Despite the rapid progress made in the electronic design of imaging work stations for medicine, much less effort has gone into the design of environments in which such systems will be used. Based on studies of radiologist film reading sessions, considerable time will be spent working at such viewing systems. If the rooms in which the work stations are placed are not conducive to comfortable work, it will certainly not favor electronic viewing over film reading. In examining existing reading environments, it is also apparent that they are not optimal, even for film. Since some of the problems for film and electronic viewing overlap, such as heat generation (by the alternators, viewboxes, or work station electronics) and glare from light sources, it should be possible to develop solutions that are applicable to both environments, or to rooms that will feature both viewing systems. This paper will discuss some of the approaches to designing environments in which viewing of images is supported by the room architecture and engineering, rather than being degraded by it. To illustrate these points a design, based on the constraint of a real room size and available architectural materials, will be developed.
The exchange of information between a Radiology Information System (RIS) and a PACS is essential to optimizing the utility of a PACS. Some of the benefits awarded by implementing an interface include a reduction or elimination of repetitious data entry, the availability of more accurate information on the PACS, a reduction in workload for the technologists, registration clerks, transcriptionists, etc, and the availability of more accurate data for automating the PACS. This paper discusses the Georgetown experience of interfacing an HIS/RIS and PACS, by describing the development of the interface and its impact on clinical operations.
INTRODUCTIONThe radiology department of the future will be dramatically different in its operations because of the rapid development of digital radiography devices and image management technology. The introduction of new diagnostic devices such as MRI, CT, and SPECT has given powerful tools to diagnosticians, without changing the basic operational mode of radiology service. Recent advances in computed radiography (CR) and image management and communication systems (IMACS) have made it possible to move a significant portion of radiology service toward a filmless environment. It is increasingly clear that within the next several years a fully automated radiology service, with only a limited use of films, can be achieved. In such an environment the operations of a radiology service may be significantly different from those of a film -based service.At Georgetown University, an IMAC system consisting of a dozen imaging devices, a dozen workstations, a teleradiology system, and an archive based on a juke box, have been installed over the past two years. The development and implementation of the Georgetown system gave us valuable experience that can be useful for the next phase of the "total digital department" project. This is primarily a program outline paper highlighting the major steps that were needed to develop a successful total digital radiology department. Such a project is more than a technical project. Very often a disproportionate amount of emphasis is placed on the equipment configuration, to the neglect of other managerial and operational issues. This paper describes the other operational and programmatic issues in developing the image management component of the radiology department of the future. TOTAL DIGITAL RADIOLOGY SERVICEThe total digital radiology service (TDRS) is an integrated hospital -wide radiology service based on all digital imaging devices that do not require the use of any conventional x ray films except in a couple of special areas. A general description of a TDRS is presented here. Functional integrationThe activities of the radiology service-can be grouped into the following categories in terms of the flow of images and information: scheduling, image acquisition, transporting images, image management, image presentation, diagnostic report generation, image archive, report distribution, diagnostic consultation, and administrative support activities. Some of these activities take place on demand and on schedule. In current radiology operations, certain portions of the operation are computerized and automated. However, there are many breaks in the operations and many parts are managed manually, requiring duplicate efforts resulting in delays and inefficiencies. The TDRS refers to an environment in which all these activities are automated by means of computer -based networks and archives. This implies that the use of conventional films will be kept to the absolute minimum.
One of the advantages that a picture archiving and communications system (PACS) is supposed to provide over a film-based operation is improved performance in retrieving images. Although it seems selfevident that this should be so, this experiment was intended to verify this and to provide some time comparisons for the two methods. The experiment consisted of randomly selecting ultrasound and computed tomography cases and determining how Iong it took to retrieve files at a PACS workstation or in person from the fUe room. To simulate actual retrieval volumes, a total of 40 cases from current to 6 months old, 20 cases from the past year, and 10 cases more than 1 year old was selected. Results indicate that PACS retrieval can indeed be faster than file room retrieval. However, the difference is less for recent cases than for older cases. For cases 6 or fewer months old, the workstation retrieval was approximately 2.5 minutes faster per case than the film file room. This time difference increased markedly when extended to the 1-year and older-than-l-year groups. This report details the results of this study and provides information about the reliability of the two archives.
Despite the rapid progress made in the electronic design of imaging work stations for medicine, much lees effort has gene into the deeign of environments in which euch eyetems will be used. Baeed on etudies of radiologist film reading seseions, considerable time will be epent working at such viewing systeme. If the rooms in which the work stations are placed are not conducive to comfortable work, it will certainly not favor electronic viewing over film reading. In examining existing reading environments, ir is aleo apparent that they are not optimal, even for film. Since come of the problems for film and electronic viewing overlap, such as heat generation (by the alternators, viewboxes, or work station electronics) and glare from light sources, it should be poesible to develop solutions that are applicable to both environments, of to rooms that will feature both viewing systems. This paper will discuss some of the approaches to designing environments in which viewing of images is supported by the room architecture and engineering, rather than being degraded by it. To illustrate these points a design, based on the constraint of a real room size and available architectural materiale, will be developed. ment will be used. Unfortunately, aside from the reports of ter Haar Romeny 11 and Balter and Janower? 2 little attention has been given to such environmental design in the medical imaging literature. The problem raises both architectural and engineering concerns, and requires considerable use of human-factor design principles. We have had the opportunity to work on the design of a reading area within the department. This area will support conventional film as well as picture archiving communication systems (PACS) workstation reading, and will be used by the Abdomi nal Imaging Division. As such, a combination of plain film, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound cases will be interpreted. This new reading room is a renovation of an existing space, and so is subject to the constraints of existing bearing walls, columns, and major ductwork.We will examine the design for this space with discussion of the principles used.TTHE Society of Photo-Optical Instrumentation Engineers (SPIE) medical imaging meeting last year, we presented a paper that examined ergonomic features of radiology workstations and reading environments/Both prior to and since that time, extensive work has been done on the design of such work stations to better suit the tasks performed by medical imaging specialists, and to make such performance more efficient from the viewpoints of human factors and productivity. 21~ In particular, analysis of the work patterns of radiologists 79 have been combined with advances in person-computer interaction (user interfaces) resulting in viewing and reading systems that are far ahead of older aproaches. 6's'1~In addition to the workstation itself, we also examined the environment in which such equip-
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