Open-source protocol frees images trapped in PACS.

Medical Device Daily European Editor

PISA, Italy -- By the end of this year radiology workstations will offer a new capability for the web-based transfer of diagnostic quality medical images with other hospitals.

You may wonder why this is not already possible.

In a digital age when teenagers easily trade snapshots on iPhones, it seems impossible that the impressive imaging workstations found in hospitals are unable to send images to other medical centers.

Yet as any woman with a lump in her breast has learned, the transfer of medical images between specialists today is achieved with old-fashioned, 20th century compact discs.

To the point where radiology departments are overwhelmed with stacks of CDs sliding off shelves and scattered on desktops with more arriving by special couriers, patients and even taxi drivers everyday.

The first problem in transferring images over the internet is the confidentiality of patient information, though you may wonder how secure your breast images really are on a CD laying around radiology reading stations.

The bigger problem is interoperability, the compatibility of data stored on these muscular picture archiving and communication systems (PACS).

Not only are these systems not interoperable, the lack of compatibility between systems from different manufacturers is intentional, part of a long-standing commercial strategy.

While vendors say they conform to international standards, such as Digital Imaging and Communications in Medicine (DICOM), each also adds small lines of software coding and tags to images to frustrate image transfer and keep customers captive to their equipment.

Buried under CDs and infuriated to see teenagers easily swapping photos, radiologists have had enough as prisoners of their PACS systems.

A first effort was the recently introduced new generation of vendor-neutral systems that for an additional charge can bolt on to existing PACS to free up images for transfer.

By the end of this year radiologists will have a free solution in the form of an open-source protocol called Cross-Community Access for Imaging (XCA-I) being developed by Chicago-based Integrating the Healthcare Enterprise (IHE) in a joint effort with DICOM.

"This is the CD Buster that will give you access to images when you want, where you want on any system capable of pulling DICOM data," promises Chris Lindop, who leads the Interoperability & Standards group for GE Healthcare (Chalfont, UK) and is the lead author for the new integration profile with the open-source association IHE.

At the IHE European Connectathon held here last week, a connectivity marathon among 117 health IT systems in the development pipeline, Lindop was running multiple verification tests for the new protocol.

XCA-I levels the playing field for medical image transfer by providing a capability that can be added to all existing software, whether proprietary, built-to-purpose PACS or independently developed vendor-neutral systems.

"This is far more than peer-to-peer exchanges, it is designed to break barriers between organizations to enable a secure image exchange," said Lindop.

Enabled exchanges could be hospital-to-hospital, community-to-community or between massive health information enterprises, such as Kaiser Permanente and the Mayo Clinics. Equipped with the XCA-I retrieving gateway, a DICOM-capable computer system can pull images through an access broker " and then you can do what you need with the image, displaying it, storing it, or sharing it within your network," said Lindop.

Vendors integrating XCA-I will validate the interoperability of their systems at the IHE North American Connectathon to be held in Chicago in January 2012.

After this testing the new capability will progressively become available as an upgrade to existing imaging systems, though some vendors are expected to informally preview the new image transfer features at the Radiology Society of North America (RSNA) exhibition in Chicago in November, 2011.

The IHE Integration Profile is currently in the final stages of public comment with IHE, and the corresponding DICOM supplement 149 is currently out for letter ballot as it moves toward approval.

XCA-I applies Simple Object Access Protocol (SOAP) for moving images and uses the DICOM standards for image transfer syntax that now carry more meta data.

"We are on the frontier of DICOM development with XCA-I, making the first step toward web-based DICOM services," said Lindop.

A new feature of the XCA-I protocol will be the ability to use "fuzzy" search terms for patient data, which Lindop prefer to call cross-enterprise discovery queries.

The disparity, diversity and dysfunctions of patient identification between systems, and even within the same hospital, continue to pose a significant challenge to sharing digital records.

Looser search terms mean an Emergency Department can enter a number of variation on a patient's name or identity in the query box to find images and medical records.