PACS used while on-call: a national survey of radiology program directors and chief residents

Oblique lateral interbody fusion at L5-S1: feasibility, surgical approach window, incision line, and influencing factors

PURPOSE

The primary aim of this study was to describe the feasibility, surgical approach window (SAW), and incision line (IL) for oblique lateral interbody fusion at L5-S1 (OLIF51) using computed tomography (CT). A secondary aim was to identify associations among approach characteristics and demographic and anthropometric factors.

METHODS

We performed a radiographic study of 50 male and 50 female subjects who received abdominal CT imaging. SAW was measured as the distance from the midline to the medial border of the iliac vessel. IL was measured at the skin surface corresponding to the distance between the center of the disc space and SAW lateral margin. OLIF51 feasibility was defined as the existence of at least a 1-cm SAW without retraction of soft tissues.

RESULTS

For the left side, the OLIF51 SAW and IL were 12.1 ± 4.6 and 175.1 ± 55.3 mm. For the right side, these measures were 10.0 ± 4.3 and 185.0 ± 52.5 mm. Correlations of r = 0.648 (p < 0.001) and r = 0.656 (p < 0.001) were observed between weight and IL on the left and right sides, respectively. OLIF51 was not feasible 23% of the time.

CONCLUSION

To our knowledge, this is the largest CT study to determine the feasibility of performing an OLIF51. Without the use of retraction, OLIF51 is not feasible 23% of the time. Left-sided OLIF51 allows for a larger surgical approach window and smaller incision compared to the right side. Larger incisions are required for adequate surgical exposure in patients with higher weight.

Quantitative Evaluation of PACS Query/Retrieve Capabilities

The PACS (Picture Archiving and Communication System) market is heterogenous with dozens of PACS providers having deployed installations in healthcare facilities. The DICOM® query and retrieve interfaces provided by PACS have multiple variations, related to the implemented SOP (Service Object Pair) Classes, transfer syntaxes, extended negotiations, matching attributes, and matching types. These variations can make integration of a new DICOM® consumer with a PACS complex and time consuming. Even if most of PACS products provide a DICOM® conformance statement with a description of its query/retrieve capabilities, there is no collective analysis describing the various PACS query and retrieve capabilities and variations. Also, application developers and healthcare facilities lack a method to evaluate the PACS capabilities and classify its functionalities. GE designed a method to evaluate the PACS capabilities in terms of query retrieve functionalities. Our aim is to analyze several PACS in test and production environments, using our method to provide the DICOM® object consumers a macroscopic knowledge of query/retrieve capabilities of PACS functionalities and its different variations. Our evaluation can also be used by PACS and VNA (Vendor Neutral Archive) developers to evaluate their query/retrieve capabilities, for quality improvement purpose.

Needs Assessment Using a Structured Prioritization Schema: An Open Letter to PACS Vendors

PURPOSE

The aim of this work was to prioritize in a quaternary academic environment necessary elements of a replacement PACS.

METHODS

This quality improvement work was conducted at one academic medical center and was "not regulated" by the institutional review board. Three workgroups (10-15 members each) with unique resident, fellow, and attending radiologists; IT specialists; and departmental leaders convened in 2018 to prioritize elements for a PACS replacement project, including integrated IT tools. Each workgroup met two or three times and represented one of three missions (clinical, research, and education). Six elements assigned the highest priority were distilled from each workgroup. The resulting 18 elements were condensed into survey format and distributed to all department residents, fellows, and faculty members for 5-point Likert-type prioritization stratified by mission. Data were collected over 2 weeks.

RESULTS

The survey response rate was 37% (71 of 192; 17 of 44 residents, 3 of 27 fellows, and 51 of 121 faculty members). Self-reported work effort was 63 ± 26% clinical, 14 ± 11% education, 15 ± 21% research, and 8 ± 14% administration. Aggregate priority ratings across all domains were highest for "stable system with predictable behavior" (mean, 4.51), "minimizes repetitive non-value-added work" (mean, 4.40), "interoperability" (mean, 4.12), and "near-instantaneous load times" (mean, 4.07). Clinical-specific ratings for these elements were even higher (means, 4.85-4.90). The lowest aggregate scores were mobile device compatibility (mean, 3.03), connectivity to nonaffiliated sites (mean, 3.01), and integrated instant messaging (mean, 2.87).

CONCLUSIONS

The department prioritized a stable and interoperable system that minimized non-value-added work. In other words, participants wanted a functioning PACS. PACS vendors should prioritize a reliable experience over niche add-ons.

The Current State and Path Forward For Enterprise Image Viewing: HIMSS-SIIM Collaborative White Paper

Clinical specialties have widely varied needs for diagnostic image interpretation, and clinical image and video image consumption. Enterprise viewers are being deployed as part of electronic health record implementations to present the broad spectrum of clinical imaging and multimedia content created in routine medical practice today. This white paper will describe the enterprise viewer use cases, drivers of recent growth, technical considerations, functionality differences between enterprise and specialty viewers, and likely future states. This white paper is aimed at CMIOs and CIOs interested in optimizing the image-enablement of their electronic health record or those who may be struggling with the many clinical image viewers their enterprises may employ today.