Digital references streamline image interpretation process

With the shift to digital image management and interpretation firmly established in radiology, some of its leading thinkers are focusing on another step in the process: a digital reference text that radiologists can easily access at the workstation and use as a decision support tool.

Amirsys led the way in 2001 with its Pocket Radiologist series of reference texts, available as a small handbook or software package that could be loaded into personal digital assistants. Now the company is preparing to introduce its STATdx program that will integrate the reference system into PACS workstations.

Instead of seeking out a printed reference text or subspecialist expert, the radiologist will click a button at the workstation to open up a database of reference images and text descriptions. Search mechanisms will allow the interpreting radiologist to find diagnoses by anatomy, pathology, or keyword or use all three simultaneously.

STATdx has completed beta testing at several high-volume practices and will be formally launched in July. Initial texts will cover brain, spine, musculoskeletal, and head and neck imaging. Others are in development.

Like the Pocket Radiologist series, STATdx is based on the idea that the steadily increasing volume of radiology procedures and the short supply of radiologists make researching an unusual case or finding a luxury. Providing that information at the point of service can shave minutes off the time required to review the images and write the report.

Radiologists who have tried the system confirm that it can be a time saver. Dr. Ron Miller is a radiologist with Salt Lake City's Utah Imaging Associates. The practice comprises 30 radiologists and handles about 500,000 imaging exams per year. The STATdx system guides users to a probable diagnosis and provides other possibilities if the differential diagnosis indicates that the initial suggestion is incorrect, Miller said.

In the case of a cerebellar-pontine angle mass, for example, the section for this finding will bring up the most common lesions. But it also allows the user to easily review the differential diagnosis and images for other possibilities, quickly drilling down to the best matchups. In difficult cases, STATdx can cut the time needed to reach a diagnosis in half, he said.

"When I did my fellowship, I always complained that with the textbook you had to know quite a bit to get to the true diagnosis. It didn't give you the probabilities. No text does that, but STATdx does," Miller said.

STATdx, which will be licensed to institutions at prices based on their size, is installed via CDs but can be updated on the Internet. It can be viewed on an adjacent terminal or a Microsoft-based workstation.

The latter system is in use at Scottsdale Medical Imaging, a 30-radiologist practice with 11 facilities that generate about 200,000 outpatient exams per year.

By providing an electronic reference system that can be accessed through a virtual private network or an intranet, STATdx is helping the practice achieve its goal of becoming completely paperless, said Dr. Jim Whitfill, chief information officer.

"We can have a study read anywhere, but radiologists continue to require reference material," he said.

Amirsys, which was founded by University of Utah radiologists Dr. Ric Harnsberger and Dr. Anne Osborn, is now a cooperative that is 80% owned by its radiologist writers. Osborn, a neuroradiologist who has earned a global reputation for her skill as a textbook author, is the chief editor. Harnsberger is the CEO and author of the STATdx section on head and neck imaging.

Although the material used in STATdx remains available in book form, Harnsberger predicts that the hard-copy format will be obsolete in three years.