Arlington-based Virginia Hospital Center (VHC) performs nearly 200,000 imaging studies annually, between its cardiology and radiology departments. Behyar Ghahramani, manager of medical systems engineering at VHC, estimates that cardiology accounts for between 45,000 and 50,000 studies a year, while radiology is responsible for 140,000 to 150,000. Imaging related to other specialty areas in the hospital is routed to the radiology PACS as well.
“We wanted to have one imaging application for all of the imaging data in the enterprise,” Ghahramani explains. “Using the same applications limits the cost of moving the data from the SAN to the second tier and off-site storage facility. It offers both efficiencies of scale and ease of management.”
In November 2010, Ghahramani got his wish when VHC implemented the Synapse Cardiovascular integrated image and information system from FUJIFILM Medical Systems USA, Stamford, Connecticut. VHC had been using the company’s Synapse PACS for more than a decade, and the addition of the cardiovascular information system enabled the hospital to establish a single archive for both radiology and cardiology images. “We already had the infrastructure to distribute radiology images,” Ghahramani says. “They go through the RIS, which extends to the information portal. Having that already in place meant we didn’t have to make two interfaces.”
Both Synapse Cardiovascular and the Synapse PACS are tied to VHC’s SAN, but the SAN offers limited local storage for cardiology images, routing them instead through the Synapse PACS—immediately, in the case of catheterization-laboratory images, or after a 12-hour delay, in the case of echocardiography.
“The echocardiography studies are not typically read right away, and sometimes, the cardiologist would like to add a snapshot or some text to the image, so we didn’t want to have one study on the radiology side and another on the cardiology side,” Ghahramani notes. “The 12 hours give the cardiologists a bit of lag time, and they usually come and dictate within four or five hours, unless it’s a stat case or an emergency.”
Once radiology and cardiology images have been routed to the Synapse PACS, a hierarchical storage manager (HSM) manages both, using rules established by Ghahramani and his team. “According to the rules, all studies that are more than two years old are copied and moved to the second tier to open up that SAN storage space,” he says. “In the second tier, we used to use DVD storage, but we’re migrating over to a hard-drive–based solution now.”
In the future, he says, “The HSM will copy all data to the hard-drive–based second tier, and the data will have a time stamp. If anyone tries to access them from Synapse, it will check for the data, and if the data are not there, Synapse will pull them from the second tier. That should give them about five or 10 seconds of delay, which is acceptable.” A query/retrieve functionality that works between the Synapse PACS and Synapse Cardiovascular systems enables cardiology users to request their images using the PACS, while radiology users continue to request them as they always have.
Clinical Upside and Cost Efficiencies
Clinically, Ghahramani says, the shared archive offers multiple advantages for both the radiology and cardiology departments. “Having a single point of access for all images is tremendous,” he notes. “Before, the radiologists would sometimes get a call from cardiology upstairs, needing them to look at images, and they would need to go up to the second floor—and sometimes, even scrub in; now, they can do the consultation right there, on the phone.” In addition, when members of either department are on call, “Because everything is accessed from the portal, they all have access remotely,” Ghahramani says.
When a member of either department needs access to the other specialty’s images to understand a patient’s history fully or to complement a current study, the process is now quick and efficient, Ghahramani adds. “Cardiology has its own stress test, but in nuclear medicine in radiology, we do some tests that are needed for comparisons or complementary clinical information,” he says, “and often, when the radiologists look at vascular studies on ultrasound, it’s useful to them to see the patient’s echocardiogram, if there is one.
Of course, there are efficiencies to be gained from using a single archive on the IT side as well. Ghahramani says, “In terms of cost savings, we don’t have