PACS

Bill McCollough

Tom Carulli

Siemens Corporate Research

William Ross

Corrections or additions?

This article by Melinda Sherwood was published in U.S. 1 Newspaper on June 23, 1999.

All rights reserved.

Sirius: Making Medical Diagnostics Digital

You have just had several X-rays and MRIs taken of

what appears to be a torn shoulder. Before your doctor can determine

that, however, you have to drive across town — a one-armed patient

in a stick-shift vehicle — to pick up the unwieldy pieces of film

from the radiologist. "No courier service?" you ask. No, is

the inevitable answer.

Fifteen years ago, forward-thinking experts figured this medical annoyance

would be long gone by now. For medical imaging purposes, they said,

film would be dead. Doctors would be sending X-rays and CAT scans

back and forth to each other over digital networks that reached remote

places instead. In the digitized world of medicine, a doctor looks

at the X-rays of a man just admitted to the emergency room from his

laptop computer at home; a physician E-mails the results of an MRI

to a specialist, who returns a second opinion within minutes. Ordinary

people get extraordinary medical attention in a jiffy, and doctors

are unfettered by time and distance.

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PACS

The technology to realize that vision exists today. Picture Archiving

and Communication Systems (PACS), as they are called, are commonly

discussed among radiologists and others in the medical industry. Commonplace

they are not, however. PACS are notoriously expensive. Networking

a typical hospital environment, where cranky old machines co-exist

with new high-tech devices, each produced by a different manufacturer,

has not been an easy task for software developers.

Sirius Corporation, a medical imaging software company that just opened

its headquarters at Exit 8A, hopes to have solved some of those problems.

The company produces its own version of a PACS called the Multimedia,

Image, and Information Capture System (MIICS). Tom Carulli, CEO, believes

that MIICS can do something that the others cannot: network together

medical equipment by any manufacturer. "It could be a Kodak, a

GE, or a Pfizer," Carulli says. "Our software captures and

manages the image no matter how old it is or who manufactured it.

Nobody can make those talk together like we can."

In the field of medical imaging, companies like General Electric,

Siemens, and Picker are already well-established players. Each are

rewiring hospitals and revolutionizing medicine with their own PACS.

With only five engineers working out of its Springfield, Virginia,

research office, and an administrative staff of eight at Exit 8A,

Sirius is a small outfit by comparison. Just last year Sirius began

installing PACS for its first clients at the University of Southern

California’s nuclear medicine teaching hospital, university medical

school, and AIDS clinic. Carulli says it’s too soon to give an estimate

for this year’s revenue. He adds: "We are already profitable on

paper this month."

Although research and development continues in Springfield, the company’s

administrative offices are in New Jersey and California. The location

of Sirius was strategic, says Carulli. "Central and Northern Jersey

have the single largest concentration of the two technologies that

relate to what we do — medical imaging and telecommunications,"

he says.

Before its commercial incarnation, the core technology behind Sirius

enabled the military to capture aerial images of the ground. It was

technology with which the founder of Sirius, Bill McCollough, was

well acquainted. He worked on signal processing, imagery analysis,

and electronic warfare for the intelligence branch of the U.S. Air

Force during the 1980s. Although the imaging technology existed, says

McCollough, it wasn’t compatible with the kind of equipment used by

the medical community. "The government was always ahead of the

commercial sector in imaging," he says. "MR systems and CT

systems have been digital since day one, 20 years ago. But it wasn’t

end-user based. It was all on UNIX. I wanted to explore migrating

the technology down to PCs, which are much friendlier."

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Bill McCollough

McCollough holds a BS in engineering from the University of Iowa (Class

of 1982) and a master’s in electrical engineering from the Air Force

Institute of Technology, 1987. After his term in the military, McCollough

worked for Titan Corporation and later Sensor Systems Inc., where

he became the vice president of engineering and head of the software

development team for the National Institute of Health’s high-end medical

volume visualization system.

In 1994 McCollough broke away from the corporate world and began development

of software that could be used to put medical images in a more user-friendly

form — preferably Windows-based systems. His laboratory was the

basement of his Alexandria, Virginia, home, where he lives with his

wife and three kids. As McCollough talked to radiologists more and

more, he realized that to serve the industry’s needs, his software

had to do more than put images up on a screen for viewing. "When

it was going through its beta phase, we worked on the imaging portion

of the problem — that’s the sexy part, that’s what people see.

Once you got through the imaging portion, it was believable,"

he says. "But then they wanted to know how to get the data there

— how to move the data around." Radiologist wanted to be able

to manipulate the images and attach medical records and voice files

as well.

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Tom Carulli

In 1997 one of McCollough’s partners met with Yuri Paritsky,

an associate professor of radiology at USC, to discuss the research.

Feeling that the new technology was promising, Paritsky contacted

Carulli, an old friend now in the business of start-ups.

Carulli holds a BS in engineering from West Point, Class of 1972,

and received a law degree from Fordham in 1980. He served as an armored

cavalry officer in the United States Army from 1972 to 1977. Five

years ago, he left his position as managing partner of Cooper and

Dunham, one of the country’s oldest intellectual property law firms,

to do investment banking and start-ups. One of the companies Carulli

helped launch was Mirror World, a New Haven company that produces

computer information management systems and interfaces. He presently

serves on the board.

Carulli passed McCollough’s software by a jury of peers at Mirror

World, who all said the technology was sound from a computer science

standpoint. He then raised several million dollars from two large

money funds to get the Sirius product — the Multimedia, Image,

and Information Capture System (MIICS) — to the market.

The MIICS system enables doctors to capture, retrieve, and view medical

images from CAT scans, MRIs, ultrasounds, fluoroscopy, and any other

medical imaging device on a network compatible with UNIX or Windows-based

systems. In its entirety, MIICS is comprised of a server that stores

the image data, either for short term or long term, view stations

where the image can be analyzed and voice or medical charts can be

modified, a web server that feeds data to the Internet, and other

devices such as scanners and direct capture equipment. Everything

is stored in DICOM format — an industry standard developed by

the American College of Radiology (ACR) and the National Electrical

Manufacturers Association (NEMA). Sirius software also enables legacy

equipment — medical equipment manufactured before implementation

of DICOM — to communicate on a DICOM network.

The greatest advantage of the MIICS system, says Lawrence Tannenbaum,

chief of neuro-radiology at JFK Medical Center in Edison and a member

of Sirius’ advisory board, is that it allows equipment produced by

various manufacturers to communicate harmoniously. "It brings

equipment from multiple vendors and gets them to speak together in

a happy fashion," he says. "There’s nobody out there to do

that and that’s a problem. It’s a niche market — but it may be

a very important niche market."

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Siemens Corporate Research

Meanwhile, at Siemens Corporate Research Inc. on College Road, PACS

are also developed. Siemens already has systems installed at the University

of Michigan, Mayo Clinic in Jacksonville, Florida, and Cleveland Clinic.

Rick Primo, marketing manager of Siemens Health Services in Iselin,

says that his company has been producing multi-modality, multi-vendor

equipment since 1992. "We just use common industry protocols,"

he says. "We would take the signal coming out of the scanner and

feed it into an interface and take the old signal — which might

be analog — and covert that signal into DICOM. It’s really the

DICOM standard that made the market for PACS viable."

Viable, yes, but still not easy and obviously not "plug and play."

Robert Britain, vice president of medical diagnostics at NEMA, explains

that the DICOM standard has evolved over 15 years. "The DICOM

standard is not a regulatory standard; it’s an industry academic standard,"

he says. "It’s the best effort standard — and it keeps getting

better." The organization released specifications for the third

edition of DICOM in 1998.

In other words a piece of equipment meeting the first generation DICOM

standard may not be able to talk to a device set to the newest version

of the standard. "They’re absolutely not able to talk to each

other," Carulli says of DICOM standard equipment. "That’s

why we’re in business." Nonetheless, Carulli acknowledges hefty

competition. "Each of them does some of the things we do, some

of them try to do the things we do, and some of them do the things

we do," he says.

With what it considers an all-star executive team, however,

Sirius has a considerable advantage. McCollough is president and chief

technology officer of Sirius, and Paritsky, still at USC, is the company’s

medical director. Dave Cruickshank, a former sales manager for both

Philips Medical Systems and Toshiba, where he sold CAT and MRI systems,

is the company’s vice president of sales. "There’s lots of good

technology that never makes it," he says. "This was the right

intersection of technology and people. Each of our sales executives

has their own very deep rolodex of hospitals and businesses that they’ve

done business with for a long time."

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William Ross

Now all Sirius has to do is break down resistance among parts of the

medical industry to going digital. William Ross, a staff radiologist

at the Robert Wood Johnson University Hospital at Hamilton (where

everything is still done on film), says that hospitals are generally

wary of such a large investment. "PACS are wonderful, but they’re

very expensive," he says. "Hospitals work on a shorter time

frame, and the payback period is four to five years and you have to

put out a lot of capital."

That’s not the case, says Carulli. While the average high-end Sirius

system for a hospital costs roughly $3 million, the more standard

sale is somewhere between $250,000 (for a small server, a few view

stations, and five or six connection ports). "As we educate hospitals,"

Carulli says, "we tell them this: instead of buying the whole

system, let’s network all of your CTs, for example, but not your ultrasound,

or MRIs." Once they’ve done that, the network is there and it’s

just a matter of accumulating the smaller parts, he says.

Expense is not the only concern of hospital administrations, however;

with mergers going on in the medical diagnostics industry while the

technology is still evolving, many, says Ross, are concerned about

the technology becoming obsolete. He has no doubt, though, of where

the PACS industry is headed: "It’s certainly the wave of the future,

without question."

Sirius, 104 Interchange Plaza, Suite 202, Cranbury

08512. Tom Carulli, CEO. 609-409-4449; fax, 609-509-4450. Home

page: www.siriuscorp.com.

Corrections or additions?


This page is published by PrincetonInfo.com

— the web site for U.S. 1 Newspaper in Princeton, New Jersey.

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