When contemplating implementation of an enterprise-wide advanced visualization solution, expect to hear many concerns voiced by various stakeholders—and look for the CIO’s voice to be front and center among them. Topping the CIO’s list of concerns will most probably be whether (and to what extent) the proposed advanced visualization solution is scalable.
Duleep L. Wikramanayake is CIO for Advanced Radiology Consultants, Trumbull, Connecticut. He says, “If scalability is limited or missing, I wouldn’t even consider adopting that particular solution. The lack of scalability will leave you flat-footed. You’ll discover that your physicians love advanced visualization and will use it more and more often; soon, you’ll be fielding requests for more users and requests to save the studies longer. Only if you have scalability can you accommodate all this.”
Another CIO concern is proprietary versus open-source technology. “The best advanced visualization solutions in an enterprise environment are those that are as nonproprietary as possible,” Wikramanayake says. “Here’s why: Say you have an advanced visualization solution that is based on proprietary technology. It might be ideal for your needs, but then the brains behind that proprietary product decide to leave the company. With them go the company’s potential for making future enhancements to that product. Now you’re stuck with a solution that becomes increasingly less viable over time. You avoid all that by buying a solution built from off-the-shelf components.”
Advanced Radiology Consultants first needed an advanced visualization solution in 2005, having recently acquired a multislice CT scanner; that need was satisfied by procuring a lone thick-client workstation. “I’m sorry, but a thick client, from my perspective, is ugly,” Wikramanayake says. “It’s just very hard to support if, as we are, you’re a distributed organization that acquires images anywhere and then reads them anywhere.”
The problem with Advanced Radiology Consultants’ thick-client workstation was accessibility—the lack of it, to be precise. Because there was only one workstation, not every radiologist and technologist who wanted to use advanced visualization could freely do so. If the workstation was busy, users had to wait their turns. “That’s how it goes with a thick-client model: Access points are usually very limited, and they are limited because workstations are so very expensive,” Wikramanayake says. “We have 20 radiologists and about 75 technologists in our group. Clearly, one workstation was going to be inadequate.”
Advanced Radiology Consultants—one of the nation’s oldest imaging groups, and among Connecticut’s largest—owns modalities capable of generating advanced visualization studies at each of its eight imaging centers and at Bridgeport Hospital (where the group is contracted to provide full-time coverage). The multislice images are distributed and archived via PACS.
Earlier this year, Advanced Radiology Consultants replaced that lone advanced visualization workstation with a Visage CS thin-client solution from Visage Imaging, Andover, Massachusetts. One of its selling points was that Advanced Radiology Consultants could implement this product without the need to make changes to its IT infrastructure. “The product was basically plug ‘n’ play,” Wikramanayake says. “Visage is Web based, so if you have browser capability, you can easily bring it aboard—all you need is an Internet connection and an IP address. It’s a remarkably clean application, and very well supported. Visage’s thin client also works on any workstation, desktop computer, or laptop. As long as what you’re using connects to the Internet, you can access and use advanced visualization.”
It helped that Advanced Radiology Consultants’ IT infrastructure is about as robust as it comes. “Our group recognized, some years ago, that modern imaging is as much dependent on cutting-edge IT as it is on innovative radiologic equipment, and so we invested accordingly,” Wikramanayake says. That investment resulted in a gigabit network across the Advanced Radiology Consultants enterprise—270 miles of dark fiber connecting all sites by means of a synchronous optical networking ring configuration. “Any advanced visualization solution needs bandwidth of at least 20 megabits to function properly. Otherwise, as you attempt to deliver the slices to the user, bottlenecks will form,” Wikramanayake says. “That’s true of both thin-client