Improvements in computer technology are introduced so rapidly that a state-of-the-art information-processing system acquired today will almost surely be superseded in about 18 months, upon the market introduction of products offering twice as much computing power. According to Moore's Law, those newer systems will, themselves, be superseded 18 months after that by freshly unveiled products twice as powerful. Gordon E. Moore, Phd, the Intel cofounder and chair emeritus for whom Moore's Law was named in 1965, expects this rapid doubling of capability to continue through at least 2017.¹

syngo® is Siemens comprehensive software solution for all medical imaging tasks, applications, and systems. All workplaces from acquisition modalities to independent workstations share the same user interface and operating principles

In medical imaging, this progression is every bit as exciting as it is helpful to productivity and quality of care, but it also means that systems become obsolete very quickly. Owners must invest sizable sums in replacement technology at intervals more frequent than their budgets can easily tolerate, or else risk falling behind their competitors in the quest to be (and remain) on the cutting edge.

Seeking to address this problem of early obsolescence, Siemens Medical Solutions, Malvern, Pa, undertook a technology initiative that enables all Siemens modalities to remain state of the art, its CT scanner, x-ray, and ultrasound systems for no less than 36 months after their acquisition; for its MRI machines, this term lasts at least 72 months.

Markus B. Lusser, segment manager of radiology/CT for Siemens Medical Solutions, says, "We are designing our products with built-in upgradability. For all products that we currently manufacture, we provide, as part of our service agreement, software updates and upgrades as necessary to keep these systems current. Then, 36 months after installation, we replace the entire computer platform, which has the effect of turning these products into entirely brand-new ones with regard to their performance capabilities. This is provided at no additional cost, and the service agreement is priced at almost the same level as our earlier standard service agreements."

The actual number of months that the useful life of equipment is extended as a result of this upgradability strategy varies by imaging modality, Lusser says. "With CT and x-ray, the hardware upgrade that occurs 36 months after the acquisition happens once in the machine's lifetime, so at some point before or after the arrival of the second 36-month period, the user will need to purchase a new CT or x-ray system," he explains. "In the case of MRI, which, historically, has a much longer life cycle than CT, we will provide the complete hardware upgrade twice during the machine's lifetime (at 36 months and 72 months after acquisition). Thus, the user will not really need to consider to replacing that MRI unit for, perhaps, 36 months beyond that, at month 108."

Siemens does not offer to upgrade the onboard computer hardware beyond those points because scanner technology is likely to progress dramatically enough, during that time, to make purchasing an entirely new system a better economic choice, Lusser notes.

UNIFORM INTERFACE

To Lusser's knowledge, Siemens is the only vendor offering an obsolescence-delaying program for imaging technology. "We are able to do this because we have elected to base all of our products on Intelchip-powered computers operating in a Microsoft Windows" environment," he says. "We can, very easily and cost effectively, make these continuous updates and upgrades to greatly forestall obsolescence."

In addition to standardizing based on Intel chips and the Windows operating system, Siemens has combined those elements with a common platform and applications, as well as a user interface system called syngo®. Aziz Aktas, Siemens' head of marketing and vice president of the Department of Software Components and Workstations, says, "The intent of syngo is to integrate medical imagingto support a seamless, streamlined work flow within patient care and, therefore, to increase user productivity." Lusser reports that when imaging professionals and information technology managers first hear about syngo, they sometimes imagine it to be merely a clever marketing ploy, rather than the breakthrough informatics strategy that it is.

According to Aktas, syngo is based on a universal three-tier architecture and adds an imaging platform to the underlying Windows operating system (NT/2000/XP). Common applications (ie viewing, filming, 3D) as well as specialized syngo applications comprise a building block-like system that covers all medical imaging applications, unified by a common intuitive user interface. "From the user's standpoint, this interface is advantageous in that it makes work easier, since the on-screen environment is always going to be a familiar one, across the enterprise," he says.

Lusser adds, "Ordinarily, a user would encounter great difficulties in performing tasks with modalities (or at workstations) other than those that he or she had been trained to use. Lacking such cross-training, a user's mobility around the enterprise is limited, and that has an adverse affect on productivity. Users cannot just pick up and move, for example, to an unfamiliar workstation on the other side of the imaging department and continue their work there. The syngo user interface changes everything. Now, the different types of modalities and workstations all have a common look and feel, so the user can freely move from modality to modality or workstation to workstation and not be at a loss."

Lusser notes that one goal for syngo was a design with screens that show a bare minimum of buttons, boxes, pull-down menus, and submenus that users would need to click in order to perform tasks. He says, "We felt that the fewer inputs the user would have to provide, the easier the operation, and the more quickly that work would be accomplished. Minimal input boxes and the like would also help keep the appearance of the screens very clean, which, in turn, would appeal aesthetically to users and further increase their satisfaction." The resulting user interface is so intuitive that, Lusser says, "Administrators who are not trained to operate CT equipment can literally walk up to the display screen for the first time and, without any training, initiate a scan. We let administrators do this when we are demonstrating the system at a presentation, but only for illustrative purposes. We do not, of course, have them scan actual patients. The larger point, however, is that cross-training can be accomplished in a much shorter time and can involve much less demand on training resources."

BUILDING BLOCKS

syngo achieves its uniform look and feel by means of software plug-ins: one for each modality, workstation, and application across the department, institution, or freestanding imaging center. "We take a building-blocks approach," Lusser says. "If a radiology department needs to harmonize the interface between, say, a CT scanner and a picture archiving and communications system workstation, all that is necessary is the acquisition of the add-on module specific to the applications. There also are add-ons that provide for fly-through, image fusion, and numerous other capabilities."

syngo is facile at adapting to individual work-flow requirements, Aktas reports. "Various protocols support the entire clinical work flow, and user-specific settings can be implemented easily via syngo's configuration platform," he says. "In this way, syngo takes into account individual work situations and standard processes, as well as personal preferences." syngo also interfaces with systems made by other companies. "We write the codes for these other products in syngo's built-in software so that they can be integrated into the different modalities," Lusser says. "Siemens performs cross-vendor tests to ensure that the modalities will be able to interface through syngo, provided those vendors' imaging system comply with the Digital Imaging and Communications in Medicine, Health Level 7, or modality worklist standards."

syngo comes in a ready-to-use form, but it can be customized to suit the preferences of individual enterprises. "The customization tools included with syngo are many," Lusser says, "and with syngo being based in Windows, it is very easy to add applications." These include radiology information system/hospital information system integration. Lusser explains, "Our approach also greatly simplifies what is involved in connecting the systems and their applications to the hospital's network. This is especially helpful to a teaching institution that wants to be able to add an image captured by the CT scanner effortlessly to an instructional slide presentation. With simple copy and paste commands made possible by syngo, the user takes the desired output from the imaging modality and drops it into Microsoft PowerPoint" or a word-processing program. If the user wants others to be able to access those chosen images, they can be copied and pasted to the network."

BIRTH OF A STANDARD

syngo is easy to use, but this is not necessarily true of its initial installation, which is why Siemens assumes full responsibility for its implementation. "Before an enterprise purchases one of our syngo-equipped products, we send a project manager and support team to the buyer's site to inspect the physical facilities and infrastructure, to determine the best location for the system, and to recommend communications network enhancements, as appropriate," Lusser says. "Once the purchase has been completed, our project-management team attends to all the site-preparation details, along with those required to complete the installation of the system."

Lusser adds, "The team also is responsible for user training, and we accomplish that in three phases. The first takes place at our training center in North Carolina. When users complete the course there, they are equipped to operate within the syngo environment. The second phase of training takes place at the user's own site and involves a week of instruction in using the applications. The third phase entails a few additional days of follow-up training, about 2 or 3 months later, to fine-tune acquired and practiced skills."

Siemens began developing syngo in 1995. The company decided to move forward on the project after noticing the problems encountered by customers working with nonuniform user-interfaces. "Historically, scanners, workstations, and other medical equipment ran different operating systems and, consequently, had different user interfaces," Lusser says. "We recognized that these differences were an impediment to efficient work flow and productivity. Once we committed ourselves to the development of syngo as the remedy to this problem, we decided that we would make it an integral feature of all of our products."

In 1999, Siemens introduced a CT scanner that was the first of its offerings to incorporate syngo fully. Now, there is speculation that syngo might emerge as an industry standard, Lusser says. "We think that syngo is the future," he asserts. "It is a well-designed integration of information technology into classic medical imaging modalities. More than that, it is a solution to the problems of streamlining work flow and obtaining a corresponding increase in productivity."

Rich Smith is a contributing writer for Decisions in Imaging Economics.

References:

1. Moore GE. The continuing silicon technology evolution inside the PC platform. Available at: http://www.intel.com/update/ archive/issue2/feature.htm. Accessed October 8, 2002.