Filmless Radiology Research Articles

Filmless radiology in the Emergency Department

The introduction of standardization in image formatting allowed the development of a picture archiving and communication system, or filmless radiology. In practice, we have found advantages in quick access and availability, image manipulation, and cost savings to outweigh the disadvantages of portability and system down time.

Filmless radiology: a dream becomes reality.

The experience of the first filmless imaging department in an Australian hospital

Impact of filmless radiology on frequency of clinician consultations with radiologists.

The purpose of the study was to determine the impact of filmless operation on the relative frequency of in-person consultations in the radiology department between radiologists and clinicians. The transition to filmless operation at the Baltimore Veterans Affairs Medical Center was associated with an 82% reduction in the in-person consultation rate for general radiography and a 44% reduction for cross-sectional imaging despite an increase in the volume of studies. The major reason for this decrease was the convenient access to current and prior images provided by the PACS (picture archiving and communication system). Radiology departments contemplating a transition to filmless operation should prepare for communication with clinicians to shift from being mostly in person to being conducted more and more through electronic forms of communication.

Care and feeding of a staff for filmless radiology.

Texas Children's Hospital, a definitive care pediatric hospital located in the Texas Medical Center, has been constructing a large-scale picture archival and communications system (PACS) including ultrasound (US), computed tomography (CT), magnetic resonance (MR), and computed radiography (CR). Developing staffing adequate to meet the demands of filmless radiology operations has been a continuous challenge. Overall guidance for the PACS effort is provided by a hospital-level PACS Committee, a department-level PACS Steering Committee, and an Operations Committee. Operational Subcommittees have been formed to address service-specific implementation, such as the Emergency Center Operations Subcommittee. These committees include membership by those affected by the change, as well as those effecting the change. Initially, personnel resources for PACS were provided through additional duties of existing imaging service personnel. As the PACS effort became more complex, full-time positions were created, including a PACS Coordinator, a PACS Analyst, and a Digital Imaging Assistant. Each position requires a job description, qualifications, and personnel development plans that are difficult to anticipate in an evolving PACS implementation. These positions have been augmented by temporary full-time assignments, position reclassifications, and cross-training of other imaging personnel. Imaging personnel are assisted by other hospital personnel from Biomedical Engineering and Information Services. Ultimately, the PACS staff grows to include all those who must operate the PACS equipment in the normal course of their duties. The effectiveness of the PACS staff is limited by their level of their expertise. This report discusses our methods to obtain training from outside our institution and to develop, conduct, and document standardized in-house training. We describe some of the products of this work, including policies and procedures, clinical competency criteria, PACS inservice topics, and an informal PACS newsletter. As the PACS system software and hardware changes, and as our implementation grows, these products must to be revised and training must be repeated.

Bridging the gap: linking a legacy hospital information system with a filmless radiology picture archiving and communications system within a nonhomogeneous environment.

A health level 7 (HL7)-conformant data link to exchange information between the mainframe hospital information system (HIS) of our hospital and our home-grown picture archiving and communications system (PACS) is a result of a collaborative effort between the HIS department and the PACS development team. Based of the ability to link examination requisitions and image studies, applications have been generated to optimise workflow and to improve the reliability and distribution of radiology information. Now, images can be routed to individual radiologists and clinicians; worklists facilitate radiology reporting; applications exist to create, edit, and view reports and images via the internet; and automated quality control now limits the incidence of "lost" cases and errors in image routing. By following the HL7 standard to develop the gateway to the legacy system, the development of a radiology information system for booking, reading, reporting, and billing remains universal and does not preclude the option to integrate off-the-shelf commercial products.

Crossing the digital divide--moving from film to filmless radiology.

Crossing the digital divide--moving from film to filmless radiology.

The Integration of Filmless Radiology in a Resorative General Practice

The Integration of Filmless Radiology in a Resorative General Practice

Rationale and strategies for teaching filmless radiology to medical students

Rationale and strategies for teaching filmless radiology to medical students

Planning and cost analysis of digital radiography services for a network of hospitals the Veterans Integrated Service Network

This study analysed the design and cost of a picture archiving and communications system (PACS), computerized radiography (CR) and a wide-area network for teleradiology. The Desert Pacific Healthcare Network comprises 10 facilities, including four tertiary medical centres and one small hospital. Data were collected on radiologists' workloads, and patient and image flow within and between these medical centres. These were used to estimate the size and cash flows associated with a system-wide implementation of PACS, CR and teleradiology services. A cost analysis model was used to estimate the potential cost savings in a filmless radiology environment. ATM technology was selected as the communications medium between the medical centres. A strategic plan and business plan were successfully developed. The cost model predicted the cost-effectiveness of the proposed PACS/CR configuration within four to six years, if the base costs were kept low. The experience gained in design and cost analysis of a PACS/teleradiology network will serve as a model for similar projects.

Introduction to SCAR 98: The 15th Symposium for Computer Applications in Radiology: Filmless Radiology—Reengineering the Practice of Radiology for the 21st Century

Introduction to SCAR 98: The 15th Symposium for Computer Applications in Radiology: Filmless Radiology—Reengineering the Practice of Radiology for the 21st Century

The path to a filmless radiology department: the HUP experience.

The path to a filmless radiology department: the HUP experience.

A human vision model for filmless radiology system design and optimization

A human vision model for filmless radiology system design and optimization

Updating a legacy PACS: experience with hardware and operational integration during transition to a new architecture.

The transition of the WVUH PACS to a new configuration that can support filmless radiology has been delayed by several “midcourse” corrections on the part of the primary PACS vendor. If the current product development time lines are reliable, then it will have been an 8 year process that will allow WVUH to be a filmless hospital in time for the next millennium.

Large-scale PACS implementation.

The transition to filmless radiology is a much more formidable task than making the request for proposal to purchase a (Picture Archiving and Communications System) PACS. The Department of Defense and the Veterans Administration have been pioneers in the transformation of medical diagnostic imaging to the electronic environment. Many civilian sites are expected to implement large-scale PACS in the next five to ten years. This presentation will related the empirical insights gleaned at our institution from a large-scale PACS implementation. Our PACS integration was introduced into a fully operational department (not a new hospital) in which work flow had to continue with minimal impact. Impediments to user acceptance will be addressed. The critical components of this enormous task will be discussed. The topics covered during this session will include issues such as phased implementation, DICOM (digital imaging and communications in medicine) standard-based interaction of devices, hospital information system (HIS)/radiology information system (RIS) interface, user approval, networking, workstation deployment and backup procedures. The presentation will make specific suggestions regarding the implementation team, operating instructions, quality control (QC), training and education. The concept of identifying key functional areas is relevant to transitioning the facility to be entirely on line. Special attention must be paid to specific functional areas such as the operating rooms and trauma rooms where the clinical requirements may not match the PACS capabilities. The printing of films may be necessary for certain circumstances. The integration of teleradiology and remote clinics into a PACS is a salient topic with respect to the overall role of the radiologists providing rapid consultation. A Web-based server allows a clinician to review images and reports on a desk-top (personal) computer and thus reduce the number of dedicated PACS review workstations. This session will focus on effective strategies for a seamless transition. Critical issues involve maintaining a good working relationship with the vendor, cultivating personnel readiness and instituting well-defined support systems. Success depends on the ability to integrate the institutional directives, user expectations and available technologies. A team approach is mandatory for success.

Deployable teleradiology and telemedicine for the US military

The US military has been an effective proponent of digital imaging and teleradiology for the past 15 years. A digital imaging network that can eliminate the use of X-ray film can make the requirements simpler for military medicine. X-ray film requires the storage of new, unexposed films that have a fixed shelf life, and the storage and use of chemicals and water for processing. In some deployed situations, the chemical discharge has to be collected and shipped out of the deployed area. The technology of electronic imaging is therefore intrinsically important to military medicine. In December of 1995, the US government started to deploy 20 000 US troops to Bosnia–Herzegovina as part of NATO's peace keeping operation (IFOR). A full complement of medical support facilities was to be established in the Bosnia region and Hungary where the deployment was staged. Primetime III was a project to deploy telemedicine and teleradiology capabilities linking these medical treatment facilities (MTF). The deployment of telemedicine was not the responsibility of our engineering team. This paper deals with the deployable teleradiology (DEPRAD) system that was installed by the ISIS Center at a number of facilities for filmless radiology and teleradiology services.

Deployable teleradiology: Bosnia and beyond

The United States military has been an effective proponent of digital imaging and teleradiology for the past 15 years [1]. A digital imaging network that eliminates the use of x-ray film makes military medicine requirements simpler. X-ray film requirements include storage of new, unexposed films, storage and use of chemicals and water for processing, and disposal of chemicals. In some deployed situations, the chemical discharge needs to be collected and shipped out of the area. Therefore, the ability to implement electronic imaging and eliminate or greatly reduce the dependence on film, chemicals, and water are intrinsically important to military medicine. In December 1995, the United States government began deployment of 20,000 United States troops to Bosnia-Herzegovina as part of NATO's peacekeeping implementation force (IFOR) operation. A full complement of military medical support facilities was established in Bosnia. An army base in Hungary was the location from which the deployment was staged. The project to deploy telemedicine and teleradiology capabilities to the medical treatment facilities (MTF) in Bosnia and Hungary became known as PrimeTime III [2]. This paper deals with the deployable teleradiology (DEPRAD) system that was installed by the Imaging Science and Information Systems (ISIS) Center, Department of Radiology, Georgetown Medical Center, Washington, DC, at a number of facilities to implement filmless radiology and teleradiology services in support of PrimeTime III.

Reconfiguring radiology to the new environment: The approach of the US military

Summary. US health care has seen several changes in the past 5 years, some instigated by government, others by the demands of society. The emphasis in all these changes is improvement in the efficiency of, and ease of access to, health care. This is well illustrated by the discipline of radiology where such improvements are being achieved by the incorporation of information technology into the discipline. The development of a filmless radiology department and the creation of a virtual radiology environment is described in this article, and the advantages resulting from these technological advances are discussed.

Computed radiography in pediatric radiology

A LTHOUGH COMPUTED radiography (CR) has been in clinical use since 1983,1 the introduction of the technology to pediatric institutions did not take place until approximately 1989. 2 Sixty-five children's hospitals in North America were surveyed in 1992. Four of 39 respondents had CR. 3 In Australia, only one of six pediatric centers had CR in 1995. 4 The most beneficial aspects of CR were considered to be consistency of image quality, potential dose reduction, including reduced retakes, ability to alter contrast and brightness, and networking to picture archival and communications systems (PACS). CR with film production is considered to be a less desirable objective to soft copy viewing on a PACS, because limitations of radiology services in a film based environment are well recognized) Plain x-ray examinations account for most imaging studies performed in pediatric institutions. At the Royal Alexandra Hospital for Children (RAHC) in Sydney, Australia, a free-standing pediatric facility, approximately 45,000 examinations are performed annually. Approximately 73% of these studies are for routine radiography using CR. Chest and extremity examinations accounted for most of the regions examined. CR has enabled filmless radiology departments to become a practical reality. CR images are networked with images from all other modalities into an integrated acquisition, archival, and display system.

A filmless radiology learning file for the internet: Chakri Inampudi, M.D., T.L. Kamplain, J.K. Smith M.D., Ph.D., University of Alabama at Birmingham, Birmingham, AL

A filmless radiology learning file for the internet: Chakri Inampudi, M.D., T.L. Kamplain, J.K. Smith M.D., Ph.D., University of Alabama at Birmingham, Birmingham, AL

Large picture archiving and communication systems of the world--Part 2.

A survey of 82 institutions worldwide was done in 1995 to identify large picture archiving and communication systems (PACS) in clinical operation. A continuing strong trend toward the creation and operation of large PACS was identified. In the 15 months since the first such survey the number of clinical large PACS went from 13 to 23, almost a doubling in that short interval. New systems were added in Asia, Europe, and North America. A strong move to primary interpretation from soft copy was identified, and filmless radiology has become a reality. Workstations for interpretation reside mainly within radiology, but one-third of reporting PACS have more than 20 workstations outside of radiology. Fiber distributed data interface networks were the most numerous, but a variety of networks was reported to be in use. Replies on various display times showed surprisingly good, albeit diverse, speeds. The planned archive length of many systems was 60 months, with usually more than 1 year of data on-line. The main large archive and off-line storage media for these systems were optical disks and magneto-optical disks. Compression was not used before interpretation in most cases, but many systems used 2.5:1 compression for on-line, interpreted cases and 10:1 compression for longer-term archiving. A move to digital imaging and communication in medicine interface usage was identified.