CR contributes to more equitablehealth outcomes in Australia

April 1, 2009

Queensland Health, which provides public health services across a highly decentralized population base in the Australian state of the same name, now has digital image acquisition at all of its medical imaging sites.

Queensland Health, which provides public health services across a highly decentralized population base in the Australian state of the same name, now has digital image acquisition at all of its medical imaging sites. This means that rural and remote image acquisition sites are well positioned to take advantage of the digital imaging paradigm.

The disparity in health outcomes between the city and “the bush” is a recognized issue in Australia. Some sites are already able to move images across the network and access radiologists' interpretations and/or specialists' consultations. Work to establish full wide area network (WAN) connectivity for the remaining sites is continuing. Once this is complete, all of QH's image acquisition facilities will have equitable access to these specialist services that can make a pivotal contribution to clinical decision making and patient management.

QH includes the provision of medical imaging services to 130 facilities. Introduction of digital image acquisition at these sites began in 2006. The latest project, j.net, was completed in July 2008. It involved installation of computed radiography at 86 sites and made QH the first state health service in Australia to provide digital acquisition of general radiographic examinations at all of its imaging facilities.

A significant proportion of sites that have medical imaging services provided by QH offer only general radiography (87 sites). Licensed x-ray operators carry out all diagnostic image acquisition work at 77 of these facilities.

The aim of the j.net project was to establish a minimum level of digital image capture and processing equipment at all sites. An accurate register of existing equipment was established as a first step. This involved collating survey data from previous projects and following up by telephone to confirm the information.

The following CR equipment was procured from Fujifilm Australia and Carestream Health: single CR reader, “dry” film printer, document scanner for scanning in request form, and workstation with CD/DVD burning capability. A site survey tool was developed to identify preinstallation requirements.

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 procedure. The results of these QA tests were recorded, and images were forwarded to a QH physicist for further assessment.

The greatest challenge was the transportation of staff carrying out onsite installation and training. Because some centers had limited accommodation, personnel needed to travel in and out on the same day. Charter planes were used to reach many areas. Staff were dropped off in the morning, then picked up at the end of the day.

The installation phase was completed within project timelines on 23 June 2008. Use of local resources was pivotal in meeting project timelines. This involved identifying staff who were in the vicinity or paid regular visits to facilities.

A survey distributed to radiographers and licensed operators achieved a response rate of 36% (120 respondents). Overall, 90% of respondents expressed satisfaction with the project outcomes, and many comments were positive. The high satisfaction rate reflects the quality of the project processes and the attention paid to the change management aspects of introducing new technology. This result appears to support the assertion that change can be managed effectively by paying careful attention to communication, planning, process evaluation, and training.

Site visits played an important part in the planning and preparation of the project, as did the communication of project outcomes to staff. Clarification of the project's scope could have been improved. Many users were under the impression that the equipment would immediately let them transfer images to other QH sites, but this was not the case.

Project stakeholders also identified concerns about the cost-effectiveness of the new technology. Costs are typically saved when moving to a digital imaging environment due to the reduced need for film, wet chemicals, film storage, and handling costs. Health Service Districts will, however, still have to purchase some film and CDs for image distribution and storage, due to the delay in connecting to the LAN/WAN for image transfer. They will also be responsible for post-warranty servicing of the CR equipment.

Filmless radiology departments have reported a significant decrease in overall examination turnaround times, though the introduction of digital acquisition systems alone has not produced a significant reduction in average examination time. The move to CR must be recognized as the first step toward a filmless environment.