Revolution in Diagnostic Digital Imaging ... CD-Roms, Internet Replacing X Ray Negatives?

BRONX, N.Y. -- Montefiore Medical Center has installed a new digital imaging system that brings instant, interactive diagnostic imagery right into patients' homes, physician's offices and to remote sites over the Internet.

"It's a major breakthrough that will benefit patients and will change the way some physicians practice medicine," says Nogah Haramati, MD, chief of radiology at Montefiore Medical Center's Weiler Division.

Beginning in August of 2002, Montefiore's Radiology Department has stored, in a central data bank, digital images of a patient's diagnostic X ray, CT-scan or MRI. When a patient has an MRI exam, he or she takes home a CD-Rom of the image and can view it on a home or office computer, or give the digitized disk to his or her physician. No special software is needed. Most remarkable, physicians can access the images over the Internet, rotate the images, measure the size of tumors, and advise patients about a diagnosis and even add notes to the patient's permanent medical record directly online.

Montefiore's Weiler Division already has 14 new work stations, with advanced software and two-panel monitors (to compare two separate images side by side), distributed throughout the Emergency Department (ED) and the intensive and coronary care units. All 14 computers are linked directly to the hospital's centralized radiology image bank, and to each other -- a model system for the entire medical center. To date, Montefiore has trained 300 physicians, nurses, technicians and medical students to use the system and more are being instructed.

"X-ray films, the old method used by radiologists, are static. Digital images are interactive," said Haramati. "For example, a Montefiore physician, whether in the hospital or on the Internet in an office elsewhere, can use our stored imagery to customize what is viewed. The physician can manipulate an X-ray image of a lung using a sophisticated display method called histogram analysis to get a better view of a lesion or possible mass, or view side by side "before" and "after" MRI images of a patient's brain after being treated for stroke."

Joel Cohen, MD, a neurologist at Montefiore, says the new digital imaging system, called Integrad, has revolutionized the way he practices medicine. "Instant access to images is key," he says. Cohen recently installed a wide-band cable connection to his home computer so that, as an attending neurologist on weekend call in the Emergency Department, he can help residents diagnose patients immediately. As one example, he was called by a ED resident just before midnight on a weekend to help evaluate a 55-year-old woman with a history of breast cancer, who came to the ED with complaints of back pain, leg numbness and weakness. Cohen immediately accessed the MRI image over the Internet, reviewed the scan, image by image, with the resident and confirmed a tumor compressing the spine. A radiation oncologist was promptly called and radiation therapy was initiated without having to wait until morning.

"This was a neurological emergency requiring immediate intervention in order to prevent permanent paralysis," said Cohen.

Use of CD-Roms by patients is surprising the medical community. Cohen referred one of his patients to a specialist at another hospital, and the patient took along an MRI image of his brain on a CD-Rom. Physicians at the other hospital were not familiar with the technology but, because the disk is so easy to use, they were able to view the digital imagery of the patient's cancer and confirm the best treatment.

Recently, two medical residents hovered over a monitor in the cardiac care unit waiting for an X-ray image of a patient who had been transferred from the ED an hour before. When the X-ray image from the ED appeared on their screen in the CCU, they knew immediately that the patient's emergency resulted from congestive heart failure and they put the patient on a diuretic drug. Prior to the advent of this high speed digital imagery, the slower process of developing the film and physically transporting the large negative from radiology to the CCU would have taken several hours -- a period of time crucial in treating heart failure.

Montefiore Medical Center, The University Hospital and Academic Medical Center for the Albert Einstein College of Medicine, is an internationally recognized leader in patient care, education, research and community services. Montefiore provides treatment programs for patients with all major illnesses and has distinguished centers of excellence in heart care, cancer care, children's health, women's health and surgery.

Source: Montefiore Medical Center

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