PACS Integration of Semiautomated Imaging Software Improves Day-to-Day MS Disease Activity Detection

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Fig 1.
Software integration into PACS workflow. This flow diagram outlines how the new MR imaging studies for patients with MS are processed by the VisTarsier software in a virtual machine once they are signed off in the radiology information system (RIS) by the radiographer. Successful processing requires all systems to be operational and compatible sequences to be available.
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Fig 2.
The proportion of scans showing MS progression within each year. This scatterplot highlights the number of scans and the proportion in which new and enlarging lesions were detected for each study group during each year. The position on the vertical axis corresponds to the proportion of scans showing progression. The position along the horizontal axis corresponds to the study year. The lighter shade corresponds to scans generated with the software.

Table 1:

Demographic and clinical data across each group^{^a}

	Proportion	CSSC	Software-Assisted		P Value
Scans belonging to female patients	52/65 (80.00%)		599/841 (71.22%)		.23
Primary reporting doctors with fellowship certification	47/65 (72.31%)		586/841 (69.68%)		.36
Age at scan	Mean, 44 yr, 139 days	SD, 11 yr, 223 days	Mean, 43 yr, 15 days	SD,11 yr, 256 days	.72
Time since diagnosis	Mean, 10 yr, 47 days	SD, 6 yr, 230 days	Mean, 9 yr, 58 days	SD, 6 yr, 234 days	.61
EDSS	Median, 2.0	Quartiles, 25% = 1.9, 75% = 3.1	Median, 2.0	Quartiles, 25% = 1.0, 75% = 3.5	.45

↵a This table summarizes the demographic and clinical details for all eligible patients who underwent an MR imaging brain scan at the Royal Melbourne Hospital from July 1, 2015, until June 30, 2017. χ² and t test statistics were performed to confirm group similarities.³¹

Table 2:

Treatment used at scanning for each study group^{^a}

Medication	CSSC (No.)	Software-Assisted (No.)
Fingolimod	35.85% (19)	37.30% (282)
Natalizumab	32.08% (17)	27.12% (205)
Dimethyl fumarate	3.77% (2)	7.80% (59)
Alemtuzumab	1.89% (1)	3.44% (26)
Glatiramer acetate	5.66% (3)	2.78% (21)
Interferon β	5.66% (3)	3.57% (27)
Other^{^b}	9.43% (5)	6.61% (50)
No active treatment	5.66% (3)	11.38% (86)
Total	100% (53)	100% (756)
Proportion on higher efficacy therapies (fingolimod/natalizumab/alemtuzumab)	69.87%	67.84%

↵a This table summarizes the number and proportion for each disease-modifying agent at scanning.
↵b Other treatments include teriflunomide, ocrelizumab, rituximab, stem cell transplantation.