Zero-footprint viewer + server-side rendering: Building a true Web PACS

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 - zerofootprint

When the development team at Viztek convened to reimagine its current PACS release, the first thing that went onto the white board was “zero footprint viewer—no exceptions.” To make that happen, Viztek approached the company that holds the exclusive patent on the idea of presenting a DICOM image in a Web page to obtain a license from Heart Imaging Technology.

Accessibility, however, was not the endgame: Viztek also sought a complete diagnostic experience with full viewing functionality—so server-side rendering was added to the mix. In a Q & A with Steve Deaton, vice president, Viztek, Raleigh, N.C., ImagingBiz took a look under the hood of the company’s new Exa-PACS release.

Steve Deaton, Vice President, Viztek, Raleigh, N.C.

What is a zero footprint (ZFP) viewer and why was it so important to Viztek?

Deaton: A true zero footprint viewer is a cloud-based viewer that does not require any additional  installs at the local workstation to support full diagnostic toolsets.

A zero-footprint viewer exists 100% within a Web browser with no add-ons, widgits, Active-X controls or anything to give the computer any other problem (or reason) to butt heads with any other program. It’s just a viewer— though powerful and diagnostic—that exists solely within a Web page: If you log into a Web site with credentials, you see your list of studies.

True ZFP is substantially different from other PACS viewers, which require that additional program(s)be installed, triggering the need for administrative privileges That means someone from IT has to come up and log you in to be able to install or update it.

Since ZFP operates in a Web browser, it will work on Apple computers, Microsoft operating system, even Linux, whatever workstation a facility wants to roll out, it will work natively with that.

The market is craving the 2.0 version of accessibility. Radiologists want all of their tools and all of their functions, whatever computer they sit down at, whether it is a one-month-old high-end computer or a five-year-old laptop. ZFP is ideal for both the radiologist and the IT team.

Is Exa-PACS primarily a software solution or is hardware involved as well?

Deaton: It has server-side rendering. The typical PACS viewer has to download the whole DICOM dataset and likely  uses pre-fetching or auto-routing to get studies to each workstation intelligently.

Since everything exists within a Web page with this new product, the combination of it being zero footprint and server-side rendering means that there is no more need to pre-fetch or auto-route studies. A radiologist sitting at a hotel or a hospital logged into another site with a mediocre Internet connection can open a 6,000-slice CT study, and it will open up in 3 seconds with no prefetching or auto routing, and you will be able to see full diagnostic quality and use all of the advanced tools—MPR, MIP, synchronized scrolling.

This is not a lite product that has just opened up accessibility. This is a full-on diagnostic instantaneous viewer over any Internet connection, because it is zero-footprint and utilizes server-side rendering—we took those two things and put them together to make an amazing product.

If this patent has been around for a decade, why aren’t zero footprint viewers more prevalent?

Deaton: Heart IT had the patent for many years, but code languages that are robust enough for diagnostic zero footprint have not existed until pretty recently. Over the last few years, some code languages like HTML 5 have helped to get zero-footprint moving, but not diagnostic quality – that’s the real difference.

The market is just now on the cutting edge of heating up, and technology can support these ideas if you have a sharp programming staff. New coding languages have recently been invented, and when leveraged, you can now write very complex programs into a Web page natively—like a whole DICOM viewer with MIP and MPR and all of that. Every year our programmers attend conferences such as those hosted by Google and Facebook. While we are not going to get into creating a search engine or a social media Web site like Facebook, we are going to become aware of other coding trends that can benefit a high-transactional, busy, busy market.

What functionality does this ZFP technology have that others don’t?  

Deaton: The full diagnostic capability is big; multi-monitor support is very big, the fact that we have a solution to integrate voice dictation and voice recognition while still remaining ZFP is huge.