PACS workstations are dead. Long live 3D.

February 24, 2004

Three-D image management capability will be essential within two years and must be incorporated into PACS workstations, a leading radiologist told a HIMSS education session Monday.National statistics show that radiologists are reading more studies than

Three-D image management capability will be essential within two years and must be incorporated into PACS workstations, a leading radiologist told a HIMSS education session Monday.

National statistics show that radiologists are reading more studies than ever, a condition prompted by the output of new imaging technologies and exacerbated by chronic staffing shortages.

"The challenge is how to read more studies without sacrificing quality," said Dr. Eliot Siegel, chief of radiology at the VA Maryland Health Care System.

Since PACS has not been able to keep up with the storage requirements of thin-section scanner output, radiologists are now combining thin sections to speed up the interpretation process.

"The problem is we lose the diagnostic advantages of thin sections," Siegel said. "Even though we have multichannel scanners, radiologists are still constrained to view images on the axial plane like we used to with the old scanners, with relatively thick planar sections, negating added value."

One of the biggest challenges is trying to integrate 3D tools into existing PACS, Siegel said. PACS does not currently support 3D processing.

In one sense, PACS workstations resemble light boxes - they brings images up for review, but they don't allow the ability to reconstruct in different planes or do 3D, Siegel said. It's not practical for radiologists interpreting studies at a PACS workstation to slide over to a different, dedicated 3D multiplanar workstation.

Keeping up with current workflow demands will require integrating PACS and 3D, he said.

"We need to completely rethink PACS workstation design," he said. "Sitting with a mouse and clicking on icons and pull-down menus doesn't work anymore."

Siegel's premise was one part of the SCAR University road show that made a house call in Orlando Monday at the HIMSS meeting.

Radiologist Dr. Bruce Reiner, associate professor of radiology at the University of Maryland, Richard Morin, Ph.D., a physicist at Mayo Clinic, Jacksonville and chair of SCAR's TRIP (transforming the radiology interpretation process) Initiative, and George Bowers of Health Care Consultants in Baltimore appeared before the HIMSS session. They consoled healthcare professionals who are trying to understand the transformation of radiological interpretation.

"Technology is changing so rapidly it's now necessary to look at how radiologists do things," Bowers said.

At Mayo, in 1994, the typical cross-sectional imager would view about 1500 images/day, Morin said. When electronic imaging appeared, that increased in 2002 to some 16,000 images/day.

If image volume continues to increase at this rate, by 2006 the same imager will be expected to view 80,000 images/day - requiring 22.2 hours at one image per second, Morin said.

According to Reiner, there are three emerging technologies that could help alleviate the problem: computerized physician order entry, decision support tools such as CAD, and multimedia reporting.