Total Digital Department: Implementation Strategy

Abstract

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.

SPIE Medical Imaging 50th anniversary: history of the Picture Archiving and Communication Systems Conference

“…Held in Newport Beach, California, the meeting was chaired by Samuel J. Dwyer III, R. Gilbert Jost, and Roger H. Schneider. Architecture descriptions and PACS evaluation papers dominated the meeting, 149 – 165 with a few papers covering archives, 166 – 168 networks 169 – 171 and displays. 172 – 175 Multiple papers described radiology information systems (RIS) and their important link to PACS functionality.…”

<title>Evaluation of a picture archiving and communication system with combined voice and data traffic</title>

“…This communication can either be by standard telephone, such as is done at UCLA for communication between the radiologists and the MRI technologist [2], or by voice communication over that PACS network itself. The advantages of having access to voice communication without having to move from the workstation area [3,4] motivated PACS designers to include the ability to transmit packetized voice in their network designs. In particular, the system suggested by Kositpaiboon et al [5] at the University of Ottawa provides a voice channel allowing users to talk to each other.…”

PACS and its hospital-wide implementation: A case study at the Madigan Army Medical Center

“…nostic Imaging Support) (9) , IMAC (Image Management and Communication) (1 0) , TDRS (Total Digital Radiology Service) (11) , IDSS (Integrated Diagnostic Support System) ( 1 2 -584- …”