Visage 7: A Revolutionary High-Speed Enterprise Viewer

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In a world of PACS and enterprise imaging, the performance of the enterprise viewer often takes a back seat. For Brad Levin, an imaging veteran of more than two decades, it’s a mystifying mindset since the diagnostic workstation (viewer) is literally the front seat of a radiologist’s day-to-day existence.

Levin joined Visage Imaging as general manager for North America because he recognized that its technology defined a refreshingly new paradigm, bringing the viewing interface to the forefront and into the 21st century. While other viewers stagnated, Visage Imaging broke from the pack and innovated Visage 7, a breakthrough enterprise-imaging platform powered by server-side processing. Visage 7 delivers user-customizable, multi-display, protocol-driven interpretation for radiologists, clinical access for referring physicians, and mobile access for all imaging stakeholders.
In addition to supporting the complete set of traditional diagnostic imaging modalities, Visage 7 enables interpretation of digital mammography (FDA 510K and IHE Mammography Image Profile), digital breast tomosynthesis (DBT) and PET/CT, as well as advanced visualization modules for neurology, oncology, and cardiac analysis. It’s an impressive list, with native code, and it’s all combined with tremendous speed.

“Speed is something everyone instantly recognizes with our application,” he says. “When radiologists sit at their diagnostic workstation, they don’t care about the infrastructure of the PACS. They don’t care about the ancillary systems. They are interrogating images over and over again, and they need to do it in a sophisticated and frequently time-sensitive way.”

In the case of a stat read from a remote site, timeliness is always a prime consideration. If radiologists must wait to access current images and their related priors, and wait for technologist-generated reconstructed views from a separate advanced visualization workstation, it can cause workflow problems—not to mention detrimental effects on patient care.

Anything that delays the diagnostic report should be avoided, and Levin contends that Visage 7 beats the competition on speed, all while maintaining cutting-edge quality. “What if someone presents in the emergency room, and it’s a stroke case where time is brain,” he says. “The stroke protocol is in place, and the patient is put on the CT scanner. The clock is ticking. The faster the stroke team gets a clinical opinion, the faster they can decide on pharmaceuticals and save brain. Radiologists not only need immediate access to those images, but they also need a complete set of powerful tools for interpretation.”

Server-side Processing

The power for all that speed comes via optimized algorithms in different layers of the platform. According to Malte Westerhoff, PhD, chief technology officer, Visage Imaging, the crucial rendering engine is powered by fast and scalable ‘server-side’ image processing. “The adaptable streaming engine provides smooth, interactive streaming even over ‘thin pipes’ and in wide area network [WAN] scenarios,” says Westerhoff, who also serves as general manager of Visage Imaging GmbH in Europe.

Essentially, the thin-client, intelligent streaming does not require the movement of DICOM payloads. As a result, the DICOM payload never leaves the Visage 7 server, only the necessary image pixels are streamed to requesting client devices, and thin-slice volumes are pre-processed at the server. This innovative approach eliminates DICOM routing to workstations, and in seconds delivers incredibly fast display of current and related prior imaging studies regardless of the size of the datasets.

The workflow layer integrates traditional PACS-style 2D viewing, workstation-type 3D viewing, post-processing, and fully transparent thin-slice reporting. It’s an approach that Westerhoff describes as a “revolutionary and much more efficient reading experience for the radiologist, which allows for customized clinical review for referring physicians, and ‘anywhere access’ via our mobile client—with all of it supported by the same core technology stack for technology simplification.”

Levin calls it “leveraging horsepower on the server-side,” which is possible since Visage 7 is essentially streaming the data. “We are able to stream a two-slice CR or a CT with 6,000 thin slices, for example, right to the reading radiologist’s desktop, in seconds with the entire study available, ” he explains. “Over the LAN or WAN, Visage