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WAN optimization improves throughput for medical images

High-resolution images can tax any network. The problem is multiplied when bandwidth is scarce. That's why a rural Mississippi medical imaging firm turned to WAN optimization.

In this case study, the IT director of a medical imaging firm with more than a dozen clients in rural Mississippi and Tennessee explains how wide area network (WAN) optimization helped improve image transmission without the need for additional bandwidth or data circuits. The project has been so successful, the IT director said, that physicians equate the WAN optimization vendor "with a way to make transmission better and faster."

Time is of the essence when it comes to emergency medical diagnostics, especially when radiology interpretation is outsourced to a third-party. Every minute it takes for a medical image to cross the network is another minute before the image is analyzed, a diagnosis is made and treatment is administered. But ensuring timely delivery of high-resolution medical images is difficult when files are transmitted over a broad geographic area lacking modern broadband technology.

This scenario was challenging Imaging Associates of Northern Mississippi’s ability to meet its turnaround promise for its customers.

"We have a commitment to supply a radiology report for an ER study within an hour. Sometimes that's very difficult depending on the number of images being transmitted," said Cavett Otis, IT director of Imaging Associates. "The less time that it takes to transmit the study, the more time the doctor has to make an accurate interpretation and fall within the guidelines of getting the report back as quickly as possible."

Imaging Associates provides radiology interpretation services to 11 health care facilities across northeast Mississippi and one in central Tennessee. The facilities transmit their X-ray, MRI, CAT scan and ultrasound images to Imaging Associates via WAN, DSL, cable T-1 and a variety of other public and private Internet and network connections.

The company faces a constant struggle to get images to reading locations without spending money on additional data circuits and bandwidth, Otis said. "The bandwidth issue in rural America is the biggest issue we faced."

Otis turned to WAN optimization. Unfortunately, the first tests he conducted, using caching technology, were unsuccessful. "Each image is a new set of data, so caching doesn't have any effect on that. We're not repeating data that’s already in the cache," Otis said. We did a couple small tests with cache, and it had no impact whatsoever."

WAN optimization vendors also use compression and protocol optimization to increase network throughput. Since medical images cannot be modified, only protocol optimization was a viable option for Imaging Associates. Otis found a WAN optimization product that effectively uses protocol optimization when he agreed to a free 60-day trial with Circadence Corp.

Circadence installed its MVO 1200 Wan Optimization software in three offices, including Tippah County Hospital, Imaging Associates' most bandwidth-restricted location.

"Within seven days the results were dramatic," Otis said. "It was almost unbelievable. We went from sending an X-ray image that's roughly 10 megabits of data in two minutes, 10 seconds to as quick as 17 or 18 seconds." More generally, Otis said Imaging Associates has experienced a 50% reduction in transmission time for each image.

Circadence MVO 1200 WAN Optimization is designed to optimize any kind of traffic, including incompressible objects like medical images. MVO works by gathering information about what’s happening on the network. When it intercepts traffic that must be optimized, it uses this information to increase the throughput and speed delivery.

"In order to achieve higher throughput, it comes down to understanding the network environment in real time and being able to transfer content in a more efficient way than traditional networking," said Rob Shaughnessy, Circadence CTO.

Circadence MVO 1200 works inside the VPN tunnel that Imaging Associates uses to connect to all client sites. This VPN security makes HIPAA compliance a non-issue, Otis said. Moreover, "If the endpoint device receiving the data supported encryption, then that would be supported as well as an alternative to VPN, but we’re not using that capability at this time.”

We haven't added any bandwidth to four different locations in the last three years. We just use more of the software as we add different locations to read from.

Cavett Otis, IT director, Imaging Associates of Northern Mississippi

Circadence offers MVO as an appliance or software. Altogether, Imaging Associates has five hardware-only installations and 15 software licenses. Otis said a Circadence box is deployed at a couple hospital sites between the Web server and Internet. The software client is deployed on standalone PCs in remote offices and even doctors' homes.

"The software-only client is very easy to install and configure, and can be rolled out to a machine in a very short amount of time," said Otis, adding that Imaging Associates recently began deploying MVO on doctor's mobile devices.

Because the product has proven cost-effective, adding the software client to another location is no big deal. Otis said the annual support contracts for MVO equipment costs less than what it would cost to add two more T1 lines.

"In some places we can't add more bandwidth. In some places we could have. But by using MVO we're able to avoid adding data circuits and incurring those additional monthly charges," Otis said. "We haven't added any bandwidth to four different locations in the last three years. We just use more of the software as we add different locations to read from."

With the improvement in transmission speeds, Imaging Associates no longer worries about meeting its contractual obligations with its clients. In fact, the time savings has enabled the company to increase its client base. "The only way we are able to do that is because we have more time. Time is money, and in radiology, that's very true," Otis said.

Crystal Bedell is a freelance technology writer specializing in security and networking. She writes articles, tips and guides to help IT professionals evaluate technology, secure and modernize their IT infrastructure, solve business problems and prepare for IT certifications. She can be reached at

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