Clinicians press for more standard CD-ROMs

Some clinicians are so discouraged by nonstandard CD-ROMs generated at imaging centers they are calling on the radiology community to improve the way it transfers imaging data to referring physicians.

One leading oncologist, Dr. Douglas W. Blayney, medical director of the University of Michigan Comprehensive Cancer Clinic, told Diagnostic Imaging the imaging community needs to improve its "chaotic and disjointed transfer methods."

Clinician frustration stems from difficulties attempting to open CD-ROMs given to patients at imaging facilities to present to their physicians.

"As a clinical oncologist, I not only use diagnostic images to make treatment decisions, but most important, to demonstrate to my patients the effects of treatment on their tumors," Blayney said.

Almost every day, a patient brings him a CD-ROM with images from a recent CT, MRI, or PET scan, and he is unable to share the images with the patient, Blayney said.

"Though most discs come with image viewing software as an executable file ('.exe'), I am prohibited by antivirus software from loading executable files onto our desktop computers," he said.

Blayney, who is also editor of the American Society of Oncology's Journal of Oncology Practice, said these snags interfere with patient care, slow him down, and distract from the time and energy he devotes to patients. His concerns with outside CD-ROMs are detailed in a recent editorial (J Oncol Pract 2008;4[1]:1).

The standard for diagnostic image interchange is DICOM, yet many radiology clinics burn discs as JPEGs or in an otherwise proprietary format.

Dr. Richard K. J. Brown, director of general clinical nuclear imaging at Michigan University Hospital, said that JPEG images may look good, but they do not contain the diagnostic depth that DICOM format allows.

"My diagnostic radiology colleagues have taught me to adjust the window and level of images to bring out details in bone, soft tissue, and lung, but many of the proprietary formats we receive on CD-ROMs don't allow for this type of interaction," he said.

Blayney recommends instead that imaging centers burn data on CDs in DICOM format and that a DICOM viewer be included on the disc so clinicians can also view images on their home computer.

Eventually, Blayney would like to see CD-ROMs eliminated altogether.

"I would like to get to a place where we exchange clinical data with the efficiency of the banking and travel industries," he said.

Blayney said his financial institution lets him see not only his bank balances and portfolios, but also, from the same screen, even lets him see transactions and valuations of mutual funds held with other companies.

"In addition, they allow me to view images of handwritten checks without loading them onto my computer's hard drive - a service I would like see provided by my diagnostic imaging facilities," he said.