When it comes to imaging, Boston's Massachusetts General Hospital (MGH) is going against the grain. It's not that MGH isn't into outsourcing. It's just that instead of business being diverted from MGH, it's being sent to the hospital.

Since the MGH 3D imaging service began in 1999, it has processed more than 150,000 exams. But instead of staying the course and delivering care exclusively to its own patients, MGH created a national Tele3D Advantage system using Atlanta-based Neurostar's Virtual Radiology Network (VRN). Designed to pull images from a variety of sources, the Web-based system will provide MGH with all the 2D data needed to compile, compose and create 3D renditions, and send them back. Though the processing time varies depending on the type of scan performed, customers typically receive their images in approximately three hours.

According to Marc Deary, senior project manager at First Consulting Group, Long Beach, Calif., services like MGH's may offer a host of possibilities for providers that might otherwise have been priced out. "PACS is still not cost effective for a small, community or rural hospital," he says. "They really have to go through a lot to say they want to spend $2 million on imaging software. Going with a fee-per-click system might be an opportunity to get PACS or even to take it one step further," he says, as it might be like getting PACS capabilities without actually buying the system.

MGH has gone from putting out two scans a day to as many as 140 with 40 different protocols. The hospital began its free 3D image reconstruction service in hopes of one day taking it to town. Eight years and 150,000 exams later, with more than 100 radiologists on staff, that day has come. And according to John DeVries, director of 3D business development at MGH, the target customer is the small to medium sized hospital. The idea is to leverage MGH's resources into a fee-per-click teleradiology service.

"Not only don't we cost anything to get started," DeVries says, "but you don't have to buy a work station to work with us, you don't have to hire a new staff member to work with us, you don't have to train them, you don't have to develop new scan or 3D protocols." The range of clinical radiology offerings includes liver resections, cardiac calcium scoring and spine bone fractures.

DeVries says the criteria for the selection of Neurostar was that it be easy to implement, be "plug-and-play," and use remote installation so that CIOs would need to worry about integration as little as possible. "We wanted an interface that would work with a GE PACS, or a Siemens or a Stentor, or whoever it might happen to be," he says.

DeVries says he has found training for the small to mid-sized hospital users of the MGH system to be much harder than he would have expected. For technologists to be fully trained in processing and creating images, MGH requires them to go through a 12-month process. "It's a very extensive, very detailed training program, and everybody that we come across aways says, 'Can I send somebody to your site for a week of training and they'll be ready?’” he says. "And we always say, 'Well, not really. If they want to come for a year, then maybe we can talk.’”

According to Deary, hospitals providing imaging services to other hospitals is in its infancy. DeVries agrees, "We're just dipping our toes in the water to work it, to fine-tune our processes for external clients. There's certainly more to come from this story."