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This article by Melinda Sherwood was published in U.S. 1 Newspaper on June 23, 1999.
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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.
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,"
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."
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
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."
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."
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,
08512. Tom Carulli, CEO. 609-409-4449; fax, 609-509-4450. Home
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