Picture archiving communication systems in the intensive care unit

Work flow redesign: the key to success when using PACS. 2002

OBJECTIVE. Our objective is to emphasize the importance of work flow redesign, rather than filmless operation itself, to achieve cost reduction and improvement in productivity with picture archiving and communication systems (PACS). CONCLUSION. Our 8-year experience with PACS shows that the greatest benefit of the transition to a digital system has been the ability to use it as a tool to reengineer overall work flow, both in the imaging department and throughout the health care enterprise.

Work flow redesign: the key to success when using PACS

OBJECTIVE

Our objective is to emphasize the importance of work flow redesign, rather than filmless operation itself, to achieve cost reduction and improvement in productivity with picture archiving and communication systems (PACS).

CONCLUSION

Our 8-year experience with PACS shows that the greatest benefit of the transition to a digital system has been the ability to use it as a tool to reengineer overall work flow, both in the imaging department and throughout the health care enterprise.

Implantação de um mini-pacs (sistema de arquivamento e distribuição de imagens) em hospital universitário

Este trabalho apresenta a implementação de um mini-PACS (sistema de arquivamento e comunicação de imagens) que está sendo estruturado junto ao Serviço de Radiodiagnóstico do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, como parte do projeto de um serviço de radiologia digital ("filmless").

Thoracic imaging--then and now

The chest radiograph has proved a robust diagnostic aid over the last century. The accumulation of knowledge about chest disease by radiography has been gained slowly during the last 90 years. New impetus has been given by the development of computed tomography and the recent refinements of high resolution and spiral computed tomography. The pathophysiological insights provided by these new techniques have been obtained in a remarkably short period, with the promise of more to come.

Current status of computed radiography in emergency departments

This study reports the findings of a computed radiography (CR) imaging experience questionnaire sent to 35 emergency departments (ED) in North America. A total of 25 responses to the questionnaire were received corresponding to a return rate of 71%. The median daily workload was 71 patient examinations and the average number of films per patient examination for the 21 facilities was 3.0 +/- 0.8. A total of 91% of respondents printed to film all ED trauma images obtained with CR with only one ED claiming to be filmless. CR in the ED was easy to use and had significant benefits of reducing examination repeat rates, permitting a prompt availability of radiographic images, improving image quality, providing improved operational efficiency, and eliminating lost films. Major limitations of CR were deemed to be limited viewing stations, CR costs, and inefficient patient ID entry. Radiology departments were very happy with the introduction of CR into the ED setting with approximately half being highly satisfied and half somewhat satisfied. The degree of satisfaction by ED personnel was similar with about half being highly satisfied, 40% somewhat satisfied, and the remainder neutral. The fact that not a single respondent was in any way dissatisfied shows that CR can play a useful role in the ED setting.

A digital imaging and communications in medicine (DICOM) print service for chest imaging

Large-scale picture archiving and communication systems (PACS) have not been widely implemented in this or other countries. In almost all radiology departments film remains the medium for diagnostic interpretation and image archive. Chest imaging is the dominant screening examination performed within most imaging departments and as such, is an extremely high-volume, low-margin examination. Digital technologies are being applied to chest imaging to overcome limitations of screen-film receptors (limited latitude) and current film management systems (single-image copy). Efficient management of images and information is essential to the success of a chest imaging program. In this article we report on a digital imaging and communications in medicine (DICOM)-based centralized printing network for chest imaging. The system components and their operational characteristics are described. Our experience integrating DICOM-compliant equipment supplied by several vendors is described. We conclude that the print model supported by DICOM is adequate for cross-sectional (eg, computed tomography and magnetic resonance) imaging but is too simplistic to be generally applied to projection radiography.

Experience and design recommendations for picture archiving and communication systems in the surgical setting

An analysis of the efficacy of a picture archiving and communication system (PACS) in the surgical domain was undertaken at the Baltimore Veterans Affairs Medical Center. Interviews with surgeons and staff were conducted and supplemented by direct radiologist observation in the operating room (OR) and surgical outpatient clinic to determine patterns of routine clinical PACS use, levels of satisfaction both within and outside of the OR, and perceptions of the relative efficacy of the system in comparison to film. These data as well as suggestions from the surgical staff members were used to make recommendations for specific modifications in PACS design and operation to improve the current system and to help prescribe design improvements for future PAC systems. A high level of satisfaction with the system was found and the use of PACS was favored over film by a majority of surgeons and their staff. Findings of this study suggest that the design of a hospital-wide PAC system must have the flexibility to accommodate the specific requirements of a wide variety of end-users in their unique hospital environments.

A cost-analysis of computed radiography and picture archiving and communication systems in portable radiography

A total of 40,000 portable examinations are performed each year at Shands Hospital (Gainesville, FL), a 570-bed teaching hospital. Radiographs are obtained using a screen-film combination with the films digitized for transmission to displays in four intensive care units. A cost-analysis of replacing screen-film with computed radiography (CR) integrated into a filmless picture archiving and communication system (PACS) network was performed. Equipment requirements included two CR units, three high-resolution dual monitor displays, and an archive to store 3 months of image data. The capital costs were amortized over a 5-year period. Capital and operating costs of the proposed expansion to the existing PACS network, together with anticipated cost savings, were determined. The maximum data transfer rate for portable examinations was 150 MByte per hour and approximately 400 GByte of image data are generated each year. These figures were used to determine the hardware requirements for handling the acquisition, transfer, and display of the images. Annual costs of the proposed expansion were about $220,000. Cost savings were achieved by elimination of film, including its handling by technologists/library clerks, and amounted to about $200,000 per year.

Quality assurance and quality control of an intensive care unit picture archiving and communication system

Most radiology departments have established quality assurance (QA) and quality control (QC) programs for conventional film-based image management systems. At many institutions, digital image management systems, or picture archiving and communication systems (PACS), are replacing part or all of the film management system. In these situations, it is important to control the quality of the digital images that are produced. The observed frequency of eight types of image-related errors occurring on an image viewing station located in a medical intensive care unit is reported. Images on the viewing station were checked for 12 consecutive weeks. Film images available in the radiology reading room and digital images on the viewing station were compared with a list of completed examinations produced by the radiological information system. Overall, 1,082 patient examinations were encountered. Seventy-six images (7.02% of all images) were observed with errors. In addition, four previously unencountered types of errors were observed in 11 images (1.01% of all images). The majority of the errors are attributed to interfaces either between information systems or between the PACS and the user. It is concluded that QA-QC procedures are necessary for PACS, and that good interfaces, both between information systems and between humans and computer systems, are essential for successful PACS implementations.