Workstation interface affects PACS acceptance

Since the workstation interface is the primary site of interaction between the radiologist and PACS, perhaps no factor is more important in radiologist acceptance.

A slow, cumbersome interface can cause frustration, require additional time, and increase labor costs of ancillary personnel.

"The interface is where the rubber meets the road," said Dr. M. Elon Gale, chief of radiology at the VA Boston Health Care System.

PACS can be more than just an archive or a method of displaying images. It can actually perform the functions of file room support, said Gale, who published a paper on the topic (An automated PACS workstation interface: a timesaving enhancement, AJR, 2000;174:33-36).

In order to increase acceptance among radiologists, the Boston VA, with the help of its PACS vendor (eMed Technologies) redesigned the workstation interface. The principal enhancement was a macro mechanism that reduced the number of image management mouse clicks.

"The interface that we use follows the KISS (keep it simple, stupid) principle," Gale said.

The original interface had been a typical display. Radiologists opened the worklist by clicking the appropriate desktop icon to select the patient's folder. After choosing the study series from current and/or prior examinations, as well as the destination display screen for each image set, the selected images would appear on the workstation screens.

Before radiologists could start interpretation, however, they had to click an icon to notify the server and other workstations that the study was opened for interpretation. After interpretation, the radiologists then had to mark the study as read by clicking another icon.

The Boston VA optimized its PACS operation by retooling the interface to include a small dialogue box called AutoRead, which enables users to perform multistep functions with a single click.

"AutoRead has a single click feature that allows radiologists to mark a case interpreted, bring up the next case, bring up old historicals - without having to go through worklist clicks and decision-making," Gale said.

Decision-making in terms of where to route images, and who gets to read what, is basically predefined in the algorithms used to set up the workstation and server, he said.

AutoRead closely emulates the operation of a prehung lightbox, according to Gale. Instead of having to go through a series of pull-down menus - selecting an item, loading, going back and repeating the process - the radiologist uses the streamlined interface to have images loaded so they can be read with a minimum amount of interaction, thereby enhancing user satisfaction and acceptance.