telemedicine system radiologi

April 2003

Telemedicine Systems, Radiology

Purpose

Teleradiology systems electronically transmit radi-ologic images and consultative text from one locationto another. Designed to facilitate rapid diagnosis andconsultation by imaging specialists, teleradiology sys-tems link hospital departments to other departments,other hospitals, physicians’ homes, or clinics by meansof telephone lines, digital networks, and/or microwaveor satellite transmission. Because image data can betransmitted thousands of miles, hospitals and remoteemergency medical centers that do not have an in-house radiologist can transmit images to a radiologist

at a larger hospital for review and interpretation.Teleradiology allows two-way online consultation andenables a radiologist to serve several freestandingradiologic clinics or mobile centers without leaving thehospital’s radiology department. Teleradiology is alsoused by the military during warfare and by emergencymedical personnel during natural disasters to improveemergency diagnosis and treatment.

Principles of operationTeleradiology systems are configured to exchange

data between the transmitting and receiving sites,frequently by means of the Internet or World WideWeb. The complexity of a teleradiology system dependslargely on user needs, and most display stations andnetworks can be customized to include such featuresas multiple viewing monitors, permanent (archival)image storage, and image data manipulation.

A typical teleradiology system consists of an imagecapture station and a receiving station. The imagecapture station includes a personal computer (PC)with a high-speed modem, a high-resolution display

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Scope of this Product ComparisonThis Product Comparison covers dedicated tel-eradiology systems, as well as those that areexpandable to picture archiving and communica-tion systems (PACS). For more information onimage transmission, networking, and storage,see the Product Comparison titled PICTURE AR-CHIVING AND COMMUNICATION SYSTEMS (PACS),RADIOLOGY.

These systems are also called: teleradiologysystems

UMDNS informationThis Product Comparison covers the following de-vice term and product code as listed in ECRI’sUniversal Medical Device Nomenclature System™(UMDNS™):

• Information Systems, Telemedicine, Radiology[16-994]

5200 Butler Pike, Plymouth Meeting, PA 19462-1298, USATelephone +1 (610) 825-6000 ● Fax +1 (610) 834-1275 ● E-mail [email protected]

card, a viewing monitor, and an image capture device.Before it can be stored or transmitted, the film imagemust be digitized (converted into a series of numbers)by the capture device, which electronically divides theimage into rectangular areas called picture elements(pixels); the sequence of pixel values representing theimage can then be stored, processed, and transmitteddigitally.

There are several capture devices available for dig-itizing film images. The most basic device uses aclosed-circuit television (TV) camera focused on a lightbox and linked by a video cable to a capture card insidethe PC. The film to be transmitted is laid on the lightbox, and the camera is focused on the film until adesirable image is observed on the video monitor. Thisimage is freeze-framed, stored as a digital file, and sentover a modem to the receiving station. Because digit-izing in this manner results in a low-resolution image,low-contrast chest radiographs requiring higher reso-lution should not be digitized using this method. Othermethods of digitizing include the use of a charge-coupled device scanner to digitize film images line byline. Certain scanners provide significantly high reso-lution, optimize optical density, and can scan all sizesand types of radiographic film. See the Product Com-parison on FILM DIGITIZERS for more information.

In direct image capture (DICAP), images from digi-tal modalities such as computed tomography (CT),magnetic resonance imaging (MRI), and ultrasound(US) are acquired before the multiformat film is made.Referred to as video capture cards, DICAP interfacestap directly into the video signals produced as thepatient is being scanned, converting these analog sig-nals into digital signals for storage and transmission.

The pixel size and the number of gray levels for eachpixel determine the image resolution. Spatial resolu-tion improves as pixel size decreases, and contrastresolution improves as bit depth increases. For 64shades of gray, 6 bits are required for each pixel en-coded; for 256 shades of gray, 8 bits are needed. TheAmerican College of Radiology (ACR) recommendsthat display systems for CT, MRI, US, nuclear medi-cine, and digital fluorography have resolutions of512 × 492 × 8 bits or more. Likewise, systems fordigitized radiographic films, computed radiography(CR), and digital radiography (DR) should have reso-lutions of 2048 × 2048 × 8 bits or more. Because of theamount of information that must be transmitted foreach pixel, digital transmission is almost alwaysslower than analog transmission. To compensate, digi-tal systems usually use sophisticated high-speedtransmission modems, resulting in a slightly highercost.

The modem converts the digital data from the PCinto an analog signal for transmission over standardtelephone lines, digital subscriber lines (DSL), cablemodems, or dial-up high-speed modems.

Another modem at the receiving station then con-verts the incoming analog signal into digital data forthe display computer. Modem speed is measured inbits per second (bps) of data transmitted or received,and speeds can range from 13,000 to 28,800 bps.Speeds greater than 28,800 bps can be achieved overleased lines dedicated to data transmission. Unlikeanalog transmission, digital transmission is not af-fected by background noise or other audio interferencebecause there is a sufficiently wide difference betweenthe frequencies of the digital signal to avoid encodingerrors.

Images are stored in the computer memory or a diskdrive; the number of images saved is limited by the sizeof the computer memory and the capacity of the diskdrive. Short-term storage of data can be accomplishedusing a redundant array of inexpensive disks (RAID).For archival (i.e., permanent) storage, suppliers offermagneto-optical disks (MODs), recordable compactdiscs (CD-Rs), digital linear tapes (DLTs), and digitalvideo (or versatile) discs (DVDs). Jukeboxes — archi-val library systems that accommodate several differ-ent types of storage media and are expandable toseveral hundred terabytes — are also available.

Some suppliers have established relationships withapplication service providers (ASPs) to enhance theirofferings. The mainframe computers or distributedservers managing the files and databases reside at aremote location on the ASP’s technological infrastruc-ture. Only the workstations and a limited selection ofcommunications equipment are physically present inthe hospital. The ASP server is linked to the hospitalover a wide area network (WAN) using the Internet, avirtual private network (VPN), or a private line. Thehospital rents the application from the ASP on a per-user, per-transaction, or per-month basis. An ASPprogram is designed to resemble a local area network(LAN) system, although all the operations are con-ducted using an Internet browser or a thin-client front-end application and are transmitted over a WAN.Maintenance and upgrades are performed according tothe ASP’s schedule, and the level of customization isoften less than that for an in-house installation be-cause the ASP will try to standardize its proceduresfor many customers.

After image capture and/or conversion, the imagesare then transmitted to a remote location for viewing.The computer system controls the acquisition, display,

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manipulation, and transmission of image data. Work-stations at each site are used for interactively review-ing digitized radiologic images before and aftertransmission, for archiving digital images, and forcontrolling the capture devices and printers.

Several image enhancement features are availablewith many teleradiology systems. Software can beused to enhance contrast, improve edge delineation, ormagnify an area of interest. Most systems havepan/zoom, scrolling, and brightness/contrast controlfunctions. Some also offer selectable window width andlevels, color, grayscale adjustment, and text integra-tion. By altering the image contrast through adjust-ment of the grayscale, the radiologist can evaluate bothsoft and radiopaque tissue from the same radiograph.This is particularly useful in the evaluation of chestpathology or trauma.

Image transmission and networks

A teleradiology system is usually configured as aLAN and therefore can be interfaced with larger PACSor other computer systems (e.g., radiology, hospital,laboratory). Most teleradiology systems can also beintegrated into a wider network, encompassing multi-ple hospitals, clinics, and/or other healthcare facilities.

Computer workstations and peripheral devices areconnected with file servers or a central host computerby coaxial, twisted-pair, and/or fiberoptic cable to forma LAN that allows communication between devices.Coaxial and fiberoptic cables offer greater electronictransmission capacity but are costly and relativelydifficult to install in existing buildings. Twisted-paircable, consisting of one or more pairs of insulated wiretwisted together, is often already in place for telephonesystems.

Various network architectures are available, de-pending on the supplier. In a centralized network, alarge central computer (host) houses all programs,files, and other data available for users connected tothe network; the host computer also controls networkoperations. Since all of the processing and storagehardware is in a central location, environmental secu-rity (e.g., personnel access, fire control) is simplified.Although control of a centralized network is straight-forward, expansion beyond a certain number of termi-nals or a certain amount of data storage can requirecostly hardware upgrades such as added terminal con-trol units, larger central processing units (CPUs) tohandle the increased workload, and additional diskdrives to handle increased storage. In addition, if thecentral host computer fails, the terminals connected toit cannot be used.

In a distributed network, each user on the LAN hasa PC that can function independently from the net-work, as well as access shared files and programs fromthe file server(s). If the LAN should fail, users can stilluse their PCs; however, some central functions maynot be accessible. Expanding this type of networkusually requires adding another computer to the net-work and updating the system’s software.

In a client/server network, PCs, microprocessor-based laboratory instruments, and other workstationsare client devices with stand-alone processing anduser-interface capabilities. The clients are connectedto dedicated servers — larger PCs, file servers, orminicomputers — that provide applications softwareprograms, storage, database management programs,and other utilities upon request from the client device.Adding additional PCs usually does not affect theprocessing power of other clients.

In a peer-to-peer network, all computers are on thesame communications level; that is, each computer canact as a server on the network, capable of initiating andterminating sessions, exchanging data and files, andprocessing information. A peer-to-peer network archi-tecture is typically used for smaller LANs because it isrelatively simple to install and manage. For largerLANs,dedicated multiple servers are usually used to accom-modate a greater number of users and operations.

The LAN, which connects users within a limitedarea (e.g., a building or building complex), can beintegrated into a larger network encompassing multi-ple hospitals, clinics, and other healthcare facilities. Ametropolitan area network (MAN) serves users in ageographic region (e.g., city, suburb); a WAN covershundreds or thousands of miles. Several LANs can belinked together to form a MAN or WAN using tele-phone lines or microwave, satellite, fiberoptic, or ra-dio-frequency devices for real-time data, voice, orimage transmission.

Recently, the Internet and World Wide Web havebecome important in the transmission of patient re-ports and diagnostic images. Some facilities have de-vised innovative ways to transmit and access imagesover hospital intranets. PCs are located in patientrooms and radiologist offices so that patients and phy-sicians can view images and reports. The intranetprovides image distribution over a standard Ethernetnetwork. Many suppliers are now offering image ac-cess using the Internet or Web-based technologies.Images can now be accessed at remote sites using aWeb browser (e.g., Microsoft Internet Explorer,Netscape Navigator) over DSL, cable modems, or dial-up high-speed modems. Some suppliers use Web-based

Teleradiology Systems

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technologies for both intranet and Internet imagedistribution.

With Web servers included with the system, manysuppliers allow full 12-bit images to be delivered.Studies have been conducted to verify the diagnosticquality of the transmitted images. In one study, radi-ologists reported no significant loss of image accuracyfor CT systems. Additionally, a telemedicine project atone rural hospital provided a practical, cost-effectivealternative to transporting patients to the nearestfacility, which was more than 50 miles away. Somesystems may allow remote-to-remote diagnostics inwhich the physicians are at separate locations, bothseparate from the facility.

Bandwidth (the amount of data that can be trans-mitted), transmission speed, and communicationscosts vary with the type of transmission media avail-able. Newer high-speed transmission media may notbe available in some rural areas. Plain old telephoneservice (POTS), also called public switched telephonenetwork, allows transmission speeds of 1.2 to 28.8 Kbpsfor voice or modem data; switched-56, a digital service,allows transmission speeds of 56 or 64 Kbps for videoand data (no voice).

Integrated Services Digital Network (ISDN), astandard for digital connection between the networkand user, allows transmission speeds of 64 Kbps to 1.5Mbps for voice, data, full-motion video, and images.With ISDN, there are two interfaces: Basic Rate Inter-face (BRI) and Primary Rate Interface (PRI). SwitchedMultimegabit Data Service allows transmissionspeeds of 56 Kbps to 100 Mbps for data, images, voice,and video. Dedicated (fixed) circuit networks (e.g., T-1,T-3) allow transmission speeds from 384 Kbps to 45Mbps for data and voice, but transmission is restrictedto users on the network.

Frame relay, a digital network, allows transmissionspeeds of 56 Kbps to 1.54 Mbps for data. However,frame relay is not a dial-up service; the user must bepart of the dedicated frame-relay network to transmitand receive data.

Microwave and satellite transmission can also beused for telemedicine. Microwave hookups are rela-tively expensive compared to standard telephone lines,and they have a limited range of 5 to 10 miles. Systemswith a 20-mile range are available at a higher cost. Inaddition, an unobstructed line of sight must be main-tained for microwave transmission to work. In theUnited States, a Federal Communications Commis-sion license is required to operate microwave transmis-sion equipment. Satellite transmission is a moreexpensive method of data transmission because it

requires the purchase of additional equipment, includ-ing the satellite transmitter (uplink) and the receiver(downlink). The major disadvantage of the satellitesystem is its high cost. Also, in some countries, the useof satellite communications may be restricted or mayrequire the use of a special license.

Data compression

Another factor affecting transmission time is thedegree of data compression. Digital images are com-pressed (i.e., pieces of information are dropped) so thatthe image occupies less space and can be transmittedfaster. Compression is expressed as a ratio; a ratio of10:1 means that for each piece of information in thetransmitted matrix, 10 have been dropped from theoriginal before transmission. Lossless compression(2.5:1 to 4:1) is a nondestructive algorithm that com-presses data with no accompanying change in pixelvalues or grayscale range; it is most commonly usedfor transmitting low-contrast chest or bone x-rays.Lossy (destructive) compression, which uses ratiosranging from 5:1 to 100:1, changes pixel values slightlyand is used for high-contrast images, such as thoseobtained from CT and MRI, which can withstand ahigher degree of compression without a noticeablevisual difference. Some manufacturers offer selectablecompression ratios so that the operator can regulateimage detail and transmission speed for each imagetransmittal.

Other algorithms for data compression can be hard-wired into the modem or the computer or be incorpo-rated into the software. One algorithm, for example,is suppression of repeated characters, which evaluateseach individual pixel and, when the same value isrepeated for several adjacent pixels, assigns a code forthe pixel intensity and a value for the number of timesthis intensity is repeated. Strings of leading zeros ortrailing blanks can be eliminated by data compaction.Systems can combine several data-compression anddata-compaction algorithms to achieve maximum re-dundancy reduction. Once compressed data is trans-mitted, an algorithm at the receiving end is used toreconstruct the data to form an image as close aspossible to the original.

The most common compression algorithms cur-rently used are based on the Joint PhotographicExperts Group (JPEG) standard for still-image com-pression. Other algorithms increasing in use includewavelet compression, which compresses the image asa whole, allowing more data to be compressed whilestill maintaining image quality. This technique is be-ing used to compress large image files such as chestx-rays for transmission.



Data-compression use is a debatable issue, andsome have questioned whether images constructedfrom a compression ratio greater than 3:1 are accept-able. However, proponents of high-ratio data compres-sion claim that if correctly used, it does not result inany appreciable degradation in the quality of the trans-mitted image.

Whenever data-compression techniques or high-speed transmission devices are used, the probability ofimage degradation or destruction increases, and somesort of error-checking procedure is necessary. Error-checking algorithms can be hardwired into the high-speed modems or into the computer. Error-checkingsoftware functions can be updated periodically withnewer algorithms. In one simple form of error check-ing, the length of each data line transmitted is re-viewed, and lines that are too short are rejected andautomatically retransmitted. Error-checking algo-rithms should have zero error tolerance to ensurefidelity in image transmission. Certain error-checkingalgorithms can increase transmission time.

Security

The patient’s right to privacy makes system securitya major consideration: computer access to patient filesmust be controlled. Most suppliers use multilevel userpasswords and user identification codes to limit per-sonnel access to information required for their particu-lar job. System design should mask the password fromthe screen during entry to prevent unauthorized peo-ple from seeing it. Also, systems now offer audit trailsas well as automatic logoff if a terminal is left idle fortoo long to prevent unauthorized access to data.

Confidentiality, driven in the United States by theHealth Insurance Portability and Accountability Act of1996 (HIPAA), is a major concern when purchasing aradiology telemedicine system. In addition to usinguser-unique passwords and user IDs, facilities shouldconsider adjusting monitor positions so that onlyauthorized personnel can view the screen, having re-pair technicians sign a confidentiality waiver, refrain-ing from using e-mail as a means of transferringpatient data, performing random audits, putting upfirewalls (only necessary if connected to outside net-works), and using access restriction and encryption.The administrative simplification provisions of HIPAAcall for the standardization of electronic health infor-mation transactions. Also included are standards forkeeping health information secure, for giving patientscontrol over the disclosure of their health records, andfor establishing unique identifiers for healthcare provid-ers, health plans, employers, and individuals. Compli-ance is only required for electronic health information;

paper record compliance is voluntary. Compliance re-quirements vary for each part of HIPAA and are alsodifferent depending on the facility’s size. For moreinformation on HIPAA, see the Health Devices articlecited below.

Reported problemsSome computer components are sensitive to vari-

ations in temperature, humidity, and line voltage. Likeany other large electrical device, these computers gen-erate considerable heat during operation, which candamage components such as drives and microprocessorchips. Depending on the system, temperatures mayneed to be restricted to within a few degrees of 20° to23°C. Although these restrictions typically apply tomainframe computers, users should be aware that PCsand minicomputers may be adversely affected by tem-peratures outside this range. Humidity must be lowenough to prevent condensation but high enough toeliminate static electricity. Lint and dust from carpetsand paper, as well as chemical fumes that affect elec-tronics and storage media, may necessitate the use ofan air-filtering system.

Electrical fluctuations can damage computer com-ponents, impair performance, disrupt program opera-tion, and destroy data. Preventive measures includeinstalling an online uninterruptible power supply. Al-though a dedicated line isolated for the CPU may notcompensate for voltage variations, it may be useful toreduce signal noise. Copying disks at regular intervalsprotects stored information. Damage can also resultfrom component failure or user abuse.

To reduce the downtime due to system failures, mostcomputers offer redundant fault tolerance, whereby aduplicate set of main components (e.g., processors,drives) serves as a backup. A less expensive option in-volves the use of disk mirroring (storing data in dupli-cate) to provide backup if one disk becomes inoperable.

No software is without programming errors, whichmay affect the proper functioning of the software. Attimes, these errors are discovered only after the soft-ware has been installed and is in use. Suppliers shouldprovide quick resolution of programming errors oncethey are found.

Teleradiology equipment should be tested on a regu-lar basis; a thorough quality-assurance programshould be established. Overall system performanceshould be tested weekly, and components such as laserdigitizers, monitors, and video framegrabbers shouldbe tested monthly or quarterly.



Data-compression techniques and other methodsdesigned to shorten transmission periods have re-sulted in errors. Although high-ratio data compres-sion remains one of the most controversial issuessurrounding teleradiology, the use of error-correctioncircuitry and software and improvements in the qual-ity of transmission methods have greatly increased theoverall accuracy of radiographic diagnosis by teleradi-ology. Hospitals should develop a policy concerning themaximum amount of compression permitted to ensureaccurate transmission of diagnostically useful images.

There have also been legal concerns about usingdigital images for diagnosis, including safe storage andlength of storage, access to information, disseminationof stored information, and unauthorized access to re-cords. In addition, as the use of teleradiology for remotediagnosis increases, more questions about physicianliability and licensure have arisen. The new standardestablished by ACR for teleradiology addresses physi-cian licensure and credentialing issues related toteleradiology.

Purchase considerationsThe following should be considered before purchas-

ing a teleradiology system:

• Availability of a direct connection to CT, MRI, US,and other imaging modalities

• The need for a film digitizer to digitize plain films

• Image acquisition and transmission times

• Maximum image matrix size that can be acquiredand transmitted

• Multitasking capabilities (The system should beable to simultaneously digitize one image whiletransmitting another.)

• Availability of cost-effective WAN transmission(e.g., ISDN, DSL, cable modem)

• User-friendliness of the computer system

• Physician adaptability to image interpretation us-ing a computer monitor rather than a traditionalfilm viewer

• Image and data storage needed

• The use of portable systems for on-call radiologists

• Hardware and software requirements for integrat-ing with other information systems in the facility orinterfacing with PACS or other information systems

• System upgradability

• Multiple-site networking capabilities for integra-tion with a MAN or WAN

• Service providers for both hardware and softwaremaintenance and the location and availability ofservice representatives

• Financial stability of the supplier

Applications of the teleradiology system should alsobe considered. Real-time review by consulting physi-cians at different sites requires high-resolution imagesand rapid transmission by either ISDN or satellite forpoint-to-point transmission or by dedicated coaxialcable, DSL, or cable modems for LAN transmission.Image transmission to on-call radiologists at homerequires transmission over telephone lines; each radi-ologist should have a high-resolution computer moni-tor at home, and the department should have aportable modem, CPU, and hard disk that the radiolo-gist can carry home when on-call. If hard-copy reviewis desired, the department should invest in a laserimager.

If the teleradiology system is to be integrated witha PACS, compatibility with communications stand-ards should be considered. An international standardfor network architectures, called Open System Inter-connect (OSI), was developed under the guidance of theInternational Organization for Standardization (ISO).ACR and the National Electrical Manufacturers Asso-ciation (NEMA) have established the ACR/NEMADigital Imaging and Communications standard (DI-COM 3.0), which ensures data exchange among imag-ing devices, regardless of the brand or image formatused. The standard sets minimum requirements forhardware, data-link service, networking, messagepresentation, and applications. DICOM 3.0 was de-vised so that several devices meeting the standardcould be organized into a system without customizedinterfaces.

Supplier-specific network architectures are beingreplaced by open architectures that comply withACR/NEMA and ISO/OSI standards. The adoption ofan industrywide standard will allow hospitals to in-stall multisupplier systems and should reduce theexpenses of implementing a totally digital department.To facilitate networking, any new equipment pur-chased should be DICOM compatible.

A facility should choose a system that provides theresolution and performance characteristics that bestsuit its needs. Obtaining a list of users from the manu-facturer and talking with experienced teleradiologistsbefore purchasing a system may prove helpful.

Cost containment

The most critical consideration in purchasing a tel-eradiology system is cost-effectiveness. Teleradiology



is cost-effective only if it reduces a hospital’s expenseswithout adversely affecting patient diagnoses andtreatment or if it improves patient care to a greaterextent than it increases expenses.

Using hardware already in the department can re-duce initial expenditures. In addition, for buyers thatlack the initial capital necessary to purchase an entiresystem, leasing the hardware can be an attractiveoption.

The initial acquisition cost does not accurately re-flect the total cost of owning and operating a teleradi-ology system. Operating costs include hardware/software maintenance, telecommunications and net-working, and upgrade costs. These costs may be offset,however, by reductions in patient transfer and physi-cian travel costs, time savings, and improved qualityof care. On-call teleradiology systems are available forapproximately $15,000 to $20,000; systems used foroverread networks can be purchased for $60,000 to$80,000.

DICOM 3.0 specifies CD-Rs as standard storagemedia. At a cost of less than $1.00/CD-R, using CD-Rscan reduce film costs and the need for film storagespace. Compact disc (CD)-writable drives are availablefor $100 to $500, and CD jukeboxes that hold close to100 GB of data are available for approximately $9,000.

ECRI recommends that, to maximize bargainingleverage, hospitals negotiate pricing for maintenancefees for software and hardware before the system ispurchased. Buyers should also negotiate for a nonob-solescence clause or access to a growth path. Buyersshould also make sure that applications training isincluded in the purchase price of the system. Somesuppliers do offer more extensive on-site or off-sitetraining programs for an additional cost.

In response to the need for integration of teleradiol-ogy systems with existing devices (e.g., imaging equip-ment, PACS), several suppliers have emerged as“systems integrators,” offering computer hardware,specialized software interfaces, medical peripherals,and other interfacing solutions to integrate existingequipment and new teleradiology equipment in thehealthcare organization. In addition, ECRI’s HealthSystems Group can assist in the planning and instal-lation of a teleradiology system.

Stage of developmentAlthough telemedicine was first used in the 1960s,

teleradiology systems were not widely used until the1980s. Early systems used slow-scan TV technology,producing analog signals that required several minutes

for transmission over telephone lines. Digital systemsnow dominate the teleradiology market, and advancesin microcomputers and film-scanning technology allowhigh-speed digitization of film images, lossless datacompression, automatic transmission, and image en-hancement. Teleradiology has benefited from the in-creased availability of relatively inexpensive, powerfulPCs with high-resolution monitors, as well as from theincreased use of digital imaging technologies such asMRI and CT. Installation of teleradiology systems inmobile imaging centers that provide MRI and CT isalso increasing.

Continued improvements in telecommunicationstechnology, microcomputers, compression algorithms,interactive workstations, and digitizing technology, aswell as the demand for faster and more convenientinformation transfer within the medical community,will increase the demand for teleradiology systems anddigital data transmission. The future growth of a na-tional and international telecommunications infra-structure will also facilitate the installation and use ofteleradiology systems. Image and data transmissionvia cable modem is a faster and more cost-effectivealternative to ISDN and T-1 lines. With transmissionrates of 1.5 Mbps, this cable service uses coaxial net-works rather than phone lines. Progressive wavelettechnologies allow rapid access of images over slower-speed lines or via real-time display stations.

Currently, teleradiology systems are most fre-quently used for subspecialty consultations and foroff-site reading of images by on-call radiologists. Theemphasis on managed care, integrated healthcare de-livery networks, and the computer-based patient re-cord has increased the interest in expandingteleradiology applications and the market for teleradi-ology systems. Independent radiologist groups arepartnering with radiology departments at researchinstitutions, teleradiology equipment suppliers, and/ortelecommunications companies to provide specializeddiagnostic services and, in some cases, teleradiologyplatforms and communications services, via overreadnetworks. These networks, which are rapidly growingin response to managed care, typically consist of mul-tiple remote sites that transmit images to facilitieswith fully staffed radiology departments or to radiolo-gist groups.

Most recently, telemedicine — the delivery of medi-cal care to patients worldwide through telecommuni-cations technologies and multimedia applications —has emerged as a new method of healthcare deliveryin Europe, the United States, the Middle East, andother regions. By combining teleconferencing, tele-phone consultations, teleradiology, telepathology, and



other technologies and applications, telemedicine may,in the future, help decrease healthcare costs world-wide, as well as improve the quality of care in somecountries. (See the Product Comparison titled VIDEO-CONFERENCING SYSTEMS, TELEMEDICINE for moreinformation.)

The escalating interest in telemedicine and the suc-cess of ongoing telemedicine projects suggest that themarket for this technology will increase dramaticallyover the next decade, as will the number of programsavailable. Future clinical applications are predicted toinclude mentoring of surgeons, home monitoring ofcritically ill patients, remote control of robotically as-sisted surgery, and advanced healthcare delivery tomore rural areas.

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Standards and guidelines

Note: Although every effort is made to ensure that thefollowing list is comprehensive, please note that otherapplicable standards may exist.

American College of Radiology. Standard for teleradi-ology. 1994 (revised 2002).

American College of Radiology/National ElectricalManufacturers Association. Digital imaging andcommunications in medicine (DICOM) part 1: intro-duction and overview [standard]. 1999 (revised2000).

Digital imaging and communications in medicine(DICOM) part 2: conformance [standard]. 1999 (re-vised 2000).



Digital imaging and communications in medicine(DICOM) part 3: information object definitions[standard]. 1999 (revised 2000).

Digital imaging and communications in medicine(DICOM) part 4: service class specifications [stan-dard]. 1999 (revised 2000).

Digital imaging and communications in medicine(DICOM) part 5: data structure and semantics[standard]. 1999 (revised 2000).

Digital imaging and communications in medicine(DICOM) part 6: data dictionary [standard]. 1999(revised 2000).

Digital imaging and communications in medicine(DICOM) part 7: message exchange [standard].1999 (revised 2000).

Digital imaging and communications in medicine(DICOM) part 8: network communication supportfor message exchange [standard]. 1999 (revised2000).

Digital imaging and communications in medicine(DICOM) part 9: point to point communication sup-port for message exchange [standard]. 1999 (revised2000).

Digital imaging and communications in medicine(DICOM) part 10: media storage and file format formedia interchange [standard]. 1999 (revised 2000).

Digital imaging and communications in medicine(DICOM) part 11: media storage application profiles[standard]. 1999 (revised 2000).

Digital imaging and communications in medicine(DICOM) part 12: media formats and physical me-dia for media interchange. [standard]. 1999 (revised2000).

Digital imaging and communications in medicine(DICOM) part 13: print management point-to-pointcommunication [standard]. 1999 (revised 2000).

Digital imaging and communications in medicine(DICOM) part 14: grayscale standard display func-tion [standard]. 1999 (revised 2000).

American Health Information Management Associa-tion. Patient photography, videotaping, and otherimaging [guideline]. 1995 (updated 2001).

Canadian Association of Radiologists. CAR standardfor communication: diagnostic radiology. 1997 (re-viewed 2001).

Center for Devices and Radiological Health. Guidancedocument for the preparation of premarket notifica-tion [501(k)] applications for communications systems

(powered and non-powered environmental controlsystems) [guidance article]. 1995.

Institute of Medicine. Telemedicine: a guide to assess-ing telecommunications in health care. [report].1996.

International Electrotechnical Commission. Guide-lines for implementation of DICOM in radiotherapy[standard]. 2002.

Medical electrical equipment — part 1: general re-quirements for safety [standard]. IEC 60601-1(1988-12). 1988.

Medical electrical equipment — part 1: general re-quirements for safety. Amendment 1 [standard].IEC 60601-1-am1 (1991-11). 1991.

Medical electrical equipment — part 1: general re-quirements for safety. Amendment 2 [standard].IEC 60601-1-am2 (1995-03). 1995.

Medical electrical equipment — part 1: general re-quirements for safety. Section 1. Collateral stan-dard: safety requirements for medical electricalsystems. IEC 60601-1-1 (1992-06). 1992.

Medical electrical equipment — part 1: general re-quirements for safety. Section 1. Collateral stan-dard: safety requirements for medical electricalsystems. Amendment 1. IEC 60601-1-1-am1 (1995-11). 1995.

Medical electrical equipment — part 1: general re-quirements for safety. Section 2. Collateral stan-dard: electromagnetic compatibility — requirementsand tests. IEC 60601-1-2 (2001-09). 2001.

Physician Insurers Association of America. Tele-medicine: an overview of applications and barriers[report]. 1996.

Royal Australian and New Zealand College of Radiolo-gists. Position on teleradiology. 2001.

Royal College of Radiologists. Guide to informationtechnology in radiology, teleradiology, and PACS.2000.

Society for Computer Applications in Radiology. Un-derstanding teleradiology [recommendation]. 1994.

Citations from other ECRI publicationsHealth Devices

Learning about telemedicine services: where to begin?1997 Apr;26(4):178-9.

Telecommunications in healthcare. 1997 Jul;26(7):263-85.

Telemedicine: an overview. 1999 Mar;28(3):88-103.



The buzz on HIPAA: how HIPAA will affect the elec-tronic transmission of health information. 2000 Dec;29(12):472-6.

Health Technology Trends

Telemedicine bridges miles to link physicians withpatients. 1992 Oct;4(10):4-5.

HCFA names telemedicine test sites to evaluate cover-age. 1994 Sep;6(9):4-5.

New technology brief. Teleradiology is medical center’sresponse to managed care. 1994 Sep;6(9):3, 5.

Teleradiology equipment needs defined in new stan-dard. 1994 Nov;6(11):7.

ECRI forum: hospital telecommunications need man-agement attention. 1995 May;7(5):8.

Telemedicine needs further evaluation. 1995 Jul;7(7):6.

Telemedicine gains ground in rural facilities, but hur-dles remain. 1997 Apr;9(4):4-5.

A California anticoagulation clinic uses telemedicineto connect with its patients at home. 1998 Mar;3(10):8.

Supplier information

Agfa

Agfa Corp HealthCare (US) [409923]10 S Academy StGreenville SC 29601Phone: (864) 421-1600Fax: (864) 421-1622E-mail: [email protected]: http://www.agfa.com/healthcare

Agfa-Gevaert Ltd (Australia) [376483]372-394 Whitehorse RdNunawading, VIC 3131AustraliaPhone: 61 (3) 92647711Fax: 61 (3) 92647890E-mail: [email protected]: http://au.agfa.com

Agfa-Gevaert Ltd (UK) [324525]27 Great West RoadBrentford, Middlesex TW8 9AXEnglandPhone: 44 (20) 82314517Fax: 44 (20) 82314951E-mail: [email protected]: http://www.agfa.co.uk

Agfa Hong Kong Ltd [193770]Cavendish Centre 14/Fl23 Yip Hing StreetWong Chuk HangHong Kong SARPeople’s Republic of ChinaPhone: 852 25559421Fax: 852 28736172E-mail: [email protected]: http://www.medical.agfa.com.hk

Applicare

Applicare Medical Imaging bv [248763]Postbus 936NL-3700 AX ZeistThe NetherlandsPhone: 31 (30) 6926000Fax: 31 (30) 6926010E-mail: [email protected]: http://www.applicare.com

BRIT Systems

BRIT Systems [183017]1909 Hi Line Dr Suite ADallas TX 75207-3322Phone: (214) 630-0636, (800) 230-7227Fax: (214) 630-1638E-mail: [email protected]: http://www.brit.com

Canon

Canon Europa NV [157138]Bovenkerkerweg 59-61Postbus 2262NL-1180 EG AmstelveenThe NetherlandsPhone: 31 (20) 5458926Fax: 31 (20) 5458220

Canon Medical SystemsDiv Canon USA Inc [362077]15955 Alton PkwyIrvine CA 92618-3616Phone: (949) 753-4162Fax: (949) 753-4164E-mail: [email protected]: http://www.usa.canon.com



DeJarnette Research

DeJarnette Research Systems Inc [155951]401 Washington Ave Suite 1010Towson MD 21204-4821Phone: (410) 583-0680Fax: (410) 583-0696E-mail: [email protected]: http://www.dejarnette.com

DR Systems

DR Systems Inc [187974]9369 Carroll Park Dr Suite BSan Diego CA 92121-3264Phone: (858) 625-3344, (800) 794-5955Fax: (858) 625-3335E-mail: [email protected]: http://www.dominator.com

eMed Technologies

eMed Technologies Corp [364784]25 Hartwell AveLexington MA 02421-3102Phone: (781) 862-0000, (866) 363-3669Fax: (781) 861-6360E-mail: [email protected]: http://www.emed.com

GE Medical Systems

GE Medical Systems Asia (Japan) [300443]4-7-127 AsahigaokaHino-shiTokyo 191-8503JapanPhone: 81 (3) 425826820Fax: 81 (3) 425826830E-mail: [email protected]: http://www.gemedical.co.jp

GE Medical Systems Europe [171319]283 rue de la Miniereboite postale 34F-78533 Buc CedexFrancePhone: 33 (1) 30704040Fax: 33 (1) 30709855E-mail: [email protected]: http://www.gemedicalsystems.com

Images-on-Call

Images-on-Call [292045]10024 Monroe DrDallas TX 75229-5703Phone: (214) 902-8337, (877) 349-0248Fax: (214) 902-8303E-mail: [email protected]: http://www.imagesoncall.com

IMCO Technologies

IMCO Technologies Corp [372414]N27 W23957 Paul Rd Suite 101Pewaukee WI 53072-6204Phone: (262) 523-4445, (800) 300-7734Fax: (262) 523-1141E-mail: [email protected]: http://www.imco-tech.com

IMCO Technologies GmbH [401045]High-Tech-Center 1CH-8274 TaegerwilenSwitzerlandPhone: 41 (71) 6667665Fax: 41 (71) 667664E-mail: [email protected]: http://www.imco-tech.com

Integrated Modular

Integrated Modular Systems Inc [373258]14 Tenby RdPO Box 616Havertown PA 19083-5313Phone: (610) 789-7000, (800) 220-9729Fax: (610) 789-7310E-mail: [email protected]: http://www.integratedmodular.com

RADIN Group GmbHDiv SOHARD AG [407310]Wuerzburger Strasse 197D-90766 FuerthGermanyPhone: 49 (911) 97341270Fax: 49 (911) 97341299E-mail: [email protected]: http://www.radin.de



IntelliRAD

IntelliRAD Solutions Pty Ltd [416540]Level 1 123 Camberwell RoadEast Hathorn, VIC 3123AustraliaPhone: 61 (3) 98119901Fax: 61 (3) 98119919E-mail: [email protected]: http://www.intellirad.com.au

Kodak

Eastman Kodak CoHealth Imaging Div [273728]343 State StRochester NY 14650-1132Phone: (716) 724-4000, (800) 677-9933Fax: (716) 724-7611Internet: http://www.kodak.com/go/health

Eastman Kodak Co (United Kingdom) [177666]PO Box 591 Uxbridge One1 Harefield RoadUxbridge, Middlesex UB8 1YDEnglandPhone: 44 (1895) 844065Internet: http://www.kodak.co.uk

Eastman Kodak (Japan) Ltd [227142]4-7-35 Kita ShinagawaShingawa-kuTokyo 104-0001JapanPhone: 81 (3) 56445040Fax: 81 (3) 56445051Internet: http://www.kodak.co.jp

Line Imaging

Line Imaging Systems [155958]240 Townsend Sq111 South StOyster Bay NY 11771Phone: (516) 624-7400, (800) 330-5463Fax: (516) 624-2049E-mail: [email protected]: http://www.lineimaging.com

McKesson

McKesson Medical Imaging Group [410524]10711 Cambie Rd Suite 130Richmond BC V6X 3G5CanadaPhone: (604) 279-5422, (800) 661-5885Fax: (604) 279-5468E-mail: [email protected]: http://www.mig.mckesson.com

Medasys

Medasys Japan K K [362142]Grand Verger 1012120-6 HigashinaganumaTokyo 206-0808JapanPhone: 81 (42) 3706421Fax: 81 (42) 3706422E-mail: [email protected]: http://www.medasys.co.jp

Medasys SA [202262]Espace Technologique de Saint-AubinImmeuble Le MercuryF-91193 Gif-Sur-Yvette CedexFrancePhone: 33 (1) 69337300Fax: 33 (1) 69337301E-mail: [email protected]: http://www.medasys.com

Medpacs

Medpacs Displays Inc [292047]2480 Nagawicka RdHartland WI 53029-9345Phone: (262) 367-0181Fax: (262) 367-9574E-mail: [email protected]: http://www.medpacs.com

Merge eFilm

Merge Technologies Inc [233833]1126 S 70th StMilwaukee WI 53214-3151Phone: (414) 977-4000, (877) 446-3743Fax: (414) 977-4200E-mail: [email protected]: http://www.merge.com

Philips

Philips Medical Systems Asia [188101]30/Fl Hopewell Centre17 Kennedy RoadWanchaiHong Kong SARPeople’s Republic of ChinaPhone: 852 28215888Fax: 852 25276727E-mail: [email protected]: http://www.medical.philips.com



Philips Medical Systems North America [102120]22100 Bothell Everett HwyPO Box 3003Bothell WA 98041-3003Phone: (425) 487-7000, (800) 526-4963Fax: (425) 485-6080E-mail: [email protected]: http://www.medical.philips.com

Philips Nederland bv Medical Systems [152365]Postbus 90050NL-5600 PB EindhovenThe NetherlandsPhone: 31 (40) 2782559Fax: 31 (40) 2780160E-mail: [email protected]: http://www.medical.philips.com

RADIN

RADIN Group GmbHDiv SOHARD AG [407310]Wuerzburger Strasse 197D-90766 FuerthGermanyPhone: 49 (911) 97341270Fax: 49 (911) 97341299E-mail: [email protected]: http://www.radin.de

RamSoft

RamSoft Inc [250071]16 Four Seasons Pl Suite 215Toronto ON M9W 6E5CanadaPhone: (416) 674-1347, (888) 343-9146Fax: (416) 674-7147E-mail: [email protected]: http://www.ramsoft.biz

Rogan

Rogan-Delft bvA Delft Instruments Co [416247]Gildtrom 37NL-3905 TB VeenendaalThe NetherlandsPhone: 31 (318) 583150Fax: 31 (318) 583170E-mail: [email protected]: http://www.rogan-medical.com

Sectra Imtec

Sectra Imtec AB [248761]Teknikringen 2S-583 30 LinkopingSwedenPhone: 46 (13) 235200Fax: 46 (13) 212185E-mail: [email protected]: http://www.sectra.se

Siemens

Siemens Canada Ltd [174735]2185 Derry Rd WMississauga ON L5N 7A6CanadaPhone: (905) 819-8000, (888) 303-3353Fax: (905) 819-5777E-mail: [email protected]: http://www.siemens.caSiemens Medical Solutions USA IncNuclear Medicine Group [399200]2501 N Barrington RdHoffman Estates IL 60195-5203Phone: (847) 304-7700, (800) 767-2313Fax: (847) 304-7707E-mail: [email protected]: http://www.siemens.com/med

Vepro

Vepro GmbH [199545]An der Tuchbleiche 26D-64319 PfungstadtGermanyPhone: 49 (6157) 800600Fax: 49 (6157) 800666E-mail: [email protected]: http://www.vepro.com

ViTel Net

ViTel Net (Visual Telecommunications NetworkInc) [335217]8201 Greensboro Dr Suite 820McLean VA 22102Phone: (703) 448-0999Fax: (703) 749-9559E-mail: [email protected]: http://www.vitelnet.com

About the chart specificationsThe following terms are used in the chart:

Multimodality: The imaging modalities from which theteleradiology system can acquire, digitize, and/ortransmit images.



Compression ratios: A measure of the degree to whichimage data is compressed to reduce image transmis-sion times and/or data storage requirements. Thehigher the ratio, the more the data is compressed.

Maximum matrix size transmitted: The maximum pixelmatrix size that the system can transmit.

Transmission time for maximum matrix: Transmissiontimes vary depending on the size of the image ma-trix, the type of compression and compression ratio,and the transmission method.

ROI magnification: The ability to demarcate and mag-nify a region of interest in the image.

List price, std configuration: The prices that appear inthe charts represent a wide range of system configu-rations. Prices vary depending on user-selected op-tions and customizations. Some of the pricinginformation in this chart has been derived from listprices reported on a supplier’s Web site or to ECRI’sin-house information services by healthcare institu-tions and by suppliers. A footnote identifies theseprices. In these instances, suppliers have declined toprovide HPCS directly with prices and may not haveconfirmed the information. These prices are estimatesand may or may not reflect discounts, options, spe-cial packages, and multiple-unit sales. They areprovided for the convenience of our readers.

Abbreviations:

ACR — American College of Radiology

ARO — After receipt of order

ATM — Asynchronous transfer mode

B/W — Black and white

CCD — Charge-coupled device

CD-R — Recordable compact disc

CE mark — Conformite Europeene mark

CR — Computed radiography

CRT — Cathode ray tube

CT — Computed tomography

DAT — Digital audiotape

DHCP — Dynamic Host Configuration Protocol

DICOM 3.0 — Digital Imaging and Communica-tions in Medicine Standard

DR — Digital radiography

DSA — Digital subtraction angiography

DSL — Digital subscriber line

EN — European Norm

FDA — U.S. Food and Drug Administration

FDDI — Fiber Distributed Data Interface

FTP — File transfer protocol

GS — Gepruefte Sicherheit

GUI — Graphical user interface

HIS — Hospital information system

HL7 — Health Level 7

HW — Hardware

IEEE — Institute of Electrical and Electronics Engi-neers

ISDN — Integrated Services Digital Network

ISO — International Organization for Standardiza-tion

JPEG — Joint Photographic Experts Group; a datacompression standard

LAN — Local area network

LCD — Liquid crystal display

LED — Light-emitting diode

LIS — Laboratory information system

MDD — Medical Devices Directive

MIP/MPR — Maximum-intensity projection/multiplanar reconstruction

MR — Magnetic resonance

MRA — Magnetic resonance angiography

MRI — Magnetic resonance imaging

NEMA — National Electrical ManufacturersAssociation

NM — Nuclear medicine

NTSC — National Television System Committee

PACS — Picture archiving and communicationsystem

PAL — Phase alternation line; a European color-television coding system (625 lines; 50 Hz)

PC — Personal computer

PET — Positron emission tomography



POTS — Plain Old Telephone Service

RAID — Redundant array of inexpensive disks

RAM — Random-access memory

RIS — Radiology information system

ROI — Region of interest

SC — Soft copy

SCU/SCP — DICOM Service Class User/ServiceClass Provider

SECAM — Sequential Couleur avec Memoire; color-television standard of 625 scan lines and 25 in-terlaced frames per second

SVGA — Super Video Graphics Array

SW — Software

TCP/IP — Transmission Control Protocol/InternetProtocol

UPS — Uninterruptible power supply

US — Ultrasound

VAC — Volts of alternating current

VPN — Virtual private network

WAN — Wide area network

WIP — Work in progress

XA — X-ray angiography

Note: The data in the charts derive from suppli-ers’ specifications and have not been verified throughindependent testing by ECRI or any other agency.Because test methods vary, different products’ specifi-cations are not always comparable. Moreover, prod-ucts and specifications are subject to frequent changes.ECRI is not responsible for the quality or validity ofthe information presented or for any adverse conse-quences of acting on such information.

When reading the charts, keep in mind that, unlessotherwise noted, the list price does not reflect supplierdiscounts. And although we try to indicate whichfeatures and characteristics are standard and whichare not, some may be optional, at additional cost.

For those models whose prices were supplied to usin currencies other than U.S. dollars, we have alsolisted the conversion to U.S. dollars to facilitate com-parison among models. However, keep in mind thatexchange rates change often.

Need to know more?For further information about the contents of this

Product Comparison, contact the HPCS Hotline at +1(610) 825-6000, ext. 5265; +1 (610) 834-1275 (fax); [email protected] (e-mail).



Product Comparison Chart

MODEL AGFA APPLICARE APPLICARE BRIT SYSTEMS

IMPAX Web 1000 RadWorks 6.0 WebViewer 5.1 Radiology Workbench

WHERE MARKETED Worldwide Worldwide Worldwide USA

FDA CLEARANCE Yes Yes Yes Yes

CE MARK (MDD) Yes Yes Yes No

MULTIMODALITY All modalities CT, MRI, US, CR, CR, CT, MR, US, NM, All DICOMx-ray, DR, NM, DX, XA, RF, DR, DX, MG,PT, VL, PR, SR, KO IO

IMAGE CAPTURELight box Not specified No NA No

Size, cm (in) Not specified NA NA NAVideo framegrabber Not specified Yes NA High resolution

Resolution Not specified All resolutions NA 1024 x 1024,512 x 512

Direct digitalimage capture Not specified Yes NA Yes

Film digitizer(s) Yes Canon, Lumisys, How- NA Kodak Lumiscan,tek, Vidar, Array, VidarTWAIN compliant

Scan speed, sec 45 for 2K x 2K Digitizer dependent NA 30, 6-20Shades of gray 4,096 Digitizer dependent NA 4,096 (3584 x 4352)

MODEM SPEEDS, Kbps 28.8, 56, ISDN, DSL, All speeds for ana- All speeds for ana- 14.4, 19.2, 28.8,cable modem log, ISDN, ATM, T-1 log, ISDN, ATM, T-1 ISDN/T-1/ATM *

IMAGE TRANSMISSIONSending computer PC server Intel Intel Intel, Windows based **

Compression ratios User selectable, 3:1 lossless, user- Client-side select- User selectable;wavelet, lossy or selectable lossy able lossy wavelet gradual transmissionlossless wavelet and JPEG and JPEG available

Maximum matrix sizetransmitted 4K x 4K No maximum Connection/compres- 2560 x 2048;

sion dependent 4K x 4K ***Transmission time

for maximum matrix Depends on compres- Connection dependent Connection dependent Connection dependentsion & transmission

WAN transmissionTelephone line Yes Yes Yes YesMicrowave Yes Yes Yes YesSatellite Yes Yes Yes YesISDN Yes Yes Yes YesT-1 Yes Yes Yes YesSwitched-56 Yes Yes Yes YesATM Yes Yes Yes YesOthers Web/Internet Yes None specified DS-3, DSL, cable

modemLAN protocols used Ethernet, TCP/IP, Ethernet, TCP/IP, TCP/IP, Ethernet, TCP/IP, Microsoft

ATM Windows NT protocols Windows NT protocols RAS

AVAILABLE INTERFACES RIS, HIS, HL7, DICOM HIS/RIS, custom, HIS/RIS, custom, Optional HL7, DICOMActiveX, command ActiveX, commandline, scripting line, scripting

EXPANDABLE TO PACS Yes Yes Yes Yes

DICOM 3.0 CONFORMANT Yes Yes Yes Yes

HL7 COMPLIANT Yes Not specified Not specified Optional

Colons separate data on similar models of a device. This is the first of* Also 33.6 Kbps, 56 Kbps, cable modems, and DSL. three pages covering** Also RS/6000 with appropriate network adapter card. the above model(s).*** 4K x 4K with optional 50-micron spot-size laser. These specifications

continue onto thenext two pages.






IMAGE RECEPTIONReceiving computer Sun Win/Tel Intel Intel Any DICOM that

supports the correcttransfer syntax *

Storage Unlimited Up to maximum Not specified Customizedsupported by NT

Memory, MB 128-512 64 64 64 minimum,128 recommended

Maximum number ofimages stored Depends on matrix Up to available disk Not specified Customized

and image type space

IMAGE DISPLAYNumber of display

stations supported Unlimited Unlimited Unlimited Unlimited

Number of monitorsper station 1 1 to 8 1 1 or 2

Display monitor Varies Not specified Not specified B/W; color optionalSize Varies 15" and up 17" and up Up to 25"

Resolution, pixels SVGA or better Up to maximum Up to 2560 x 2048, 1280 x 1600, 1024 xsupport by NT viewport size max 1248, 1500 x 2000,

1280 x 1024 2000 x 2500

Grayscale levels 256 256 256 4,096 with windowand level controls

Split-screen images Yes User definable User definable >20

ROI magnification Yes Yes Yes Yes

Image-enhancementfeatures Pan/zoom, annotate, Windows-configurable Window/level, width, Pan/zoom, window

measure, window/ user interface, pan/ ROI, pan/zoom/flip/ and level controlslevel, rotate, zoom/flip/rotate/ rotate/invert, mag- for grayscales,mirror image, white mirror/invert, mag- nifying glasses, annotation by textboarding, conference nifying glasses, angle/distance mea- or voice, edgemode, thumbnail angle/distance surement, cine, cut enhancement, work-view, CT scout mode measurement, ROI lines, application list, scout films,

statistics, studies synchronization, image synchroniza-compare, linked cine study/series com- tion, Web-enabled,loops, histograms, pare, display anno- reports w/integra-MIP/MPR, text/box/ tations, key images, tion, preset/point-circle/free-form HIS/RIS/report inte- and-click window/annotations, overlay ** gration level, ROI

OPTIONS Cardiology display Multiple background None specified RAID (fast-accesstools, integration synchronous, send/ disk), voice dicta-into 3rd-party receive, unlimited tion, waveletproducts such as EPR sites, reports on compression, voice

all actions of send- transcriptionand-receive sites,view as arrive

Colons separate data on similar models of a device. This is the second of* Also RS/6000 with appropriate network adapter card. three pages covering** Also shutters, image-enhancement filters, key images/frames, hanging protocols. the above model(s).

These specificationscontinue onto thenext page.






SYSTEM SECURITY Password w/auto ex- Group and individual Windows NT authenti- User ID, group,piration, auto log- user IDs, U.S. Dept. cation, SSL for data firewalls availableoff, password- of Defense transfer, query re-assigned privileges * C2-level security strictions, data log

POWER REQUIREMENTS 110-240 VAC, PC dependent PC dependent 120 VAC, 60 Hz50-60 Hz

PLANNING & PURCHASEList price,

std configuration $45,000-180,000 $15,357 Not specified $10,000+

Warranty 1 year 1 year 1 year 1 year

Delivery time, ARO 45-60 days <4 weeks <4 weeks 2 weeks, SW; 1 monthLumisys scanner

Monthly maintenanceHardware Contract available, 10% purchase price Not specified 12% purchase price

depends on config per year per yearSoftware Contract available, 10% purchase price 10% purchase price 12% purchase price

depends on config per year per year per yearTraining w/purchase Demo disk available Custom Custom Not specified

Telephone support 24 hr, toll-free Optional remote Yes 24 hr, toll-freenumber maintenance by phone hotline, Internet

Year first sold 1994 1994 1998 1994

Number installed >300 worldwide >9,000 >75 ~120

Last softwareupdate November 2002 December 2001 July 2000 December 2001

Fiscal year January to December January to December January to December January to December

OTHER SPECIFICATIONS DICOM compatible; 24-bit true-color Image enhancement None specified.upgradable, images; stand-alone, also includes multi-scalable store and forward, frame display, user-architecture; workgroup configura- selectable compres-PC-based viewing and tions possible; Web sion, modality-basedWeb viewer viewer and archive compression qualityavailable. available. GMP and factor, user

ISO 9001 conformance profiles, and userstatements permissions.available.

Colons separate data on similar models of a device.* Also data access controls, 3rd-party user authentication, comprehensive audit trail, 128-bit SSL encryption of DICOM header

and pixel data.




MODEL CANON DEJARNETTE RESEARCH DR SYSTEMS EMED TECHNOLOGIESFAILED TO RESPOND *

PACS/Teleradiology Radiance TeleShare Film-Free Efficiency DICOM Bridge/View :IQ System eMed.net On Call

WHERE MARKETED Worldwide Worldwide Asia/Pacific, USA Primarily Australia,Europe, and NorthAmerica


CE MARK (MDD) No Submitted No Yes

MULTIMODALITY CT, MRI, CR, NM, US, Yes CT, MRI, DSA, NM, All modalities andPET, DR, dig fluoro, US, CR, PET plain film, exceptfilm digitizer mammography

IMAGE CAPTURELight box No No No No

Size, cm (in) NA NA NA NAVideo framegrabber No Optional Yes Yes

Resolution NA 2048 x 2048 Up to 1280 x 1024 2048 x 2500

Direct digitalimage capture DICOM, Interfile, Yes DICOM format Yes

JPEG, GIFF, TIFF **Film digitizer(s) Vidar, Lumisys, Lumisys Laser Lumisys Lumiscan,

Canon Vida Sierra

Scan speed, sec 15-45 115 lines/sec 30 30 at 2KShades of gray 4,096 256-1,024 4,096 Up to 4,096

MODEM SPEEDS, Kbps 56 33,600, ISDN 56; T-1, ISDN, DSL, Up to 56; 128 ISDNcable

IMAGE TRANSMISSIONSending computer Sun workstation in PC PC Pentium-compatible

PACS environment PCCompression ratios 2:1 lossless to Configurable up to 3:1, 15:1, user See footnote ***

50:1 lossy, user ~100:1 selectableselectable

Maximum matrix sizetransmitted Unlimited 4K x 4K Unlimited 2048 x 2560

Transmission timefor maximum matrix Not specified 3 min, 37 sec (4K 35 sec Varies with

over Ethernet) compression ratioWAN transmission

Telephone line Yes Yes Yes YesMicrowave Yes Yes No NoSatellite Yes Yes Yes NoISDN Yes Yes Yes YesT-1 Yes Yes Yes YesSwitched-56 Yes Yes Yes YesATM Yes Yes Yes YesOthers Available through No DS-3 Frame relay

FTP transmissionLAN protocols used FTP Ethernet, TCP/IP Ethernet, TCP/IP 10BaseT, 100BaseT

Ethernet, TCP/IP

AVAILABLE INTERFACES PACS, RIS, HIS HL7 or flat record RIS, HIS, PACS, LIS, DHCP, HL7, DICOMto RIS/HIS, DICOM/ CCOWACR-NEMA 2.0 to PACS

EXPANDABLE TO PACS Interfaces with PACS Yes Yes Yes

DICOM 3.0 CONFORMANT Query/retrieve, Yes Yes Yessend, print WIP

HL7 COMPLIANT Adaptable to site Yes Yes Yes

Colons separate data on similar models of a device. This is the first of* Specifications current as of March 2002. three pages covering** Also RAW and Sun Raster. the above model(s).*** 2-5:1 lossless to 100:1 lossy wavelet, selectable : 2:1 lossless, 3:1 JPEG lossless, 7:1 lossy, lossy wavelet selectable. These specifications

continue onto thenext two pages.






IMAGE RECEPTIONReceiving computer Mac, PC home PC PC when using the Pentium-compatible

computers, or Internet PC, NT server, Win-Sun SPARCstation dows 2000/NT server **

Storage User configurable, 9 GB hard drive 10 GB hard drive, Up to 1.5 TB9 GB HD, DAT, AIT, minimum specified 1.44 MB floppy,jukeboxes CD-R

Memory, MB 64 minimum 128 MB minimum 128 64 to 512recommended specified

Maximum number ofimages stored User configurable 250 to 1,450 Variable Unlimited, with

(2K x 2K) wavelet compressionfacilitated archive


stations supported Unlimited Unlimited Up to 4 Unlimited

Number of monitorsper station 1, user configurable 1 to 4 2 to 4 1 to 4

Display monitor Grayscale Yes B/W, color Not specifiedSize 1024 x 768, 1280 x 21" Up to 21" 21"

1024, 2048 x 2560Resolution, pixels Unlimited with 1.2K x 1.6K, 1024 x 1024, Up to 4096 x 4096

magnification 2K x 2.5K 1600 x 1200,1280 x 1024,1024 x 768

Grayscale levels 16-bit grayscale and 256 256 256, up to 4,09624-bit color

Split-screen images Multiple windows Yes Variable and stack Yessupported mode also offered

ROI magnification Unlimited bilinear Yes Yes Yesmagnification

Image-enhancementfeatures Window/level, clip, Window/level, flip/ Optional color, pan, Pan/zoom, window/

pan, cine rotate, hanging zoom, window/level, level, magnifyingprotocols text annotation, glass, tile mode,

rotate, mirror, stack mode withonboard patient cine, selectivedemographic page printing, auto imagetransmitted with sequence prepara-image file tion, MPR/MRA,

compression levelannotation

OPTIONS None specified DICOM print, Communication Web- Software onlycompression/ delivery module availabledecompression,direct point-to-point transmission,Web enabled

Colons separate data on similar models of a device. This is the second of* Specifications current as of March 2002. three pages covering** Depends on configuration. the above model(s).







SYSTEM SECURITY Password required Password/VPN User ID, multilevel User password, userencryption password ID, access controls

POWER REQUIREMENTS Standard home 90-132/100-240 VAC, 120 VAC 110/120 VAC, 60 Hz,computer 47-63 Hz, 200 W max <20 A


std configuration $1,500-90,000 $15,000+ $75,000-100,000 $1,800+


Delivery time, ARO 1-2 weeks 90 days 120 days 90 days

Monthly maintenanceHardware Based on Not specified 16% of purchase Service contract

configuration price for 100% HW availableSoftware Based on Not specified Upgrade coverage Maintenance contract

configuration availableTraining w/purchase 40 hr on-site, Tailored to customer 2-7 days, based on On-site

customizable needs installation sizeTelephone support Toll-free hotline, 24 hr service 24 hr, toll-free 24 hr, 7-day, toll-

Web support, upgrade support hotline free help deskYear first sold 1994 1991 1992 1993

Number installed Not specified Thousands 165 >7,800

Last softwareupdate November 2000 Twice annually or as March 2003 September 2002

neededFiscal year January to December January to December January to December January to December

OTHER SPECIFICATIONS Software only; ACR-NEMA 2.0 CCOW compliant; full Scalable design todistributed and conformant; protocol PACS available. enterprise PACS;supported with conversion from image-distributionrecommended minimum various proprietary networks; flexibleconfiguration. manufacturers. DICOM-transfer or

Web-access sub-scription-basedpricing available;RIS interface; net-work management anduser support onlinefault isolation;problem resolutionand training.

Colons separate data on similar models of a device.* Specifications current as of March 2002.




MODEL GE MEDICAL SYSTEMS IMAGES-ON-CALL IMAGES-ON-CALL IMCO TECHNOLOGIES

Centricity PACS Images-on-Call PACS Workstation IMCO-RAD

WHERE MARKETED Worldwide USA USA Europe, NorthAmerica, SouthAmerica


CE MARK (MDD) Yes Not specified Not specified Yes

MULTIMODALITY All DICOM IODs Any video-based or Any video-based or CT, MRI, US, DSA,including DX, MG DICOM modality, film DICOM modality, film NM, CR, DR, RF, SC

IMAGE CAPTURELight box No No No Yes

Size, cm (in) NA NA No 35 x 43 (14 x 17)Video framegrabber Optional Yes No Yes

Resolution 1024 x 1024, 2K x 2K NA 1024 x 1024;512 x 512 512 x 512 available

Direct digitalimage capture Optional DICOM No Yes

Film digitizer(s) Laser, CCD Laser, CCD No Laser, CCD

Scan speed, sec 75, 115 lines/sec 30-50 No 13-60Shades of gray 4,096 4,096 No 256 or 4,096

MODEM SPEEDS, Kbps 128 ISDN; 56 POTS; All, T-1, DSS, ISDN, All, T-1, DSS, ISDN, Up to 56TCP/IP WAN config DSL, cable, Internet DSL, cable, Internet

IMAGE TRANSMISSIONSending computer Sun, Intel PC PC PC Windows NT/2000/XP

Compression ratios DICOM, JPEG, pro- Up to 60:1, modality Up to 60:1, modality Nonegressive wavelet * and user selectable and user selectable

Maximum matrix sizetransmitted 2048 x 2560 4K x 5K 4K x 5K Up to 2K x 2.5K

Transmission timefor maximum matrix Varies with Varies with medium Varies with medium 0.1-3 sec, depending

available bandwidth and compression and compression on configurationWAN transmission

Telephone line Yes Yes Yes YesMicrowave Yes Yes Yes OptionalSatellite Yes Yes Yes OptionalISDN Yes Yes Yes OptionalT-1 Yes Yes Yes OptionalSwitched-56 Yes Yes Yes OptionalATM Yes Yes Yes OptionalOthers Yes Frame relay, others Frame relay, others DS-3, SMDS, spread

spectrumLAN protocols used Ethernet, TCP/IP Ethernet, TCP/IP, Ethernet, TCP/IP, TCP/IP, DICOM 3.0

IOC sockets IOC sockets over TCP/IP

AVAILABLE INTERFACES DICOM, HL7 DICOM DICOM RIS, HIS, PACS



HL7 COMPLIANT DICOM/HL7 interface Optional Not specified Yes

Colons separate data on similar models of a device. This is the first of* Also optional variable lossless/lossy. three pages covering

the above model(s).These specificationscontinue onto thenext two pages.






IMAGE RECEPTIONReceiving computer Intel PC PC PC/XP/2000 Windows NT/2000/XP

Storage Variable All media All media 2 GB hard disk,floppy, CD-R

Memory, MB 512-2,000 64 or more 1 GB 96 minimum

Maximum number ofimages stored Variable Unlimited Unlimited 2,000-20,000,

depending onconfiguration


stations supported Unlimited Unlimited Unlimited Virtually unlimited

Number of monitorsper station 1 to 4, with mixed 1 to 4 1 to 4 Up to 8

third monitorDisplay monitor CRT or flat panel Color or grayscale All Monochrome, color

Size 21" 14" or larger All 15", 17", 19", 21"

Resolution, pixels 1728 x 2048 (CRT), Up to 2.5K x 2K All 1280 x 1024, 1200 x1536 x 2048 (LCD), 1600, 1700 x 2300,1280 x 1024 (LCD) * 2000 x 2500

Grayscale levels 256 256 onscreen; 12 Bit 256 or 4,096adjustable to 4,096

Split-screen images 1:1 to 30:1, custom- 1, 2, 4, 6, 9, 12, 1, 2, 4, 6, 9, 12, 1 to 64 or moreized to user logon ** 15, 20, 30 on 1 15, 20, 30 on 1 ***


Image-enhancementfeatures Pan/zoom, flip/ro- False color, image False color, image Pan/zoom, window/

tate, orientation, invert, preset invert, preset level, invert/next/prior image, window/level or window/level or mirror, rotate,patient exam, sin- user-adjustable user-adjustable simultaneousgle/multi-image flip/rotate, cine, flip/rotate, cine, receive/view images,display format, vid- stack, zoom, magni- stack, zoom, magni- sharpen/smooth,eo invert, window/ fy, ROI heat units, fy, ROI heat units, annotation, ROIlevel, annotation, measurements, measurements, measurement, full-measurement, cine Doppler color Doppler color resolution magnify-mode/display, man- ing glass, side-by-ual/auto, worklist, side comparison,integral RIS/PACS pseudocolor, routedesktop, spine label † reports with images

OPTIONS Centricity Enter- None specified Transmit, HL7 Upgradable to PACS,prise archive, Web videoconferencing,portal, RIS voice recognition,

document scanning,HIS/RIS interface

Colons separate data on similar models of a device. This is the second of* 2048 x 2560 (CRT, LACD); 1200 x 1600 (CRT, LCD). three pages covering** Based on display protocol or manual. the above model(s).*** And user choice. These specifications† Also communication tools, MIP/MPR, advanced tools for large data-set handling, advanced postprocessing applications. continue onto the

next page.






SYSTEM SECURITY User ID, User ID; multilevel HIPAA standards User ID, multilevelSSL encryption on password available password, advancedWeb security features

optional

POWER REQUIREMENTS 120/220 VAC, 120 VAC, 60 Hz, 120 VAC, 60 Hz, 110/220 VAC,50/60 Hz 12 A, 400 W 12 A, 400 W 50/60 Hz


std configuration $5,000+ $1,800+ Not specified $10,000-75,000

Warranty 1 year, hardware 1 year 1 year 1 year

Delivery time, ARO Variable 30-120 days 60-180 days 60-120 days

Monthly maintenanceHardware Not specified Optional Optional Configuration

dependentSoftware Not specified Optional Optional Configuration

dependentTraining w/purchase Variable Included Included 1-10 days on-site

Telephone support 24 hr, toll-free 24 hr, 7 days 24 hr, 7 days 24 hr, toll-freehotline available available hotline

Year first sold 1993 1988 2002 Not specified

Number installed 10,000+ worldwide 940+ transmit sites, Not specified 2404,500+ receive

Last softwareupdate September 2002 October 2001 November 2002 Not specified

Fiscal year January to December Not specified Not specified January to December

OTHER SPECIFICATIONS None specified. None specified. None specified. Compatible with allimaging modalities;scalable by price/performancearchitecture; basedon industryoperating system anddatabase standards;document scanning;RAID; UPS; HIS/RISinterface; DICOM3.0.

Colons separate data on similar models of a device.




MODEL INTEGRATED MODULAR INTELLIRAD INTELLIRAD KODAKFAILED TO RESPOND * FAILED TO RESPOND *RADIN Integrated ePAX Web Voyager Imaging DirectViewImage Distribution Teleradiology System

WHERE MARKETED Worldwide Asia, Australia, Asia, Australia, WorldwideEurope Europe

FDA CLEARANCE Yes No No Yes

CE MARK (MDD) Yes No No Yes

MULTIMODALITY CR, CT, MR, US, RF, Via DICOM, DICOM All, image capture AllSC, RT, NM, PET, Capture or Voyager w/DICOM 3.0, frameDX, MG, XA 2x/3x teleradiology grab, film digitizer


Size, cm (in) NA NA NA 35 x 43 (14 x 17)Video framegrabber Optional Via Voyager 2x/3x Yes High resolution

Resolution Not specified 1K x 1K, 4K x 4K 1K x 1K, 4K x 4K Not specifiedby framegrabbing by framegrabbing

Direct digitalimage capture DICOM DICOM DICOM Yes

Film digitizer(s) CCD Support through Laser, CCD, LED, all Kodak-Lumisys,Voyager x work- TWAIN driver- Vidarstation compatible scanners

Scan speed, sec 9-44 9/1K, 19/2K, 39/4K 9/1K, 19/2K, 39/4K Not specifiedShades of gray 256, 4,096 4,096, 12-bit 4,096, 12-bit Not specified

MODEM SPEEDS, Kbps ISDN and up 33.6 ISDN, PSTN, 33.6 ISDN, PSTN, 56, ISDN, DSL, cabledepends on modem depends on modem

IMAGE TRANSMISSIONSending computer Intel PC IBM-compatible PC IBM-compatible PC PC compatible

Compression ratios 2:1 lossless, user- Lossless or lossy 30:1 user select- User selectableselectable lossy 30:1 compression able, wavelet or

JPEGMaximum matrix size

transmitted Unlimited Unlimited Unlimited 2500 x 2000

Transmission timefor maximum matrix Depends on size and Connection dependent Connection dependent Varies

line speedWAN transmission

Telephone line Yes TCP/IP protocols TCP/IP protocols YesMicrowave Not specified TCP/IP protocols TCP/IP protocols YesSatellite Yes TCP/IP protocols TCP/IP protocols YesISDN Yes TCP/IP protocols TCP/IP protocols YesT-1 Yes TCP/IP protocols TCP/IP protocols YesSwitched-56 Not specified TCP/IP protocols TCP/IP protocols YesATM Yes TCP/IP protocols TCP/IP protocols YesOthers None specified Any network that Any network that SMDS

supports TCP/IP supports TCP/IPLAN protocols used Ethernet, TCP/IP TCP/IP TCP/IP TCP/IP

AVAILABLE INTERFACES RIS, HIS, PACS, DICOM, RIS/HIS via DICOM, RIS/HIS via Optional RIS, HIS,DICOM worklist, HL7 HL7 broker HL7 broker PACS

EXPANDABLE TO PACS Yes Yes, to IntelliRAD Yes Yes


HL7 COMPLIANT Yes WIP WIP Via a PACS broker

Colons separate data on similar models of a device. This is the first of* Specifications current as of March 2002. three pages covering






IMAGE RECEPTIONReceiving computer Intel PC, Windows PC based IBM PC PC compatible

OS, InternetExplorer 5.0/5.5/6.0

Storage Not specified Unlimited 75 GB HD, CD-RW, VariesDVD, MOD, RAID,FDDI, any standardnonproprietary PC-based hardware

Memory, MB Not specified 1 Gh RAM 256 RAM or greater, Varies128 MB RAM minimum

Maximum number ofimages stored Varies Unlimited Unlimited via CD-RW, Varies

MOD; depends onhardware


stations supported Up to 100 Unlimited Web appli- Unlimited Unlimited(simultaneous) cation support

Number of monitorsper station 1 See footnote ** 2 1

Display monitor B/W/clr/grayscale B/W/clr/grayscale ColorSize 21" recommended 21", 24" 21", 24" 12-24"

Resolution, pixels 1024 x 768 minimum Up to 2048 x 2048, Up to 2048 x 2048, From 800 x 600 todepends on monitor depends on monitor maximum supportedand graphics card and graphics card by MS Windows

driversGrayscale levels 256, true color 256, depends on 256, depends on 256; 24- and 32-bit

monitor monitor color palettesSplit-screen images 1 to 16 User selectable User selectable User selectable,

multiformatROI magnification Yes Yes Yes Yes

Image-enhancementfeatures Window/level, pan, Window/level, pan, Window/level, pan, Cine, page mode,

rotate, mirror, text zoom, annotation, zoom, annotation, contrast/brightness,annotations, rotate, mirror, auto rotate, mirror, auto invert/revert, pan/measurements window/level, flip window/level, flip zoom, flip, rotate,

horizontal/vertical, horizontal/vertical, audio note, auto re-sharpen, emboss, sharpen, emboss, redial & reconnect,edge-enhancement edge-enhancement annotate, edgemeasurements, measurements, sharpen, hangingprotractor, gamma protractor, gamma protocols, pushescorrection correction images from server

to client of on-call, client can usepull mode for ad hoc

OPTIONS None specified Video teleconferenc- Video teleconferenc- Autoforwarding,ing, aggregation ing, aggregation calendar(more than 1 (more than 1phone line), wavelet phone line), waveletcompression, 12-bit compression, 12-bitimaging, DICOM SCU, imaging, DICOM SCU,DICOM print DICOM print

Colons separate data on similar models of a device. This is the second of* Specifications current as of March 2002. three pages covering** 1 via Web application; 2-monitor support via Voyager 3.x workstation. the above model(s).






SYSTEM SECURITY User name, password, User ID, image User ID, image Password protection,encryption encryption during encryption during administrator logon

transmission transmission option

POWER REQUIREMENTS Configuration Universal Universal Not specifieddependent


std configuration Not specified AUS$9,500 (US$4,922) AUS$9,500 (US$4,922) Not specifiedSW only SW only

Warranty Not specified 1 year, hardware; 90 1 year, hardware; 90 6 months; optionaldays, SW days, SW extensions

Delivery time, ARO 1 month 2-3 weeks 2-3 weeks 30 days typical

Monthly maintenanceHardware Available Not specified Not specified Not specified

Software Available Not specified Not specified Not specified

Training w/purchase As required 1 day on-site 1 day on-site Yes

Telephone support 24 hr/7 days, toll- Yes Yes 24 hr, toll-freefree hotline

Year first sold 1998 1999 1999 1992

Number installed 300+ ~70 ~70 >2,300 installationsworldwide

Last softwareupdate February 2002 June 2001 June 2001 February 2002

Fiscal year January to December Not specified Not specified January to December

OTHER SPECIFICATIONS Web-based; Windows 2000/NT. Windows 2000/NT. Remote retrieval;customizable; simultaneously send/integratable into receive multipleRIS; referring- sites; support forphysician paper laser printer;friendly. print/fax report

background trans-mission; fail-safetelecommunications;auto redial toestablish client/server communica-tion; encryptionoptions: 56-bit(DES), 128-bit(Blowfish), and160-bit (TripleDES).





MODEL LINE IMAGING MCKESSON MCKESSON MEDASYSFAILED TO RESPOND * FAILED TO RESPOND **WinRad ALI UltraWeb 2.1 ALI WebGX 3.0 Dx Multimodality

WHERE MARKETED Europe, Pacific Rim, Worldwide Worldwide WorldwideUSA

FDA CLEARANCE Yes Yes Yes Submitted

CE MARK (MDD) Yes No No Not specified

MULTIMODALITY CT, MRI, NM, US, CR, All single-frame All single-frame All imagingCCD, DICOM, ACR/NEMA DICOM types DICOM types modalities

IMAGE CAPTURELight box No Not specified Not specified No

Size, cm (in) NA Not specified Not specified NAVideo framegrabber Yes ALI NewPort ALI NewPort Yes

Resolution 1024 x 1024 512 x 512, 1024 x 512 x 512, 1024 x Any1024 1024

Direct digitalimage capture Yes Not specified Not specified Optional; NTSC,

SECAM, PAL @ 30 fpsFilm digitizer(s) Vidar, Howtek, Lumysis, Vidar Lumysis, Vidar Laser, CCD, light

Lumisys, Canon, andother TWAIN scanners

Scan speed, sec 30 for 2K x 2K Not specified Not specified 30Shades of gray 4,096 Not specified Not specified 4,096

MODEM SPEEDS, Kbps Up to 56; ISDN Any TCP/IP Any TCP/IP Anyconnection connection

IMAGE TRANSMISSIONSending computer PC compatible ALI UltraPACS server ALI UltraPACS server PC Windows

Compression ratios User-selectable User-selectable System-configurable 2:1JPEG or wavelet wavelet and JPEG wavelet JPEG (10:1

(10:1 to 50:1) to 50:1)Maximum matrix size

transmitted Unlimited No maximum No maximum Any

Transmission timefor maximum matrix Depends on size and Not specified Not specified 7-10, network

connection speedWAN transmission

Telephone line Yes Yes Yes YesMicrowave Yes Yes Yes OptionalSatellite Yes Yes Yes OptionalISDN Yes Yes Yes OptionalT-1 Yes Yes Yes OptionalSwitched-56 Yes Yes Yes OptionalATM Yes Yes Yes OptionalOthers None specified Yes Yes DS-3

LAN protocols used Ethernet, TCP/IP, Ethernet, TCP/IP Ethernet, TCP/IP IEEE 802.3, TCP/IP,Token Ring, FDDI, EthernetDSL, T-1

AVAILABLE INTERFACES Yes PACS PACS CIS, RIS, HIS, PACS



HL7 COMPLIANT WIP ALI UltraPACS ALI UltraPACS Yes

Colons separate data on similar models of a device. This is the first of* Specifications current as of March 2002. three pages covering** Specifications current as of November 2000. the above model(s).

These specificationscontinue onto thenext two pages.





IMAGE RECEPTIONReceiving computer PC compatible 266 MHz Pentium II 266 MHz Pentium II Pentium PC or

minimum minimum HP 9000 workstation

Storage Hard drive, Not specified 2 GB free disk space User defined,removable media required scalable

Memory, MB ≥64 128 minimum 128 minimum 64 and up

Maximum number ofimages stored Variable Limited by available Limited by available Variable, depending

disk space disk space on image size



Number of monitorsper station Up to 8 1 1 1, 2, or 4

Display monitor B/W, color Color or grayscale Color or grayscale Color standardSize 15-21", Any, requires 24-bit Any, requires 24-bit 17" to 21"

user selectable color colorResolution, pixels Up to 2K 1028 x 768 XGA 1280 x 1024 1280 x 1024;

minimum 2560 x 2048 optional

Grayscale levels 256 256 256 256

Split-screen images Yes 1, 2, or 4 1-25 Unlimited; Windowsinterface

ROI magnification Yes No Yes Yes

Image-enhancementfeatures Window/level, flip, Pan/zoom, rotate, Image display pro- Pan/zoom,

invert, rotate, window/level tool, tocols, cross-study window/level, ROImultiple formats, flip, invert image, linking, image window/level,pan, annotation, brightness registration, stack- histogrammeasurement, patient selectable, pre- mode viewing plus equalization,information box, defined the features for ALI photomode,cine mode, magnification up to UltraWEB annotationconferencing, ROI, 400%filters

OPTIONS None specified Not specified Case sign-off Simultaneoustelemedicine andteleconference;real-timetransmission anddata reception

Colons separate data on similar models of a device. This is the second of* Specifications current as of March 2002. three pages covering** Specifications current as of November 2000. the above model(s).






SYSTEM SECURITY Hardware lock Multilevel Multilevel User ID, password,optional securityprograms

POWER REQUIREMENTS Depends on system According to PC According to PC 110/220 VAC,configuration requirements requirements 50/60 Hz, 15 A


std configuration $1,000-45,000 $8,000 plus $400/ $8,000 plus $5,000/ $1,600+user user

Warranty 1 year 1 year, software 1 year, software 1 year

Delivery time, ARO 30 days 90 days 90 days 2 weeks

Monthly maintenanceHardware Available Not specified Not specified 12% of list price

Software Available 9% 9% 12% of list price

Training w/purchase Available Tutorial Tutorial Yes

Telephone support Available 12 hr/day, Monday 12 hr/day, Monday Toll-free hotlineto Friday to Friday

Year first sold 1994 1995 Not specified 1992

Number installed >500 Not specified Not specified 50

Last softwareupdate 2001 March 2001 October 2001 July 1999

Fiscal year January to December October to September October to September Not specified

OTHER SPECIFICATIONS Mouse-driven GUI; Database search Database search Full image-Windows 98/2000/NT/ (name, ID, exam (name, ID, exam processingME/XP; 32-bit; date); report date); report capabilities; imageconference mode; viewing; access via viewing; access via math; 3-Dcustomized software intranet, dial-up, intranet, dial-up, reconstruction; ROIpackages. or VPN over the or VPN over the statistics; user-

Internet; copy/paste Internet; copy/paste programmableto other Windows to other Windows functions. Meetsprograms. programs; supports requirements of

access to multiple CSA, DICOM 3.0,Web servers. EN 609050, GS, HL7,

and UL.

Colons separate data on similar models of a device.* Specifications current as of March 2002.** Specifications current as of November 2000.




MODEL MEDPACS MERGE MERGE PHILIPSFAILED TO RESPOND *

Various Models ** Fusion Server/ PhyR Works EasyWebWorkstation

WHERE MARKETED USA Europe, Japan, USA Europe, Japan, USA Worldwide


CE MARK (MDD) No Yes Yes Yes

MULTIMODALITY CT, MRI, US, NM, CR, All major imaging All major imaging All modalitiesx-ray, PET, paper modalities modalitiesscanner ***

IMAGE CAPTURELight box No No No Not specified

Size, cm (in) NA NA NA Not specifiedVideo framegrabber No No No High resolution

Resolution NA NA NA Not specified

Direct digitalimage capture Yes Yes Yes Yes

Film digitizer(s) Vidar Sierra Plus, No No Not specifiedVidar Diagnostic PROPlus, Kodak LS75

Scan speed, sec Up to 125 lines/sec NA NA Not specifiedShades of gray 256 or 4,096 NA NA Not specified

MODEM SPEEDS, Kbps 28.8-115.2 56 33.6 14.4 Kbps to 155Mbps

IMAGE TRANSMISSIONSending computer IBM PC Intel server Intel PC Progressive wavelet

Compression ratios 1:1 (none), 3:1 Selectable Selectable Flex fixed or userlossless, 10:1 select, wavelet,lossy, configurable lossy, lossless

Maximum matrix sizetransmitted Any Selectable to 4K x Selectable to Line-speed dependent

5K 4K x 5KTransmission time

for maximum matrix See footnote † Depends on phone/WAN Depends on phone/WAN Compression/trans-and compression and compression mission dependent

WAN transmissionTelephone line Yes Yes Yes YesMicrowave Yes Optional Optional YesSatellite Yes Optional Optional YesISDN Yes Yes Yes YesT-1 Yes Yes Optional YesSwitched-56 Yes Yes Optional YesATM Yes Yes Optional YesOthers None specified None specified None specified Web, Internet

LAN protocols used Ethernet, TCP/IP Ethernet, TCP/IP, Ethernet, TCP/IP TCP/IPRIS, HIS, PACS

AVAILABLE INTERFACES DICOM, PPP, custom Yes RIS, HIS, PACS RIS, HIS, HL7,DICOM, proprietaryfor non-HL7/DICOM



HL7 COMPLIANT WIP Yes Yes Yes

Colons separate data on similar models of a device. This is the first of* Specifications current as of March 2002. three pages covering** WinRSAF, WinFilm, WinPACS NetDisplay, WinPACS TeleDisplay, DARWIN, WinPACS WebDisplay, WinDigi, WinPaper. the above model(s).*** Film digitizer also. These specifications† 15 sec POTS, 6 sec ISDN, 2 sec Internet (S12 x S12 CT). continue onto the

next two pages.






IMAGE RECEPTIONReceiving computer IBM PC Intel PC, Macintosh, Intel PC, Macintosh, PC

Sun SPARC Sun SPARC

Storage Disk, RAID Hard drive, variable Hard drive, variable 18 GB minimumsize size

Memory, MB 64-256 256 or more Variable 512suggested

Maximum number ofimages stored ~30,000 CT Variable Variable Matrix and image

images on an 8 GB dependenthard drive



Number of monitorsper station 1, 2, or 4 1, 2, 3, or 4 Selectable 1

Display monitor Yes B/W, color B/W, color Type not specifiedSize Unlimited Selectable Selectable Any size supported

Resolution, pixels 1024 x 1250, Selectable up to 5 Selectable SVGA or better2048 x 2560 megapixels

Grayscale levels 256 displayed on 8-/ Up to 1024 Selectable Original bit depth12-/16-bit images *** of DICOM image

Split-screen images 1, 2, 4, 12, 24, 48 Selectable Selectable Yes


Image-enhancementfeatures Pan, magnify, win- ROI magnification, ROI magnification, 100% maginification

dow/level, flip/ro- pan/zoom, window/ pan/zoom, window/ or greater, 8 view-tate, measure dis- level, scroll level, scroll ing formats, windowtance, ROI, mag width/length,glass, DICOM anno- rotate, magnify,tation, autosort im- measure images (seg-ages by contrast or ments, angles,echo, slice sequence areas, includingby location/time, Hounsfield values),window/level preset, cine viewer, view 2dual display for im- studies side by sideage comparison, var in split-screen modemagnification

OPTIONS None None specified None specified Supports full spect-rum of radiology &cardiology, Web-based distribution,Enterprise solutioncombines cardiology& radiology into one

Colons separate data on similar models of a device. This is the second of* Specifications current as of March 2002. three pages covering** WinRSAF, WinFilm, WinPACS NetDisplay, WinPACS TeleDisplay, DARWIN, WinPACS WebDisplay, WinDigi, WinPaper. the above model(s).*** Also support color. These specifications

continue onto thenext page.






SYSTEM SECURITY Standard window User ID and password User ID User ID, passwordsecurity; opt push- with auto expira-only security; RCS tion, auto logoff,encryption password privileges

POWER REQUIREMENTS 110 VAC, 60 Hz 110/220 VAC, 110/220 VAC, 110-240 VAC,50/60 Hz 50/60 Hz 50/60 Hz


std configuration RSFA system $7,500- Not specified Not specified Not specified$17,500 ***


Delivery time, ARO 30 days Not specified Not specified Not specified

Monthly maintenanceHardware Not specified Not specified Not specified Depends on

configurationSoftware $200 plus prior Not specified Not specified Depends on

year's support cost configurationTraining w/purchase Advanced training Not specified Not specified Yes

availableTelephone support Business hours, 24 hr, toll-free 24 hr, toll-free Yes

pager after hours service support service supportYear first sold 1989 2002 1999 1998

Number installed >1,000 Not specified Not specified 140

Last softwareupdate October 2002 NA NA February 2002

Fiscal year January to December January to December January to December January to December

OTHER SPECIFICATIONS WebDisplay allows None specified. None specified. 6 viewers for Easy-image review via the Web 4.1 (each viewerInternet from will launch auto-anywhere; matically, dependingview images as they on image type andare received; mag licenses); general,glass; full DICOM conference,annotation; sort cardiologyimages by contrast (high speed), ECG,or echo; slice EPR image,sequence by location and reportor time; window/ viewers; connect tolevel presets; quad EasyLink (RIS) todisplay for image access radiologycomparison of old/ reports; report innew, contrast/non- 3 sections: patient,contrast, echo1/2; study, and reportinteractive information; reportscine of stacked can be printed orimages; images can saved to local PCbe e-mailed, made (depending oninto BMPs, printed; rights).DICOM class to lasercamera or storage.

Colons separate data on similar models of a device.* Specifications current as of March 2002.** WinRSAF, WinFilm, WinPACS NetDisplay, WinPACS TeleDisplay, DARWIN, WinPACS WebDisplay, WinDigi, WinPaper.*** Display software $2,500-$5,000; display software and hardware $6,000-$45,000.




MODEL RADIN RAMSOFT ROGAN SECTRA IMTEC

Radin 2.0 ULTRAPRO PACS HyperPACS EOL/MASS IDS5

WHERE MARKETED Worldwide Worldwide Worldwide Worldwide


CE MARK (MDD) Yes No Yes Yes

MULTIMODALITY CR, CT, DR, DS, DX, US, RF, CT, MRI, DX, CT, MRI, US, XA, IO, CT, MRI, DSA, CCDES, GM, MG, MR, NM, XA, CR, MG, SC, NM, NM, CR, DR, RF, SC, camera, US, CR, SCPT, OT, RF, RT, US PT, MR MG, SR, RG, PX, ES *


Size, cm (in) NA NA 35 x 43 (14 x 17)Video framegrabber Optional Matrox, Foresight Yes High resolution

Resolution Standard video 640 x 480, All Not specified768 x 576, others

Direct digitalimage capture Yes DICOM Yes Yes

Film digitizer(s) Not specified Howtek, Vidar, Laser, CCD: Lumisys, YesRadLink Vidar, Howtek

Scan speed, sec Not specified Variable 30-60 ~30Shades of gray Not specified 256, 1,024 256 or 4,096 4,096

MODEM SPEEDS, Kbps 28,800 and up 56+ All speeds for 14.4 Kbps toanalog, ISDN, T-1 155 Mbps

IMAGE TRANSMISSIONSending computer Radin server IBM PC, Windows NT, 2000, Win 2000 or XP PC

Windows NT/2000 IntelCompression ratios 3:1 lossless, user- 3:1 JPEG lossless, None, 2:1 lossless, 3:1, 10:1, user

selectable lossy 34 JPEG 2000 user-selectable selectablelossless ** lossy

Maximum matrix sizetransmitted Unlimited Variable Unlimited Unlimited

Transmission timefor maximum matrix Depends on size and Connection dependent Depends on Not specified

compression configurationWAN transmission

Telephone line Yes Yes Yes YesMicrowave Yes Yes Optional YesSatellite Yes Yes Optional YesISDN Yes Yes Yes YesT-1 Yes Yes Yes YesSwitched-56 Yes No Optional YesATM Yes No Optional YesOthers Not specified Cable, DSL DS-3, SMDS, spread Not specified

spectrumLAN protocols used TCP/IP, Ethernet Ethernet, TCP/IP Ethernet, TCP/IP, Ethernet, TCP/IP,

FDDI, Fast Gigabit ATM, FDDIEthernet, DICOM 3.0

AVAILABLE INTERFACES RIS, HIS, PACS PACS, RIS, HIS RIS, HIS, DICOM HIS, RIS, PACSmodality worklist,HL7, IHE



HL7 COMPLIANT With PACS broker Yes Yes Optional

Colons separate data on similar models of a device. This is the first of* Also VL and PET. three pages covering** JPEG lossy, JPEG 2000 lossy (variable ratio). the above model(s).

These specificationscontinue onto thenext two pages.






IMAGE RECEPTIONReceiving computer IBM PC Windows 98/ME/NT/ Windows NT/2000 PC Windows/2000/XP

2000/XP

Storage 20 GB hard disk 0-66 GB 26 GB hard disk; ≥8 GBhard drive, floppy, floppy; CD-R; DVD-RCD-R, DVD-RAM

Memory, MB 256 256-4,126 16 minimum ≥256

Maximum number ofimages stored None, on-demand Variable 2,000 to unlimited, Not specified

architecture depends on config-uration


stations supported Up to 500 simul- Unlimited Unlimited Unlimitedtaneous

Number of monitorsper station 1, 2 1 to 5 1 to 4 1 to 4

Display monitor Yes Color, grayscale Monochrome, color B/W; color optionalSize 21" recommended Variable 15", 17", 19", 21" 17" to 21"

Resolution, pixels 1024 x 768 and up 1024 x 768, 1200 x 1600, 1280 x Up to 4000 x 35001100 x 1600, 1024, 1700 x 2300,1536 x 2048, 2000 x 25001048 x 2156

Grayscale levels 256 256-1,024 256 or 4,096 4,096

Split-screen images Various layouts 1, 2, 8, or 1 to 64 or more Yesthumbnail *


Image-enhancementfeatures Pan, zoom, window, Pan, zoom, Pan/zoom, window/ Pan/zoom, window,

level, edge enhance- window/level, level/invert, mir- zoom, textment, rotate, flip, text annotation, ror, rotate, simul- annotation, scroll,invert, real-time mirror, invert, taneous receive/view edge enhancement,cine measurements (angle images, annotation, others

area, circumference, sharpen/smooth, ROIdistance), pitter- measurement, full-ing, histogram, resolution magnify-rotation ing glass, side-by-

side comparison,pseudocolor, routesreports w/images,hanging protocols

OPTIONS None specified Archiving Upgradable to PACS; Archiving, MPR,videoconferencing, grand rounds,voice recognition, orthopedicdocument scanning, templates, defaultHIS/RIS interface display protocols,

3rd-party clinicalapplications

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the above model(s).These specificationscontinue onto thenext page.






SYSTEM SECURITY User name, password, User ID, security User ID, multilevel User ID, password/user groups, user password password, advanced biometrics swipecardlevels, data encryp- security featurestion optional

POWER REQUIREMENTS 170/220 VAC, 110/220 VAC, 110/220 VAC, Not specified50/60 Hz 50/60 Hz 50/60 Hz


std configuration $16,000 and up Depends on $10,000-75,000 Not specifiedconfiguration


Delivery time, ARO 1-3 months 6-8 weeks 60-120 days Not specified

Monthly maintenanceHardware Depends on Depends on Configuration Not specified

configuration configuration dependentSoftware Depends on Depends on Configuration Not specified

configuration configuration dependentTraining w/purchase 2-5 days on-site Yes Custom Not specified

Telephone support 24 hr toll-free Yes Yes Not specifiedhotline

Year first sold 2000 1998 1987 1990

Number installed >450 Not specified >200 worldwide >2,200

Last softwareupdate July 2002 December 2002 February 2003 April 2002

Fiscal year January to December January to December January to December May to April

OTHER SPECIFICATIONS Web-based solution; Patient database; Compatible with all None specified.selectable compres- scheduling; hard imaging modalities;sion; image delivery copy; reporting; scalable by price/on demand; data administrative re- performance archi-encryption; wavelet ports and communica- tecture; based oncompression. tion logs; demo industry operating

available; DICOM system and databaseprinting; Windows standards; optionalprinting; CD RAID backup, UPS;writing. DICOM 3.0.

Colons separate data on similar models of a device.




MODEL SIEMENS VEPRO VITEL NETFAILED TO RESPOND * FAILED TO RESPOND *SIENET MEDIMAGE ViTel Net System

WHERE MARKETED Worldwide Worldwide Worldwide

FDA CLEARANCE Yes Yes Yes

CE MARK (MDD) Yes Yes Submitted

MULTIMODALITY CT, MRI, DR, DF, US, CT, MRI, plain film, X-ray, CT, MRI,DA, DSA, NM, x-ray US, NM, DSA, video, DSA, NM, US

CR, cath, angio

IMAGE CAPTURELight box No Yes Yes

Size, cm (in) NA 35 x 43 (14 x 17) 35 x 43 (14 x 17)Video framegrabber Yes Yes Yes

Resolution Not specified Up to 2K x 2K 640 x 480

Direct digitalimage capture Yes Yes Yes

Film digitizer(s) Laser, CCD Laser, CCD Laser, CCD

Scan speed, sec 45 for maximum size 115 lines/sec 75 lines/secShades of gray 4,096 4,096 256

MODEM SPEEDS, Kbps 28.8, ISDN, cable 56.4, 8-channel, 56 to 1.5 MB/secmodem, DSL 512 ISDN

IMAGE TRANSMISSIONSending computer SPARC workstation, Silent-PC MedViser

Windows 95/NT 4.0 PCCompression ratios Up to 2.5:1 2:1 lossless, user None for DICOM

lossless; >10 lossy selectable, 8:1 images, JPEG loss-JPEG, wavelet standard less

Maximum matrix sizetransmitted Any, depends on Unlimited 4096 x 5120

DICOM contentTransmission time

for maximum matrix Vary (w/compression, 35 modem; 4 ISDN for Connection dependentmatrix size, medium) 1024 x 1024

WAN transmissionTelephone line Yes Yes YesMicrowave Yes Optional YesSatellite Yes Optional YesISDN Yes Yes YesT-1 Yes Yes YesSwitched-56 Yes Optional YesATM Yes Yes YesOthers DSL Optional E1, DS3

LAN protocols used TCP/IP Ethernet, TCP/IP Ethernet, TCP/IP

AVAILABLE INTERFACES DICOM, RIS, HIS All HIS, RIS, PACS, RIS, HIS, PACSCIS

EXPANDABLE TO PACS Yes Yes Yes

DICOM 3.0 CONFORMANT Yes Yes Yes

HL7 COMPLIANT Optional Yes Yes

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IMAGE RECEPTIONReceiving computer SPARC workstation, Silent-PC MedViser

Windows 95/NT 4.0 PC

Storage RAID, tape, OD 40 GB hard drive, 80 GB hard driveminimum, 120 MB (variable), CD,floppy, CD-R, DVD 1.44 MB floppy,

jukebox

Memory, MB Configurable 256-512 512

Maximum number ofimages stored Hardware dependent 16,000, 512 x 512/ Varies based on

low compression 8:1 storage mediaselected


stations supported Technically Unlimited Unlimitedunlimited

Number of monitorsper station 1 to 4 1 to 8 Up to 4

Display monitor Color; B/W optional B/W, color Grayscale, SVGASize 17", 21" 17", 18", 20", 21", 17" to 21"

22" TFT flat panelResolution, pixels 1280 x 1024 or Up to 2048 x 2048 2048 x 2560,

2048 x 2560 1024 x 1024

Grayscale levels 256 256 256

Split-screen images 64 maximum, 1, 2, 4, 9, 12, 16, Up to 12configurable 20, 25, user defined

ROI magnification Yes Yes Yes

Image-enhancementfeatures Zoom/pan, window/ Zoom, window, Zoom, window level,

level/invert, scroll, color 4x magnification,flip/rotate, conversion, contrast measurement (lineardistance/angle/ optimizing, report and area), rotation,annotate, cine mode display, window mirror, annotation

level by user, 4 (text, graphic,filters in 3 levels, audio)Houndsfield, NUKcolor scheme

OPTIONS Multimedia reporting Complete database Custom design,tool management report generator,

electronicsignature

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the above model(s).These specificationscontinue onto thenext page.





SYSTEM SECURITY User ID, password User ID, password, User ID, multilevelfingerprint password

POWER REQUIREMENTS 90-122 VAC or 180- 110/220 VAC, 120 VAC, 60 Hz,264 VAC, 47-63 Hz 50/60 Hz 30 W


std configuration Not specified $4,500+ $35,000-150,000

Warranty Not specified 1 year 1 yr, HW/SW; extend-ed warranty opt

Delivery time, ARO Not specified 1 month 30-45 days

Monthly maintenanceHardware Not specified Available 15% of price, annual

(covers maintenance)Software Not specified Available 15% of price, annual

(covers license)Training w/purchase Not specified 1 day, user 2-3 days

customizableTelephone support Not specified 24 hr 24 hr, 7-day, toll-

freeYear first sold 1992 1991 1994

Number installed Not specified 2,000 125

Last softwareupdate June 1999 August 2002 November 2001

Fiscal year October to September January to December January to December

OTHER SPECIFICATIONS Seamless integration Sold with or without None specified.into PACS. integrated PACS;

automatic send/receive stations;logbook forautomatic invoice;full error checking;receiving SWis available forfree; also transmitscardio films andother documents.




telemedicine system radiologi

Documents

information systems

telemedicine systems

image capture device

communication systems

product code

communication systems

typical teleradiology

basic device