Digital Image Management Primer: Integrating ECHO

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  Surgeon’s view of the mitral valve obtained with real-time three dimensional transesophageal echocardiography, in a patient with severe mitral insufficiency, secondary to mitral valve prolapse. Arrow points to prolapsing P2 scallop as predominant mechanism of pathology. Patient underwent successful quadrangular resection of this scallop and repair of the mitral valve, with complete resolution of mitral insufficiency. (Source: Judy Mangion, MD, Brigham and Women’s Hospital)

While cost-savings might not be immediately apparent, benefits of digital echo include increased accuracy and efficiency, ease of accessing information and better patient care.

Echocardiography remains the first line imaging modality for many cardiac indications. The advent of 3D and 4D echo as well as speckle tracking translates into increasing pressure to make efficient and clinically effective use of the data. More sites are turning to digital image management solutions, but wedding echo and digital image management can befuddle even the most IT-savvy practice. The benefits, however, outweigh the difficulties.

Echo image management is fraught with challenges. Fewer than 30 percent of labs have embraced digital echo management, estimates Alan Katz, MD, director of cardiac imaging and informatics at St. Francis Hospital in Roslyn, N.Y. Reluctance to invest originates in several corners. For starters, vendors have not adopted DICOM standards for echo, and each vendor stores echo data in a different format.

Cardiology practices are left with unappealing options: review images on the echo cart or purchase vendor workstations for image review. Usually, sites wind up with workstations from multiple echo vendors, which can be a financial burden and breaks down universal access to images. What’s more, unlike deploying a digital cath lab, integrating echo into the digital image management strategy does not correlate with an immediate cost-savings, says Katz.

The benefits of the digital approach, however, are real and include increased accuracy and efficiency, ease of accessing information and better patient care. There are economic gains as well. “Echo may be over utilized because it’s difficult to review prior studies or access images acquired at other locations,” says Judy Mangion, MD, associate director, non-invasive lab, division of cardiovascular medicine at Brigham and Women’s Hospital. Integrating echo into the digital image management platform can help the bottom line and prevent unnecessary tests.

Plus, as the clinical value of echo grows, it’s important for referring physicians to be able to easily access the data. “Echo provides much more information than in the past. Changes in the technology make it possible to quantify many parameters with echo,” says Smadar Kort, MD, director of cardiovascular imaging and echocardiography at Stony Brook University Medical Center in Stony Brook, N.Y. For example, physicians can use echo to quantify the severity of regurgitation in patients with valvular disease or plan valve replacement procedures.

The digital model


More facilities are bringing echo into the digital era. Take, for example, Brigham and Women’s Hospital, which stores echo studies digitally on a GE Healthcare Centricity PACS; clinicians can use the system to review any cardiovascular images throughout the enterprise or at home. “Having all of the information at our fingertips helps us sort through the various differential diagnoses,” shares Mangion. For example, cardiologists can correlate echo data with other studies to determine if a lesion is flow limiting.

Stony Brook University Medical Center archives all echo data on a server. All echo data are available for review, analysis and comparison, and can be accessed enterprise-wide by referring physicians. Although other cardiac modalities like MRI and CT are stored on a separate PACS, physicians can retrieve all images at any hospital computer. The PACS and dedicated echo server can be accessed through the web for universal enterprise review by referring physicians.

Similarly, St. Francis Hospital stores echo and cardiac images on Agfa HealthCare’s IMPAX CV and on an EMC Corporation Centera storage solution. The PACS holds seven years of cardiac imaging data, and a web viewer makes it possible for physicians to view studies offsite or for several users to view or post-process data concurrently. Because echo produces fairly large datasets, images are compressed at 20:1, a ratio that does not