Assistance was given to staff at rural and remote facilities in completing the survey. QH staff who already visited these areas, including engineers and radiographers, provided a basic understanding of the technology and workflow requirements for the transition to digital image acquisition.

Site preparation work began once the surveys had been completed. This proved to be challenging for sites where access to local maintenance was extremely limited. For example, one facility had already been waiting a year to have air-conditioning installed.

Some darkrooms were small, and the CR unit could not be positioned without first removing sinks and existing processors. This meant that site work had to be completed as near to the installation date as possible so as not to interrupt access to imaging services. Facilities offering radiography may be located more than 100 km apart in this region. CR equipment was installed in an alternative location on the same site in some cases. Equipment was mounted on trolleys to facilitate relocation by local staff at a later date.

The site surveys identified that LAN access would be an issue. Work areas previously used as darkrooms generally had no access points. QH's Information Directorate provided a network map for all j.net sites at the start of the project. Six facilities were missing from the map, suggesting that the QH network did not service them.

The wide area network (WAN) connection to most sites had low bandwidth, typically less than 10 Mb/sec. Specialist network infrastructure advice was required to work out whether the existing network provided adequate bandwidth.¹ QH identified a requirement for network socialization testing to inform the required bandwidth for image distribution. Network socialization testing involves connection of the CR device in a test environment to establish how the transfer of images affects network performance and interaction with other network applications; this is required by the QH Information Directorate to ensure that new applications do not compromise existing mission-critical applications.

Small switches were purchased so that components of the CR system (reader, workstation, and printer) could be connected to each other in a LAN configuration. This helped to overcome immediate network issues and keep within project timelines. A decision was also taken to exclude WAN connection from the j.net project scope. Connection to the WAN and digital distribution of images became part of a wider ongoing radiology informatics program.

TESTING AND TRAINING

Acceptance testing is mandatory before a newly installed system is put into clinical use. QH provided training to the vendor engineer responsible for each installation so that he or she could perform the basic quality assurance (QA) procedure. The results of these QA tests were recorded. Images were forwarded to a QH physicist for further assessment and confirmation of acceptance.

Training for the licensed operators was complicated by the wide geographical distribution of sites. This meant that either the trainer or the operator had to make a lengthy journey to meet face to face. Most licensed operators had no previous knowledge of CR. Some had difficulty obtaining cover so that they could be released from their primary duties for training.

The low number of x-ray examinations performed at some sites made it all the more important for operators to be trained well and their skills reinforced (Figure 1). Data from one site indicated that just 12 patients underwent x-ray radiography over the course of a year.

A training plan was developed that incorporated an introduction to CR, onsite applications training provided by the vendor, and follow-up training with competency assessment.