Hermes in an Evolving Multi-Site Organization
The Ottawa Hospital Experience
By Ran Klein, PhD and Lionel S. Zuckier, MD
Department of Nuclear Medicine, The Ottawa Hospital
The Ottawa Hospital (TOH) has one of the largest nuclear medicine departments in Canada with 8 attending physicians, over twenty technologists, a dozen cameras and 14,000 nuclear imaging exams performed annually (in addition to 9,000 bone mineral density studies). TOH is the product of the amalgamation of three regional hospitals, with the Department of Nuclear Medicine spanning two geographical sites. The University of Ottawa Heart Institute (UOHI) nuclear cardiology group maintains close relations with TOH and performs an addition 6,000 cardiac scans annually. Through its academic affiliations, the Department has an active teaching portfolio that draws domestic and international medical students, residents, fellows, sabbatical researchers, graduate students and technologist students.
|TOH Nuclear Medicine by the numbers|
|SPECT (Siemens, Philips)||5|
|Gamma only (Mediso)||3|
|Procedures per Year|
Hermes is the primary image storage and analysis system within the Department of Nuclear Medicine and has served the department’s needs and challenges since 1995 – the first installation in Canada. The current iteration of our Hermes network consists of a single image archive server for both sites, aggregating imaging data from all imaging modalities. It interfaces our hospital wide HIS, RIS and PACS systems, the Hermes network at UOHI, and several other diagnostic and research systems. Eleven dedicated workstations are utilized by our physicians and researchers. Hermes systems have continued to evolve over time, delivering improved services and efficiencies:
In the past, data were processed and analyzed using proprietary software on the vendor workstation. Hermes offers vendor-neutral analysis solutions that have enabled us to gradually shift image processing and analysis tasks away from the vendor environment to the Hermes system. In our current practice all image acquisition data is sent to Hermes for archiving, SPECT reconstruction, visualization and analysis. This operational change has enhanced standardization regardless of the specific data acquisition device, has harmonization procedures and nomenclature between our sites and users, and has enabled us to apply state-of-the-art technologies across all modalities with a single system update.
Today we perform almost all SPECT image reconstruction with Hermes HybridRecon using iterative methods that include attenuation, scatter and resolution corrections, enabling state-of-the-art SPECT reconstruction on all our devices without the need to purchase individual licenses for each camera. We have leveraged these technologies to reduce our injected activities while maintaining diagnostic image quality - even with older imaging equipment. Interestingly, for research purposes, we have been able to retrieve previously acquired SPECT data and reprocess it using the most-current Hermes reconstruction algorithms. After an extensive, independent evaluation of HybridRecon quantitative SPECT, we have adopted its routine use for all SPECT-CT studies, enabling us to measure standard-uptake-values (SUV) with almost any radiopharmaceutical, which has enabled novel research even in long established clinical exams.
Our physicians and technologists utilize Hermes HybridViewer with predefined, application-specific protocols for most image analysis and visualization. Because system configuration is centralized across the Hermes network, technologists and physicians use the exact same tools throughout the Department, mitigating inconsistencies and the need to maintain duplicate tools. Furthermore, configuration changes can be deployed across the entire Hermes networks simultaneously with minimal maintenance overhead.
TOH has capitalized on Hermes’ promise to provide vendor-neutral data storage and processing to eliminate the needs for duplicate software for each camera installation. This approach has dramatically reduced capital expenditures associated with acquiring these software, while enhancing standardization of processing across the department to the benefit of simplifying teaching and maintenance of a single set of tools.
Virtualization of Services
Through a substantial system update in 2014, dedicated Hermes workstations in each camera control room were replaced by a single application server providing access to all Hermes services via thin client on standard enterprise hospital computers. This virtualization produced substantial cost savings, reduced the number of computer systems requiring maintenance, and freed up valuable physical space, by eliminating the need for an additional task-specific computer system at each workstation. Since the application server is accessible from anywhere on the TOH computer network, it has been further leveraged by our clinicians and physicist for remote access and for presentation of clinical cases at board rounds within the full-featured clinical environment.
Throughout our 20+ year relationship with Hermes, their team of technical experts and application specialists have enabled tailored solutions to our evolving needs in a timely manner. Over the past year alone, their support team have delivered custom clinical solutions including quantitative count-rate based image display, modified gastric emptying protocols for oatmeal studies and a semi-automated quantification protocol for right-to-left shunt studies. Using built-in, powerful and simple to use scripting features, we have tailored numerous other protocols to suite our needs. Collectively we have developed predefined protocols for commonly performed exams which standardize display and automate analysis of complex procedures. These efforts have dramatically reduced variability between operators, reduced human errors, increased clinician confidence, and enabled development of more complex analyses.
Automation & Integration
Hermes has been a collaborative partner in streamlining our workflow by continually improving automation and integration with other clinical and research systems. In 2016 we were the first Hermes site to integrate between our Hermes and radiology PACS system (McKesson), which in turn is linked to our voice-recognition dictation system (PowerScribe). Through this integration, patient selection by the interpreting physician is synchronized across all three systems with the click of the mouse, reducing repetitive work, increasing efficiency, and mitigating patient selection errors. Our physicians now regard this feature as a key desirable-attribute for other clinical systems.
Integration with well-established third-part vendors is expected in the field, but Hermes systems have enabled us to easily integrate proprietary tools for research and clinical use through simple scripting and standardized, vendor-neutral, image data formatting. At UOHI, for example, we were able to seamlessly integrate our quantitative myocardial flow reserve software (FlowQuantTM) into our clinical routine enabling our technologists to process cardiac PET studies from their Hermes workstation to produce graphical quantitative flow reserve reports that are automatically appended to the Hermes database. Consequently, we were able to transition our research technology into routine clinical use and to increase our research samples sizes from dozens of patients to thousands.
A look to the future
Hermes has empowered Nuclear Medicine in Ottawa for over two decades. With its current research and development efforts in the realms of multi-modality image visualization, machine learning and artificial intelligence Hermes holds promise to further propel molecular imaging. Thus, at TOH we remain confident that Hermes, as a clinical solutions provider, is well positioned to meet our evolving needs well into the future.
Ran Klein and Lionel Zuckier have collaborative research agreements with Hermes Medical Solutions which include in-kind financial support.