PACS simulator helps ready residents for rigors of call

Call preparation consists of lectures, case conferences, core rotations, independent reading, and review of teaching files. A simulator developed at the University of Pittsburgh Medical Center gives residents practice in reviewing and interpreting call-like cases independently, without placing patients at risk of misinterpretation.

“This approach is a step toward a competency-based practice of radiology,” said Dr. Alexander J. Towbin of the radiology department at UPMC.

The UPMC simulator was designed to be both DICOM- and Health Insurance Portability and Accountability Act (HIPAA)-compliant, to mimic or be integrated with the hospital PACS, and to function as a PACS (Acad Radiol 2007;14[10]:1271-1283).

Residents have unique private logins that allow them to track their performance. The simulator contains a variety of cases thought to be either typical of the cases seen at UPMC (post-transplant ultrasound), “can't miss” cases (pulmonary embolism, stroke), or uncommon cases that should not be missed (cardiac tamponade). The simulator could also help standardize resident education, Towbin said. Residents may not see a case of hepatic arterial stenosis on their ultrasound rotation or in a case conference, for example. But by using the simulator, each resident can interpret such a case and learn of the specific findings.

“Even though we use the simulator to help prepare residents for call, it has other potential applications, such as to gain continuing medical education credits, or competency for new modalities such as cardiac CT and to test oneself,” he said.

The simulator also addresses deficiencies in the Medical Imaging Resource Center initiative instituted by the RSNA to standardize the approach to digital teaching files. A major MIRC imperfection is the author inclusion of only one image or at most a few key images. The advantage is the radiologist is able to see key case findings rapidly.

Normally, radiologists use both pertinent positives and negatives from all of the images to help narrow their differential diagnosis to a more specific diagnosis, according to Towbin. The UPMC simulator includes the entire DICOM imaging data set.

“This is the most important aspect of the simulator because it allows the user to interpret the entire case in a manner identical to typical practice,” Towbin said. “Images can be manipulated as needed to come to a specific diagnosis.”