Increasingly orthopaedic departments are using digital radiology and imaging systems. We review the technical features of a digital radiology system for the orthopaedic surgeon. The pros and cons of digital and computed radiology are discussed. Hardware and software requirements for storage, retrieval, manipulation, and display of digital images are reviewed. The potential benefits to the clinician and the patient are outlined.
Living with Digital ImagingDigital imaging technologies were embraced at an early stage by many orthopaedic surgeons before their introduction in the workplace. The development of digital imaging is shown in Table 1. Picture archive and communication systems (PACS) have been in use in orthopaedic departments worldwide for more than 10 years. We must remember that computers may be used to support information management, general administration, and clinical practice in a health service. However, looking back on the progress made to date in medical information technology, we can see a complicated mix of failures, near successes, and unconditional successes. We are aware of failed promises from medical technology vendors who promoted devices designed to supposedly streamline our practice and create more leisure time. The computerized electronic patient record (EPR) is a good example, although it is viable in a few cutting-edge hospitals, it has yet to become universally available, in part because of a lack of standardized vocabularies and data structures. The resulting problem, although a boon to commercial interconnect vendors, probably has done more to halt the progress of medical technology than any other factor.At the other extreme are some stellar successes in the application of technology to medicine. For example, laboratory automation now is so standardized that most of us take blood analysis for granted. Computer-driven MRI and CT scanning has revolutionized imaging. It is unfortunate that so many hospitals have not become more widely competent with EPR. Simpson and Gordon 9 stated that "the proper foundation for healthcare computing should be clinical information systems based on the individual patient" and "with such systems, paperless operation is possible". However, very few hospitals currently can function completely in a paperless environment. Digital imaging has some exciting developments but these have to be implemented in an intelligent manner.A PACS permits the acquisition and eventual display of digital images throughout a hospital and beyond thereby rendering conventional radiology with film obsolete. The benefits range from ease of image delivery to multiple sites, the phenomenon of the lost radiograph should be abolished, and patient radiation doses and the need for repeat examinations can be reduced by manipulation of radiographs that previously might be deemed underexposed or overexposed. Despite wide-ranging potential benefits PACS have faced many difficulties and have limitations. 19 Increasing computer acceptance and literacy and rapid technologic advances have resol...
