Digital breast tomosynthesis (DBT) is one of the most exciting new technologies in breast imaging. DBT poses a challenge to existing departmental, enterprise, and cross-enterprise image storage, distribution and viewing infrastructures.

DBT is a relatively new modality that is finally coming to market after many years of development and evaluation. Early evidence suggests that it has superior performance to full-field digital mammography (FFDM). Accordingly, it is likely to become popular, and there are already hundreds of installations according to one of the currently approved vendors, despite there being no additional reimbursement for the use of DBT yet.

View this special forum and hear the discussion between early adopters, clinicians, and vendors on how to address the challenges posed by DBT images for acquisition, storage, distribution, compression, display, CAD and long-term archival.

Learn how to avoid repeating the same interoperability mistakes with DBT as the “first” time around with FFDM. In addition, examine how to make use of the DICOM Standard Breast Tomosynthesis object, rather than proprietary formats.

There were many great presentations that came from SiiM.  Here are a few of them.  They will all link from the Siim.org web site.

• Digital Breast Tomosynthesis & the Informatics Infra-Structure – Standards & Interoperability
• Imaging Innovations – Tying the Pieces Together
• Digital Breast Tomosynthesis – PACS/Workstation Vendor Perspective
•  Infrastructure Issues Regarding Digital Breast Tomo Implementation
• Tomosynthesis: Lessons Learned and Challenges
• Digital Breast Tomosynthesis & the Informatics Infra-Structure – How Digital Breast Tomosynthesis
• Tomosynthesis Display and Storage Dilemmas

The original information source is here.

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The post Video – Vendor Neutral Archive (VNA) Explained appeared first on Healthcare IT Systems.

The solution will encompass everything from digital X-rays, patient notes and scanned letters.

Originally VNAs were an advancement the was initiated  due to issues with proprietary solutions related to PACS or Picture Archive Communications Systems.  The main issues were integration restrictions and with data migration when an organization wanted to change vendors or move to a different solution.

Currently VNAs aren’t just for PACS anymore.  They are equipped to handle data from many departments within the healthcare enterprise using industry protocols such as DiCOM, HL7 and XDS. Using standard protocols is what allows the VNA to be ‘neutral’.

You can read the Inquirer article by clicking here.

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Years ago when I was working for an imaging vendor, they bought a technology company and leveraged to develop a PACS Vendor Neutral Archive.  The term was still in its infancy, however the functionality seemed obvious given the name ‘VNA’.

The integration process between our PACS and the new VNA went very well.  We were able to send various DICOM images from our PACS and the VNA was receiving everything without a glitch.  We were also able to query the VNA from our PACS Viewer and retrieve images.  Things were good…until…

It didn’t take long to see through the normal course of PACS Administration duties that corrections that were made in PACS did not forward to the VNA.  Image Pre-fetching was another function we had taken for granted that wasn’t a feature.  Two critical features that just ‘happened’ using a PACS system, were now not available.

One of the major benefits we had was owning PACS and our VNA was we were able to implement changes internally without involving any other vendors.

In this scenario the VNA and PACS both used Oracle databases.  Eventually we had the two Oracle databases linked to one another and updates and changes were being updated.

Before we got the synchronization issues worked out, coming in during the implementation and seeing the PACS Admins do reconciliations twice, once in PACS and once in the VNA, was not a good feeling.

One of the biggest challenges VNA companies are having now is synchronization with PACS.  The vendor I worked for accomplished with through database communication, however not every company has the luxury of controling both sides of an issue.

Vendors are able to take advantage of an an IHE profile called IOCM – Imaging Object Change Management in order to accomplish this task.

Imaging Object Change Management (IOCM) specifies how one actor communicates local changes applied on existing imaging objects to other actors that manage copies of the modified imaging objects in their own local systems. The supported changes include (1) object rejection due to quality or patient safety reasons, (2) correction of incorrect modality worklist entry selection, and (3) expiration of objects due to data retention requirements. It defines how changes are captured and how to communicate these changes.

Here is a great article from OTech Imaging the expands on the PACS/VNA synchronization issue.  Click >>>HERE<<< to read the article.  You’ll be directed to OTech Web site.

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Herman Oosterwijk, President, OTech Inc published a >>> white paper <<<  that described and defined what a Vendor Neutral Archive (VNA) is.  He also discussed some essential features and aspects of VNAs.

Although the White Paper was sponsored by TerraMedica, there weren’t any mentions of vendors or any other proprietary information.

If you are unfamiliar with VNAs or simply want to enhance and expand your knowledge in this subject area, the white paper will provide you with that information.

The first thing that may surprise readers is that a vendor neutral archive is not a standard of any kind.  In fact, I imagine the term was invented by some company’s marketing team.

VNAs do not fit or conform to any sort of IHE standard, therefore much care must be given when doing vendor selection.  Although VNAs are not a standard, they however use existing profiles and standard protocols such as DICOM, HL7 and XDS.

The term Vendor Neutral Archive gives the reader the impression that the archive will be able to fit in to any environment and work easily with minimal issues or integration challenges.  This couldn’t be further from the truth. Integration is a critical factor in any implementation.

Some go smoother than others, however that is more to do with the flexibility and features of the software as well as the skill of the integration engineers.  Also some healthcare organizations having varying requirements with different degrees of complexity.

One of the initial catalysts for a Vendor Neutral Archive was due to migration challenges organizations faced when moving from one PACS vendor to another.  Although DICOM is a standard, it was clear with all of the image migration challenges that vendors had different interpretations of that standard.  As a result PACS image migrations were long in duration, complex and expensive.

As the PACS market evolved,  healthcare centers looked for ways to leverage their existing PACS infrastructure and share data.  Other departments in the hospital also wanted to store and share data as well. What was needed was a configurable multi-function PACS server that could accommodate the various requirements from various healthcare departments.

With more departments and in some cases institutions wanting to store and share data, the level of complexity also increased.  Traditionally each department was like a silo containing individual patient IDs and visit identifiers.  In order to have a continuity of care and keep all of the data reconciled to the correct patient, more than a PACS server would be required. Patient IDs would need to be reconciled.

The paper mentions 5 distinct architectures, which deal with the challenges listed above, however I believe the last three architectures combined would be a closer vision of what most people feel a VNA is or should be.

There is a checklist at the end of the White Paper that readers can use when doing vendor selection or formulating a RFP

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Merge Healthcare  was named the number one global market leader in providing vendor neutral archive (VNA) solutions by InMedica, a division of IMS Research.

iConnect VNA consolidates, standardizes and archives images and data from disparate picture archiving systems, specialties and sites, giving clinicians a consolidated view of all diagnostic images. And, being vendor agnostic, it also provides the flexibility to add or replace storage systems as needed due to growth or outdated solutions.

Merge’s iConnect VNA customers accounted for 37% of all studies archived in VNAs in 2011. In total Merge clients have stored over 200 million studies which equates to over 13 billion images. InMedica predicts that the market for VNA solutions will grow from 75 million studies in 2011 to 570 million studies by 2016, a 49.9% Compound Annual Growth Rate (CAGR).

The press release stated…

As the industry’s first true standalone vendor neutral archive, iConnect VNA has been successfully integrated with over seventy-five PACS vendors and specialty workstations at over 350 sites across the United States. In over half of iConnect VNA implementations, Merge’s customers have integrated third-party PACS systems with iConnect VNA.

I would like to know how Merge and/or IMS Research has defined  ‘true vendor neutral archive’.  The term means a lot of different things to a lot of different people. The article claims that Merge is the leader in VNA (vendor neutral archive), but not necessarily the largest PACS provider nor does it claim to manage the most images.  The statement is a reference as to the scope of their VNA business across their own customer sites.

“Our clients continue to add 150 million images every month to iConnect VNA. This volume accounts for over one third

of all studies archived in VNAs. That’s a phenomenal feat and we are proud to achieve this market leadership position,” said Jeff Surges, CEO of Merge Healthcare. “As we continue our move to the cloud, the volume of clients and images we support validates our credibility as a provider, our ability to scale and our forward-thinking approach to healthcare.”

iConnect VNA is part of the iConnect suite, Merge’s comprehensive offering for viewing, sharing and archiving any type of image, anywhere, any time. It also includes iConnect® Access*, a zero-download DICOM image and XDS server and iConnect®Share, an Internet-based gateway for image sharing between enterprises. iConnect VNA acts as the backbone of an enterprise imaging strategy. With current trends in patient safety and healthcare reform as well as competition for referring physicians, the need for image sharing across the enterprise is more critical than ever.

*As of this writing iConnect Access is not FDA-cleared for diagnostic use on mobile devices.

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