World's first digital radiology department offers lessons

In 1992, the Danube Hospital at the Socio Medical Care Center, a 1300-bed facility in Vienna, Austria, implemented what is believed to be the world's first strictly digital radiology system.

Nine years later, Dr. Walter Hruby, chair of Danube's filmless radiology department and editor of a new PACS book (Digital (R)evolution in Radiology, Springer, 2001, ISBN 3-211-83410-9), reports that not only is digital radiology an excellent working clinical tool for improving healthcare, it also has the potential to become financially successful, since the focus shifts from saving film to increasing productivity and efficiency.

Characterizing his hospital's PACS as a synergistic triumph, Hruby told a November RSNA audience that the benefit of PACS exceeds the sum of its parts.

"Digital radiology allows the functional integration of physically separated systems, centralized archiving and image display, rapid access to images from multiple locations, and effective image communication," he said. "It is now possible to show the benefits that evolve from the implementation of these digital technologies."

Digital radiology's main advantage is the fast, reliable access it offers to all relevant medical information, which saves time, speeds up the report turnaround process, and results in better diagnosis, he said.

Faster access to images and the elimination of film searches have resulted in increased departmental efficiency.

"The fact that the increase of the number of patients and services in our department did not require an increase of staff shows that the stepwise implementation of newer technology resulted in an increase of efficiency," Hruby said.

Hruby's PACS has also contributed to lower length-of-stay and lower cost of radiology services. Compared with other Austrian hospitals, Danube's average hospitalization time is a full day less (7.1 to 8.0), and the average cost of radiology services is 16% lower.

Though per-study data volumes have consistently increased over the years, with higher resolution, thinner slices, and additional MR sequences, the modular design of Hruby's PACS allows components like the archive to be swapped without any major changes to the system structure. Danube's archive collected 6.5 million Mbytes of data from 140,000 imaging studies in 1999 alone.

Nevertheless, since no PACS is ever simply plug-and-play, Hruby advises selecting a vendor carefully.

"Over the last years, a rather frequent system upgrade proved to be not only necessary, but also cost- and efficiency-effective," he said. "The choice of a major vendor was an advantage, both in the development of new technology and in its service and maintenance."