Impact of PACS on the education of radiology residents: the residents' perspective

A narrative review of e-learning in professional education of healthcare professionals in medical imaging and radiation therapy

OBJECTIVES

This literature review attempts to explore the characteristics of e-learning tools used to develop the qualifications and skills of healthcare professionals in medical imaging and radiation therapy, and to promote the effectiveness and acceptance of e-learning through highlighting the outcomes of its implementation where applicable.

KEY FINDINGS

From the literature search in the PubMed and ResearchGate databases we concluded to 21 articles, which were included in the qualitative synthesis. Acceptance of e-learning tools was confirmed. Also, e-learning can be part of healthcare professionals' blended learning. The acquisition of new or improvement of existing knowledge, the improvement of clinical skills and the increase of the self-confidence of healthcare professionals in their daily practice were recorded, as outcomes of the e-learning implementation. The importance of human-computer interaction for the comprehension of theoretical concepts and practical aspects using multimedia was also captured. No significant findings emerged among the 21 articles against the adoption of the e-learning for the training of healthcare professionals. The Internet is the channel used for synchronous and asynchronous interaction of trainees with instructors.

CONCLUSIONS

We concluded that e-learning is an attractive training method, equally or occasionally more effective than the traditional educational methods for the lifelong training of healthcare professionals in the field of medical imaging and radiation therapy. Also, many collaborative web-based applications provide the necessary means to build an e-learning program, according to the training needs of each professional team.

IMPLICATIONS FOR PRACTICE

This new knowledge corroborates the perspective of e-learning beneficial contribution to remote interaction and collaboration of healthcare professionals in medical imaging and radiation therapy. Collaborative web-based tools are already available to decision makers and stakeholders, who want to develop an e-learning program.

Cinebot: Creation of Movies and Animated GIFs Directly from PACS-Efficiency in Presentation and Education

The presentation of radiology exams can be enhanced through the use of dynamic images. Dynamic images differ from static images by the use of animation and are especially useful for depicting real-time activity such as the scrolling or the flow of contrast to enhance pathology. This is generally superior to a collection of static images as a representation of clinical workflow and provides a more robust appreciation of the case in question. Dynamic images can be shared electronically to facilitate teaching, case review, presentation, and sharing of interesting cases to be viewed in detail on a computer or mobile devices for education. The creation of movies or animated images from radiology data has traditionally been challenging based on technological limitations inherent in converting the Digital Imaging and Communications in Medicine (DICOM) standard to other formats or concerns related to the presence of protected health information (PHI). The solution presented here, named Cinebot, allows a simple "one-click" generation of anonymized dynamic movies or animated images within the picture archiving and communication system (PACS) workflow. This approach works across all imaging modalities, including stacked cross-sectional and multi-frame cine formats. Usage statistics over 2 years have shown this method to be well-received and useful throughout our enterprise.

Pedagogical Approaches to Diagnostic Imaging Education: A Narrative Review of the Literature

OBJECTIVE

The purpose of this study was to examine literature on how radiology is taught and learned by both radiology residents and undergraduates in the health professions.

METHODS

A review of the literature was performed using relevant key words. Articles were retrieved through December 2012 using PubMed, ScienceDirect, ERIC, Proquest, and ICL databases along with a manual review of references.

RESULTS

Of the 4716 unique abstracts reviewed by the author, 91 were found to be relevant to the purpose of this study. The literature retrieved reported pedagogical approaches to teaching radiology including the following: problem solving, technology as teacher, independent learning tools, visiting lectureships, case based teaching, and conferences. There was some exploration of the relative effectiveness of educational formats. Suggestions for future research identify 7 areas of relative consistency.

CONCLUSION

Radiology is a clinical skill that requires integration science, clinical information, clinical experiences, and information recorded on diagnostic imaging studies. The research in this area focuses on problem solving, the use of algorithm/scripts, introducing uncertainty in clinical scenarios, incorporating technology in learning environments, active learning techniques, and methods of independent learning. Although the literature in this area is still in its infancy, the research examining the relative effectiveness of these various educational formats is often contradictory, suggesting that this is a complex area of study with numerous factors influencing student learning.

Radiology report turnaround time: effect on resident education

RATIONALE AND OBJECTIVES

To compare resident workload from Emergency Department (ED) studies before and after the implementation of a required 1-hour report turnaround time (TAT) and to assess resident and faculty perception of TAT on resident education.

MATERIALS AND METHODS

Resident study volume will be compared for 3 years before and 1 year after the implementation of a required 1-hour TAT. Changes to resident workload will be compared among the different radiology divisions (body, muscuolskeletal (MSK), chest, and neuro), as well as during different shifts (daytime and overnight). Residents and faculty at two Midwest institutions, both of which have a required report TAT, will be invited to participate in an online survey to query the perceived effect on resident education by implementation of this requirement. A P < .05 was considered statistically significant.

RESULTS

A significant decrease in resident involvement in ED studies was noted in the MSK, chest, and neuro sections with average involvement of the 3 years before the 1-hour TAT of 89%, 88%, and 82%, respectively, which decreased to 66%, 68%, and 51% after the 1-hour TAT requirement (P < .05). The resident involvement in ED studies only mildly decreased in the body section from an average before the 1-hour TAT of 87% to 80% after the 1-hour TAT requirement (P < .1). There was an overall significant decrease in resident ED study involvement during the daytime (P = .01) but not after hours during resident call (P = .1). Seventy percent of residents (43 of 61) and 55% of faculty (63 of 114) responded to our surveys. Overall, residents felt their education from ED studies during the daytime and overnight were good. However, residents who were present both before and after the implementation of a required TAT felt their education had been significantly negatively affected. Faculty surveyed thought that the required TAT negatively affected their ability to teach and decreased the quality of resident education.

CONCLUSIONS

Residents are exposed to fewer ED studies after the implementation of a required 1-hour TAT. Overall, the current residents do not feel this decreased exposure to Emergency room studies affects their education. However, residents in training before and after this requirement feel their education has been significantly affected. Faculty perceives that the required TAT negatively affects their ability to teach, as well as the quality of resident education.

Picture Archiving and Communication System (PACS): Clinician's Perspective About Filmless Imaging

Picture archiving and communication systems (PACS) are most appropriate means of acquiring, archiving, and communicating all forms of radiology imaging. The present study is to decide applicability of PACS, its exact role in patient care, and benefit as a teaching tool. To compare conventional imaging with picture archiving and communication system from user's point of view, impact of PACS on patient care and teaching. This was a single center, observational study over a period of 4 weeks from 15 January 2010 to 15 February 2010 carried out in Pravara Rural Hospital. For the present study, 100 users from various clinical disciplines were included who routinely use PACS. A pretested questionnaire related to various aspects of PACS was devised considering its advantage to clinicians, role in patient care, and as tool for teaching. Out of 100 users, 85 % users reported PACS easy to very easy for handle. Ninety-four percent users reported PACS as useful tool for the hospital. Fifty-one percent of users found image quality at image review workstation to be good to very good against 49 % found it poor to very poor. There have been several studies to demonstrate the benefits of PACS to users, but many of these have concentrated on radiology trainees, users in a particular department. Present study concentrates on the impact that PACS has made to the working of the clinicians in many different disciplines. The perceived benefits of PACS outnumbered the disadvantages and reflected the widely documented benefits of PACS in the literature.

Physicians' views and assessments on picture archiving and communication systems (PACS) in two Turkish public hospitals

A picture archiving and communication system (PACS) is a medical imaging technology which provides economical storage of and convenient access to images from multiple modalities (source machine types). PACS have been widely introduced as a credible alternative to the traditional film-based radiological service. This study was planned and conducted to determine the physicians' views and assessments on PACS in two public hospitals in Turkey. A questionnaire was prepared by viewing the literature related to PACS. The questionnaires were distributed several times to a total of 150 physicians two public hospitals in Ankara, Turkey. The overall response rate is 46%. Some questions required a graduated score in response and others an open ended response. The majority of physicians judged PACS to be a major advance for their hospitals with less frustration than using film high quality images and an improvement in their working lives and patient care. They reported that PACS gave them to radiology reports in short time. Also physicians believed that PACS has improved their consultations. Open ended questions were prepared with concerning the benefits and disadvantages of PACS. The assessments of the physicians demonstrated many more benefits than disadvantages of PACS in their hospitals. PACS has been accepted well by a wide percentage of hospital physicians. PACS evolves over time components are frequently replaced and so the users must expect continuous learning about new updates and improved functionality. The implementation of the PACS clearly contributes to an increase in the productivity of health professionals and physicians.

Evaluation of medical student experience using medical student created StudentPACS flash based PACS simulator tutorials for learning radiological topics

RATIONALE AND OBJECTIVES

With studies regularly containing hundreds of images, the authors believe that the ability to efficiently review numerous images and identify findings is an important skill to teach medical students. Using the StudentPACS Adobe Flash extension, created within their department, the authors created StudentPACS modules that provide users with a virtual picture archiving and communication system environment, in which findings can be selected by mouse, triggering questions with referenced answers. The aim was to assess medical students' impressions of how learning from these modules compared to their personal experiences learning radiology from textbooks or static images.

MATERIALS AND METHODS

StudentPACS modules were created by medical students on elective under the supervision of resident and attending radiologists. MS I to IV students were then asked to complete StudentPACS modules that tied in with their current coursework, followed by an anonymous survey. Approximately 293 students participated.

RESULTS

The majority of students reported that StudentPACS modules were either equivalent to or better than learning from static images or textbooks (90 +/- 3% [257 of 285], P < .00002), were not difficult to use (85 +/- 4% [248 of 293], P < .00002), presented them with clinical content that tied in well with the depicted imaging (90 +/- 3% [263 of 293], P < .00002), and taught them new information (69 +/- 5% [202 of 293], P < .00002). Most respondents felt the StudentPACS modules presented information they would find useful in clinical practice (91 +/- 3% [266 of 293], P < .00002), reported satisfactory experiences using StudentPACS modules as a source of self-directed learning material (79 +/- 5% [232 of 293], P < .00002), and stated that they would use StudentPACS modules for learning different topics in the future (85.6 +/- 4% [244 of 285], P < .00002).

CONCLUSION

Medical students found using StudentPACS modules at least equivalent to, if not better than, using static books or annotated images.

Picture, archiving and communication system in the Italian NHS: a primer on diffusion and evaluation analysis

This contribution focuses on picture archiving and communication systems (PACS) in the Italian National Healthcare System (NHS). It finally aims to test the Chiefs Radiology Department's perceptions about PACS along the main evaluation dimensions emerging from the literature. First, a brief review of the main literature concerning PACS evaluation leads the authors to classify the different approaches undertaken and highlight the main variables of investigation. Second, the evidence emerging from a survey is presented and discussed in the light of the literature review. The survey aims to: (a) map out the degree of PACSs diffusion and their main features in the Italian NHS; (b) verify whether and how PACS impact the dimensions analyzed in many evaluation studies carried out to date; (c) test the relationship between some measured impacts and specific PACS features.

Challenges to radiology resident education in the new era

Over the past decade, there have been many developments that have changed the practice of radiology and the education of radiology residents. These include workforce issues, the institution of the Accreditation Council for Graduate Medical Education duty-hours restrictions, the increased use of night float systems, and the implementation of picture archiving and communication systems as well as voice recognition. This article reviews the impact on resident education, summarizes potential problems introduced by these changes, and examines proposed solutions.

Impact of PACS and voice-recognition reporting on the education of radiology residents

RATIONALE AND OBJECTIVES

The introduction of picture archiving and communication system (PACS) has decreased the time needed to interpret radiology examinations resulting in an increased workflow. Because of concerns that the increase in exam throughput and the use of voice recognition may have a negative impact upon radiology resident education, a survey was conducted to assess the impact of PACS and voice recognition.

MATERIALS AND METHODS

Residents at four diagnostic radiology training programs were surveyed. Survey topics included resident demographics, didactic and technical issues, and areas for improvement.

RESULTS

One hundred thirty-four residents were polled with 42 respondents (42/134, 31.3%). The majority have been using PACS for more than 1 year (29/41, 70.7%) to interpret 75-100% of cases (33/39, 84.6%). A majority believed PACS is a superior teaching tool to printed film (28/38, 73.7%). However, only a minority (9/40, 22.5%) indicated that PACS was always used to contain teaching files and to conduct departmental conferences (5/40, 12.5%). The majority of respondents believed PACS have decreased the time needed to interpret diagnostic examinations (33/41, 80.5%). A majority (80.6%, 25/31) indicated that voice recognition takes more time than the traditional dictation and transcription process, where 51.3% (20/39, 51.3%) felt that voice recognition works well less than 50% of the time.

CONCLUSIONS

Residents believe that PACS has positively affected their learning experience but indicate that it can be better utilized for resident education. Residents believe that voice recognition is less reliable and more time consuming than the traditional dictation system.

Relevant training issues for introduction of digital radiology: results of a survey

Council Directive 97/43/Euratom establishes the need for adequate training of radiology staff. The transition to digital radiology implies changes in various imaging aspects, which are not sufficiently covered by current institutional training programmes. This work aimed to assess how professionals, experienced in digital imaging, acquired their expertise and hence, what form institutional training should take. Within DIMOND III, a survey on training and resources was performed among radiology professionals. A lack of institutional education for digital radiology was found. In the transition to digital radiology, 30-35% train on the job and another 23-28% receive training from digital equipment vendors. A general agreement exists on the need for new quality criteria and strategies for dose management. Issues relevant for conventional/digital transition are only sparsely covered in EC training programmes. Based on these results, a set of training issues was produced, to be included in future European guidelines.

Picture archiving and communication systems: the users' view

A study was undertaken to assess the acceptability to users of a Picture Archiving and Communication System (PACS). A questionnaire was issued to 208 users. Some questions required a graduated score in response and others a free text response. 101 responses were received from a cross section of hospital staff. The majority of users judged PACS to be a major advance for the hospital, with high quality images, less frustration than using film and an improvement in their working lives. They judged that it had made a positive change in their working practices and had met their expectations. They welcomed the access it gave them to Radiology reports. There was more ambivalence about the impact it had made to the efficiency of clinic consultations and the conduct of ward rounds. Free text responses were made concerning the benefits and disadvantages of PACS. Analysis of these demonstrated many more benefits than disadvantages. The Radiology department has been enabled to address the concerns of staff raised through the questionnaire, and has been encouraged by the positive responses. PACS has been accepted well by a wide cross section of hospital staff. It has improved their working lives and made a major contribution to the working of the hospital as a whole.

Postgraduate musculoskeletal fellowship training in the United States: current trends and future direction

OBJECTIVE

To document current postgraduate musculoskeletal training program (accredited and unaccredited) curricula and approaches to education.

DESIGN AND PATIENTS

Questionnaires were sent to all musculoskeletal training programs. Responses regarding radiology residency and fellowship program sizes, types of imaging and invasive procedures included, and other program parameters were solicited. Features of accredited and unaccredited programs were compared. Teaching approaches, including the use of web-based or distance learning were evaluated.

RESULTS

Twenty-nine (73%) of 40 musculoskeletal programs responded to the questionnaire. Twenty-eight percent of programs were accredited and 72% unaccredited. Radiology residencies were also present at all responding institutions (the majority had a class size of 4-8/year). Residency programs in related specialties included pathology 96%, orthopedics and rheumatology 90%, oncology 83% and pain management 69%. The majority (93-100%) provided training in radiography, MRI and CT. Spine MRI was included in 69% of programs, ultrasonography in 62% and positron emission tomography in 24%. Arthrography and diagnostic and therapeutic injections (100%) were included in all programs. Other invasive procedures, including spine and radiofrequency ablation, were offered less frequently. Teaching approaches included conferences (100%), journal clubs (62%), multidisciplinary conferences (45-90%), web-based learning (30%) and distance learning (7%). Forty-one percent of programs offered off-site rotations.

CONCLUSIONS

The majority of musculoskeletal training programs prepared trainees for private or academic practice. There are inconsistencies that could be improved to better prepare trainees for careers in musculoskeletal imaging.

PACS utilization in radiologic research

RATIONALE AND OBJECTIVES

The authors investigated patterns of utilization of the digital picture archiving and communication system (PACS) in radiologic publications in order to ascertain whether there may be a correlation between PACS use and demographic/cultural factors such as geographic location, radiologic specialization, and use of advanced radiologic technologies.

MATERIALS AND METHODS

A total of 1,037 articles in 22 randomly selected issues of AJR: American Journal of Roentgenology and of Radiology (1999-2001) were reviewed for the rate of PACS use and the type of PACS used. Articles for which PACS use or nonuse was established were further classified according to originating continent or region, imaging modality, study design (whether retrospective or prospective), and the use of advanced radiologic technology. The use of a PACS was then correlated with these factors. The data were recorded and statistics were prepared by means of statistical software. The nonparametric (chi2) test also was run by using this software.

RESULTS

PACS had been used and reported in the preparation of 225 of the 1,037 articles. The type of PACS used was mini PACS (eg, systems using digital imaging and communications in medicine [DICOM] protocols or precursors) in 55 (24%) and department- or hospital-wide PACS in 161 (72%). Most of the articles for which use of a PACS was reported had originated in North America (60%), Europe (22%), or Asia (14%). PACS were used in almost half of retrospective studies and in one-fourth of prospective studies (P < .01). A low correlation was found between utilization of PACS and use of other advanced technologies.

CONCLUSION

Although PACS were utilized in the preparation of a substantial proportion of articles published in the two major radiology journals, there was a great disparity in the rate of PACS use among world regions. The proportion of studies originating in North America for which a PACS was used was nearly three times the number of similar studies originating in Europe, and more than four times the number originating in Asia.

Impact of pager notification on report verification times

RATIONALE AND OBJECTIVES

The purpose of this study was to assess the impact on times of verification (TOVs) by a pager notification system (PNS) that informs physicians when reports are available for signature.

MATERIALS AND METHODS

An automated PNS was implemented in the authors' department in November 2000. Monthly report verification times of each physician were collected for 3 months in the years before and after initiation of the PNS. Radiologists enrolled in the PNS and those who were not were assigned into two groups for analysis. Mean TOVs for the two sets of 3 months and for the two groups were calculated and differences recorded. Two-tailed t tests were used to assess for statistical differences between the groups.

RESULTS

Twenty-nine of 37 radiologists voluntarily enrolled in the PNS (group 1). Mean TOV was 26.75 hours (standard deviation [SD] = 17.76) for these physicians before and 14.48 hours (SD = 11.86) after the PNS was employed (P < .01). For those physicians who did not enroll in the PNS, mean TOV was 11.53 hours (SD = 5.55) before and 9.77 hours (SD = 9.86) after the PNS was employed (P = .33). Both the absolute and percentage reductions in TOVs were significantly greater for those physicians enrolled in the PNS than for those who were not (P = .035). Twenty-three of 29 (79%) physicians who used the PNS showed a reduction in their report turnaround times.

CONCLUSION

Linking the PNS with the radiology information system to notify physicians of unsigned reports was effective in reducing report verification times.