The Economic Advantages of Thin-client Technology

Clear clinical benefits have resulted from the widespread adoption of multidetector CT (MDCT) technology, as well as from the use of advanced, contrast-enhanced, and functional MRI applications. The resulting increase in data-handling needs, however, has been less welcome at facilities that are not equipped to deal with it. For example, a standard abdominal/pelvic study produces 60 to 70 images, but an MDCT study might yield 900 images. CT angiography can create 2,000 images, and a multiphase cardiac study might involve 8,000 images. Cardiac CT can require 4 gigabytes of memory for data storage, even before postprocessing. Four times as much information will be generated per study as higher resolutions become standard. For facilities that are already struggling to handle today’s data, this increase will underscore the need to solve multiple problems that are already evident: network bandwidth that is too low, workstation memory that is too small, servers that are too slow, and software that is too old to handle advanced imaging data. The Thin-client Answer The solution to these problems, for an increasing number of imaging providers, is to shift away from PACS with 3D workstations in favor of thin-client systems that use central processing and exam databases. Streaming technology makes it possible for physicians to use their own PCs to gain access to original 3D data and to use multiplanar reformatting and 3D navigation tools. These operations involve no transmission of data from modalities to PACS to workstations and do not impede network data flow. In addition to solving problems of access and workflow, thin-client technology has considerable economic benefits to offer the enterprises that adopt it. One such enterprise is Massachusetts General Hospital (MGH), Boston, where more than a million exams per year are generated by the hospital and the outlying sites in its health system. For primary interpretation, MGH relied on PACS, and images reached referring physicians via Web-based distribution. This system became impractical for support of the number of 3D visualizations needed, according to Keith Dreyer, DO, PhD, who is vice chair of radiology at MGH and assistant professor of radiology at Harvard Medical School. He explains that referring physicians need not the 10,000 images that an exam might generate but, instead, 3D representations of the images, along with the ability to slice into the 3D dataset to plan surgeries and measure changes. The implementation of thin-client technology brought that capability with it. Hardware and Support Because the use of thin-client technology allows 3D images to be viewed immediately from any PC of clinical quality, the cost savings gained by avoiding the purchase of new image-viewing hardware can be massive, particularly for larger health systems. A second large financial benefit is that there is no need to pay for maintenance and repair or for service contracts to support all that hardware. Savings are also obtained because it is not necessary to synchronize hardware upgrades throughout the system every few years in order to maintain cutting-edge capabilities. Instead, if a hardware upgrade is called for, it is limited to the central servers. As one of the five largest US pediatric radiology departments, the pediatric imaging department of Children’s Hospital, Birmingham, Ala, has experienced the image-handling problems of high-volume providers. Its RIS/PACS could not use the 3D capabilities of the parent University of Alabama Medical Center, and it needed to give access to 3D images and image-manipulation tools to referrers. By implementing thin-client technology from Visage Imaging (Carlsbad, Calif) in 2006, the hospital was able to avoid additional hardware/support costs beyond standard PCs while integrating its RIS/PACS with the thin-client system. The entire hardware addition was limited to two radiology-department servers. Before that change, as Stuart A. Royal, MD, clinical professor in the pediatric radiology section of the University of Alabama, Birmingham, explains, clinicians who wanted to see original data had to travel to the radiology department. Now, they have rapid access to original images and can use 3D image data efficiently, but there was no expenditure for any additional hardware. Network and IT Resources Image processing, when performed using a thin-client configuration, uses a central server and Web distribution. This means that the need to update software is limited to the server, instead of being required for each workstation throughout the health system (and its referring community) in order to maintain consistency. In addition to reducing software-upgrade fees, this represents a significant decrease in the time that IT staff would otherwise be forced to spend in the field, going to each viewing station and performing its software update. For the same reason, extending thin-client capability to new users can be accomplished using Web-based operations, eliminating the need to travel to each new user site to install and configure a viewing station’s software. Thin-client technology, by concentrating data and image processing in central servers, avoids straining the network resources of the enterprise. Bandwidth needed by other information systems is not used for 3D image manipulation, and image transfers do not overburden or slow the network already in place. For example, when the Visage CS solution was installed at Dartmouth-Hitchcock Medical Center, Lebanon, NH, there was no need to change the network to accept the flow of large datasets, according to Michael Tsapakos, MD, chief of body imaging. As soon as the DICOM routing rules had been configured so that they included the new Visage server, the physicians were able to download thin-client software to connect directly to the server, which began processing images immediately after its installation. Tsapakos notes that avoiding the large commitment of IT staff time that other image-processing methods might require brings down the thin-client system’s total cost of ownership significantly. Flexibility and Expansion The cost of capital should be considered in weighing the advantages of thin-client technology. Not only are hardware needs greatly reduced, but the structure of the system permits it to be expanded as needed over time instead of installed all at once. This can reduce the cost of financing an extensive system by allowing its cost to be spread across multiple capital-budget periods (so that the need to borrow funds might be decreased or eliminated). This ability to expand thin-client capabilities also means that future needs can be readily met, even if they are unforeseen today. For example, it may be impossible to predict the effects of future mergers and acquisitions on 3D imaging needs, but thin-client users will still be able to adapt to meet those new needs at a low cost. As pressures favoring consolidation in imaging continue to grow, this flexibility becomes even more important. The UK’s Nuffield Health Group, for example, has experienced ongoing expansion and now includes 32 hospitals, a large fleet of mobile hospitals and operating rooms, health clubs, employee health centers, and MRI/CT services. When 64-slice CT was added to the group’s capabilities, providing 3D images to the entire network became more than its RIS/PACS could handle cost effectively. Mike Leach, the group’s head of IT, says that the Visage CS system’s centralized approach will save the group more than £100,000 (around $150,000). Revenue Growth Higher levels of reimbursement may be available for 3D imaging, helping users of thin-client technology for image processing increase their revenues while they continue to reduce costs. At Dartmouth-Hitchcock Medical Center, the number of 3D reconstructions performed per month doubled within two months of the Visage system’s installation. Tsapakos notes that reimbursement is at least $4,000 higher per month, and that this figure does not represent the thin-client system’s full potential to increase revenue. Given the economic pressures faced by imaging providers, the revenue-growth and cost-savings opportunities represented by thin-client systems will only become more attractive as advances in imaging increase the need to manage large volumes of data without large increases in spending.