE MARKETED Worldwide USA USA Europe, NorthAmerica, SouthAmerica
FDA CLEARANCE Yes Yes Yes Yes
CE MARK (MDD) Yes Not specified Not specified Yes
MULTIMODALITY All DICOM IODs Any video-based or Any video-based or CT, MRI, US, DSA,including DX, MG DICOM modality, film DICOM modality, film NM, CR, DR, RF, SC
IMAGE CAPTURELight box No No No Yes
Size, cm (in) NA NA No 35 x 43 (14 x 17)Video framegrabber Optional Yes No Yes
Resolution 1024 x 1024, 2K x 2K NA 1024 x 1024;512 x 512 512 x 512 available
Direct digitalimage capture Optional DICOM No Yes
Film digitizer(s) Laser, CCD Laser, CCD No Laser, CCD
Scan speed, sec 75, 115 lines/sec 30-50 No 13-60Shades of gray 4,096 4,096 No 256 or 4,096
MODEM SPEEDS, Kbps 128 ISDN; 56 POTS; All, T-1, DSS, ISDN, All, T-1, DSS, ISDN, Up to 56TCP/IP WAN config DSL, cable, Internet DSL, cable, Internet
IMAGE TRANSMISSIONSending computer Sun, Intel PC PC PC Windows NT/2000/XP
Compression ratios DICOM, JPEG, pro- Up to 60:1, modality Up to 60:1, modality Nonegressive wavelet * and user selectable and user selectable
Maximum matrix sizetransmitted 2048 x 2560 4K x 5K 4K x 5K Up to 2K x 2.5K
Transmission timefor maximum matrix Varies with Varies with medium Varies with medium 0.1-3 sec, depending
available bandwidth and compression and compression on configurationWAN transmission
tate, orientation, invert, preset invert, preset level, invert/next/prior image, window/level or window/level or mirror, rotate,patient exam, sin- user-adjustable user-adjustable simultaneousgle/multi-image flip/rotate, cine, flip/rotate, cine, receive/view images,display format, vid- stack, zoom, magni- stack, zoom, magni- sharpen/smooth,eo invert, window/ fy, ROI heat units, fy, ROI heat units, annotation, ROIlevel, annotation, measurements, measurements, measurement, full-measurement, cine Doppler color Doppler color resolution magnify-mode/display, man- ing glass, side-by-ual/auto, worklist, side comparison,integral RIS/PACS pseudocolor, routedesktop, spine label † reports with images
OPTIONS Centricity Enter- None specified Transmit, HL7 Upgradable to PACS,prise archive, Web videoconferencing,portal, RIS voice recognition,
document scanning,HIS/RIS interface
Colons separate data on similar models of a device. This is the second of* 2048 x 2560 (CRT, LACD); 1200 x 1600 (CRT, LCD). three pages covering** Based on display protocol or manual. the above model(s).*** And user choice. These specifications† Also communication tools, MIP/MPR, advanced tools for large data-set handling, advanced postprocessing applications. continue onto the
SYSTEM SECURITY User ID, User ID; multilevel HIPAA standards User ID, multilevelSSL encryption on password available password, advancedWeb security features
optional
POWER REQUIREMENTS 120/220 VAC, 120 VAC, 60 Hz, 120 VAC, 60 Hz, 110/220 VAC,50/60 Hz 12 A, 400 W 12 A, 400 W 50/60 Hz
PLANNING & PURCHASEList price,
std configuration $5,000+ $1,800+ Not specified $10,000-75,000
Warranty 1 year, hardware 1 year 1 year 1 year
Delivery time, ARO Variable 30-120 days 60-180 days 60-120 days
Monthly maintenanceHardware Not specified Optional Optional Configuration
dependentSoftware Not specified Optional Optional Configuration
dependentTraining w/purchase Variable Included Included 1-10 days on-site
Telephone support 24 hr, toll-free 24 hr, 7 days 24 hr, 7 days 24 hr, toll-freehotline available available hotline
Year first sold 1993 1988 2002 Not specified
Number installed 10,000+ worldwide 940+ transmit sites, Not specified 2404,500+ receive
Last softwareupdate September 2002 October 2001 November 2002 Not specified
Fiscal year January to December Not specified Not specified January to December
OTHER SPECIFICATIONS None specified. None specified. None specified. Compatible with allimaging modalities;scalable by price/performancearchitecture; basedon industryoperating system anddatabase standards;document scanning;RAID; UPS; HIS/RISinterface; DICOM3.0.
Colons separate data on similar models of a device.
MODEL INTEGRATED MODULAR INTELLIRAD INTELLIRAD KODAKFAILED TO RESPOND * FAILED TO RESPOND *RADIN Integrated ePAX Web Voyager Imaging DirectViewImage Distribution Teleradiology System
WHERE MARKETED Worldwide Asia, Australia, Asia, Australia, WorldwideEurope Europe
FDA CLEARANCE Yes No No Yes
CE MARK (MDD) Yes No No Yes
MULTIMODALITY CR, CT, MR, US, RF, Via DICOM, DICOM All, image capture AllSC, RT, NM, PET, Capture or Voyager w/DICOM 3.0, frameDX, MG, XA 2x/3x teleradiology grab, film digitizer
IMAGE CAPTURELight box No No No Yes
Size, cm (in) NA NA NA 35 x 43 (14 x 17)Video framegrabber Optional Via Voyager 2x/3x Yes High resolution
Resolution Not specified 1K x 1K, 4K x 4K 1K x 1K, 4K x 4K Not specifiedby framegrabbing by framegrabbing
Direct digitalimage capture DICOM DICOM DICOM Yes
Film digitizer(s) CCD Support through Laser, CCD, LED, all Kodak-Lumisys,Voyager x work- TWAIN driver- Vidarstation compatible scanners
Scan speed, sec 9-44 9/1K, 19/2K, 39/4K 9/1K, 19/2K, 39/4K Not specifiedShades of gray 256, 4,096 4,096, 12-bit 4,096, 12-bit Not specified
MODEM SPEEDS, Kbps ISDN and up 33.6 ISDN, PSTN, 33.6 ISDN, PSTN, 56, ISDN, DSL, cabledepends on modem depends on modem
IMAGE TRANSMISSIONSending computer Intel PC IBM-compatible PC IBM-compatible PC PC compatible
Compression ratios 2:1 lossless, user- Lossless or lossy 30:1 user select- User selectableselectable lossy 30:1 compression able, wavelet or
JPEGMaximum matrix size
transmitted Unlimited Unlimited Unlimited 2500 x 2000
Transmission timefor maximum matrix Depends on size and Connection dependent Connection dependent Varies
line speedWAN transmission
Telephone line Yes TCP/IP protocols TCP/IP protocols YesMicrowave Not specified TCP/IP protocols TCP/IP protocols YesSatellite Yes TCP/IP protocols TCP/IP protocols YesISDN Yes TCP/IP protocols TCP/IP protocols YesT-1 Yes TCP/IP protocols TCP/IP protocols YesSwitched-56 Not specified TCP/IP protocols TCP/IP protocols YesATM Yes TCP/IP protocols TCP/IP protocols YesOthers None specified Any network that Any network that SMDS
MODEL INTEGRATED MODULAR INTELLIRAD INTELLIRAD KODAKFAILED TO RESPOND * FAILED TO RESPOND *RADIN Integrated ePAX Web Voyager Imaging DirectViewImage Distribution Teleradiology System
IMAGE RECEPTIONReceiving computer Intel PC, Windows PC based IBM PC PC compatible
OS, InternetExplorer 5.0/5.5/6.0
Storage Not specified Unlimited 75 GB HD, CD-RW, VariesDVD, MOD, RAID,FDDI, any standardnonproprietary PC-based hardware
Memory, MB Not specified 1 Gh RAM 256 RAM or greater, Varies128 MB RAM minimum
Maximum number ofimages stored Varies Unlimited Unlimited via CD-RW, Varies
MOD; depends onhardware
IMAGE DISPLAYNumber of display
stations supported Up to 100 Unlimited Web appli- Unlimited Unlimited(simultaneous) cation support
Number of monitorsper station 1 See footnote ** 2 1
Resolution, pixels 1024 x 768 minimum Up to 2048 x 2048, Up to 2048 x 2048, From 800 x 600 todepends on monitor depends on monitor maximum supportedand graphics card and graphics card by MS Windows
driversGrayscale levels 256, true color 256, depends on 256, depends on 256; 24- and 32-bit
monitor monitor color palettesSplit-screen images 1 to 16 User selectable User selectable User selectable,
rotate, mirror, text zoom, annotation, zoom, annotation, contrast/brightness,annotations, rotate, mirror, auto rotate, mirror, auto invert/revert, pan/measurements window/level, flip window/level, flip zoom, flip, rotate,
horizontal/vertical, horizontal/vertical, audio note, auto re-sharpen, emboss, sharpen, emboss, redial & reconnect,edge-enhancement edge-enhancement annotate, edgemeasurements, measurements, sharpen, hangingprotractor, gamma protractor, gamma protocols, pushescorrection correction images from server
to client of on-call, client can usepull mode for ad hoc
OPTIONS None specified Video teleconferenc- Video teleconferenc- Autoforwarding,ing, aggregation ing, aggregation calendar(more than 1 (more than 1phone line), wavelet phone line), waveletcompression, 12-bit compression, 12-bitimaging, DICOM SCU, imaging, DICOM SCU,DICOM print DICOM print
Colons separate data on similar models of a device. This is the second of* Specifications current as of March 2002. three pages covering** 1 via Web application; 2-monitor support via Voyager 3.x workstation. the above model(s).
MODEL INTEGRATED MODULAR INTELLIRAD INTELLIRAD KODAKFAILED TO RESPOND * FAILED TO RESPOND *RADIN Integrated ePAX Web Voyager Imaging DirectViewImage Distribution Teleradiology System
SYSTEM SECURITY User name, password, User ID, image User ID, image Password protection,encryption encryption during encryption during administrator logon
transmission transmission option
POWER REQUIREMENTS Configuration Universal Universal Not specifieddependent
PLANNING & PURCHASEList price,
std configuration Not specified AUS$9,500 (US$4,922) AUS$9,500 (US$4,922) Not specifiedSW only SW only
Number installed 300+ ~70 ~70 >2,300 installationsworldwide
Last softwareupdate February 2002 June 2001 June 2001 February 2002
Fiscal year January to December Not specified Not specified January to December
OTHER SPECIFICATIONS Web-based; Windows 2000/NT. Windows 2000/NT. Remote retrieval;customizable; simultaneously send/integratable into receive multipleRIS; referring- sites; support forphysician paper laser printer;friendly. print/fax report
LAN protocols used Ethernet, TCP/IP, Ethernet, TCP/IP Ethernet, TCP/IP IEEE 802.3, TCP/IP,Token Ring, FDDI, EthernetDSL, T-1
AVAILABLE INTERFACES Yes PACS PACS CIS, RIS, HIS, PACS
EXPANDABLE TO PACS Yes Yes Yes Yes
DICOM 3.0 CONFORMANT Yes Yes Yes Yes
HL7 COMPLIANT WIP ALI UltraPACS ALI UltraPACS Yes
Colons separate data on similar models of a device. This is the first of* Specifications current as of March 2002. three pages covering** Specifications current as of November 2000. the above model(s).
These specificationscontinue onto thenext two pages.
invert, rotate, window/level tool, tocols, cross-study window/level, ROImultiple formats, flip, invert image, linking, image window/level,pan, annotation, brightness registration, stack- histogrammeasurement, patient selectable, pre- mode viewing plus equalization,information box, defined the features for ALI photomode,cine mode, magnification up to UltraWEB annotationconferencing, ROI, 400%filters
OPTIONS None specified Not specified Case sign-off Simultaneoustelemedicine andteleconference;real-timetransmission anddata reception
Colons separate data on similar models of a device. This is the second of* Specifications current as of March 2002. three pages covering** Specifications current as of November 2000. the above model(s).
Colons separate data on similar models of a device. This is the first of* Specifications current as of March 2002. three pages covering** WinRSAF, WinFilm, WinPACS NetDisplay, WinPACS TeleDisplay, DARWIN, WinPACS WebDisplay, WinDigi, WinPaper. the above model(s).*** Film digitizer also. These specifications† 15 sec POTS, 6 sec ISDN, 2 sec Internet (S12 x S12 CT). continue onto the
Image-enhancementfeatures Pan, magnify, win- ROI magnification, ROI magnification, 100% maginification
dow/level, flip/ro- pan/zoom, window/ pan/zoom, window/ or greater, 8 view-tate, measure dis- level, scroll level, scroll ing formats, windowtance, ROI, mag width/length,glass, DICOM anno- rotate, magnify,tation, autosort im- measure images (seg-ages by contrast or ments, angles,echo, slice sequence areas, includingby location/time, Hounsfield values),window/level preset, cine viewer, view 2dual display for im- studies side by sideage comparison, var in split-screen modemagnification
OPTIONS None None specified None specified Supports full spect-rum of radiology &cardiology, Web-based distribution,Enterprise solutioncombines cardiology& radiology into one
Colons separate data on similar models of a device. This is the second of* Specifications current as of March 2002. three pages covering** WinRSAF, WinFilm, WinPACS NetDisplay, WinPACS TeleDisplay, DARWIN, WinPACS WebDisplay, WinDigi, WinPaper. the above model(s).*** Also support color. These specifications
MODEL MEDPACS MERGE MERGE PHILIPSFAILED TO RESPOND *
Various Models ** Fusion Server/ PhyR Works EasyWebWorkstation
SYSTEM SECURITY Standard window User ID and password User ID User ID, passwordsecurity; opt push- with auto expira-only security; RCS tion, auto logoff,encryption password privileges
std configuration RSFA system $7,500- Not specified Not specified Not specified$17,500 ***
Warranty 1 year 1 year 1 year 1 year
Delivery time, ARO 30 days Not specified Not specified Not specified
Monthly maintenanceHardware Not specified Not specified Not specified Depends on
configurationSoftware $200 plus prior Not specified Not specified Depends on
year's support cost configurationTraining w/purchase Advanced training Not specified Not specified Yes
availableTelephone support Business hours, 24 hr, toll-free 24 hr, toll-free Yes
pager after hours service support service supportYear first sold 1989 2002 1999 1998
Number installed >1,000 Not specified Not specified 140
Last softwareupdate October 2002 NA NA February 2002
Fiscal year January to December January to December January to December January to December
OTHER SPECIFICATIONS WebDisplay allows None specified. None specified. 6 viewers for Easy-image review via the Web 4.1 (each viewerInternet from will launch auto-anywhere; matically, dependingview images as they on image type andare received; mag licenses); general,glass; full DICOM conference,annotation; sort cardiologyimages by contrast (high speed), ECG,or echo; slice EPR image,sequence by location and reportor time; window/ viewers; connect tolevel presets; quad EasyLink (RIS) todisplay for image access radiologycomparison of old/ reports; report innew, contrast/non- 3 sections: patient,contrast, echo1/2; study, and reportinteractive information; reportscine of stacked can be printed orimages; images can saved to local PCbe e-mailed, made (depending oninto BMPs, printed; rights).DICOM class to lasercamera or storage.
Colons separate data on similar models of a device.* Specifications current as of March 2002.** WinRSAF, WinFilm, WinPACS NetDisplay, WinPACS TeleDisplay, DARWIN, WinPACS WebDisplay, WinDigi, WinPaper.*** Display software $2,500-$5,000; display software and hardware $6,000-$45,000.
AVAILABLE INTERFACES RIS, HIS, PACS PACS, RIS, HIS RIS, HIS, DICOM HIS, RIS, PACSmodality worklist,HL7, IHE
EXPANDABLE TO PACS Yes Yes Yes Yes
DICOM 3.0 CONFORMANT Yes Yes Yes Yes
HL7 COMPLIANT With PACS broker Yes Yes Optional
Colons separate data on similar models of a device. This is the first of* Also VL and PET. three pages covering** JPEG lossy, JPEG 2000 lossy (variable ratio). the above model(s).
These specificationscontinue onto thenext two pages.
IMAGE RECEPTIONReceiving computer IBM PC Windows 98/ME/NT/ Windows NT/2000 PC Windows/2000/XP
2000/XP
Storage 20 GB hard disk 0-66 GB 26 GB hard disk; ≥8 GBhard drive, floppy, floppy; CD-R; DVD-RCD-R, DVD-RAM
Memory, MB 256 256-4,126 16 minimum ≥256
Maximum number ofimages stored None, on-demand Variable 2,000 to unlimited, Not specified
architecture depends on config-uration
IMAGE DISPLAYNumber of display
stations supported Up to 500 simul- Unlimited Unlimited Unlimitedtaneous
Number of monitorsper station 1, 2 1 to 5 1 to 4 1 to 4
Display monitor Yes Color, grayscale Monochrome, color B/W; color optionalSize 21" recommended Variable 15", 17", 19", 21" 17" to 21"
Resolution, pixels 1024 x 768 and up 1024 x 768, 1200 x 1600, 1280 x Up to 4000 x 35001100 x 1600, 1024, 1700 x 2300,1536 x 2048, 2000 x 25001048 x 2156
Grayscale levels 256 256-1,024 256 or 4,096 4,096
Split-screen images Various layouts 1, 2, 8, or 1 to 64 or more Yesthumbnail *
side comparison,pseudocolor, routesreports w/images,hanging protocols
OPTIONS None specified Archiving Upgradable to PACS; Archiving, MPR,videoconferencing, grand rounds,voice recognition, orthopedicdocument scanning, templates, defaultHIS/RIS interface display protocols,
3rd-party clinicalapplications
Colons separate data on similar models of a device. This is the second of* Variable configurations available, depending on display-card matrix size. three pages covering
the above model(s).These specificationscontinue onto thenext page.
SYSTEM SECURITY User name, password, User ID, security User ID, multilevel User ID, password/user groups, user password password, advanced biometrics swipecardlevels, data encryp- security featurestion optional
POWER REQUIREMENTS 170/220 VAC, 110/220 VAC, 110/220 VAC, Not specified50/60 Hz 50/60 Hz 50/60 Hz
PLANNING & PURCHASEList price,
std configuration $16,000 and up Depends on $10,000-75,000 Not specifiedconfiguration
Warranty 1 year 1 year 1 year 1 year
Delivery time, ARO 1-3 months 6-8 weeks 60-120 days Not specified
Monthly maintenanceHardware Depends on Depends on Configuration Not specified
configuration configuration dependentSoftware Depends on Depends on Configuration Not specified
configuration configuration dependentTraining w/purchase 2-5 days on-site Yes Custom Not specified
Telephone support 24 hr toll-free Yes Yes Not specifiedhotline
Year first sold 2000 1998 1987 1990
Number installed >450 Not specified >200 worldwide >2,200
Last softwareupdate July 2002 December 2002 February 2003 April 2002
Fiscal year January to December January to December January to December May to April
OTHER SPECIFICATIONS Web-based solution; Patient database; Compatible with all None specified.selectable compres- scheduling; hard imaging modalities;sion; image delivery copy; reporting; scalable by price/on demand; data administrative re- performance archi-encryption; wavelet ports and communica- tecture; based oncompression. tion logs; demo industry operating
available; DICOM system and databaseprinting; Windows standards; optionalprinting; CD RAID backup, UPS;writing. DICOM 3.0.
Colons separate data on similar models of a device.
MODEL SIEMENS VEPRO VITEL NETFAILED TO RESPOND * FAILED TO RESPOND *SIENET MEDIMAGE ViTel Net System
SYSTEM SECURITY User ID, password User ID, password, User ID, multilevelfingerprint password
POWER REQUIREMENTS 90-122 VAC or 180- 110/220 VAC, 120 VAC, 60 Hz,264 VAC, 47-63 Hz 50/60 Hz 30 W
PLANNING & PURCHASEList price,
std configuration Not specified $4,500+ $35,000-150,000
Warranty Not specified 1 year 1 yr, HW/SW; extend-ed warranty opt
Delivery time, ARO Not specified 1 month 30-45 days
Monthly maintenanceHardware Not specified Available 15% of price, annual
(covers maintenance)Software Not specified Available 15% of price, annual
(covers license)Training w/purchase Not specified 1 day, user 2-3 days
customizableTelephone support Not specified 24 hr 24 hr, 7-day, toll-
freeYear first sold 1992 1991 1994
Number installed Not specified 2,000 125
Last softwareupdate June 1999 August 2002 November 2001
Fiscal year October to September January to December January to December
OTHER SPECIFICATIONS Seamless integration Sold with or without None specified.into PACS. integrated PACS;
automatic send/receive stations;logbook forautomatic invoice;full error checking;receiving SWis available forfree; also transmitscardio films andother documents.
Colons separate data on similar models of a device.* Specifications current as of March 2002.