Web-based image delivery system finds its way into OR

Once the radiology department becomes filmless, the next step is providing digital images to clinicians in departments throughout the hospital.

The operating room, however, continues to be problematic. Most institutions print film for the OR long after filmless imaging has taken root elsewhere in the enterprise. Space constraints present the primary difficulty in providing soft-copy images to OR suites.

Ohio State University Medical Center, which transfers PACS images to a Web server for distribution throughout the enterprise, has demonstrated one way of overcoming this obstacle with the OR. OSUMC initiated a pilot program installing dual flat-panel monitors in six of the institution's 26 operating rooms.

"Because of limited space in the OR, an additional computer was discouraged," said Dr. William F. Bennett, an assistant professor of radiology in OSU's College of Medicine and Public Health.

So Bennett mounted the central processing unit tower, keyboard, and mouse on the wall to conserve floor space and reduce interference with existing equipment. Images are displayed on two flat-panel monitors mounted above the towers. The monitors simulate traditional viewboxes used by surgeons while operating.

Bennett's OR system communicates with the hospital backbone by Ethernet connections. The displays are twin 19-inch active matrix LCD flat panels (1024 x 768 resolution) driven by Matrox G-450 dual-display graphics cards. They allow two or more images to be displayed at reasonable size.

After six months, both successes and failures have been noted. The distance between the operating table and the monitors requires the surgeon to walk away from the table to view the images, although this problem may be addressed by suspending the monitors from the ceiling nearer to the table. Another problem already fixed was the inability of orthopedic surgeons to use templates for orthopedic hardware.

Reaction from most of the surgeons has been positive, Bennett said. The most serious problem was the difficulty in displaying MRIs. OSUMC plans to develop protocols in which specific images are selected with thumbnails to reduce the number of images through which the surgeons must scroll.

The key to success of this configuration is acceptance by the surgeons. Training operating room personnel to use the system is critical to reduce the number of computer-related complaints, Bennett said.

"It is helpful if the surgeons are familiar with the system outside the OR, as in our case with the hospital-wide Web-based system," he said.