Test Drive xr.ay App for Teleradiology

Are you interested in mHealth? Do you own an iPad?

If the answer is yes, you should test drive our new xr.ay App for teleradiology.

How to Use the xr.ay App

1. Download xr.ay App from the App Store

from the Apple App Store. Simply click here to be redirected to the App Store.

2. Try it with the preview account

Account: aycan

Password: aycan

You can use the demo account without OsiriX PRO.

3. Test Drive OsiriX PRO with xr.ay Plugin

In order to send you own DICOM images to the xr.ay App on the iPad, you need to download the OsiriX PRO software with the aycan xr.ay App plugin. Otherwise contact aycan or your local aycan Reseller for more information and a personal offer.

aycan teleradiology app for iPad 2

aycan successfully tested its’ teleradiology app for use on the new iPad 2. The multi-threaded architecture of the aycan app harmonizes with the iPad 2’s new Dual Core 2 Processor. And, with the improved features and functionality of the iPad 2 over its predecessor, the aycan app works even better:

• The transmission of images is clearly faster because the de-compression and decryption ability of the app is improved due to the iPad 2’s new A5 processor.

• With the iPad 2’s new graphics’ chip, displaying images (scrolling and W/L) in split-view mode is significantly improved.

• With the new video out support feature, medical monitors can now be connected to the iPad 2, which allows the app to be used for image viewing where higher resolution is required.

The app is currently available for free from Apple's European App Store. The app was designed to allow for simple, fast, and safe transfer of DICOM images from hospitals and imaging centers to radiologists and referring physicians with an iPad. It’s designed to work seamlessly with aycan OsiriX PRO, easily allowing DICOM images to be sent from Osirix PRO to any iPad including those that are 3G UMTS enabled. The new app does not require the set up of a VPN tunnel as all images are automatically encrypted. The aycan teleradiology app has received the CE-mark. FDA clearance to follow.

aycan teleradiology app key features:

• Automatic Data Encryption

• WL/WW, Zoom, Pan

• ROI’s

• Display and Synchronization of 2 Image Series

• Embedded Dictation

• Push Notification

• Screen Shot Capture

xr.ay App auf dem iPad 2

Heute haben wir das xr.ay App für die Teleradiologie auf dem neuen iPad 2 getestet.

Die Übertragung der Bilder ist deutlich schneller, da das dekomprimieren und entschlüsseln auf dem neuen A5 Prozessor beschleunigt wird. Die Multithread Architektur des xr.ay App harmoniert perfekt mit dem Dual Core iPad 2 Prozessor.

Beim Darstellen (Scrollen und Fenstern) im Splitview Modus bringt der neue Grafikchip eine deutliche Performancesteigerung.

Das Beste ist aber der Anschluß eines externen Displays an das iPad 2 mit der Full HD Auflösung von 1920x1080 Bildpunkten. Damit läßt sich die xr.ay App (Medizinprodukt Klasse I) an einen Befundmonitor anschließen und konform der DIN 6868-57 und der QS-RL betreiben.

Das xr.ay App steht ab sofort in Apples App Store kostenlos zum Download zur Verfügung. Mit dem xr.ay App ist eine einfache, sichere und schnelle Übertragung von DICOM Bildern von der Klinik auf das iPad von Radiologen oder Zuweisern möglich. Das App benötigt keinen VPN Tunnel und ermöglicht den Transfer der medizinischen Bilder von OsiriX PRO auch auf UMTS iPads. Das App ist ein CE-gelabeltes Medizinprodukt.

Key Features:

» WL/WW, Zoom, Pan

» ROIs

» Anzeigen/synchronisieren von 2 Serien

» Eingebaute Diktierfunktion

» Push Notification

» CE-Label als Medizinprodukt

Weblinks:

Klicken Sie hier um das xr.ay App herunterzuladen.

Klicken Sie hier für eine Videopräsentation.

OsiriX PRO 2.0 erhält FDA Clearance

Mit der neuen, zertifizierten OsiriX PRO Workstation mit 64-bit und CE-Label als Medizinprodukt der Klasse IIb unterstreicht die aycan Digitalsysteme GmbH erneut, ihre Kompetenz in Sachen digitaler Bildbe- und verarbeitung sowie Darstellung.

Die Software ist bereits seit Ende 2010 als Medizinprodukt der Klasse IIb mit CE-LAbel in Europa erhältlich. Jetzt hat auch die US-amerikanische FDA die Marktzulassung im Rahmen einer 510(k) Premarket Notification als Class II Device erteilt.

Neben Bugfixes und Verbesserungen sind in der neuen Version einige Neuerungen implementiert.

Weblinks:

FDA Devices cleared in March 2011

ECR 2011 OsiriX PRO Workshop Summary

The workshops were listed in the official ECR 2011 program. 305 people registered at myesr.org prior to the congress.

Apple was very generous and sent 24 iMac's 27" to Vienna for the trainings.

400+ people attended the workshops. Each participant received a nice T-Shirt.

We performed 8 Basic Workshops and 8 Advanced Workshops with three different focuses, which was very well received by the workshop attendees.

The final statistics from ESR about the OsiriX PRO workshop at ECR 2011 are showing a better result than the 2010 results. 254 evaluation sheets were returned to ESR.

How do you rate the practical training?

Legend: very good: 1, good: 2, fair: 3, poor: 4

1.30 (1.44) +9.7%

How would you rate your learning experience during this session?

Legend: very good: 1, good: 2, fair: 3, poor: 4

1.37 (1.44) +4.9%

How likely is it that the workshop will change your working method in the future?

Legend: very likely: 1, likely: 2, unlikely: 3

1.50 (1.56) +3.8%

Should the topic be repeated during a future ECR?

Yes: 98.8% (98.6%)

We want to thank all participants and we are trying to organize this event next year again. For other trainings please refer to our Workshop Calendar.

Workstation Face-Off

Top Developers invited to Vienna
Featured in aycan's April 2011 issue of "News and Views"

aycan, with its' OsiriX PRO workstation, was among seven companies invited to demonstrate imaging systems at this year's European Society of Radiology Meeting.

aycan was among only seven companies invited to demonstrate their imaging system during the Workstation Face-Off session at this year’s European Society of Radiology (ESR) meeting. Imaging systems were selected that feature novel technological developments in diagnosis, therapy planning, and therapy guidance.

Coordinated by Prof. Hans-Christoph Becker and Dr. Anno Graser from Munich, this year's Face-Off addressed the industry’s challenge to meet the growing demand for more powerful image-data manipulation. A number of tasks were given to all participants such as providing 3D volume-rendered images of aortic valves from a superior perspective, along with maximum, minimum, and average diameter measurements. Another task was to define a target lesion, using RECIST (Response Evaluation Criteria in Solid Tumors) 1.1 Guidelines, and performing comparison assessments of lesions on more than two time-points. Using its OsiriX PRO (a cost effective, FDA and CE certified, 64-bit fast, highly-functional workstation for conventional, multi-slice and other image reading), aycan completed all the tasks successfully and in a timely manner.



An ESR panel is currently assessing each company’s performance with findings to be released from the Society in the next few months. Final rankings will be based, in part, on the workstations ability to manage large volumes of data, and perform in a normal “reading room” setting as determined by expert users. 



Along with aycan, the other companies that participated were GE Healthcare, Philips Healthcare, Siemens Healthcare, Terarecon, Visage Imaging, and Vital Images.

Past participants have faced-off on other key areas including the measurement of stenosis in CT angiography, and perfusion imaging and analysis of CT and PET images. Emerging technologies demonstrated in past Face-Off sessions have led to advanced tool development including tools for more efficient readings such as 3D viewing, automated polyp detection, and efficient length and volume measurements. This year, new computer aided diagnosis (detection) techniques demonstrated could be instrumental in the development of a more efficient and clinically relevant workflow.



ESR took place March 3rd through 7th in Vienna, Austria. Learn more about the event at http://www.myesr.org and read our next newsletter for results of the Face-Off.

Medical Monitor

How to Choose
Featured in aycan's April 2011 issue of "News and Views"

Amidst ever-changing technology and the ongoing debate on standards and regulations for medical monitors, how do you choose one that will support increased productivity and more accurate readings?

With numerous monitors available on the market, varying needs of users, and ever-increasing budget pressure, its important to select the right monitor for your needs. Below is a basic overview of how to go about selecting a monitor along with detailed guidelines from the industry’s leading bodies.

First, Determine the Application

Choosing a medical monitor depends first on what you plan to use it for. Outside of general office monitors, there are two categories of monitors in the digital medical environment: Clinical and Diagnostic.

• Clinical Monitors, used for displaying clinical records and DICOM images, are a cost efficient option to a full-fledged diagnostic monitor, with many of them delivering calibration that is compliant with DICOM Part 14.

• Diagnostic Monitors have higher performance values than Clinical Monitors with brightness and grayscale being especially important as they provide greater image detail which is essential for readings.
  

Consider Key Performance Factors

No matter which category you fall in, determining a monitor’s performance for productivity and accuracy is based on the same key factors:

• Contrast. Contrast is simply the ratio of the luminosity of the brightest color (white) to that of the darkest color (black) that the monitor is capable of producing. The greater the contrast, the greater the detail.

• Dependability. A monitor should be stable so that what a user sees today is the same as what they’ll see tomorrow. FDA clearance and warranties are two items that indicate a monitor’s dependability.

• Grayscale. For black and white images, being able to render every shade of gray as defined by Digital Imaging and Communications in Medicine (DICOM), the American College of Radiology (ACR), and the American Association of Physicists in Medicine (AAPM) guidelines, is essential for accurate readings. The greater the grayscale, the more detail you will see in the image, which is particularly important when viewing mammography and CR images. A DICOM grayscale look-up table is also important so that grayscale output is optimized to the human visual system.

• Luminance. Luminance is used to characterize the brightness of displays. A typical computer display emits between 50 and 300 cd/m2. For diagnostic displays, between 400 and 900 is recommended. In general, the greater the luminance the better.

• Resolution. Resolution refers to the pixel density—the number of pixels per-unit distance or area. As a general rule, the higher the resolution the sharper the image will appear. This means less clicking, panning and zooming a user will need to do to see what they need to see.

• Uniformity. An image should look the same on any monitor connected to the same network. This is particularly critical when a user views images on multiple monitors, or when sharing or collaboration is needed. Uniformity depends on the quality of the monitor's software and hardware.

• Viewing Angle. Viewing Angle is the maximum angle at which images on the monitor can be viewed without excessive degradation to the image. It is measured in degrees horizontally and vertically. The average viewing angle found in medical monitors is 170 degrees. And again, as a general rule, more is better. The greater the angle, the better the view.

Understand Legal Requirements and Standards

While there are no legal requirements on which medical monitor to use, the Federal Drug Administration (FDA), the ACR, and the AAPM have all created guidelines for the electronic viewing of medical images. These guidelines cover the performance factors discussed above as well as test patterns for sharpness at the center of the four corners, visibility of rectangles, and tests to determine if the display is free of shadows and image movements. Uniformity test criteria for luminance, and grayscale are also provided. All toll, the guidelines set best practices for creating an optimal diagnostic reading environment. Key industry guidelines can be found at the links below:

• AAPM: http://deckard.mc.duke.edu/~samei/tg18

• ACR: http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/med_phys/electronic_practice.aspx

• NEMA: http://medical.nema.org/dicom/2004/04_14PU.PDF This guideline, DICOM Part 14: Grayscale Standard Display Function, from the National Electrical Manufacturers Association (NEMA) specifies a standardized Display Function for display of grayscale images. Both the ACR and AAPM standards recommend the use of DICOM Part 14.

• FDA: http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/default.htm Although not required, for quality and liability reasons, it’s recommended to go with an FDA-cleared monitor.

Consider Cost

Of course, cost is also a key factor. Because the price difference between the three types of monitors is significant, it’s important to choose the right one for your application. On average, good quality General Office Monitors range in price from $200 to $500; Clinical Monitors range from $1,500 to $5,000, and Diagnostic Monitors price from $6,000 on up. The important thing is not to over buy or under buy for the intended application.

Watch Technology Trends

As technology continues to advance at a rapid pace, its important to understand the trends so you acquire a monitor that will give you the performance you need today and well into the future. Some trends to consider when selecting a monitor are:

• DisplayPort. DisplayPort is the new standard for connecting monitors to graphic cards--replacing the Digital Video Interface (DVI) for this purpose. It’s a small, easy-to-use connector with a simple locking mechanism that eliminates the need for screws. DisplayPort works with longer cable lengths and has potential for daisy chaining monitors (an interconnection of monitors, one after another) and other advanced features. DisplayPort can provide the same functionality as a High-Definition Multimedia Interface (HDMI) but is not expected to displace HDMI in high-definition consumer electronics devices. Most new graphics cards have DisplayPort connectors.

• Eco-Friendly Monitors. Combining ergonomic and environmental features, Eco-Friendly Monitors deliver increased comfort for improved productivity, reduced environmental burden, and ultimately lower running costs.

• 3D Stereoscopic Imaging. This technique creates/enhances the illusion of depth in an image in one of three ways: by viewing separate images from two offset sources using glasses; using glasses that filter offset images from a single source separated to each eye; or viewing without glasses as the light source splits the images directionally into the viewer's eyes.

• Quad HD Monitors. Quad HD is the next step in high-resolution large screen monitors. Instead of using many small monitors, interventional suites and operating rooms can now use one Quad HD Monitor that can be configured and optimized for image presentation from multiple inputs and uniquely configured for best-image presentation by doctor preference or procedure.

• OLEDs, E ink, and Portables (iPads, iPods, Tablets). OLED and E ink are new display technologies that could replace the LCD display. E ink is used in the Kindle, for example, and has superb viewing characteristics under daylight conditions. OLED is currently being used in some phones and small displays. Known for vibrant color reproduction and a slim form factor, OLEDs are still very expensive and there are concerns about degradation over time. iPads and iPods are appreciated for their portability, superb image quality, and providing instant access to information anytime, anywhere. Of course they have some drawbacks when compared to the criteria established by ACR and AAPM.

Look at Maintenance and Warranty

Once you’ve chosen the right monitor for the job, you’ll want to be sure it is maintained for optimal performance. This means ongoing monitoring and calibration. To minimize time and expense and ensure consistency, Quality Assurance (QA) software is available from many monitor vendors that can automate QA tests such as calibration as well as provide evidence of compliance with laws.

To protect your investment, it’s best to obtain a warranty that provides a minimum of three to five years of comprehensive coverage. The warranty should also guarantee the total image quality including brightness and color temperature.

Summary

While reading-environment conditions and a variety of software and hardware components affect image quality and interpretation, the most influential component is the monitor. To ensure you choose the right one, first determine the use of the monitor, either Clinical or Diagnostic, and then select one that aligns with the guidelines set by the industry’s key governing bodies. Be sure to also review and consider both warranty and maintenance plans as well as future technology trends as both of these can present added expense if not factored into your initial purchasing decision.

Related Readings:

There has and will continue to be much written on this subject. Below are a few articles, in addition to the industry links above, that you may find helpful as you research your monitor needs:

• http://www.healthimaginghub.com/what-monitor-to-use-for-viewing-medical-images.html

• http://www.auntminnie.com/index.aspx?sec=sup&sub=ris&pag=dis&ItemID=93832

Apple in Medicine

The Latest on iPads, Apps, and the FDA
Featured in aycan's April 2011 issue of "News and Views"

Since its inception in 1976, Apple technology has revolutionized many industries including graphic arts and printing, music, and mobile connectivity. Today, Apple technology, along with third party solutions, is transforming the medical industry.

The impact of Apple in medicine began with use of its development tools. As an example, in 2004, Apple’s well-conceived integrated development tools led to the most successful Open Source project in medicine to date, OsiriX. Developed by a team from the University of Geneva, under the lead of Professor Dr. Osman Ratib and Dr. Antoine Rosset, both trained Radiologists, OsiriX is an image-processing application dedicated to DICOM images.

After the Open Source was introduced, commercial entities began to offer various value-adds including plug-ins for radiology applications such as hanging protocols, AAA measurement tools, lung-nodule detection algorithms, and an ejection fraction tool. Medical certification, such as FDA and CE Mark, also became available for OsiriX and many of its applications. Other value-adds from commercial suppliers include support, training, and integration services. Open Source and commercial versions of OsiriX are now running on more than 60,000 Apple desktops/laptops and continue to grow in acceptance and use. Outside of its intrinsic value as a tool, OsiriX has allowed the medical community unprecedented access to a high-end DICOM viewer.



While software created with Apple’s development tools has impacted radiology and a limited number of other medical communities, it wasn’t until the introduction of the iPad in 2010 that the entire medical community was affected by Apple technology. From administration, to clinical work, to surgery, the iPad is increasingly being used in all areas of medicine due to its extreme portability, superb image quality, large screen size, and the multitude of medical apps being developed to run on it.



The first FDA approved medical app came in February 2011 with Mobile MIM from MIM Software. Approved for review and medical diagnoses of MRI, CT and PET scans, this breakthrough paved the way for future apps to be approved. And not long after, the FDA did just that with approval of Mobisante’s MobiUS for smartphone-based ultrasounds. Other hot apps currently being reviewed are for preliminary interpretation of brain CT scans, and for evaluating for the presence or absence of tuberculosis. The app-development trend is expected to continue as demand from the medical community continues to increase for solutions that increase productivity and drive down costs. 



In addition to apps, the portability of the iPad is changing how medical professionals work. For example, the University of Chicago issued over 100 iPads to residents in their medical center. According to a report from NBC, the iPad is allowing residents instant access to patients’ electronic medical records, and they in turn are able to share charts and medical images with patients at their bedsides. This allows patients to participate more in their own care and allows residents the ability to provide minute-to-minute care. This workflow improvement has also allowed residents to spend more time with their patients and less time filling out paper work—in some cases paperwork has reportedly been cut in half. 



The portability of the iPad is also contributing to growth in Teleradiology, the practice of remote review, interpretation, and diagnosis of radiological images. The iPad allows radiologists to work more easily from remote locations, which is particularly important for patients in rural areas where specialists are not available. As more apps and mobile versions of PACS systems emerge for the iPad, Teleradiology will continue to grow and become more effective.



Release of the iPad 2 (March 2011) brings even more potential for its use in medicine given its improved processor and operating system, lighter weight, and smaller size. All these advancements improve ease of mobility and performance.



In addition to Apple development tools and iPads, there are other Apple products and apps that have use in medicine. And keeping pace with all this potential is the FDA. Due to increased marketing, interest, and use, the FDA is paying closer attention to Apple products and apps for the medical community. In particular, they have expressed much concern about mobile technologies being used for diagnostic purposes. With Apple medical solutions now solidly on the FDA’s radar, it will be even more challenging for mobile-technology application providers to obtain FDA clearance and approvals.



As Apple technology continues to evolve, and companies continue to develop and obtain FDA approval of medical apps, we anticipate the Apple in Medicine List to grow along with greater productivity for its users and better care for patients. 



Related Readings:

• http://www.auntminnie.com/index.aspx?sec=sup&sub=pac&pag=dis&ItemID=94643

• http://www.nbcchicago.com/watch-this/iPad_Doctors_Chicago-116169579.html

• http://www.mimsoftware.com/products/mobile/

• http://www.apple.com/science/medicine/medicalimaging/

• http://www.macworld.com/article/158439/review_the_ipad_2./article/158439/2011/03/ipad2.html?lsrc=top_1