OBJECTIVE.We compared radiologists' times in the interpretation of CT using hardcopy films with the interpretation using a soft-copy picture archiving and communication system (PACS) computer workstation.MATERIALS AND METHODS. One hundred CT examinations were selected at random and reviewed by four board-certified radiologists experienced in soft-copy interpretation. We performed time-motion analysis to determine the total time required to display, interpret, and dictate the individual findings of CT using conventional hard-copy interpretation on a viewbox and soft-copy interpretation, using a four-monitor high-resolution (2048 × 1536 pixel) workstation.RESULTS. Time-motion analysis showed a reduction of 16.2% in the overall time required for soft-copy interpretation of CT compared with that of film. Time savings with soft-copy interpretation were observed for all four participating radiologists. The benefit of soft-copy interpretation was increased for examinations in which there were comparison studies.CONCLUSION. We found that soft-copy interpretation of CT using a PACS workstation requires less time than interpretation using conventional film hung on a viewbox. The transition to filmless imaging has the potential to improve radiologists' productivity and reportturnaround time.
The study was performed to evaluate detection of soft-tissue foreign bodies using conventional radiography (film-screen radiography), computed radiography printed on films (computed radiography-hard copy), and computed radiography displayed on a computer workstation (computed radiography-soft copy). SUBJECTS AND METHODS. Fifteen foreign bodies of different size, shape, and composition were implanted at different locations in a fresh cadaveric hand, and images were obtained using three radiographic techniques. Images were evaluated by four boardcertified radiologists to ascertain the conspicuity of the foreign bodies with the different techniques. A subjective grade was assigned to each image in an attempt to identify the relative conspicuity of foreign bodies when imaged with the three techniques. RESULTS. Computed radiography-soft copy is the preferred imaging technique for the detection of wood and plastic foreign bodies in soft tissue regardless of the size of the wood or the plastic. No significant differences in conspicuity among the three techniques were demonstrated with glass foreign bodies. CONCLUSION. Detection of soft-tissue foreign bodies is best done using computed radiography-soft copy instead of film-screen radiography and computed radiography-hard copy imaging.
The use of multiple window and level settings during soft-copy interpretation resulted in improved lesion detectability and characterization with greater diagnostic efficacy. Using soft-copy workstations, radiologists can evaluate images using multiple settings without compromising efficiency.
D ESPITE 2 DECADES of optimistic and confident predictions that filmless radiology was imminent, the centennial commemoration of Wilhelm Roentgen's discovery of the x-ray will come and go this year with only a small number of radiology departments interpreting more than a small fraction of imaging studies using a computer workstation. The reasons for this undoubtedly representa combination of economic constraints, concerns about image quality and time required for image interpretation, and the inertia that must be overcome with any paradigm shift as great as is required to abandon film for the largely uncharted waters of digital imaging.The combination of construction Ÿ associated with the Veterans Administration's (VA's) new high-tech showcase, exhaustive investigation into quality and productivity issues associated with digital imaging, a great deal of energy and enthusiasm, and perhaps a bit of naivet› resulted in the decision to pursue filmless operation at the Baltimore VA Medical Center.The anticipated advantages of the picture archiving and communication system (PACS) included better image management with fewer lost and unread studies, the use of computer enhancement to produce consistently higherquality images, the ability to provide real-time image interpretation, easier access to images for clinicians and radiologists, reduced average radiation doses, and teleradiology. These anticipated advantages, for the most part, have indeed been realized now that the system has been in routine operation for approximately 2 years with one year of near-filmless operation. Workstations located throughout the hospital have access to all images stored in both shortterm and long-term (optical jukebox) archives. Modalities interfaced to our commercial PACS include computed radiography, digital angiography, the cardiac catheterization laboratory, digital fluoroscopy, ultrasound, computed tomography (CT), magnetic resonance imaging, and nuclear medicine. Mammograms are currently produced using conventional film/screen technology and subsequently digitized into the PACS. The mammographers interpret the images from film rather than using the computer workstation because of the spatial resolution limitations of non-film-based technologies currently available for mammography. Nonradiology images from such diverse sources as dermatology, pathology, endoscopy, bronchoscopy, and intraoperative photographs are acquired, archived, and displayed using a separate PACS developed by the VA as part of the hospital information system (HIS). Al1 of the radiology/ nuclear medicine images in the commercial system are also archived and can be retrieved using this second PACS.The workstations in the radiology department use a Macintosh II or Quadra 950 system with four (2,048 x 1,536-pixel) monitors. Workstations throughout the remainder of the medical center are in a two-monitor (1,152 x 1,078-pixel) configuration and use the Quadra 950 computer. The average brightness of the 2,048 x 1,536-pixel monitors is approximately 50 foot-lamberts and...
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