PACS provides platform for new ways of working

March 5, 2008

The switch from hard-copy workflow to digital imaging is gathering pace throughout Europe. For departments that have made the switch, the gains can be significant. Installing a PACS is just the first step, though. What really matters is how the technology is then used.

The switch from hard-copy workflow to digital imaging is gathering pace throughout Europe. For departments that have made the switch, the gains can be significant. Installing a PACS is just the first step, though. What really matters is how the technology is then used.Speakers at Friday morning's refresher course will tackle this topic head on. Their brief is to answer the question, "What can PACS do today?" Used correctly, PACS can streamline daily workflow, add value to reporting services, and act as a useful resource for education and training. Delegates attending the session will learn how to realize this potential.Many radiology departments that have purchased a PACS have added speech recognition packages. This software should be fully integrated with the local PACS and RIS, allowing patient data to be shared between systems, according to Dr. Christoph Trumm, a radiologist at the Grosshadern campus, Ludwig-Maximilian University (LMU), in Munich. If this is not done, the promised efficiency gains are unlikely.Departments seeking to incorporate speech recognition into their workflow have two options. In the offline model, reports dictated by radiologists are transferred to a speech recognition server. This preliminary report is then corrected by a transcriptionist and returned to the radiologist for authorization.The online model lets radiologists review and correct their reports while they are dictating. No additional transcription is required, and the report can be completed in a single session. This model is undoubtedly the more streamlined of the two and is the method most likely to improve reporting efficiency. The only downside is the added time that radiologists must spend correcting their reports onscreen."The major advantage is that you can make the report available to your clinical partners almost instantly, which in practice means within two hours," he said.But while online speech recognition is relatively easy to implement in private practices and outpatient clinics, it is not always appropriate in teaching hospitals. The offline mode allows scope for discussion between resident radiologists and senior radiologists before the report is finalized and approved, Trumm said.Radiologists at the LMU's Grosshadern campus use the online mode to report all out-of-hours cases. Their assessment can then be available in the HIS within minutes. During routine working hours, more complicated cases, such as those from MRI and CT, are dictated and transcribed separately."For our setting, it makes sense to use both modes," he said.PACS implementation can also open up new ways of teaching and learning. Many sophisticated packages make it possible to build complex radiology archives directly on the back of PACS databases. Very simple archives can also be put together from a standard PACS. Both approaches can be used to enrich educational programs or to facilitate case conferences with clinical colleagues."PACS is undeniably the best investment we have had in our department for training. The space, the machine, the access to the archive ... The opportunities it gives to trainees are just unparalleled," said Dr. Andoni Toms, a radiologist at the Norfolk and Norwich University Hospital (NNUH) in Norwich, U.K.The NNUH is one of three sites in the U.K. that has a dedicated radiology training academy. The academies are equipped with a range of tools that are expected to make it possible to train more radiologists without increasing the number of trainers. PACS was an integral part of the setup from the outset.In Friday morning's session, Toms will outline the existing range of options for PACS-based radiology education. He plans to offer tips on how to archive cases and store data and to discuss the pros and cons of purchasing proprietary software as opposed to using a homegrown solution.His presentation will also cover some of the more sophisticated training tools being used at Norwich. One program allows residents to perform a virtual anatomical dissection and then correlate the findings with MRI or CT images from PACS. The results can be projected onto a screen and shared with the group.Residents can also use PACS for individual study. Anyone studying neuroradiology, for example, who has some free time can search and retrieve all the head CT cases reported in the past week or so and test their opinions against the archived reports."There is no way you could do that with films," Toms said. "The ability to pull up and compare sample cases very quickly and easily - you just can't do that with a hard-copy system."