Switzerland gets first filmless hospital

A 360-bed hospital in northwest Switzerland claims to be the country's first filmless healthcare institution. Doctors at the Kantonsspital Liestal, located 14 km from Basel, have abandoned all film and ceased printing images in favor of soft-copy viewing on diagnostic workstations, wall-mounted monitors, and desktop PCs.

The switch to filmless operations required considerable advance planning and hospital-wide support, according to Ferdinand Thanhofer, chief radiographer and PACS coordinator at the Kantonsspital Liestal. The radiology department had gradually replaced all imaging equipment with DICOM-compatible digital modalities in readiness for a PACS. Heads of all clinical departments were invited to attend a discussion regarding the proposed PACS purchase and to sign up to filmless operation at the same time.

"We told them 'We are not buying a PACS for the radiology department. The PACS is for the whole hospital,'" Thanhofer said.

The PACS hardware arrived during summer 2002, and system tests began that August. Diagnostic radiological workstations were arranged in a three-monitor setup, offering simultaneous viewing of RIS data and PACS images from past and previous exams. Web browser software was installed on PCs throughout the hospital, and flat-panel monitors mounted in the emergency department and operating theaters.

A few smaller departments hooked up to the network in October 2002, and then hospital-wide PACS became a reality on January 1, 2003. Doctors were initially offered a two to three-hour training session on the system, though the younger members of staff picked up the basics much more quickly, Thanhofer said.

The majority of clinical departments also adopted filmless workflow when the PACS went live. Only the orthopedists and surgeons insisted on retaining hard-copy images for a four-month trial period. They too switched to soft-copy in May 2003, having been impressed by the speed with which surgical images appeared on the wall-mounted screens, Thanhofer said.

"It takes just one or two minutes for images taken in the operating theater to be available on the monitors," he said. "This way, the orthopedic surgeons have better control of their work. More junior surgeons can also get advice from their department head, who can view the images in his or her office, while the operation is continuing."

The advantages of filmless workflow are also being appreciated throughout the Kantonsspital Liestal. Staff members no longer have to wait for hand-carried films or waste time seeking lost images, Thanhofer said.

"All the nurses love the radiology department," he said. "Before, the films were always in the wrong place. Now, the images are available everywhere in the hospital, and 10 people can look at the same pictures at the same time."