Workflow Evolution with Multimodal 3D Readings
How Multimodality Image-Reading Software can Structure your Processes

May 25, 2016

The Radprax Group is one of the largest and most advanced associations of radiologists with their own practices throughout Germany and a focus on magnetic resonance imaging. The Radprax team has continuously developed its 3D image-reading workflows to speed up and optimize its processes across a range of locations.

A Long-lasting Partnership
The partnership between the Radprax Group and Siemens long ago ceased to be confined to just medical technology. Radprax is a group of medical practices comprising 50 radiologists, specialists in nuclear medicine, cardiologists, and radiotherapists. A total of 12 locations in 8 cities makes Radprax one of the largest associations of radiological practices and medical care centers in the German state of North Rhine-Westphalia.


Initially, from 1996, the Radprax Group worked with modality-specific 3D workstations that usually came with the corresponding devices. That changed in 2006 when the group acquired a Dual Source CT system from Siemens. “With the data volumes that the Dual Source CT could handle, it pushed the boundaries of our 3D workflow at that time once and for all – if you can even call what we had back then a ‘workflow,’” recalls Steffens. “That’s why we also invested in the 3D image-processing solution syngo WebSpace at the same time. This client-server system enabled us to perform 3D reading directly at our various locations for the first time.”


Evolution of a 3D Workflow
“The software represented a significant advance in itself,” adds Dr. Alexander Klemm, IT Manager and member of the Radprax Group’s board of directors. “Previously, physicians had to go to the device and sit at the console to perform 3D reading. Every modality had its own hardware and software, and working across multiple locations would have been completely impossible,” says Klemm. However, syngo WebSpace was still restricted to CT images and the server ran on expensive hardware that needed special graphics cards. Therefore, Radprax upgraded to syngo.via1 in late 2009.

The image-reading software suite can display data from different modalities such as MRI, CT, and PET-CT, and supports the reading process by providing automatic case preparation, a structured workflow, and application-specific functions. “It really is a multimodal 3D reading solution, and also runs on standard hardware – you couldn’t ask for better,” says Klemm. “It was the right step. Other systems available on the market definitely had their strengths for particular modalities, but we needed a universal 3D reading system that would cover all modalities and be available on every PACS workstation. syngo.via represented the best package from this angle, and provided the broadest portfolio of clinical applications.”


"syngo.via now makes it possible for our colleague to read the examination without leaving home.” Dr. Heiner Steffens,
Managing Director of the Radprax Group

Better Workflow for Referring Physicians
The Radprax Group had the software in place by the fall of 2010. The server is located in the data center in the basement of Radprax headquarters in Wuppertal. Clients are incorporated in the radiological workstations at every location, and can also be installed on home-office PCs or laptops. This is a major advantage, as Steffens explains: “Today is Wednesday, and of the two employees responsible for MR mammography here, one is on leave and the other, a woman with two small children, lives in Düsseldorf and works from home. We also look after a large number of hospitals, and if a mammogram were on the agenda for today, they would need to have their examination results back quickly.”

Evaluating the examination, however, needs the right expertise, it can’t be done by just anyone. “The software now makes it possible for our colleague to read the examination without leaving home. In other words, we can provide better services, the referring physicians get their results back faster, and in difficult cases the images can be reviewed by the people with the greatest expertise,” Steffens says. In this way, the Radprax team builds up greater loyalty among its referring physicians, while also establishing a competitive advantage.

“The most important thing, however, is that we finally have a 3D reading workflow that is worthy of the name.” Dr. Heiner Steffens, Managing Director of the Radprax Group

Reading Faster and More Accurately
“The application-specific tools offered by the software allow for better reading, particularly when more difficult questions have to be dealt with, or when more accurate quantifications or more conclusive assessments of changes are required,” says Steffens. “The most important thing, however, is that we finally have a 3D reading workflow that is worthy of the name.” This solution eases the burden on both the medical technical radiology assistants (MTRAs), who are responsible for image preparation and 3D reconstruction, and on the physicians, who no longer need to perform a large number of routine tasks.

Steffens estimates that syngo.via can achieve a time-saving of around 50% for a complex CT or MRI examination that may require more than 1,000 images. The faster reading workflow also helps the Radprax Group save money; the group is one of the largest players in this field in Germany with a workload of 79,000 MRI examinations and 45,000 CT scans each year. At the same time, the software opens up new opportunities for multimodality diagnostics. Nuclear medicine and CT is the main combination used at Wuppertal – for example to examine bone metastases, which can be identified using scintigraphy and accurately pinpointed using CT.


“IT must ensure that the physicians and MTRAs can work smoothly and efficiently.” Dr. Alexander Klemm, IT Manager

Major Opportunities with IT
The use of 3D reading software also illustrates the great importance of IT in day-to-day clinical routines now. “Our work has been completely digital for years now, and we rely on our IT working smoothly,” says Steffens. ”We can see that state-of-the-art IT offers major opportunities, helping set us apart from the competition with improved services and improved diagnostics.” It was therefore logical for IT manager Klemm to be appointed as one of the directors of the Radprax Group in 2013. With his ten IT employees, Klemm sees himself as an active partner for his IT suppliers. “IT must ensure that the physicians and MTRAs can work smoothly and efficiently, using solutions that are as economical as possible,” he says.

This is also why Klemm prefers to talk about his next plans rather than the status quo. For example, to save bandwidth, Citrix terminal servers are used at Wuppertal to provide a remote connection between the locations, and they are also still used for syngo.via at this stage. For Klemm, however, this is only a transitional solution: “As soon as the software can support virtualization, we will use a virtualized server at every location to make the image data available at a local level. After all, the images are read where they are generated in most cases.”


Training as a Success Factor
Many of Klemm’s colleagues still have some major barriers to overcome when it comes to looking at new IT solutions. This is why he relies on practical training sessions in small groups, and on quality circles, which are quarterly events that present reading workflows. “Our last quality circle was a complete success because our colleague there talked in such glowing terms about syngo.via,” Steffens says with a grin. “It also helped that the hospital he looks after is very excited about the fact that Radprax has a system like this.”

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1syngo.via can be used as a standalone device or together with a variety of syngo.via-based software options, which are medical devices in their own right. syngo.via is not yet commercially available in all countries. Due to regulatory reasons, its future availability cannot be guaranteed. Please contact your local Siemens organization for further information. Prerequisites include: Internet connection to clinical network, DICOM compliance, meeting of minimum hardware requirements, and adherence to local data security regulations.

The statements by Siemens’ customers described herein are based on results that were achieved in the customer's unique setting. Since there is no "typical" hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.