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Gam NP, Sibiya MN. Doctors' perspectives on the quality of medical imaging in public hospitals in eThekwini District. Health SA 2024; 29:2389. [PMID: 38841359 PMCID: PMC11151430 DOI: 10.4102/hsag.v29i0.2389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 11/28/2023] [Indexed: 06/07/2024] Open
Abstract
Background There is a paucity of literature on perspectives of referring doctors about the quality of medical imaging services and this study closes this gap in literature. Aim This quality assurance (QA) study aimed to explore the perspectives of doctors on the quality of medical imaging services in selected regional hospitals within eThekwini District of KwaZulu-Natal. Setting The study was conducted in four public regional hospitals. Methods An exploratory descriptive qualitative research design involving 30 min-45 min of in-depth individual interviews was used. A purposive sampling technique was used to select research participants and hospitals to ensure adequate responses to the research questions. The sample involved nine participants and was guided by data saturation. Responses were recorded through notes and voice recordings and thematic analysis was used to analyse data. Results Three main themes (timeliness of examinations, communication and radiology reports and image quality) and eight subthemes (waiting times, shortage of radiographers, workload, communication between doctors and radiographers, requisition forms, unavailability of radiology reports, clarity of images and image acquisition protocols) emerged from the data. Challenges experienced were exacerbated by high workload and shortage of radiologists and radiographers. Doctors in the data collection sites were mainly dissatisfied with services provided by the medical imaging departments. Conclusion Regular engagements between medical imaging departments and doctors are important in enhancing the provision of quality care to patients. In-service training of radiographers and employment of additional radiographers and finding solutions to mitigate shortage of radiologists are recommended. Contribution This quality assurance (QA) study focused on experiences of doctors while many other medical imaging QA studies in South Africa are equipment based. In-service training of radiographers is recommended to improve image quality and communication skills.
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Affiliation(s)
- Nkululeko P Gam
- Centre for Quality Promotion and Assurance, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Maureen N Sibiya
- Division of Research, Innovation and Engagement, Mangosuthu University of Technology, Durban, South Africa
- Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
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2
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Tárnoki ÁD, Tárnoki DL, Dąbrowska M, Knetki-Wróblewska M, Frille A, Stubbs H, Blyth KG, Juul AD. New developments in the imaging of lung cancer. Breathe (Sheff) 2024; 20:230176. [PMID: 38595936 PMCID: PMC11003524 DOI: 10.1183/20734735.0176-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/25/2024] [Indexed: 04/11/2024] Open
Abstract
Radiological and nuclear medicine methods play a fundamental role in the diagnosis and staging of patients with lung cancer. Imaging is essential in the detection, characterisation, staging and follow-up of lung cancer. Due to the increasing evidence, low-dose chest computed tomography (CT) screening for the early detection of lung cancer is being introduced to the clinical routine in several countries. Radiomics and radiogenomics are emerging fields reliant on artificial intelligence to improve diagnosis and personalised risk stratification. Ultrasound- and CT-guided interventions are minimally invasive methods for the diagnosis and treatment of pulmonary malignancies. In this review, we put more emphasis on the new developments in the imaging of lung cancer.
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Affiliation(s)
- Ádám Domonkos Tárnoki
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
- National Tumour Biology Laboratory, Oncologic Imaging and Invasive Diagnostic Centre, National Institute of Oncology, Budapest, Hungary
| | - Dávid László Tárnoki
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
- National Tumour Biology Laboratory, Oncologic Imaging and Invasive Diagnostic Centre, National Institute of Oncology, Budapest, Hungary
| | - Marta Dąbrowska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | | | - Armin Frille
- Department of Respiratory Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Harrison Stubbs
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Kevin G. Blyth
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
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3
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Nguyen Q, Wybrow M, Burstein F, Taylor D, Enticott J. Understanding the impacts of health information systems on patient flow management: A systematic review across several decades of research. PLoS One 2022; 17:e0274493. [PMID: 36094946 PMCID: PMC9467348 DOI: 10.1371/journal.pone.0274493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background Patient flow describes the progression of patients along a pathway of care such as the journey from hospital inpatient admission to discharge. Poor patient flow has detrimental effects on health outcomes, patient satisfaction and hospital revenue. There has been an increasing adoption of health information systems (HISs) in various healthcare settings to address patient flow issues, yet there remains limited evidence of their overall impacts. Objective To systematically review evidence on the impacts of HISs on patient flow management including what HISs have been used, their application scope, features, and what aspects of patient flow are affected by the HIS adoption. Methods A systematic search for English-language, peer-review literature indexed in MEDLINE and EMBASE, CINAHL, INSPEC, and ACM Digital Library from the earliest date available to February 2022 was conducted. Two authors independently scanned the search results for eligible publications, and reporting followed the PRISMA guidelines. Eligibility criteria included studies that reported impacts of HIS on patient flow outcomes. Information on the study design, type of HIS, key features and impacts was extracted and analysed using an analytical framework which was based on domain-expert opinions and literature review. Results Overall, 5996 titles were identified, with 44 eligible studies, across 17 types of HIS. 22 studies (50%) focused on patient flow in the department level such as emergency department while 18 studies (41%) focused on hospital-wide level and four studies (9%) investigated network-wide HIS. Process outcomes with time-related measures such as ‘length of stay’ and ‘waiting time’ were investigated in most of the studies. In addition, HISs were found to address flow problems by identifying blockages, streamlining care processes and improving care coordination. Conclusion HIS affected various aspects of patient flow at different levels of care; however, how and why they delivered the impacts require further research.
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Affiliation(s)
- Quy Nguyen
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, Australia
- * E-mail:
| | - Michael Wybrow
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, Australia
| | - Frada Burstein
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, Australia
| | - David Taylor
- Office of Research and Ethics, Eastern Health, Melbourne, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
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4
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Montazeri M, Khajouei R. Determining the Effect of the Picture Archiving and Communication System (PACS) on Different Dimensions of Users' Work. Radiol Res Pract 2022; 2022:4306714. [PMID: 35265375 PMCID: PMC8901356 DOI: 10.1155/2022/4306714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/22/2022] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
The impact of the picture archiving and communication system (PACS) on healthcare costs, information access, image quality, and user workflow has been well studied. However, there is insufficient evidence on the effect of this system on different dimensions of the users' work. The objective of this study was to evaluate the impact of the PACS on different dimensions of users' work (external communication, service quality, user intention to use the PACS, daily routine, and complaints on users) and to compare the opinions of different groups of users about the PACS. This study was performed on the PACS users (n = 72) at Kerman University of Medical Sciences, including radiologists, radiology staff, ward heads, and physicians. Data were collected using a questionnaire consisting of two parts: demographic information of the participants and 5-point Likert scale questions concerning the five dimensions of users' work. Data were analyzed using descriptive statistics, ANOVA, and Pearson's correlation coefficient statistical tests. The mean of scores given by the PACS users was 4.31 ± 0.86 for external communication, 4.18 ± 0.96 for user intention to use the PACS, 3.91 ± 0.7 for service quality, 3.16 ± 0.56 for daily routine, and 3.08 ± 1.05 for complaints on users. Radiologists and radiology staff had a more positive opinion about the PACS than other clinicians such as physicians (P < 0.01, CI = 95%). Factors such as user age (P < 0.01, CI = 95%), job (P < 0.001, CI = 95%), work experience (P < 0.001, CI = 95%), and PACS training method (P=0.037, CI = 95%) were related to the impact of the PACS on different dimensions of users' work. This study showed that the PACS has a positive effect on different dimensions of users' work, especially on external communication, user intention to use the system, and service quality. It is recommended to implement PACSs in medical centers to support users' work and to maintain and strengthen the capabilities and functions of radiology departments.
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Affiliation(s)
- Mahdieh Montazeri
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Khajouei
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
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5
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Eloy C, Bychkov A, Pantanowitz L, Fraggetta F, Bui MM, Fukuoka J, Zerbe N, Hassell L, Parwani A. DPA-ESDIP-JSDP Task Force for Worldwide Adoption of Digital Pathology. J Pathol Inform 2022; 12:51. [PMID: 35070480 PMCID: PMC8721866 DOI: 10.4103/jpi.jpi_65_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/15/2021] [Indexed: 12/11/2022] Open
Affiliation(s)
- Catarina Eloy
- Department of Pathology, Institute of Molecular Pathology and Immunology of University of Porto (IPATIMUP), Porto, Portugal.,Department of Pathology, Medical Faculty of Porto University, Porto, Portugal
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Japan
| | - Liron Pantanowitz
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Marilyn M Bui
- Department of Pathology, Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Norman Zerbe
- Charité - University Medicine Berlin & Research IT Services, Berlin Institute of Health & Institute of Pathology, Berlin, Germany
| | - Lewis Hassell
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Anil Parwani
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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6
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Hasani N, Hosseini A, Sheikhtaheri A. Effect of Implementation of Picture Archiving and Communication System on Radiologist Reporting Time and Utilization of Radiology Services: A Case Study in Iran. J Digit Imaging 2021; 33:595-601. [PMID: 31898036 DOI: 10.1007/s10278-019-00314-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We aimed to determine the effect of PACS implementation on the radiologist reporting time and utilization of radiology services in a hospital in Iran. This study was conducted in three 6-month periods (before PACS implementation, immediately after the implementation, and 1 year after implementation). Data related to reporting time of CT examinations were collected from 5074 patients with 6613 examinations and compared using the Friedman test. The utilization rate of radiology services was conducted about CT scans and radiographies. Therefore, 17,862 patients with 36,321 radiographies and 7155 patients with 10,571 CT scans were evaluated, and the ratio of the number of examinations to the number of patients and patient days was compared in three periods. The mean of reporting time on CT scan examinations in the period of immediately after PACS was changed compared to the period of before PACS from 13.05 to 24.18 days and compared to 1 year after PACS implementation, to 4.14 days (P value < 0.05). The utilization rate in CT scans, 1 year after PACS increased at least 10% to 25% compared to the immediately after PACS and before implementing PACS. The utilization rate in radiographies, 1 year after PACS, increased at least 16% to 78% compared to the immediately after PACS and before PACS implementation. In conclusion, the mean of the radiologist reporting time for CT scans is significantly decreased by PACS in the long-term. Additionally, the utilization rate of radiology services is increased in the short- and long-term after PACS implementation in most examinations of CT scan and radiography examinations.
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Affiliation(s)
- Najmeh Hasani
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - AghaFatemeh Hosseini
- School of Public Health, Department of Biostatistics, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Abbas Sheikhtaheri
- Health Management and Economics Research Center, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran.
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7
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Al-Kahtani N, Al-Dhaif E, Alsaihtati N, Farid K, AlKhater S. Clinicians' Perceptions of Picture Archiving and Communication System (PACS) Use in Patient Care in Eastern Province Hospitals in Saudi Arabia. J Multidiscip Healthc 2021; 14:743-750. [PMID: 33833519 PMCID: PMC8020125 DOI: 10.2147/jmdh.s296828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/09/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The picture archiving and communication system (PACS) is one of the most important tools used in patient care in many hospitals worldwide. It allows clinicians to remotely communicate and consult with other clinicians on patient cases and view diagnostic images from different angles, thus facilitating patient diagnosis and treatment. Several studies have been conducted in Saudi Arabia to evaluate different aspects of PACS use; however, no comprehensive study has been conducted in its Eastern Province. This study aimed to investigate clinicians’ perceptions of the advantages and disadvantages of the use of PACS in Eastern Province hospitals in Saudi Arabia and identify the factors that affect their perceptions and its use. In addition, it aimed to gather recommendations of clinicians for improving the system and its implementation. Methods A qualitative approach with grounded theory method was employed. A sample of 18 residents, radiologists, and consultants from three Eastern Province hospitals in Saudi Arabia participated in the study. Data were collected using semi-structured interviews over a period of 7 months. Results The perceived advantages of PACS included providing quality images and the ability to manipulate their resolution, whereas the perceived barriers included low-speed internet connections and technical problems. Participants recommended providing clinicians remote access to the system and implementing a mobile PACS application. The theory that emerged from the analysis revealed that demographic, system-related, and hospital-related factors affected participants’ perspectives of PACS and its use. Conclusion The results of this study and its theoretical model can help identify areas of improvement and inform policy and strategic planning for the effective implementation of PACS in patient care in Saudi Arabia.
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Affiliation(s)
- Nouf Al-Kahtani
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Esra Al-Dhaif
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Noor Alsaihtati
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Khalid Farid
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Suzan AlKhater
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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8
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Lee B, Abbott A, Davidson S, Syrkin L, LeFever G, Van den Abbeele AD. Centralized Clinical Trial Imaging Data Management: Practical Guidance from a Comprehensive Cancer Center's Experience. J Digit Imaging 2020; 32:849-854. [PMID: 30564956 DOI: 10.1007/s10278-018-0161-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Medical imaging is an integral part of clinical trial research and it must be managed properly to provide accurate data to the sponsor in a timely manner (Clune in Cancer Inform 4:33-56, 2007; Wang et al. in Proc SPIE Int Soc Opt Eng 7967, 2011). Standardized workflows for site qualification, protocol preparation, data storage, retrieval, de-identification, submission, and query resolution are paramount to achieve quality clinical trial data management such as reducing the number of imaging protocol deviations and avoiding delays in data transfer. Centralization of data management and implementation of relational databases and electronic workflows can help maintain consistency and accuracy of imaging data. This technical note aims at sharing the practical implementation of our centralized clinical trial imaging data management processes to avoid the fragmentation of tasks among various disease centers and research staff, and enable us to provide quality, accurate, and timely imaging data to clinical trial sponsors.
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Affiliation(s)
- Brandon Lee
- Department of Imaging and Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.
| | - A Abbott
- Department of Imaging and Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - S Davidson
- Department of Information Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - L Syrkin
- Department of Imaging and Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - G LeFever
- Department of Imaging and Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - A D Van den Abbeele
- Department of Imaging and Center for Biomedical Imaging in Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.,Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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9
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Abbasi R, Sadeqi Jabali M, Khajouei R, Tadayon H. Investigating the satisfaction level of physicians in regards to implementing medical Picture Archiving and Communication System (PACS). BMC Med Inform Decis Mak 2020; 20:180. [PMID: 32758220 PMCID: PMC7405331 DOI: 10.1186/s12911-020-01203-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 07/28/2020] [Indexed: 11/17/2022] Open
Abstract
Background User satisfaction with PACS is considered as one of the important criteria for assessing success in using PACS. The objective of this study was to determine the level of user satisfaction with PACS and to compare its functional features with traditional film-based systems. Methods This study was conducted in 2017. Residents at three large university hospitals in Kerman filled-out a self-administered questionnaire consisting of three parts: demographic information of participants, user satisfaction with PACS, comparing features of the two digital and traditional imaging systems. The validity of this questionnaire was approved by five medical informatics, radiology, and health information management specialists and its reliability was confirmed by Cronbach’s alpha (86%). Data were analyzed using descriptive statistics and the Spearman, Mann Whitney U and Kruskal-Wallis statistical tests. Results The mean of the participants’ ages was 31.4 (±4.4) years and 59% of the participants were females. The mean of physicians’ satisfaction with PACS’ had no significant relationship with their age (P = 0.611), experience of using PACS (P = 0.301), specialty (P = 0.093), and percent of interpretation of images with PACS (P = 0.762). It had a significant relationship with the participants’ computer skills (P = 0.022). Conclusions The mean of physicians’ satisfaction with PACS was at a moderate to a high level, yet there are still problems in the successful implementation of these systems and establishing interoperability between them. PACS has not fully met all the demands of physicians and has not achieved its predetermined objectives, such as all-access from different locations.
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Affiliation(s)
- Reza Abbasi
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Monireh Sadeqi Jabali
- Research Centre for Health Information Management, Kashan University of Medical Sciences, Kashan, Iran
| | - Reza Khajouei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamidreza Tadayon
- Research Centre for Health Information Management, Kashan University of Medical Sciences, Kashan, Iran. .,Faculty Member of Health Information Technology Department, Neyshabur University of Medical Sciences, Neyshabur, Iran.
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10
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L'Imperio V, Brambilla V, Cazzaniga G, Ferrario F, Nebuloni M, Pagni F. Digital pathology for the routine diagnosis of renal diseases: a standard model. J Nephrol 2020; 34:681-688. [PMID: 32683656 PMCID: PMC8192318 DOI: 10.1007/s40620-020-00805-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/10/2020] [Indexed: 11/03/2022]
Abstract
Whole-slide imaging and virtual microscopy are useful tools implemented in the routine pathology workflow in the last 10 years, allowing primary diagnosis or second-opinions (telepathology) and demonstrating a substantial role in multidisciplinary meetings and education. The regulatory approval of this technology led to the progressive digitalization of routine pathological practice. Previous experiences on renal biopsies stressed the need to create integrate networks to share cases for diagnostic and research purposes. In the current paper, we described a virtual lab studying the routine renal biopsies that have been collected from 14 different Italian Nephrology centers between January 2014 and December 2019. For each case, light microscopy (LM) and immunofluorescence (IF) have been processed, analysed and scanned. Additional pictures (eg. electron micrographs) along with the final encrypted report were uploaded on the web-based platform. The number and type of specimens processed for every technique, the provisional and final diagnosis, and the turnaround-time (TAT) have been recorded. Among 826 cases, 4.5% were second opinion biopsies and only 4% were suboptimal/inadequate for the diagnosis. Transmission electron microscopy (TEM) has been performed on 41% of cases, in 22% changing the final diagnosis, in the remaining 78% contributed to the better definition of the disease. For light microscopy and IF the median TAT was of 2 working days, with only 8.6% with a TAT longer than 5 days. For TEM, the average TAT was 26 days (IQR 6-64). In summary, we systematically reviewed the 6-years long nephropathological experience of an Italian renal pathology service, where digital pathology is a definitive standard of care for the routine diagnosis of glomerulonephritides.
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Affiliation(s)
- Vincenzo L'Imperio
- Department of Medicine and Surgery, Pathology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
| | - Virginia Brambilla
- Department of Medicine and Surgery, Pathology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giorgio Cazzaniga
- Department of Medicine and Surgery, Pathology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Franco Ferrario
- Department of Medicine and Surgery, Pathology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Manuela Nebuloni
- Pathology Unit, ASST Sacco-Fatebenefratelli, University of Milan, Milan, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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11
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Wang Y, Yan F, Lu X, Zheng G, Zhang X, Wang C, Zhou K, Zhang Y, Li H, Zhao Q, Zhu H, Chen F, Gao C, Qing Z, Ye J, Li A, Xin X, Li D, Wang H, Yu H, Cao L, Zhao C, Deng R, Tan L, Chen Y, Yuan L, Zhou Z, Yang W, Shao M, Dou X, Zhou N, Zhou F, Zhu Y, Lu G, Zhang B. IILS: Intelligent imaging layout system for automatic imaging report standardization and intra-interdisciplinary clinical workflow optimization. EBioMedicine 2019; 44:162-181. [PMID: 31129095 PMCID: PMC6604879 DOI: 10.1016/j.ebiom.2019.05.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 12/24/2022] Open
Abstract
Background To achieve imaging report standardization and improve the quality and efficiency of the intra-interdisciplinary clinical workflow, we proposed an intelligent imaging layout system (IILS) for a clinical decision support system-based ubiquitous healthcare service, which is a lung nodule management system using medical images. Methods We created a lung IILS based on deep learning for imaging report standardization and workflow optimization for the identification of nodules. Our IILS utilized a deep learning plus adaptive auto layout tool, which trained and tested a neural network with imaging data from all the main CT manufacturers from 11,205 patients. Model performance was evaluated by the receiver operating characteristic curve (ROC) and calculating the corresponding area under the curve (AUC). The clinical application value for our IILS was assessed by a comprehensive comparison of multiple aspects. Findings Our IILS is clinically applicable due to the consistency with nodules detected by IILS, with its highest consistency of 0·94 and an AUC of 90·6% for malignant pulmonary nodules versus benign nodules with a sensitivity of 76·5% and specificity of 89·1%. Applying this IILS to a dataset of chest CT images, we demonstrate performance comparable to that of human experts in providing a better layout and aiding in diagnosis in 100% valid images and nodule display. The IILS was superior to the traditional manual system in performance, such as reducing the number of clicks from 14·45 ± 0·38 to 2, time consumed from 16·87 ± 0·38 s to 6·92 ± 0·10 s, number of invalid images from 7·06 ± 0·24 to 0, and missing lung nodules from 46·8% to 0%. Interpretation This IILS might achieve imaging report standardization, and improve the clinical workflow therefore opening a new window for clinical application of artificial intelligence. Fund The National Natural Science Foundation of China.
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Affiliation(s)
- Yang Wang
- Department of Radiology, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Fangrong Yan
- Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xiaofan Lu
- Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Guanming Zheng
- Department of Statistics, University of Michigan, Ann arbor 48105, USA
| | - Xin Zhang
- Department of Radiology, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Chen Wang
- Department of Radiology, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Kefeng Zhou
- Department of Radiology, NanJing GaoChun People's Hospital, No.9 Chunzhong Road, GaoChun, NanJing, China
| | - Yingwei Zhang
- Department of Respiratory, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Hui Li
- Department of Respiratory, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Qi Zhao
- Department of Respiratory, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Hu Zhu
- College of Telecommunication and Information Engineering, Nanjing University of Posts and Telecommunications, No.66 Xin Mofan Road, Nanjing, China
| | - Fei Chen
- Department of Radiology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, Jiangsu, China
| | - Cailiang Gao
- Department of Radiology, Chongqing Three Gorges Central Hospital, Chongqing 404000, China
| | - Zhao Qing
- Department of Radiology, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Jing Ye
- Department of Radiology, Northern Jiangsu People's Hospital, No.98 Nantong West Road, Yangzhou, Jiangsu 225001, China
| | - Aijing Li
- Department of Radiology, Ningbo No. 2 Hospital, No. 41, Xibei street, Haishu District 315010, Zhejiang, China
| | - Xiaoyan Xin
- Department of Radiology, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Danyan Li
- Department of Radiology, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Han Wang
- Department of Radiology, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Hongming Yu
- Department of Radiology, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Lu Cao
- FL 8, Ocean International Center E, Chaoyang Rd Side Rd, ShiLiPu, Chaoyang Qu, 100000 Beijing Shi, China
| | - Chaowei Zhao
- FL 8, Ocean International Center E, Chaoyang Rd Side Rd, ShiLiPu, Chaoyang Qu, 100000 Beijing Shi, China
| | - Rui Deng
- FL 8, Ocean International Center E, Chaoyang Rd Side Rd, ShiLiPu, Chaoyang Qu, 100000 Beijing Shi, China
| | - Libo Tan
- FL 8, Ocean International Center E, Chaoyang Rd Side Rd, ShiLiPu, Chaoyang Qu, 100000 Beijing Shi, China
| | - Yong Chen
- Department of Medical Administration, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Lihua Yuan
- Department of Radiology, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Zhuping Zhou
- Department of Radiology, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Wen Yang
- Department of Radiology, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Mingran Shao
- Department of Radiology, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Xin Dou
- Department of Radiology, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Nan Zhou
- Department of Radiology, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Fei Zhou
- Department of Radiology, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Yue Zhu
- Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Bing Zhang
- Department of Radiology, the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China.
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Raghavan UN, Hall CS, Tellis R, Mabotuwana T, Wald C. Probabilistic Modeling of Exam Durations in Radiology Procedures. J Digit Imaging 2019; 32:386-395. [PMID: 30706209 DOI: 10.1007/s10278-018-00175-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In this paper, we model the statistical properties of imaging exam durations using parametric probability distributions such as the Gaussian, Gamma, Weibull, lognormal, and log-logistic. We establish that in a majority of radiology procedures, the underlying distribution of exam durations is best modeled by a log-logistic distribution, while the Gaussian has the poorest fit among the candidates. Further, through illustrative examples, we show how business insights and workflow analytics can be significantly impacted by making the correct (log-logistic) versus incorrect (Gaussian) model choices.
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13
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The success of walk-in-computed tomography in practice. Eur J Radiol 2018; 109:88-94. [DOI: 10.1016/j.ejrad.2018.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 11/24/2022]
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14
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Pham R, Forsberg D, Plecha D. Improved Screening Mammogram Workflow by Maximizing PACS Streamlining Capabilities in an Academic Breast Center. J Digit Imaging 2018; 30:133-140. [PMID: 27766443 DOI: 10.1007/s10278-016-9909-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to perform an operational improvement project targeted at the breast imaging reading workflow of mammography examinations at an academic medical center with its associated breast centers and satellite sites. Through careful analysis of the current workflow, two major issues were identified: stockpiling of paperwork and multiple worklists. Both issues were considered to cause significant delays to the start of interpreting screening mammograms. Four workflow changes were suggested (scanning of paperwork, worklist consolidation, use of chat functionality, and tracking of case distribution among trainees) and implemented in July 2015. Timestamp data was collected 2 months before (May-Jun) and after (Aug-Sep) the implemented changes. Generalized linear models were used to analyze the data. The results showed significant improvements for the interpretation of screening mammograms. The average time elapsed for time to open a case reduced from 70 to 28 min (60 % decrease, p < 0.001), report turn-around time with preliminary signature decreased from 151 to 107 min (29 % decrease, p < 0.001), and report turn-around time final signature from 153 to 139 min (9 % decrease, p = 0.002). These improvements were achieved while keeping the efficiency of the workflow for diagnostic mammograms at large unaltered even with increased volume of mammography examinations (31 % increase of 4344 examinations for May-Jun to 5678 examinations for Aug-Sep). In conclusion, targeted efforts to improve the breast imaging reading workflow for screening mammograms in a teaching environment provided significant performance improvements without affecting the workflow of diagnostic mammograms.
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Affiliation(s)
- Ramya Pham
- Department of Radiology, Case Western Reserve University and University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Daniel Forsberg
- Department of Radiology, Case Western Reserve University and University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.,Sectra, Teknikringen 20, SE-583 30, Linköping, Sweden
| | - Donna Plecha
- Department of Radiology, Case Western Reserve University and University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
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15
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Lichstein PM, Wilson SC, Ward WG. Compromise of Radiology Studies From Nonstandardized Viewing Platforms. Orthopedics 2018; 41:e136-e141. [PMID: 29257194 DOI: 10.3928/01477447-20171213-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/13/2017] [Indexed: 02/03/2023]
Abstract
There is no standardization of proprietary radiology viewing software platform functions allowing recorded digital radiographic imaging studies on compact discs (CDs) to be viewed in a standardized manner at subsequent institutions. Primary concerns include the following: (1) a large number of image viewing software platforms with a wide variety of features making familiarity with use difficult, (2) an inordinate amount of time required to load imaging data, (3) imaging data may not upload or be viewed with the care center's picture archiving and communication system, (4) navigation through imaging studies is inconsistent and tedious, and (5) image viewing requires additional software downloads. Additionally, images generated from "outside CDs" are frequently of low quality and resolution, eliminating the ability to render a reliable diagnosis. The authors sought to determine the frequency and extent of these functional problems by analyzing a sample of 50 consecutive radiology CDs containing imaging studies referred to a university orthopedic oncology practice. Eighteen different viewing software platforms were encountered. Only 24 (48%) of the CDs met all optimal system criteria. Mean time required to load the studies was 3.4 seconds using the picture archiving and communication system and 37.9 seconds using the proprietary viewing software (P<.001). Fifteen (30%) of the CDs did not upload to the institution's picture archiving and communication system, and 18 (36%) required additional downloads and/or license agreements. Four CDs did not contain Digital Imaging and Communications in Medicine images. Physicians using radiology studies on CDs encounter numerous difficulties in evaluating patients' imaging data because of the plethora of viewing software platforms. These difficulties add time and cost and compromise patient care. [Orthopedics. 2018; 41(1):e136-e141.].
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16
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Boyce BF. An update on the validation of whole slide imaging systems following FDA approval of a system for a routine pathology diagnostic service in the United States. Biotech Histochem 2017; 92:381-389. [PMID: 28836859 DOI: 10.1080/10520295.2017.1355476] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Pathologists have used light microscopes and glass slides to interpret the histologic appearance of normal and diseased tissues for more than 150 years. The quality of both microtomes used to cut tissue sections and microscopes has improved significantly during the past few decades, but the process of rendering diagnoses has changed little. By contrast, major advances in digital technology have occurred since the introduction of hand held electronic devices, including the development of whole slide imaging (WSI) systems with software packages that can convert microscope images into virtual (digital) slides that can be viewed on computer monitors and via the internet. To date, however, these technological developments have had minimal impact on the way pathologists perform their daily work, with the exception of using computers to access electronic medical records and scholarly web sites for pertinent information to assist interpretation of cases. Traditional practice is likely to change significantly during the next decade, especially since the Federal Drug Administration in the USA has approved the first WSI system for routine diagnostic practice. I review here the development and slow acceptance of WSI by pathology departments. I focus on recent advances in validation of WSI systems that is required for routine diagnostic reporting of pathology cases using this technology.
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Affiliation(s)
- B F Boyce
- a Department of Pathology and Laboratory Medicine , University of Rochester Medical Center , Rochester , New York
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17
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Analyzing PACS Usage Patterns by Means of Process Mining: Steps Toward a More Detailed Workflow Analysis in Radiology. J Digit Imaging 2017; 29:47-58. [PMID: 26353749 DOI: 10.1007/s10278-015-9824-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
In this paper, statistical analysis and techniques from process mining are employed to analyze interaction patterns originating from radiologists reading medical images in a picture archiving and communication system (PACS). Event logs from 1 week of data, corresponding to 567 cases of single-view chest radiographs read by 14 radiologists, were analyzed. Statistical analysis showed that the numbers of commands and command types used by the radiologists per case only have a slightly positive correlation with the time to read a case (0.31 and 0.55, respectively). Further, one way ANOVA showed that the factors time of day, radiologist and specialty were significant for the number of commands per case, whereas radiologist was also significant for the number of command types, but with no significance of any of the factors on time to read. Applying process mining to the event logs of all users showed that a seemingly "simple" examination (single-view chest radiographs) can be associated with a highly complex interaction process. However, repeating the process discovery on each individual radiologist revealed that the initially discovered complex interaction process consists of one group of radiologists with individually well-structured interaction processes and a second smaller group of users with progressively more complex usage patterns. Future research will focus on metrics to describe derived interaction processes in order to investigate if one set of interaction patterns can be considered as more efficient than another set when reading radiological images in a PACS.
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18
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Griffin J, Treanor D. Digital pathology in clinical use: where are we now and what is holding us back? Histopathology 2016; 70:134-145. [DOI: 10.1111/his.12993] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Jon Griffin
- Sheffield NHS Foundation Trust; Sheffield UK
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Bashshur RL, Krupinski EA, Thrall JH, Bashshur N. The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence. Telemed J E Health 2016; 22:868-898. [PMID: 27585301 PMCID: PMC5107673 DOI: 10.1089/tmj.2016.0149] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/10/2016] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Radiology was founded on a technological discovery by Wilhelm Roentgen in 1895. Teleradiology also had its roots in technology dating back to 1947 with the successful transmission of radiographic images through telephone lines. Diagnostic radiology has become the eye of medicine in terms of diagnosing and treating injury and disease. This article documents the empirical foundations of teleradiology. METHODS A selective review of the credible literature during the past decade (2005-2015) was conducted, using robust research design and adequate sample size as criteria for inclusion. FINDINGS The evidence regarding feasibility of teleradiology and related information technology applications has been well documented for several decades. The majority of studies focused on intermediate outcomes, as indicated by comparability between teleradiology and conventional radiology. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include reductions in patient transfer, rehospitalization, and length of stay.
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Affiliation(s)
| | | | - James H. Thrall
- Department of Radiology, Massachusetts General Hospital, Harvard, Boston, Massachusetts
| | - Noura Bashshur
- University of Michigan Health System, Ann Arbor, Michigan
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20
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Alalawi ZM, Eid MM, Albarrak AI. Assessment of picture archiving and communication system (PACS) at three of ministry of health hospitals in Riyadh region - Content analysis. J Infect Public Health 2016; 9:713-724. [PMID: 27659113 DOI: 10.1016/j.jiph.2016.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/30/2016] [Accepted: 09/01/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Picture archiving and communication system (PACS) are management information systems used for distributing, viewing and archiving digital images by integrating different types of modalities through communication networks. PACS have many advantages that can lead to improving health care quality. PACS has been widely used in hospitals in Saudi Arabia for the past 10 years. However, an extensive review of literature in the field of PACS, among physicians and radiologists in Saudi Arabia, showed lack of local studies of this costly and newly implemented technology. Therefore, this assessment is very important to provide an insightful study of PACS in Saudi Arabia to provide proper recommendations for the PACS projects implementation nationwide. OBJECTIVES The objectives of this study are to, firstly, assess the perceived benefits of PACS among physicians and radiologists specifically in quality of care, secondly, assess the perceived challenges of PACS implementation and adoption inside and outside the radiology department, and thirdly, to compare between physicians' and radiologists' perceptions toward PACS. METHODS A cross-sectional descriptive study at three of Ministry of Health (MOH) Hospitals in the Riyadh region, Saudi Arabia. The researchers used two separate surveys questionnaires, for administration to the physicians and radiologists at the three hospitals. Apart from the questionnaire, included is feedback as responses to open-ended questions. Content analysis was used to analyze the feedback under two themes: benefits or challenges. RESULTS The response rate was 46% (84/183) physicians and 88% (15/17) radiologists have participated in this study. The result showed that 70% physicians' views affirms that PACS improved physicians' efficiency. On the other hand, all radiologists who responded affirmed that PACS improved efficiency. For questions on the ability to make decisions, 69% of views have affirmed that PACS improved physician's abilities to make decisions regarding patient care. Using PACS has led to a reduction in patients' length of stay in hospital (LOS) question, 79% of total views were positive. In contrast, only 18% of physicians talked about PACS positively in summary views and 82% talked about the challenges of PACS whereas 20% of radiologists talked about PACS positively. CONCLUSIONS The results in the present study conclude that PACS was well perceived due to its numerous benefits among physicians and radiologists. However, radiologists showed more focus on the benefits of PACS than physicians. The main disadvantages are that PACS has resulted in difficulty in finding images, recurrent downtime and insufficient training.
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Affiliation(s)
- Zainab M Alalawi
- Master of Public Health (Health Informatics Track), King Saud University, Riyadh, Saudi Arabia
| | | | - Ahmed I Albarrak
- Master of Public Health (Health Informatics Track), King Saud University, Riyadh, Saudi Arabia; The Research Chair of Health Informatics and Promotion, Saudi Arabia
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21
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Hwang IC, Lee KW, Park SS, Chanthanoulay S, Sisavanh M, Rajpho V, Kim M, Billamay S, Phangmanixay S, Oudavong B. The first picture archiving and communication system in Lao People's Democratic Republic: Changes in the utilization rate of imaging tests in the first year after implementation. Int J Med Inform 2016; 94:31-8. [PMID: 27573309 DOI: 10.1016/j.ijmedinf.2016.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 06/18/2016] [Accepted: 06/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Implementation of the Picture Archiving and Communication System (PACS) is more challenging in developing countries than in developed countries. Given that the first PACS in Lao People's Democratic Republic (PDR) was successfully installed at the Children's Hospital of Lao PDR, we aimed to investigate whether the utilization rate of imaging tests increased after PACS implementation. METHODS PACS was implemented at the Children's Hospital of Lao PDR in December 2014. We compared the utilization rates of imaging tests including X-ray and ultrasound examinations between the pre-PACS period (from December 2013 to November 2014) and the post-PACS period (from December 2014 to November 2015). The utilization rate was defined as the number of imaging tests divided by the number of patients per month. RESULTS The average number of total imaging tests was 225.8/month (standard deviation [SD], 37.7) during the 1-year pre-PACS period and was 269.4/month (SD, 38.5) during the 1-year post-PACS period (P=0.0103). The utilization rate of total imaging tests significantly increased after PACS implementation (pre-PACS, 2.47%/month; post-PACS, 4.23%/month; P<0.0001). Increased utilization rates were observed for both X-rays (pre-PACS, 1.65%/month; post-PACS, 2.38%/month; P=0.0004) and ultrasound examinations (pre-PACS, 0.82%/month; post-PACS, 1.85%/month; P=0.0001). CONCLUSIONS The implementation of PACS at the Children's Hospital of Lao PDR resulted in a significant increase in the utilization rate of imaging tests, suggesting the indirect benefit of improved quality of care. Our findings showed that the benefits of PACS can be realized even in a resource-limited country such as Lao PDR.
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Affiliation(s)
- In-Chang Hwang
- Korea International Cooperation Agency (KOICA) Lao PDR Office, Vientiane, Lao Democratic People's Republic; Cardiovascular Unit, Children's Hospital, Vientiane, Lao Democratic People's Republic; Department of Radiology, Children's Hospital, Vientiane, Lao Democratic People's Republic; Cardiovascular Center & Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Kil Won Lee
- Korea International Cooperation Agency (KOICA) Lao PDR Office, Vientiane, Lao Democratic People's Republic; Department of Radiology, Children's Hospital, Vientiane, Lao Democratic People's Republic
| | - Sang Soon Park
- Korea International Cooperation Agency (KOICA) Lao PDR Office, Vientiane, Lao Democratic People's Republic; Department of Radiology, Children's Hospital, Vientiane, Lao Democratic People's Republic
| | - Siamphone Chanthanoulay
- Department of Radiology, Children's Hospital, Vientiane, Lao Democratic People's Republic; Lee Jong-Wook Fellowship Program, JW LEE Center for Global Medicine, Seoul National University & Korea Foundation for International Healthcare (KOFIH), Seoul, Republic of Korea; Department of Pediatrics, Children's Hospital, Vientiane, Lao Democratic People's Republic
| | - Malouny Sisavanh
- Cardiovascular Unit, Children's Hospital, Vientiane, Lao Democratic People's Republic; Lee Jong-Wook Fellowship Program, JW LEE Center for Global Medicine, Seoul National University & Korea Foundation for International Healthcare (KOFIH), Seoul, Republic of Korea; Department of Pediatrics, Children's Hospital, Vientiane, Lao Democratic People's Republic
| | - Virasack Rajpho
- Department of Radiology, Children's Hospital, Vientiane, Lao Democratic People's Republic; University of Health Sciences, Lao Democratic People's Republic
| | - Mijin Kim
- Korea International Cooperation Agency (KOICA) Lao PDR Office, Vientiane, Lao Democratic People's Republic
| | - Somxay Billamay
- Department of Pediatrics, Children's Hospital, Vientiane, Lao Democratic People's Republic
| | | | - Bounleua Oudavong
- Department of Pediatrics, Children's Hospital, Vientiane, Lao Democratic People's Republic; University of Health Sciences, Lao Democratic People's Republic
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22
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Meyer J, Paré G. Telepathology Impacts and Implementation Challenges: A Scoping Review. Arch Pathol Lab Med 2016; 139:1550-7. [PMID: 26619028 DOI: 10.5858/arpa.2014-0606-ra] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Telepathology is a particular form of telemedicine that fundamentally alters the way pathology services are delivered. Prior reviews in this area have mostly focused on 2 themes, namely technical feasibility issues and diagnosis accuracy. OBJECTIVES To synthesize the literature on telepathology implementation challenges and broader organizational and societal impacts and to propose a research agenda to guide future efforts in this domain. DATA SOURCES Two complementary databases were systematically searched: MEDLINE (PubMed) and ABI/INFORM (ProQuest). Peer-reviewed articles and conference proceedings were considered. The final sample consisted of 159 papers published between 1992 and 2013. CONCLUSIONS This review highlights the diversity of telepathology networks and the importance of considering these distinctions when interpreting research findings. Various network structures are associated with different benefits. Although the dominant rationale in single-site projects is financial, larger centralized and decentralized telepathology networks are targeting a more diverse set of benefits, including extending access to pathology to a whole region, achieving substantial economies of scale in workforce and equipment, and improving quality by standardizing care. Importantly, our synthesis reveals that the nature and scale of encountered implementation challenges also varies depending on the network structure. In smaller telepathology networks, organizational concerns are less prominent, and implementers are more focused on usability issues. As the network scope widens, organizational and legal issues gain prominence.
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Affiliation(s)
- Julien Meyer
- From the Department of Information Technology, HEC Montréal, Montreal, Quebec, Canada
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Olisemeke B, Chen YF, Hemming K, Girling A. The effectiveness of service delivery initiatives at improving patients' waiting times in clinical radiology departments: a systematic review. J Digit Imaging 2014; 27:751-78. [PMID: 24888629 PMCID: PMC4391068 DOI: 10.1007/s10278-014-9706-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
We reviewed the literature for the impact of service delivery initiatives (SDIs) on patients' waiting times within radiology departments. We searched MEDLINE, EMBASE, CINAHL, INSPEC and The Cochrane Library for relevant articles published between 1995 and February, 2013. The Cochrane EPOC risk of bias tool was used to assess the risk of bias on studies that met specified design criteria. Fifty-seven studies met the inclusion criteria. The types of SDI implemented included extended scope practice (ESP, three studies), quality management (12 studies), productivity-enhancing technologies (PETs, 29 studies), multiple interventions (11 studies), outsourcing and pay-for-performance (one study each). The uncontrolled pre- and post-intervention and the post-intervention designs were used in 54 (95%) of the studies. The reporting quality was poor: many of the studies did not test and/or report the statistical significance of their results. The studies were highly heterogeneous, therefore meta-analysis was inappropriate. The following type of SDIs showed promising results: extended scope practice; quality management methodologies including Six Sigma, Lean methodology, and continuous quality improvement; productivity-enhancing technologies including speech recognition reporting, teleradiology and computerised physician order entry systems. We have suggested improved study design and the mapping of the definitions of patient waiting times in radiology to generic timelines as a starting point for moving towards a situation where it becomes less restrictive to compare and/or pool the results of future studies in a meta-analysis.
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Affiliation(s)
- B Olisemeke
- Radiology Department, Heart of England NHS Foundation Trust, Birmingham, UK,
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24
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Ho J, Ahlers SM, Stratman C, Aridor O, Pantanowitz L, Fine JL, Kuzmishin JA, Montalto MC, Parwani AV. Can digital pathology result in cost savings? A financial projection for digital pathology implementation at a large integrated health care organization. J Pathol Inform 2014; 5:33. [PMID: 25250191 PMCID: PMC4168664 DOI: 10.4103/2153-3539.139714] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 06/22/2014] [Indexed: 11/28/2022] Open
Abstract
Background: Digital pathology offers potential improvements in workflow and interpretive accuracy. Although currently digital pathology is commonly used for research and education, its clinical use has been limited to niche applications such as frozen sections and remote second opinion consultations. This is mainly due to regulatory hurdles, but also to a dearth of data supporting a positive economic cost-benefit. Large scale adoption of digital pathology and the integration of digital slides into the routine anatomic/surgical pathology “slide less” clinical workflow will occur only if digital pathology will offer a quantifiable benefit, which could come in the form of more efficient and/or higher quality care. Aim: As a large academic-based health care organization expecting to adopt digital pathology for primary diagnosis upon its regulatory approval, our institution estimated potential operational cost savings offered by the implementation of an enterprise-wide digital pathology system (DPS). Methods: Projected cost savings were calculated for the first 5 years following implementation of a DPS based on operational data collected from the pathology department. Projected savings were based on two factors: (1) Productivity and lab consolidation savings; and (2) avoided treatment costs due to improvements in the accuracy of cancer diagnoses among nonsubspecialty pathologists. Detailed analyses of incremental treatment costs due to interpretive errors, resulting in either a false positive or false negative diagnosis, was performed for melanoma and breast cancer and extrapolated to 10 other common cancers. Results: When phased in over 5-years, total cost savings based on anticipated improvements in pathology productivity and histology lab consolidation were estimated at $12.4 million for an institution with 219,000 annual accessions. The main contributing factors to these savings were gains in pathologist clinical full-time equivalent capacity impacted by improved pathologist productivity and workload distribution. Expanding the current localized specialty sign-out model to an enterprise-wide shared general/subspecialist sign-out model could potentially reduce costs of incorrect treatment by $5.4 million. These calculations were based on annual over and under treatment costs for breast cancer and melanoma estimated to be approximately $26,000 and $11,000/case, respectively, and extrapolated to $21,500/case for other cancer types. Conclusions: The projected 5-year total cost savings for our large academic-based health care organization upon fully implementing a DPS was approximately $18 million. If the costs of digital pathology acquisition and implementation do not exceed this value, the return on investment becomes attractive to hospital administrators. Furthermore, improved patient outcome enabled by this technology strengthens the argument supporting adoption of an enterprise-wide DPS.
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Affiliation(s)
- Jonhan Ho
- Department of Dermatology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stefan M Ahlers
- International and Commercial Services Division, UPMC, Pittsburgh, PA, USA
| | | | - Orly Aridor
- Office of Sponsored Programs and Research Support, University of Pittsburgh Medical Center, UPMC, Pittsburgh, PA, USA
| | - Liron Pantanowitz
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey L Fine
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - John A Kuzmishin
- International and Commercial Services Division, UPMC, Pittsburgh, PA, USA
| | | | - Anil V Parwani
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Performance enhancement of a web-based picture archiving and communication system using commercial off-the-shelf server clusters. BIOMED RESEARCH INTERNATIONAL 2014; 2014:657417. [PMID: 24701580 PMCID: PMC3950496 DOI: 10.1155/2014/657417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/29/2013] [Accepted: 01/14/2014] [Indexed: 11/18/2022]
Abstract
The rapid development of picture archiving and communication systems (PACSs) thoroughly changes the way of medical informatics communication and management. However, as the scale of a hospital's operations increases, the large amount of digital images transferred in the network inevitably decreases system efficiency. In this study, a server cluster consisting of two server nodes was constructed. Network load balancing (NLB), distributed file system (DFS), and structured query language (SQL) duplication services were installed. A total of 1 to 16 workstations were used to transfer computed radiography (CR), computed tomography (CT), and magnetic resonance (MR) images simultaneously to simulate the clinical situation. The average transmission rate (ATR) was analyzed between the cluster and noncluster servers. In the download scenario, the ATRs of CR, CT, and MR images increased by 44.3%, 56.6%, and 100.9%, respectively, when using the server cluster, whereas the ATRs increased by 23.0%, 39.2%, and 24.9% in the upload scenario. In the mix scenario, the transmission performance increased by 45.2% when using eight computer units. The fault tolerance mechanisms of the server cluster maintained the system availability and image integrity. The server cluster can improve the transmission efficiency while maintaining high reliability and continuous availability in a healthcare environment.
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Abstract
Digital pathology systems offer pathologists an alternate, emerging mechanism to manage and interpret information. They offer increasingly fast and scalable hardware platforms for slide scanning and software that facilitates remote viewing, slide conferencing, archiving, and image analysis. Deployed initially and validated largely within the research and biopharmaceutical industries, WSI is increasingly being implemented for direct patient care. Improvements in image quality, scan times, and imageviewing browsers will hopefully allow pathologists to more seamlessly convert to digital pathology, much like our radiology colleagues have done before us. However, WSI creates both opportunities and challenges. Although niche applications of WSI technology for clinical, educational, and research purposes are clearly successful, it is evident that several areas still require attention and careful consideration before more widespread clinical adoption of WSI takes place. These include regulatory issues, development of standards of practice and validation guidelines, workflow modifications, as well as defining situations where WSI technology will really improve practice in a cost-effective way. Current progress on these and other issues, along with improving technology, will no doubt pave the way for increased adoption over the next decade, allowing the pathology community as a whole to harness the true potential of WSI for patient care. The digital decade will likely redefine how pathology is practiced and the role of the pathologist.
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Hains IM, Georgiou A, Westbrook JI. The impact of PACS on clinician work practices in the intensive care unit: a systematic review of the literature. J Am Med Inform Assoc 2012; 19:506-13. [PMID: 22323392 PMCID: PMC3384105 DOI: 10.1136/amiajnl-2011-000422] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess evidence of the impact of Picture Archiving and Communication Systems (PACS) on clinicians' work practices in the intensive care unit (ICU). METHODS We searched Medline, Pre-Medline, CINAHL, Embase, and the SPIE Digital Library databases for English-language publications between 1980 and September 2010 using Medical Subject Headings terms and keywords. RESULTS Eleven studies from the USA and UK were included. All studies measured aspects of time associated with the introduction of PACS, namely the availability of images, the time a physician took to review an image, and changes in viewing patterns. Seven studies examined the impact on clinical decision-making, with the majority measuring the time to image-based clinical action. The effect of PACS on communication modes was reported in five studies. DISCUSSION PACS can impact on clinician work practices in three main areas. Most of the evidence suggests an improvement in the efficiency of work practices. Quick image availability can impact on work associated with clinical decision-making, although the results were inconsistent. PACS can change communication practices, particularly between the ICU and radiology; however, the evidence base is insufficient to draw firm conclusions in this area. CONCLUSION The potential for PACS to impact positively on clinician work practices in the ICU and improve patient care is great. However, the evidence base is limited and does not reflect aspects of contemporary PACS technology. Performance measures developed in previous studies remain relevant, with much left to investigate to understand how PACS can support new and improved ways of delivering care in the intensive care setting.
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Affiliation(s)
- Isla M Hains
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, The University of New South Wales, Sydney, Australia.
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Breil B, Fritz F, Thiemann V, Dugas M. Mapping turnaround times (TAT) to a generic timeline: a systematic review of TAT definitions in clinical domains. BMC Med Inform Decis Mak 2011; 11:34. [PMID: 21609424 PMCID: PMC3125312 DOI: 10.1186/1472-6947-11-34] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 05/24/2011] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Assessing turnaround times can help to analyse workflows in hospital information systems. This paper presents a systematic review of literature concerning different turnaround time definitions. Our objectives were to collect relevant literature with respect to this kind of process times in hospitals and their respective domains. We then analysed the existing definitions and summarised them in an appropriate format. METHODS Our search strategy was based on Pubmed queries and manual reviews of the bibliographies of retrieved articles. Studies were included if precise definitions of turnaround times were available. A generic timeline was designed through a consensus process to provide an overview of these definitions. RESULTS More than 1000 articles were analysed and resulted in 122 papers. Of those, 162 turnaround time definitions in different clinical domains were identified. Starting and end points vary between these domains. To illustrate those turnaround time definitions, a generic timeline was constructed using preferred terms derived from the identified definitions. The consensus process resulted in the following 15 terms: admission, order, biopsy/examination, receipt of specimen in laboratory, procedure completion, interpretation, dictation, transcription, verification, report available, delivery, physician views report, treatment, discharge and discharge letter sent. Based on this analysis, several standard terms for turnaround time definitions are proposed. CONCLUSION Using turnaround times to benchmark clinical workflows is still difficult, because even within the same clinical domain many different definitions exist. Mapping of turnaround time definitions to a generic timeline is feasible.
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Affiliation(s)
- Bernhard Breil
- Institute of Medical Informatics, University of Münster, Domagkstraße 9, 48149 Münster, Germany.
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Contrast detail phantom comparison on a commercially available unit. Digital breast tomosynthesis (DBT) versus full-field digital mammography (FFDM). J Digit Imaging 2011; 24:58-65. [PMID: 20131074 DOI: 10.1007/s10278-009-9270-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The performance of a commercial digital mammographic system working in 2D planar versus tomosynthesis mode was evaluated in terms of the image signal difference to noise ratio (SDNR). A contrast detail phantom was obtained embedding 1 cm Plexiglas, including 49 holes of different diameter and depth, between two layers containing a breast-simulating material. The phantom was exposed with the details plane perpendicular to the X-ray beam using the manufacturer's standard clinical breast acquisition parameters. SDNR in the digital breast tomosynthesis (DBT) images was higher than that of the full-field digital mammography (FFDM) for 38 out of 49 details in complex background conditions. These differences (p < 0.05) are statistically significant for 19 details out of 38. The relative SDNR results for DBT and FFDM images showed a dependence on the diameter of the details considered. This paper proposes an initial framework for a global image quality evaluation for commercial systems that can operate with different image acquisition modality using the same detector.
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Hurlen P, Borthne A, Dahl FA, Ostbye T, Gulbrandsen P. Does PACS improve diagnostic accuracy in chest radiograph interpretations in clinical practice? Eur J Radiol 2010; 81:173-7. [PMID: 20888718 DOI: 10.1016/j.ejrad.2010.08.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 08/27/2010] [Accepted: 08/30/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the impact of a Picture Archiving and Communication System (PACS) on the diagnostic accuracy of the interpretation of chest radiology examinations in a "real life" radiology setting. MATERIALS AND METHODS During a period before PACS was introduced to radiologists, when images were still interpreted on film and reported on paper, images and reports were also digitally stored in an image database. The same database was used after the PACS introduction. This provided a unique opportunity to conduct a blinded retrospective study, comparing sensitivity (the main outcome parameter) in the pre and post-PACS periods. We selected 56 digitally stored chest radiograph examinations that were originally read and reported on film, and 66 examinations that were read and reported on screen 2 years after the PACS introduction. Each examination was assigned a random number, and both reports and images were scored independently for pathological findings. The blinded retrospective score for the original reports were then compared with the score for the images (the gold standard). RESULTS Sensitivity was improved after the PACS introduction. When both certain and uncertain findings were included, this improvement was statistically significant. There were no other statistically significant changes. CONCLUSION The result is consistent with prospective studies concluding that diagnostic accuracy is at least not reduced after PACS introduction. The sensitivity may even be improved.
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Affiliation(s)
- Petter Hurlen
- Helse Sør-Øst Health Services Research Centre, Akershus University Hospital, Sykehusveien 27, NO-1478 Lørenskog, Norway.
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Hurlen P, Østbye T, Borthne AS, Gulbrandsen P. Does improved access to diagnostic imaging results reduce hospital length of stay? A retrospective study. BMC Health Serv Res 2010; 10:262. [PMID: 20819224 PMCID: PMC2944270 DOI: 10.1186/1472-6963-10-262] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 09/06/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One year after the introduction of Information and Communication Technology (ICT) to support diagnostic imaging at our hospital, clinicians had faster and better access to radiology reports and images; direct access to Computed Tomography (CT) reports in the Electronic Medical Record (EMR) was particularly popular. The objective of this study was to determine whether improvements in radiology reporting and clinical access to diagnostic imaging information one year after the ICT introduction were associated with a reduction in the length of patients' hospital stays (LOS). METHODS Data describing hospital stays and diagnostic imaging were collected retrospectively from the EMR during periods of equal duration before and one year after the introduction of ICT. The post-ICT period was chosen because of the documented improvement in clinical access to radiology results during that period. The data set was randomly split into an exploratory part used to establish the hypotheses, and a confirmatory part. The data was used to compare the pre-ICT and post-ICT status, but also to compare differences between groups. RESULTS There was no general reduction in LOS one year after ICT introduction. However, there was a 25% reduction for one group - patients with CT scans. This group was heterogeneous, covering 445 different primary discharge diagnoses. Analyses of subgroups were performed to reduce the impact of this divergence. CONCLUSION Our results did not indicate that improved access to radiology results reduced the patients' LOS. There was, however, a significant reduction in LOS for patients undergoing CT scans. Given the clinicians' interest in CT reports and the results of the subgroup analyses, it is likely that improved access to CT reports contributed to this reduction.
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Affiliation(s)
- Petter Hurlen
- Helse Sør-Øst Health Services Research Centre Akershus University Hospital, NO-1478 Lørenskog, Norway.
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Vanderby SA, Babyn PS, Carter MW, Jewell SM, McKeever PD. Effect of anesthesia and sedation on pediatric MR imaging patient flow. Radiology 2010; 256:229-37. [PMID: 20505061 DOI: 10.1148/radiol.10091124] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the effect of sedative and anesthetic administration on the duration and costs of pediatric magnetic resonance (MR) imaging. MATERIALS AND METHODS This prospective study was approved by the institutional research ethics board; informed consent and/or assent was obtained from all participants or their parents. A patient flow study was conducted in a pediatric MR imaging clinic in which research assistants tracked participants' progress through the clinic. Demographic, visit process, and medication information was collected for 237 participants, categorized as awake, sedated, or anesthetized. The data were analyzed to (a) determine total visit duration differences, (b) investigate variations in visit stage durations according to patient type, and (c) estimate visit costs on the basis of human resource and medication use. Linear regression, the Shapiro-Wilk test, the two-tailed t test, and the nonparametric Mann-Whitney test were used. RESULTS Complete data sets were obtained for 148 awake, 28 sedated, and 27 anesthetized participants. Data revealed 12 stage sequences among patient visits; dominant sequences differed according to patient category. An awake patient's average visit duration (2 hours 21 minutes) differed significantly from that of sedated (3 hours 38 minutes, P < .001) and anesthetized (4 hours 7 minutes, P < .001) patients; sedated and anesthetized visit durations did not differ significantly (P < .073), although this finding may be attributable to the small sample sizes. Variation in stage durations was also evident within and among patient types. Visit costs for sedated and anesthetized patients were 3.24 and 9.56 times higher, respectively, than those for awake patients. Costs for anesthetized patients were 2.95 times higher than those for sedated patients. CONCLUSION Visit durations were significantly longer for anesthetized and sedated patients. Anesthetized patients incurred the highest costs, followed by sedated patients.
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Affiliation(s)
- Sonya A Vanderby
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada.
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A survey of digital radiography practice in four South African teaching hospitals: an illuminative study. Biomed Imaging Interv J 2010; 6:e5. [PMID: 21611065 PMCID: PMC3097796 DOI: 10.2349/biij.6.1.e5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 09/03/2009] [Accepted: 09/30/2009] [Indexed: 11/17/2022] Open
Abstract
Purpose: The purpose of this study was to assess radiographer familiarity and preferences with digital radiography in four teaching hospitals and thereafter make recommendations in line with the migration from screen film to digital radiography. Materials and methods: A questionnaire was designed to collect data from either qualified or student radiographers from four teaching hospitals. From the four teaching hospitals, there were a total of 205 potential respondents. Among other things, responses regarding experiences and preferences with digital radiography, quality control procedures, patient dose, advantages and disadvantages of digital radiography were sought. The information collected was based on self-reporting by the participants. The study is exploratory in nature and descriptive statistics were generated from the collected data using Microsoft Excel 2007 and StatsDirect software. Results: Sixty-three out of 205 (31%) radiographers from all the four radiology centers responded to the circulated questionnaire. Only 15% (8) of the qualified radiographers had 4 or more years of experience with digital radiography compared to 68% (36) for the same amount of experience with screen-film radiography. Sixty-one percent (38) of the participants had been exposed to digital radiography during their lectures while at university. A small proportion, 16% (10) of the respondents underwent formal training in quality control procedures on the digital X-ray units they were using. Slightly more than half (55%) of the participants felt it was easier for them to retake an image in digital radiography than in screen film radiography. Conclusion: The results of this survey showed that the participants are familiar with digital radiography and have embraced this relatively new technology as shown by the fact that they can identify both its advantages and disadvantages as applied to clinical practice. However, there are minimal quality control procedures specific to digital radiography being undertaken as such there is need for formal education, continuing education and manufacturer training with respect to quality control as institutions make the transition from conventional screen film radiology to digital radiology.
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Changements des pratiques radiologiques induites par l’implantation d’un réseau images en milieu hospitalo-universitaire. ACTA ACUST UNITED AC 2009; 90:1046-54. [DOI: 10.1016/s0221-0363(09)73244-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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MacDonald D, Neville D. Evaluating the implementation of picture archiving and communication systems in Newfoundland and Labrador--a cost benefit analysis. J Digit Imaging 2009; 23:721-31. [PMID: 19707828 DOI: 10.1007/s10278-009-9212-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 03/27/2009] [Accepted: 04/16/2009] [Indexed: 11/27/2022] Open
Affiliation(s)
- Don MacDonald
- Research and Evaluation Department, Newfoundland and Labrador Centre for Health Information, 28 Pippy Place, St. John's, NL, Canada.
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Sicotte C, Paré G, Bini KK, Moreault MP, Laverdure G. Virtual organization of hospital medical imaging: a user satisfaction survey. J Digit Imaging 2009; 23:689-700. [PMID: 19588196 DOI: 10.1007/s10278-009-9220-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 04/15/2009] [Accepted: 06/09/2009] [Indexed: 11/30/2022] Open
Abstract
A virtual medical imaging department is an innovative and demanding organizational model, to the extent that the underlying goal is to achieve a continuous and advanced organizational integration of human and physical resources, clinical data, and clienteles. To better understand the kind of benefits offered, we conducted a survey of three groups of users--radiologists, radiological technologists, and medical specialists--working in a five-site virtual organization. We received 127 valid questionnaires, for an overall response rate of 66%. The assessments vary according to the use made of the system. The scores for system quality and the quality of the data produced were markedly higher for intra-hospital use (respectively 7.9 and 8.7 out of 10) than for inter-hospital use (5.4 and 7.0). Despite the negative assessments they made of inter-hospital use, users maintained a positive attitude toward some type of virtual organization of medical imaging. Indeed, the score for Overall satisfaction with the system was very high, 8.9 out of 10. Moreover, the scores for Intended future use of the system were very high for both intra-hospital use (8.9) and inter-hospital use (8.7). We also found significant differences in perceptions among user groups.
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Affiliation(s)
- Claude Sicotte
- Department of Health Administration, University of Montreal, PO Box 6128, Station Downtown, Montreal, H3C 3J7, Quebec, Canada.
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Juenemann S, Hasler C, Brunner R. Digital imaging data on CD-R: a time trap for orthopaedic surgeons in outpatient clinics. J Child Orthop 2009; 3:59-62. [PMID: 19308614 PMCID: PMC2656835 DOI: 10.1007/s11832-008-0150-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Accepted: 11/18/2008] [Indexed: 02/03/2023] Open
Abstract
PURPOSE X-rays are presented on CD-Rs in a digital format with increasing frequency. This technique is potentially more time-consuming for the clinician compared to conventional pictures. METHODS Ten sets of six X-rays for each case were prepared in both the conventional way and in digital format on CD-R. The order was randomised. Time in seconds was measured for six experienced orthopaedic residents to present the most recent a.p. view out of a given set. As a precondition, the computer was turned on and the same viewing software was used for all digital sets. The results were compared using a non-linked Student's t-test (significance level P = 0.05). RESULTS The presentation of conventional X-rays required 21 s (+/-7.5 s) and of digital X-rays 90 s (+/-27 s), respectively (P < 0.001). CONCLUSION In spite of ideal conditions, digital X-rays on CD-R need significantly more time in the orthopaedic clinic. In major centres, patients present with different software and software in other languages, which increase the required time even further. This latter problem will be assessed in another study. This increase of preparation time required by a highly qualified staff member has implications on the economics and logistics and has a negative impact on daily clinical practice. One of the solutions might be that the CD-Rs be given to the registration desk and the data being already prepared when the patient sees the doctor. This can also include it being implemented in the digital system used in the inpatient part of the hospital and, therefore, making any other consultations or second opinions easily accessible.
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Affiliation(s)
- Stephanie Juenemann
- Department of Pediatric Orthopaedics, University Children's Hospital Basel, Postfach, 4005, Basel, Switzerland,
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Hurlen P, Østbye T, Borthne A, Gulbrandsen P. Introducing PACS to the late majority. A longitudinal study. J Digit Imaging 2008; 23:87-94. [PMID: 18979133 DOI: 10.1007/s10278-008-9160-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 08/21/2008] [Accepted: 09/28/2008] [Indexed: 11/30/2022] Open
Abstract
The purpose of this study was to study whether the benefits from introducing a picture archiving and communication systems (PACS) reported by innovators and early adopters also can be achieved by a hospital belonging to the "late majority" and to see whether such benefits are sustained, using report turnaround time (RTAT) as an indicator. Activity-related data was retrieved from the radiology information system (RIS) over a 2-year period. The median RTAT for preliminary reports was initially reduced from 12 to 2 h then increased to 3 h. For final reports, the median RTAT was initially reduced from 23 to 13 h then gradually reverted back to 22 h. Innovators and early adopters demonstrate not only that positive results can be achieved but also the importance of involving key personnel. We believe that such involvement and the focus on wider organizational concerns are important when introducing PACS to the late majority, both for achieving and sustaining positive results.
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Affiliation(s)
- Petter Hurlen
- Helse Sør-Øst Health Services Research Centre, Akershus University Hospital, Mail Drawer 95, NO-1478, Lørenskog, Norway.
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Monitoring the PACS implementation process in a large university hospital--discrepancies between radiologists and physicians. J Digit Imaging 2008; 23:73-80. [PMID: 18956231 DOI: 10.1007/s10278-008-9163-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 08/22/2008] [Accepted: 09/28/2008] [Indexed: 10/21/2022] Open
Abstract
Successfully introducing a new technology in a health-care setting is not a walk in the park. Many barriers need to be overcome, not only technical and financial but also human barriers. In this study, we focus on the human barriers to health-care information systems' implementation. We monitored the acceptance of a Picture Archiving and Communication System (PACS) by radiologists and hospital physicians in a large Belgian university hospital. Hereto, questionnaires were taken pre-implementation (T1) and 1 year after the radiology department stopped printing film (T2). The framework we used to perform the study was the Unified Theory of Acceptance and Use of Technology. Main findings were that both groups were positive toward PACS prior to the introduction and that each group was even more positive at T2 with extensive PACS experience. In general, the ratings of the radiologists were higher than those of the physicians, as the radiologists experienced more of the benefits of PACS and had to use PACS throughout the day. Two factors were salient for predicting users' intention to use PACS: the usefulness of PACS (performance expectancy) and the availability of support of any kind (facilitating conditions). The results show that our approach was successful. Both radiologists and physicians give evidence of an excellent level of user acceptance. We can conclude that the implementation of PACS into our hospital has succeeded.
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Collin S, Reeves BC, Hendy J, Fulop N, Hutchings A, Priedane E. Implementation of computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) in the NHS: quantitative before and after study. BMJ 2008; 337:a939. [PMID: 18703655 PMCID: PMC2515888 DOI: 10.1136/bmj.a939] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To assess the impact of components of the national programme for information technology (NPfIT) on measures of clinical and operational efficiency. DESIGN Quasi-experimental controlled before and after study using routinely collected patient level data. SETTING Four NHS acute hospital trusts in England. DATA SOURCES Inpatient admissions and outpatient appointments, 2000-5. INTERVENTIONS A system for ordering pathology tests and browsing results (computerised physician order entry, CPOE) and a system for requesting radiological examinations and displaying images (picture archiving and communications system, PACS). MAIN OUTCOME MEASURES Requests per inpatient, outpatient, or day case patient for full blood count, urine culture and urea and electrolytes tests, and plain x ray film, computed tomography, and ultrasonography examinations. RESULTS CPOE was associated with a reduction in the proportion of outpatient appointments at which full blood count (odds ratio 0.25, 95% confidence interval 0.16 to 0.40), urea and electrolytes (0.55, 0.39 to 0.77), and urine culture (0.30, 0.17 to 0.51) tests were ordered, and at which full blood count tests were repeated (0.73, 0.53 to 0.99). Conversely, the same system was associated with an almost fourfold increase in the use of urea and electrolytes tests among day case patients (3.63, 1.66 to 7.94). PACS was associated with a reduction in repeat plain x ray films at outpatient appointments (0.62, 0.44 to 0.88) and a reduction in inpatient computed tomography (0.83, 0.70 to 0.98). Conversely, it was associated with increases in computed tomography requested at outpatient appointments (1.89, 1.26 to 2.84) and computed tomography repeated within 48 hours during an inpatient stay (2.18, 1.52 to 3.14). CONCLUSIONS CPOE and PACS were associated with both increases and reductions in tests and examinations. The magnitude of the changes is potentially important with respect to the efficiency of provision of health care. Better information about the impact of modern IT is required to enable healthcare organisations to manage implementation optimally.
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Affiliation(s)
- Simon Collin
- Department of Social Medicine, University of Bristol
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Do clinicians read our reports? Integrating the radiology information system with the electronic patient record: experiences from the first 2 years. Eur Radiol 2008; 19:31-6. [PMID: 18682959 DOI: 10.1007/s00330-008-1098-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Accepted: 06/06/2008] [Indexed: 10/21/2022]
Abstract
This study aimed to determine how clinicians adapted to and utilized new routines for accessing radiology reports after the integration of an electronic patient record (EPR) with a radiology information system (RIS). Activity-related data describing the availability and receipt of radiology reports were collected from the EPR and the RIS over a period of 2 years. Twelve percent of the final radiology reports had not been opened 4 weeks after they had been entered into the EPR. For opened reports, the median time after a report was available in the EPR until it was first opened by a clinician was less than 1 h for preliminary reports and less than 4 h for final radiology reports. The use of radiology reports was stable during the second observation year. Some reports were not opened for professional as well as technical reasons. The integrated information systems offered a potential for improving routines related to the transmission of radiology reports. Clinicians did not fully take advantage of this potential in the 2 years after its introduction.
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