PACS usage leads to increased radiologist specialization

PACS is responsible for the trend toward increased radiologist specialization, according to a new study from Sweden. The positive effect of PACS on radiology workflow has been well documented, but this paper (J Digit Imaging 2006 Dec 27) is among the first to look at the impact of PACS on radiology work practice.

"This study is unique in both timing and scope," said Dr. Kent Fridell, of the clinical science, intervention, and technology department at the Karolinska Institutet in Huddinge. "When analog films are replaced with digital images viewed on a computer, radiologists' diagnostic practice also changes."

In the study, work practice is defined as professional role, diagnostic practice, and technology in use.

Fridell found that after PACS is introduced radiologists tend to migrate from a position of individual professional expertise to that of an actor in a network.

"As the flow of images takes new routes, new relationships are created between actors in the network," he said.

Before PACS, for instance, clinicians conferred with radiologists in clinical meetings. Radiologists are the professional experts. After PACS, however, as clinicians gain access to images, their ability to read images improves, tending to transform the role of the radiologist to that of consultant. Work practice changes from individual to teamwork.

Likewise with diagnostic practice.

With the introduction of digital imaging, the art of reading x-ray films takes on a more technical cloak.

"Suddenly, radiologists' training shifts to greater exposure to technology courses rather than interpretive diagnostic techniques," Fridell said.

Initially, this increasing technical focus creates insecurity because radiologists worry they will become less skilled readers, Fridell said. However, the technology also provides superior ability to illustrate anatomic details using new digital techniques such as 3D reconstruction, opening the door to specialization.

A radiologist can, for example, illustrate the vestibulocochlear nerve for the neurosurgeon in its full length.

"In this way, the radiologist has become a new and important advisor in discussions with the neurosurgeon," Fridell said.

This translation in work practice makes work more specialized and creates new subspecialization opportunities, he said.