Picture archiving and communications systems (PACS)have inescapably altered the face of radiology. Images are available to radiologists and clinicians alike, nearly instantaneously. For patient care management, service has improved, but without inclusion of input from radiologists. Effecting timely report availability requires reorganization of radiology. In a hospital-wide PACS environment, we undertook to render a preliminarv report on all nonprocedural computed radiography examinations within 30 minutes in a teaching environment. Two periods of time in the same month were analyzed, one before reorganization and one after. Of 686 reports, 117 were examined with a statistical significance of ~ = .05 (95% confidence) and a power of 90%. Average times for examination acquisition to preliminary report availability on the PACS decreased from 5 hours to 31 minutes, Standard deviation in report generation times decreased from 8 hours to 30 minutes. This preliminary study suggests that business process reengineering can effect improvement in information flow within a teaching facility resulting in radiologists rejoining the patient care management team. Successes, pitfalls, and future requirements are discussed.
Copyright 9 1997 by W.B, Saunders CompanyKEY WORDS: picture archiving and communications system (PACS), radiologv reports, diagnostic radiology, department management.H OSPITAL-WIDE picture archiving and communications systems (PACS) have been in use since the installation of the first medical diagnostic imaging system (MDIS) at Madigan Army Medical Center in 1992. Since this event, there has been considerable growth in this technology. With PACS carne a new era of immediate availability of roentgenographic images throughout the hospital. Image loss rates fell to less than 1%, and clinical acceptance of the system has been nearly instantaneous. Tripler Army Medical Center (TAMC), a 387-bed facility performing 115,000 examinations annually, installed an MDIS PACS in June 1996.The literature contains numerous articles and editorials elaborating on the benefits of efficiency and productivity, as well as savings and/or costs created. Additionally, numerous reports have reviewed the problem of report generation and result dissemination. None have actually described the process of departing from the old concept of batch mode reading at the alternator. Thus far, installation of PACS results in replacing the view box with a computer monitor. The past delays in presentation of routine films to the radiologist because they are in a clinic or being compiled in the file room ate no longer. The immediate availability of images allows for immediate interpretation. However, in a teaching facility with the primary objective of patient care and the secondary mission of graduate medical education, there is a precarious balance between fostering a resident teaching environment versus timely availability of interpretations to meet the clinical user's needs.To favorably influence the outcome of both sides of the equation, we engag...
Pulmonary to systemic blood flow ratios (Qp:Qs) were estimated in 16 children with ventricular septal defects using simultaneous echocardiography and radionuclide angiography, and compared to Qp:Qs measured at cardiac catheterization by the Fick principle method (Fick). When ratios of echographic left atrial dimensions (LAD) to body surface area (LAD/M2), body length (LAD/ht), and aortic root diameter (LAD/Ao) were compared to the Qp:Qs determined by Fick, the correlation coefficients were r = 0.70 for LAD/M2, r = 0.66 for LAD/ht, and r = 0.54 for LAD/Ao. The correlation coefficients between Qp:Qs by Fick, and left ventricular dimensions/M2 and fractional shortening of the left ventricle were not significant. The correlation coefficients between Qp:Qs and the ratios estimated by gamma-variate and area-ratio analysis of radioisotope pulmonary dilution curves were r = 0.92 and r = 0.84, respectively. Thus, radionuclide angiography provided more accurate quantitation of left to right shunting through a ventricular septal defect than echocardiography. However, difficulty in obtaining adequate bolus injections of the radioisotope may result in technical failures whereas echocardiographic measurement is possible in almost all pediatric patients. Finally, the gamma-variate method cannot accurately quantitate shunt ratios greater than 3.5 to 1.
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