Invention for Medical Image Management System and Method

Invented by Peter Alden Rothschild, Vijendra Guru Raaj Prasad, RadVault Inc

The RadVault Inc invention works as follows

The invention provides a method and system for managing medical images. It uses a central database management system to centrally manage electronic records that contain medical images. Remotely located or local workstations can request that queued data be delivered to them. Remotely located workstations or local image workstations communicate with the central data management system remotely via an internet interface. The central database management system updates and maintains any IP address changes of remote or local workstations, using a lookup table. In addition to pushing data to the last IP address in the lookup table, the central data management system can also push data.

Background for Medical Image Management System and Method

Diagnostic imaging technology, which offers highly sophisticated imaging tests like magnetic resonance imaging (MRI), and computed tomography(CT) has advanced tremendously over the past 20 years. There are approximately 6,000 MRI machines in America and 12,000 worldwide. A majority of MRI machines in the US can be found at small hospitals and clinics. Over 12,000 CT scanners are available in the United States, and more than 20,000 around the world. Other important markets for medical imaging include ultrasound, digital radiology, nuclear medicine and digital x-ray. The potential market for medical image management has been valued at $12 Billion globally and $5.5 Billion in the US.

The need for instant electronic delivery and the storage of radiologic images and data is greater than ever. Annually, the United States radiology market includes more than 150,000,000 x-rays, 100,000,000 sonograms, and 20 million MRI scans. There are also 30 million CT scans that medical professionals perform. This is the standard way of managing medical images in most hospitals, imaging centers and clinics. The medical image is printed on sheets of film and delivered to the radioologist for interpretation. The radiologist reviews the report and signs it. After that, the film and report are mailed or delivered to the referring physician. This can take several days or even a week. The referring doctor can contact the radioologist if there are any questions. Radiologists may have to rely on memory because they reviewed the films several days ago and no longer have them. The referring doctor must also manage hard-copy film. This could be done by either filing the films in his own office or returning them to the hospital or imaging center to be filed. The films must be physically transported or shipped to the hospital or surgery center if the patient is referred to another doctor. Films can be lost or misfiled in many ways. Doctors who have more than one office might not always have the right patient films.

Currently, there is no commercially available solution for digital delivery and archive of the ever-increasing number of radiologic data. Many patients are used to emailing attachments such as photos or files. They wonder why radiology images can’t be?emailed? Their doctors. There are many barriers that prevent a medical image from being?emailed?

Digital images are required to be electronically transported medical images. The computer interfacing hardware and software must be installed on the imaging device (e.g. MRI machine) in order to?export? the data. The data. To convert the proprietary image identification data (the head information) into a standard format such as DICOM (Digital Imagine and Communication in Medicine), a computer is required. The software must be able to view and interpret the header information of the images (viewer) for the doctor who will receive them. The majority of imaging machines are not DICOM-enabled models. Non-DICOM models will continue to dominate diagnostic image for the foreseeable future due to financial constraints imposed on imaging centers by managed care.

Each manufacturer had its own method of storing, formatting, and reconstructing data when digital modalities like CT and MRI were first introduced to clinical practice. This information was not shared with any other manufacturers. Therefore, one set of images cannot be transmitted to another machine as each image had a different format. The American College of Radiology met with the National Electronic Manufacturers Association in 1983 to discuss a standard. The Digital Imaging and Communication in Medicine Standards Committee (DICOM) was formed by the two organizations in early 1984. The first DICOM model was released in 1992 after years of hard work. A few manufacturers began to offer DICOM integration in their products by late 1994. This was usually an expensive upgrade ($20,000 to $40,000). Today, however, most manufacturers only include DICOM in new products at a substantial additional cost ($20,000 to $40,000). Many older medical imaging systems don’t have DICOM conversions available from their original equipment manufacturers. A DICOM conversion upgrade for existing products is often more costly than DICOM for new products. DICOM is a communication standard that does not specify a particular hardware architecture. It allows images to be integrated into other databases. This standard is widely used for medical image communication. It is supported by many specialties and other standard organizations around the globe.

Interfaces were developed to enable DICOM? Image systems without DICOM interfaces were not factory-equipped. A medical image management system for the general field of the invention could not supply DICOM interfaces without requiring its customers to either purchase DICOM conformant equipment or to install them at a cost exceeding $40,000 or rely on secondary capture. Secondary capture methods like video frame grabbing can lose some information because they only capture the analog 8-bit representation of the original 16 bit image pixel data. Secondary images can not be altered in the same way as original images. Due to the inherent limitations of secondary-captured data, the American College of Radiology standard states that direct capture is preferred for primary diagnosis.

It is unlikely that the general imaging center or referring physician market will accept the use of an inferior secondary capture method or an ASP that cannot connect to DICOM-equipped imaging systems. DICOM connectivity is provided by the system and method described in this invention. A medical image management system that is efficient and able to connect different imaging systems and equipment without compromising image quality is essential in order to transmit and save images. The system must be capable of extracting the proprietary data from different imaging devices. Unfortunately, most are not DICOM-enabled and cannot output. The data will be in DICOM format. DICOM is the industry standard. However, different dialects of English can use it. There are many different dialects of DICOM depending on the language used by each manufacturer. The DICOM language. This means that two systems with DICOM interfaces can still have difficulties connecting to each other. In some cases, customizing interfacing between these machines might be necessary.

Once these barriers have been overcome, it is possible to electronically transmit medical pictures in a fast and easily adoptable way. These electronic images can be presented simultaneously in multiple locations, unlike film.

Picture Archiving and Communication Systems, (PACS).

Various solutions were developed to streamline the storage and access of medical images. They include electronic records that contain the images in electronic format that can be converted for viewing on screen displays or via film printing.

One of the most well-known types of such a system is ‘Picture Archiving and Communications Systems. The PACS system provides medical image management through a set of components that allow image data acquisition, transmission and storage. These systems can be found in hospitals and imaging clinics to allow digital data to be available at various locations within the facility or radiology department. These systems are only available to radiologists and other departments within the facility. Referring physicians cannot use them. These systems are expensive ($60,000-$1,000,000) and require additional staff to install and maintain the central image management and storage systems.

Medical Images and Internet ASPs

The medical image management market is huge and involves large volumes of recurring transmissions electronic records associated with electronic images. An ASP model to manage electronic images has great potential to be a high-profitable annuity business. Many efforts have been made recently to replace, or at the very least improve, traditional film-based methods and systems for medical image management. These images can be managed electronically via an internet-based ASP model. The concept of an Internet-based Application Service Provider (ASP), for the transmission and storage medical images, is still in its embryonic stages. An ASP model is not used for the transmission and/or storage of over 300 procedures in diagnostic imaging that are performed each year in the United States.

To send an image electronically, as intended with these medical image management system, the first step must be to obtain the data from the imaging mode (CT, MR or ultrasound). to the image acquisition software at the customer’s site. This data can be obtained in two ways: primary or secondary. Primary capture is often not possible to support medical image management systems or methods. They use?secondary? instead. They often use?secondary? or?indirect? methods because primary capture is not always possible. methods. The oldest and most basic?secondary? method. Frame grabbing is the most common and basic method of capturing images. This simply captures the image on the monitor and records it. The image results are only 8 bits in depth, allowing for 256 shades of grey. This means that a lot of data has been lost. Frame grabbing is a technique that allows you to grab images from frames. It is also labor-intensive. The technologists must set the?window’ before they use?frame grabbing? The?window? and the?level? must be pre-set by technologists when using?frame grabbing? (brightness, contrast and color) of the image. This takes up too much time for the technologist compared to more advanced primary capture. Frame grabbers work by taking an analog monitor output from a digital modem and running it through an ‘analog-to-digital’ converter. This in turn degrades data. Images that were acquired using?secondary’ technology are not able to adjust the brightness or contrast (window or level) of the image at the receiving end. capture. Secondary capture is not able to measure the position and location of the image. These are extremely important for the physician. Due to the above problems, the American College of Radiology (ACR), standards for teleradiology, effective January 1, 1999, recommends that you adhere to DICOM and transmit the entire image data set. This is only possible with?primary capture? Direct capture or primary diagnosis. Primary diagnosis.

In general, most systems and methods of managing medical images in electronic records format use?pull?” Type image delivery protocol that requires the referring doctor to log on to a website and then download the patient’s images. But busy doctors don’t have the time or desire to view their patients’ images this way. The “pull” model requires the physician to log in as well as extensive physician input and time to initiate data transfer. The?pull? model requires that the physician log in and provide extensive physician input to initiate data transfer. The doctor must also wait for the image data download to complete.

The following are some more specific examples of medical image ASP efforts.

The following describes what we believe to be information about a medical imaging management system that will be provided by Amicas. Amicas is a Massachusetts-based private company. It is believed that it markets and sells software that allows radiology studies between Web servers. Amicas targets large hospitals. Amicas is expected to allow the transfer of such images between medical facilities with standard e-mail systems using UPS Document Exchange (SM). This encryption-based secure delivery system features optional password protection, real time racking, and delivery confirmation. To access the email, the physician must log in and wait for the images. The service is currently being used at four beta sites. FDA approval was granted to the company in 1997. A client’s machine must have DICOM installed in order to be considered a potential customer. Interview conducted by Dr. Adrian Gropper, CEO of Amicas, May 2, 2000 at E-Healthcare Conference in Las Vegas Nev. Gropper also stated that his company does not plan to offer off-site storage. Further, it is believed that the company employs lossy compression to compress electronic records related to medical images they manage. Amicas is thought to have a test site at Loma Linda Veterans Administration hospital.

The following describes what we believe to be information about a medical imaging management system that will be offered by a company called “eMed?”. eMed, a private company, is located in Lexington. Hospitals are the target users. The eMed.net service will include a medical image viewing app with integrated access to reports and images as well as other pertinent information via a physician’s website. eMed Technologies, a Healthcare Application Service Provider, (HASP), takes care of all aspects of server hardware, domain registration, site creation, and current content for a $2,500 monthly subscription. FDA approval has been granted to the company. Although the company prefers DICOM-equipped machines, it is capable of capturing images from non-DICOM machines in one of two ways. (1) DICOM converting device for up to $40,000 to customers; (2) frame grabbing?a method of secondary capture that is not acceptable for primary diagnostic interpretation.

The following describes what we believe to be information about a medical imaging management system that will be offered by General Electric Medical Systems in Dallas, Tex. In a press release, GE and Waukesha (Wis.) announced the news in an April. GE will use an ASP to store data generated at off-site locations. This announcement is thought to address an ASP model that GE will use for its traditional PACS system. According to the press release, GE will pilot this program in the summer 2000. However, the press release doesn’t mention many details (such connectivity to their system i.e. The press release does not mention many details, such as whether non-DICOM-compliant machines will ever receive the service; whether only GE equipment will be targeted; whether GE plans on developing any DICOM interfaces for non-DICOM equipment; and what data will be stored. Although the press release does mention a subscription fee, it doesn’t give any pricing information. GE doesn’t deliver images. Instead, the doctors log in.

The following describes what we believe to be information about a medical imaging management system that Image Medical, a private company, will provide. It is located in Palo Alto (Calif.). Large institutions are the target market. Image Medical uses an ASP model for transmitting medical images via the Internet. The Image Medical system is known as?Practice Builder?. It can be used with existing PACS, and allows you to access images and reports from anywhere. ?Practice Builder? Includes a ‘Viewer? Digital medical images: CT, MR and US. The revenue model covers infrastructure, connectivity and installation costs. The transaction fee covers image acquisition, distribution and archival. Interfaces for DICOM-equipped imaging machines are not being developed by the company.

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