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Szczykutowicz TP, Brunnquell CL, Avey GD, Bartels C, Belden DS, Bruce RJ, Field AS, Peppler WW, Wasmund P, Wendt G. A General Framework for Monitoring Image Acquisition Workflow in the Radiology Environment: Timeliness for Acute Stroke CT Imaging. J Digit Imaging 2019; 31:201-209. [PMID: 29404851 DOI: 10.1007/s10278-018-0055-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Many facets of an image acquisition workflow leave a digital footprint, making workflow analysis amenable to an informatics-based solution. This paper describes a detailed framework for analyzing workflow and uses acute stroke response timeliness in CT as a practical demonstration. We review methods for accessing the digital footprints resulting from common technologist/device interactions. This overview lays a foundation for obtaining data for workflow analysis. We demonstrate the method by analyzing CT imaging efficiency in the setting of acute stroke. We successfully used digital footprints of CT technologists to analyze their workflow. We presented an overview of other digital footprints including but not limited to contrast administration, patient positioning, billing, reformat creation, and scheduling. A framework for analyzing image acquisition workflow was presented. This framework is transferable to any modality, as the key steps of image acquisition, image reconstruction, image post processing, and image transfer to PACS are common to any imaging modality in diagnostic radiology.
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Affiliation(s)
- Timothy P Szczykutowicz
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA.
- 1005 Wisconsin Institutes for Medical Research, 1111 Highland Ave, Madison, WI, 53705, USA.
| | - Christina L Brunnquell
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Gregory D Avey
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Carrie Bartels
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Daryn S Belden
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Richard J Bruce
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Aaron S Field
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Walter W Peppler
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Peter Wasmund
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Gary Wendt
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
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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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Paré G, Lepanto L, Aubry D, Sicotte C. Toward a multidimensional assessment of picture archiving and communication system success. Int J Technol Assess Health Care 2005; 21:471-9. [PMID: 16262970 DOI: 10.1017/s0266462305050658] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Based on a prevalent framework in the information systems field, this study proposes and describes an integrated model for evaluating picture archiving and communication system (PACS) success from multiple users' perspectives. METHODS Our study details the validation process of the proposed model at a large tertiary-care teaching hospital in Canada. Both qualitative and quantitative data were collected to assess the psychometric properties of the measurement instrument and test the research hypotheses. RESULTS Our findings clearly reveal that radiologists, technologists, and clinicians have different views regarding the factors influencing PACS success. For instance, the results for radiologists show that their concern with efficiency and productivity is best guaranteed by a system that is reliable and easy to use. Furthermore, that only perceived system usefulness influenced clinicians' satisfaction with PACS is a reflection of the primary impact that technology has on their work, namely, the ability to have instant access to images from any point in the hospital. Even though, overall, all three groups view the adoption of PACS positively, the mean scores indicate that radiologists and technologists seem to be more satisfied and their expectations to be met at a higher level than clinicians. CONCLUSIONS We believe the measurement instruments developed in this study can be used as a diagnostic tool by project managers interested in better understanding the extent to which different groups of stakeholders perceive the deployment of PACS as being successful and how factors influencing perceptions of PACS success vary across user types.
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Affiliation(s)
- Guy Paré
- HEC Montréal, 3000 Cote-Ste-Catherine, Montréal, Québec H3T 2A7, Canada.
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Reiner BI, Siegel EL, Hooper FJ, Pomerantz S, Dahlke A, Rallis D. Radiologists' productivity in the interpretation of CT scans: a comparison of PACS with conventional film. AJR Am J Roentgenol 2001; 176:861-4. [PMID: 11264065 DOI: 10.2214/ajr.176.4.1760861] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We compared radiologists' times in the interpretation of CT using hardcopy films with the interpretation using a soft-copy picture archiving and communication system (PACS) computer workstation. MATERIALS AND METHODS One hundred CT examinations were selected at random and reviewed by four board-certified radiologists experienced in soft-copy interpretation. We performed time-motion analysis to determine the total time required to display, interpret, and dictate the individual findings of CT using conventional hard-copy interpretation on a viewbox and soft-copy interpretation, using a four-monitor high-resolution (2048 x 1536 pixel) workstation. RESULTS Time-motion analysis showed a reduction of 16.2% in the overall time required for soft-copy interpretation of CT compared with that of film. Time savings with soft-copy interpretation were observed for all four participating radiologists. The benefit of soft-copy interpretation was increased for examinations in which there were comparison studies. CONCLUSION We found that soft-copy interpretation of CT using a PACS workstation requires less time than interpretation using conventional film hung on a viewbox. The transition to filmless imaging has the potential to improve radiologists' productivity and report-turnaround time.
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Affiliation(s)
- B I Reiner
- Department of Radiology, Veterans Affairs Maryland Health Care System, 10 N. Greene St., Baltimore, MD 21201, USA
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Redfern RO, Horii SC, Feingold E, Kundel HL. Radiology workflow and patient volume: effect of picture archiving and communication systems on technologists and radiologists. J Digit Imaging 2000; 13:97-100. [PMID: 10847373 PMCID: PMC3453253 DOI: 10.1007/bf03167635] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
This study was performed to evaluate the changes in workflow and efficiency in various clinical settings in the radiology department after the introduction of a picture archiving and communication system (PACS). Time and motion data were collected when conventional image management was used, and again after the introduction of a PACS. Changes in the elapsed time from examination request until the image dispatch to the radiologist, and from dispatch until report dictation, were evaluated. The relationship between patient volume and throughput was evaluated. The time from examination request until dispatch was significantly longer after the introduction of PACS for examinations taken on patients from the emergency department (ED) (pre-PACS, 20 minutes; post-PACS, 25 minutes; P < .0001), and for examinations taken on patients in the medical intensive care unit (MICU) (pre-PACS, 34 minutes; post-PACS, 42 minutes; P < .0001). The interval from image dispatch until report dictation shortened significantly after the introduction of PACS in the ED (pre-PACS, 38 minutes; post-PACS, 23 minutes; P < .0001) and in the outpatient department (OPD) (pre-PACS, 38 minutes; post-PACS, 20 minutes; P < .0001). Simple least squares regression showed a significant relationship between daily patient volume and the daily median time until report dictation (F = 43.42, P < .001). PACS slowed technologists by prolonging the quality-control procedure. Radiologist workflow was shortened or not affected. Efficiency is dependent on patient volume, and workflow improvements are due to a shift from batch to on-line reading that is enabled by the ability of PACS to route enough examinations to keep radiologists fully occupied.
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Affiliation(s)
- R O Redfern
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
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Gale DR, Gale ME, Schwartz RK, Muse VV, Walker RE. An automated PACS workstation interface: a timesaving enhancement. AJR Am J Roentgenol 2000; 174:33-6. [PMID: 10628449 DOI: 10.2214/ajr.174.1.1740033] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Interface design is a key element in the efficient use of a picture archiving and communication system (PACS) workstation. In many cases, multiple mouse clicks or keyboard commands are required to open and close a case, to mark it as complete, and to retrieve and allocate screen positions to the next case. We evaluated the work flow effect of software designed for automated image display in which all of these operations are consolidated in a single mouse click. CONCLUSION Automated image display increases efficiency in image interpretation and remedies the normally cluttered presentation environment. At our institution, acceptance of automated image display has been overwhelmingly positive. In fact, automated image display has improved radiologist productivity.
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Affiliation(s)
- D R Gale
- Radiology Service, Veterans Affairs Boston Health Care System, Boston University School of Medicine, MA 02130, USA
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Mattern CW, King BF, Hangiandreou NJ, Swenson A, Jorgenson LL, Webbles WE, Okrzynski TW, Erickson BJ, Williamson B, Forbes GS. Electronic imaging impact on image and report turnaround times. J Digit Imaging 1999; 12:155-9. [PMID: 10342198 PMCID: PMC3452886 DOI: 10.1007/bf03168787] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
We prospectively compared image and report delivery times in our Urgent Care Center (UCC) during a film-based practice (1995) and after complete implementation of an electronic imaging practice in 1997. Before switching to a totally electronic and filmless practice, multiple time periods were consistently measured during a 1-week period in May 1995 and then again in a similar week in May 1997 after implementation of electronic imaging. All practice patterns were the same except for a film-based practice in 1995 versus a filmless practice in 1997. The following times were measured: (1) waiting room time, (2) technologist's time of examination, (3) time to quality control, (4) radiology interpretation times, (5) radiology image and report delivery time, (6) total radiology turn-around time, (7) time to room the patient back in the UCC, and (8) time until the ordering physician views the film. Waiting room time was longer in 1997 (average time, 26:47) versus 1995 (average time, 15:54). The technologist's examination completion time was approximately the same (1995 average time, 06:12; 1997 average time, 05:41). There was also a slight increase in the time of the technologist's electronic verification or quality control in 1997 (average time, 7:17) versus the film-based practice in 1995 (average time, 2:35). However, radiology interpretation times dramatically improved (average time, 49:38 in 1995 versus average time 13:50 in 1997). There was also a decrease in image delivery times to the clinicians in 1997 (median, 53 minutes) versus the film based practice of 1995 (1 hour and 40 minutes). Reports were available with the images immediately upon completion by the radiologist in 1997, compared with a median time of 27 minutes in 1995. Importantly, patients were roomed back into the UCC examination rooms faster after the radiologic procedure in 1997 (average time, 13:36) than they were in 1995 (29:38). Finally, the ordering physicians viewed the diagnostic images and reports in dramatically less time in 1997 (median, 26 minutes) versus 1995 (median, 1 hour and 5 minutes). In conclusion, a filmless electronic imaging practice within our UCC greatly improved radiology image and report delivery times, as well as improved clinical efficiency.
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Affiliation(s)
- C W Mattern
- Mayo Medical Center, Rochester, MN 55905, USA
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Ernst R, Le VT, Kawashima A, Caskey C, Zelitt D, Tamm E, Sandler CM. A picture archiving and communications system featuring multiple monitors using Windows98. J Digit Imaging 1999; 12:106-8. [PMID: 10342182 PMCID: PMC3452922 DOI: 10.1007/bf03168771] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
We present an effective approach to manage, review, and distribute Digital Imaging and Communications in Medicine (DICOM) images with multiple monitors using Windows98 (Microsoft Corp, Redmond, WA) that can be implemented in an office-based setting. Computed tomography (CT), magnetic resonance imaging (MRI), and angiographic DICOM images were collected, compressed, and stored using Medweb (Medweb, Inc, San Francisco, CA) software. The Medweb server used the Linux/UNIX operating system on a Pentium 333-MHz processor with 128 MB of RAM. Short-term storage capacity was about 2 weeks with routine usage of an 11-GB hard drive. Images were presented for reading on a dual-monitor Windows98 Pentium display station with 160 MB of RAM using a Medweb/Netscape (Netscape Communications Corp, Mountain View, CA) viewer. There was no significant discrepancy in diagnosis between electronic and conventional film images. Mean reading time for 32 cases was 118 seconds. The Medweb JAVA plug-in viewer loaded the first image within 30 seconds of selecting the case for review. Full uncompressed 16-bit images allowed different window settings to better assess for pathology. Multiple monitors allowed viewing various hanging protocols. Cine viewing was also possible. Key diagnostic images were electronically transmitted to referring physicians. On-call radiologists were able to access images through the Internet. By combining Medweb, DICOM, and web-browser software using desktop personal computers (PCs), an easily accessible picture archiving and communications system (PACS) is available to radiologists and referring physicians. Multiple monitors are easily configured and managed using Windows98. This system can sustain changes and can be extended to provide variable functions using inexpensive PCs.
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Affiliation(s)
- R Ernst
- Department of Radiology, University of Texas-Houston Medical School 77026, USA
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Abstract
The operational experience of a commercial teleradiology practice utilizing a wide-area ISDN network linking six imaging centers located in two states will be reviewed. Open magnet designs were chosen to complement existing high-field units available in each community. Image data was first acquired than transmitted without compression at 128 Kbytes/s to a central reading site located in McLean, Virginia for interpretation by a team of radiologists. Average transmission time was 6-8 minutes. System design allows optimal utilization of radiologists expertise in imaging interpretation while reserving the on-site patient management responsibilities such as gadolinium contrast injections and sedation to a nonradiologists physician and/or nurse practitioner. Over 15,000 teleradiology readings have been rendered via this network by January 1998.
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Affiliation(s)
- M C Davis
- Med-Tel International Corporation, McLean, VA 22102, USA
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