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Charlotte Eye Ear Nose & Throat Associates

Charlotte Eye Ear Nose & Throat Associates operates 18 clinics throughout the Charlotte region and is the largest ENT group in the Carolinas. Most of CEENTA's clinics use digital imaging of some sort, including CT, ultrasound, optical CT, fundus camera photography, and other devices. In 2009, CEENTA began looking at PACS providers in an effort to centralize images from all devices and make the images available for viewing at every location.


Situation

Though CEENTA began using digital imaging several years prior, much of the workflow hadn't changed from the days of traditional film. This was due to "islands of data" which existed on the network, created because each CT device maintained its own private database. Records were backed up and archived, however, the imaging studies were only accessible at the CT capture workstation.

Often, patients in smaller suburban locations were referred to larger clinics for a CT exam, meaning that they needed to have their images transported from one office to another before images could be interpreted and the patient could be treated. The only way to achieve this was for radiographers to either print expensive dry films, or burn images to a CD and have the patient or employee transport them from location to location. Even viewing images in an exam room at the same office location where they were taken proved to be a challenge, as print-outs were really the only option for viewing images outside of radiology.

As CEENTA continued to expand in both number of offices and digital imaging technology, the need was growing for a centralized imaging system that was accessible from any exam room in any location.


Solution

CEENTA's location in Charlotte, where Medicor Imaging is headquartered, was the perfect opportunity for collaboration. Just as Medicor Imaging worked with dental schools beginning in 2001 to develop MiPACS Dental Enterprise Solution, a new solution would be developed to accommodate the PACS needs of the Ear, Nose, and Throat community.

Medicor Imaging collaborated with CEENTA's clinicians, administrators, and IT staff to develop a PACS solution that specifically fit the needs of an ENT Practice. Using the LEADTOOLS PACS Imaging SDK, Medicor Imaging was able to develop a complete PACS Viewer and Server solution. The product is called MiPACS ENT PACS.

MiPACS Storage Server

The MiPACS Storage Server that serves as CEENTA's central image archive is the same proven PACS Server that powers image archives for the US Air Force, over 40 universities, and the Department of Veterans Affairs. MiPACS Storage Server accepts images from all of CEENTA's DICOM-enabled modalities. CT, Ultrasound, fundus, and OCT imaging can be stored to a central location in a single database.

MiPACS Medical Workstation

MiPACS Medical Workstation is the result of extensive collaboration between Medicor Imaging and CEENTA. This end-user medical viewer gives clinicians full access to each patient's imaging record from anywhere in CEENTA's 18-office enterprise. To keep in-line with the existing IT strategy at CEENTA and minimize the maintenance requirement on the IT staff, MiPACS was deployed to the exam rooms of each office via Citrix.

To the clinicians, MiPACS Medical Workstation provides access to any imaging study, no matter which office it came from. The viewer provides a unified viewer for CTs, ultrasounds, and other images, with all the tools expected from a medical viewer: window/level adjustments, zoom, magnify, cine player functionality, series comparisons, annotations, measurements, and more.

Custom Viewing Protocols

As part of Medicor and CEENTA's collaboration, clinicians provided input on the best ways to view images. CEENTA's recommendations were implemented within MiPACS Medical Workstation, allowing for customized orientation based on DICOM tags within images. The most common situation which required a change in orientation was when patients were placed in a head-first-prone position with their head raised, in order to capture coronal slices directly from a traditional CT device. The display orientation options were required so that the clinicians did not have to manually orient these images on the screen.

In addition, Medicor Imaging worked with CEENTA to develop a patient series timeline which display's a patient's imaging history, and a display protocol to allow easy access to images via a thumbnail browser.

CD Burning and Printing

One of CEENTA's desires was to incorporate a seamless CD burning and printing solution into the viewing software. Prior to using MiPACS, burning CDs was a manual process at CEENTA, and could only be performed by radiology staff. Medicor Imaging's solution was to add DICOM CD burning capabilities to the MiPACS Medical Workstation. This allowed any user to send burn and print requests to a Primera CD publisher located centrally to the clinic. Medicor further integrated with the Primera device by automatically printing labels on the CDs which were customized to include the CEENTA logo and patient demographics.

Clinical System Integration

CEENTA's clinical information system for otolaryngology is MedInformatix, which uses LEADTOOLS its document imaging functionality. Medicor Imaging worked with CEENTA and MedInformatix to create an application link which would enable the passing of patient demographic information to MiPACS Medical Workstation from MedInformatix. This offers clinicians a seamless link from the medical record to the patient's images.


The Future

As CEENTA moves forward, the implementation of a PACS has already made future plans for digital imaging expansion easier. Imaging modalities can be easily integrated into MiPACS as they are brought online throughout the organization (including ophthalmology), because of the interoperability of the DICOM standard.

Medicor Imaging will continue to seek input from CEENTA and future ENT customers to ensure that the MiPACS Medical Workstation and MiPACS Storage Server continues to fulfill the needs of the ENT community.

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