Clayton Larsen is the VP of marketing and network development at FUJIFILM Medical Systems USA Inc (FMSU of Stamford, Conn). A wholly owned US subsidiary of Fuji Photo Film Co Ltd, FMSU has a range of product offerings, including PACS, CR, X-ray, printers, networking, film, and diagnostics. Larsen, who won the Medical Marketing Association’s 1998 International In-Awe Award for Marketer of the Year, has been with FMSU since 1996. In his current role, Larsen is responsible for marketing the company’s conventional and digital diagnostic imaging products as well as developing networking technologies. He spoke with Medical Imaging about the future of FMSU, technology, and the industry itself.

What is FMSU’s view of the future of digital imaging?
Digital imaging will always be directly linked between what is happening on the clinical frontier and what is progressing in broader computer industry advancements. Medical imaging companies like Fuji must stay abreast of the clinical domain to know what problems need to be solved. We also need to know what is happening in terms of technology “raw materials,” such as hardware advancements and software capabilities. It is then our job to create tools out of these raw materials that help solve real clinical problems. Even though the majority of hospitals are film based today, when they all have achieved filmless status, there always will be a need for digital-imaging technologies. Those companies that best bridge the clinical need with technology tools, and continue to innovate, will have no shortage of business in the future.

What changes do you see on the clinical horizon, specifically in terms of new roles for technologists?
Technologists are being asked to perform more procedures with more images per procedure, along with more complex procedures. They also need to be familiar with IT, as all modalities have some workstation and network associated with it, even if there is no PACS. On top of that, a much better focus today is on quality of care and a positive experience for the patients. All this takes time and training. To make matters even more challenging, there is a shortage of imaging technologists.

I believe the industry has seen a change in the roles of the radiology department manager and chief technologists in that they are much more astute at the business and technology issues needed to run a department. Their biggest challenge is to keep a pipeline of good personnel to the department, as many of the best technologists are promoted into such roles as PACS administrators, leaving the clinical areas to be backfilled.

FMSU touts Synapse as the first next-generation PACS. In what way? What are the deficiencies of current PACS compared to the new Synapse?
We were fortunate to be able to take some extremely experienced and talented senior software architects and literally take 3 years to build a wholly new PACS, from the ground up, based on the absolute latest technologies available. Unlike other PACS companies, the architects did not have to support an existing legacy system and had the benefit of time and focus. We actually refer to Synapse as the “first next-generation PACS” because others will eventually get to the baseline that we initially offered. We refer to a next-generation PACS that has specific characteristics.

First, the system should be on-demand and shouldn’t use any auto-routing architecture to accomplish image transmission. We live in an on-demand world, and PACS should be no different. Second, one should be able to buy PACS as a software solution on industry-standard hardware and be able to grow the system from very small to extraordinarily large using exactly the same code. Third, a next-generation PACS must be Web based at its very core. Synapse has URLs associated with every image and every exam so that there is no difference between the diagnostic software and the desktop software. They are both thin client, which is automatically upgraded and can be distributed among thousands of desktops in an institution—and anywhere in the world, for that matter. Last, we believe a next-generation PACS should not be driven by cluttered icons but should have a look and feel that is consistent with other desktop applications that people use.

Beyond this core generational leap that we made, we have developed a host of unique technologies in Synapse, many of which have patent protection, that we feel have even furthered our technological lead. Fuji developed Synapse from scratch to be a broad platform for image and information management in a Web-enabled world, and we made many thorough and thoughtful architectural decisions to have our technology be cutting edge for many years to come.

Because I don’t think it’s appropriate for me to try to speak about deficiencies in other systems, I’ll just say that there are two things that are very difficult to do in PACS. One is to take a legacy PACS architecture and try to evolve it to be a next-generation PACS. The second is to take a Web-based teleradiology or image distribution system and try to make it a full-enterprise PACS. I think many of today’s PACS companies face one challenge or the other.

What is your view of the migration toward outpatient delivery of imaging procedures?
As far as an impact on technology, what outpatient delivery will do is allow physicians and radiologists to deliver care in a hospital setting and outpatient facility simultaneously. The ability to view studies from any PC from anywhere with the same set of tools and privileges will be very important. Any Web-enabled applications are going to continue to come to the forefront. Also, any technologies that can handle these very large images over modest bandwidth are going to be important, because not everybody can afford high-speed lines, but we still have to handle very large images. Thus, solutions to overcome bandwidth issues are going to be important. Finally, too, is that patients treated in outpatient facilities will still expect the full quality of care that they would in a hospital. So it will be required that all technologies can work together.

Advancements of products and technology produce more images at a quicker pace. But the number of clinicians, technologists, and radiologists hasn’t increased at the same rate. How does FMSU tackle the inevitable increased margin of error?

We certainly understand the challenge at hand. We are dealing with more information being produced by the patient care cycle, not to mention the inevitable increase in patient volume. Also, the trend to manage a department toward patient centric quality and outcomes is growing.

So when you are inundated with images, how do you maintain or even improve your level of quality? When you are bringing in an increasing number of patients and producing more diagnostic information and subsequent diagnoses, you cannot say that you’ll increase productivity at the cost of quality. That’s an unacceptable compromise. And the obvious reality is that you can’t improve quality but decrease productivity. So we need solutions that maintain the balance between quality and productivity.

The goal of Fuji’s products is to increase the quality, consistency, and efficiency of the radiology process. For example, one of the things we’ve implemented is producing superior image quality through our image processing. And with even further advances to our capabilities, such as through disease-specific processing, radiologists and other healthcare workers alike will benefit from increased specificity, which enables more rapid and accurate diagnoses.

Another way that we are able to help increase both quality and productivity is through our new, and patent-pending, Reading Protocols. Fuji’s Reading Protocols help provide repeatable, efficient, and accurate navigation through the vast quantities of diagnostic images and information. Although most PACS offer hanging protocols—or a similar ability to deal with the automation of images—we at Fuji understand that radiologists are concerned with a lot more than just the automation of images alone. It’s not just preferences regarding image appearance and format that radiologists need to have set, but also much of the other vital information required during the interpretation process. Reading Protocols allow the automation of the presentation of all the information within Synapse, including documents, image processing parameters, and results. With Reading Protocols, radiologists can apply a preset presentation model, or specified sequence, to the studies they read, allowing images and related information to appear in the desired order each and every time. This eliminates the need for radiologists to focus on presentation of information—a job that’s best left for the software—and allows them to focus on the interpretation process.

In terms of growth areas for the practice of diagnostic imaging, what are things to come?
One area is quantitative imaging, be it nuclear medicine, cardiology, or molecular imaging, specifically with MR. We’re not just looking at uptake percentages, but morphological changes over time. It’s finding ways to measure and track when following up on disease. That also leads to advances in computer-aided detection.

How do you view the importance of technology?
Technology for technology’s sake will not sell. It must be linked to a real clinical problem that is a routine challenge. Niche problems won’t be able to afford a development focus. For big problems, you need to identify the root cause to see if it really is a current workflow issue rather than requiring a new technological solution. PACS represents a new technological solution that also warrants a rework of workflow to best take advantage of the technology.

What is your view on this industry that can appear to be unbalanced in terms of the largest quantity of products and technologies coming from a small number of companies? Do the “big guys” buy out the “small fries” to avoid competition?
First, I don’t think the big guys buy out the small fries to avoid competition, it’s because they taste good. In other words, the small fries have something that the big companies don’t. Smaller companies are always more nimble in adoption and ongoing utilization of new technology, and they will always be present in the market.

When the small companies go to market, however, they have a significant disadvantage, because hospitals want to make sure that their modality or IT investment can be supported in the long run. Hospitals have justifiable risk avoidance with small companies.

One important reason for Fuji’s success in PACS is that we built Synapse with a small and tightly focused engineering team in Connecticut that was not part of a huge R&D shop. We created the culture of an engineering start-up, albeit with the very deep pockets of Fuji behind it.