Making filmless radiology work

Abstract

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...

Budget Variance Analysis of a Departmentwide Implementation of a PACS at a Major Academic Medical Center

“…From the physicians' viewpoint, PACS increases productivity, allowing physicians the ability to see more imaging studies, thus increasing throughput and the profitability of the hospital. 2 PACS also allows physicians the ability to access prior radiological studies with relative ease, compared with having to physically retrieve the images from the file room and also allows them the freedom to access radiological images anywhere work stations are installed.…”

Enterprise-wide Implementation of Digital Radiography in Oral and Maxillofacial Imaging: The University of Florida Dentistry System

“…1,2 Picture archiving and communication systems (PACS) are used in such settings to enable the integration of different imaging units and vendor products so as to ensure the ease of image communication, archiving, and retrieval without loss of data. The Digital Imaging and Communications in Medicine (DICOM) standard, developed by the National Electrical Manufacturers Association (NEMA), facilitates the distribution and viewing of radiographs and other images.…”

Experience with comparative picture archiving and communication system baseline data collection at four Veterans Affairs Medical Centers: Methodology, lessons learned, and suggestions for improvement

“…~ In order for PACS to become more widely accepted, it is important to conduct studies to assess technical and practitioner acceptability, radiology services accessibility, and costs and clinical acceptability. 2 Four Veterans Affairs (VA) Medical Centers were used asa test bed to assess the impact of PACS and teleradiology with regard to the accessibility of radiology services and the costs of providing these services. Time motion studies were performed at four VA facilities, recording dates at the time of submission of a requisition for an imaging examination to the time of verification of the imaging report.…”