Imagem: constantly refining its expertise

Imagem made its way into the healthcare system by accident. After all, what does running a simulation showing metal waves melting at Alcan and one showing the effect of treatment on tumours have in common other than using simulations for research purposes. No matter, different people came together, seized an opportunity and brought together their experience in engineering to create Imagem. 

Digitalization of the images from the radiation simulation

At the end of the 1990s, the process involved in preparing a patient for a radio therapy treatment is how Imagem acquired an understanding of the first issues in health information technology: information has to be easily accessible, and the process to have access to the information needs to be transparent and non-invasive.

Doctors need a simulator to prepare patients for radiotherapy treatment. Radiation is damaging and it should carefully target cancer cells. By using fluoroscopy, a doctor gets to see on a screen the organs of a patient in real time. Imagem undertook the project to digitalize the real-time images so that they could be displayed even when targeted radiation stops.

While researching our options, a doctor indicated preferring not to change his working methods, which required that he press a pedal to activate the radiation beam and to turn on the screen to see the image of the organs. By digitalizing the images, Imagem was able to improve the images by developing algorithms and have them displayed on the screen even when the pedal wasn’t pressed. Before then, a doctor would have seen a blank screen. 

Imagem met the doctor’s requirements without any need for him to change his work method. From then on, even without pressing on the pedal, he had access to the images without having to emit a radiation beam on the patient.

The project progressed and was completed, without ever stopping, over the course of more than 5 years.

Device used in radiation oncology to generate contours

In the simulation room, the medical physicist uses the precise measurements of a patient’s body to calculate the location of the tumour and the dose of radiation a patient will need.

Imagem built a device similar to that of a robot’s arm that could digitize the contours of a patient’s body in 3D at the level where the tumour was located. The collected data was then processed and sent to the software used by the physicist. Through this project, we became aware of the responsibility of these important healthcare players when it comes to treating patients. We also learned about all the advanced safety measures that are put in place to protect them. By desire and determination, we also became entrusted with a part of this responsibility. From there comes the second issue: security and responsibility.  

This project was implemented in two radiation oncology centres, and our device was used for over 5 years without any indication of a malfunction.   

Digital diagnostic imaging 

In the late 1990’s, there weren’t many digital devices in Québec and in the rest of Canada. Right from the start though, Imagem was interested in the use of digital diagnostic imaging (DDI) in healthcare, which was an emerging technology at the time. The engineers working at Imagem thought that DDI was a path to the future and that is why they took action.

This is when Imagem also made its mark; one of rigour and integrity from the very start as the firm emphasized the necessity to integrate the existing data on patients, focusing on interoperability before its time. Imagem also conducted the process of digitalizing X‑ray images so radiologists could have a complete patient file with results of previous examinations on film. The first beneficiaries of this system were the medical archivists who now had access to digitized information.

Imagem installed the first fully integrated teleradiology system in 2001; radiologists would use this system remotely just as if they had been physically at the hospital. Emergency physicians could rapidly, often before a patient was out of the examination room, listen to a radiologist’s vocal report. This provided great benefit regarding the quality of care.

Imagem also considers itself a forerunner in the development of the methods utilized to store images, by using hard disks and multiple copies for redundancy. This improved access to the images required for file preparation. Digital diagnostic imaging has become over the last 20 years the spearhead of the firm.

Interview: offer a vision

1. PACS V.1 Negative X (1995)

First PACS viewer: it processes the information from the images captured with various digitizers such as Howtek, Cobra Scan and Vidar. Imagem develops its expertise in digital diagnostic imaging and builds its knowledge on its clients’ areas of interest.

2. PACS V.2 Imapacs (2000)

Dicom PACS Server Imapacs v.2, Imadiag viewer, Imaview viewer, Imaris radiology information system (RIS), dictation included, with Playdiag transcription, implementation with digitalization of previous X-ray images stored on hard disks – an innovation at the time. The installation used SunRay thin clients and a Citrix application server. Creating interfaces between other applications and radiology devices became our speciality. Imagem starts its research and collaboration with different universities, in particular the Université du Québec à Chicoutimi (UQAC), and the School of Advanced Technology (ÉTS).

The suite Interview comes into existence with its 8 applications. The suite of software was used by 2 hospitals and ran for 10 years.

3. PACS V.3 Imapacs (2010)

Dicom PACS server Imapacs v.3, Gemini viewer, Imaview viewer, Imaris radiology information system (RIS) v.2, Psvox dictation and PSscript transcription, implementation with digitalization of previous X-ray images stored on hard disks – an innovation at the time.

The suite of software was used by 2 hospitals and ran for 7 years.

Postscriptum: medical report, dictation, transcription and voice recognition

A radiologist would produce his reports using a microphone and a tape cassette. Imagem proposed a more efficient tool, creating its first medical dictation and transcription system. Doctors could immediately listen to the radiologist’s voice recorded report regarding a patient. This was a fully integrated system reserved for radiology professionals. 

The Postscriptum Suite features 20 applications and is used in more than 40 healthcare institutions.

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