Radiological reporting system developed with FileMaker-Pro: cooperation with HIS, RIS, and PACS

This article briefly describes our original radiological reporting system. This system was developed with the widely used database software FileMakerPro (ver 5.5). The reporting system can obtain information about patients and examinations from a radiology information system(RIS) by the Open DataBase Connectivity(ODBC) technique. By clicking the button on the reporting system, the corresponding DICOM images can be displayed on a picture archiving and communication system(PACS) workstation monitor. Reference images in JPEG format can be easily moved from PACS to the reporting system. Reports produced by the reporting system are distributed to the hospital information system(HIS) in Portable Document Format(PDF), through another web server. By utilizing the capacity of FileMakerPro, the human-machine interface of the system has been able to be improved easily. In addition, cooperation with HIS, RIS, and PACS could be constructed. Therefore, this original system would contribute to increasing the efficiency of radiological diagnosis.     

HIS/RIS/PACS integration: getting to the gold standard

The technology for acquiring, storing, retrieving, displaying, and distributing images has advanced dramatically in recent years. The push is toward enterprise-wide image management solutions, where digital images from radiology, cardiology, and other "ologies" are seamlessly linked with information from clinical information systems and other databases, and they are accessed seamlessly from a single point of end-user interaction. The "gold standard" of system integration would provide the platform for improved workflow, patient throughput and patient safety, as well as decreased cost. Unfortunately, the gold standard remains elusive in most healthcare environments, even those with new systems. One of the earliest issues that plagued the progress of hospital information system/radiology information systems/picture archiving and communication systems (HIS/RIS/PACS) integration was a matter of language between Health Level-7 (HL7) and DICOM. This barrier was solved by the broker--a software and hardware device that accepts HL7 messages from the RIS then translates, or maps, the data to produce DICOM messages for transmission to the PACS. Technologist workflow requires patient and exam information from the RIS to flow to the modality. The broker provides support for this by taking advantage of the DICOM Modality Worklist (DMWL). Two primary problems are inherent in most brokered configurations. Workflow is driven by paper, and RIS information flows in 1 direction only, which leads to duplicative databases. Overcoming the limitations of HIS/RIS/PACS connectivity requires industry accepted communication protocols/rules. To facilitate this, the Integrating the Health Care Enterprise (IHE) initiative was developed. The goal of IHE is to provide end-users improved access to critical patient and clinical information across all systems within the healthcare delivery network. While the IHE initiative began to facilitate more efficient, predictable, and functional integration between disparate systems, vendors still had technology hurdles to overcome. System integration continues to be significantly hampered, not by technology limitations, but instead by business and political issues. In response to these challenges, several vendors have begun to offer consolidated RIS/PACS solutions and/or HIS/RIS/PACS solutions. Consequently, the prospect of the gold standard appears to be on the horizon. Single vendor consolidated systems are not, however, feasible for deployment in many healthcare organizations, and they are not necessarily the panacea.     

Integration of radiology and hospital information systems (RIS, HIS) with PACS: requirements of the radiologist.

PACS development has now reached a stage where it can clearly be stated that the technology for storage, networking and display in a fully digital environment is available. This is reflected by an already large and rapidly increasing number of PACS installations in USA, Western Europe and Japan. Such installations consist of a great variety of information systems, more or less interconnected, like PACS, HIS, RIS and other departmental systems, differing in both hardware and software. Various data - even if they only concern one person - are stored in different systems distributed in the hospital. The integration of all digital systems into a functional unit is determined by the radiologist's need of quick access to all relevant information regardless where it is stored. The interconnection and functional integration of all digital systems in the hospital determine the clinical benefits of PACS. This paper (1) describes the radiologist's requirements concerning this integration, and (2) presents some realistic solutions such as the Siemens ISI (Information System Interface), and a mobile viewing station for the wards (visitBox).     

Visibility of calcium on MR and CT: can MR show calcium that CT cannot?

PURPOSETo test the hypothesis that calcium can be visible on MR images without being visible on CT.METHODSFive different calcium salts ranging in concentration from 0 to 0.45 g/mL were suspended in 2% agarose gel and studied using T2-weighted MR, T1-weighted MR, and CT. MR signal intensity, CT attenuation, and image noise were measured. Relative visibility was determined from these measurements.RESULTSCT was shown to be more than 10 times as sensitive as T2-weighted MR or T1-weighted MR for the detection of calcium.CONCLUSIONMR cannot show calcium that is occult on CT.     

Optimizing analysis, visualization, and navigation of large image data sets: one 5000-section CT scan can ruin your whole day

The technology revolution in image acquisition, instrumentation, and methods has resulted in vast data sets that far outstrip the human observers' ability to view, digest, and interpret modern medical images by using traditional methods. This may require a paradigm shift in the radiologic interpretation process. As human observers, radiologists must search for, detect, and interpret targets. Potential interventions should be based on an understanding of human perceptual and attentional abilities and limitations. New technologies and tools already in use in other fields can be adapted to the health care environment to improve medical image analysis, visualization, and navigation through large data sets. This historical psychophysical and technical review touches on a broad range of disciplines but focuses mainly on the analysis, visualization, and navigation of image data performed during the interpretive process. Advanced postprocessing, including three-dimensional image display, multimodality image fusion, quantitative measures, and incorporation of innovative human-machine interfaces, will likely be the future. Successful new paradigms will integrate image and nonimage data, incorporate workflow considerations, and be informed by evidence-based practices. This overview is meant to heighten the awareness of the complexities and limitations of how radiologists interact with images, particularly the large image sets generated today. Also addressed is how human-machine interface and informatics technologies could combine to transform the interpretation process in the future to achieve safer and better quality care for patients and a more efficient and effective work environment for radiologists. Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11091276/-/DC1.     

Neuroimaging in non-accidental head injury: if, when, why and how

Non-accidental head injury (NAHI) in infants is an important but difficult topic. To miss or misdiagnose NAHI potentially has important consequences. The evidence base upon which to base decisions is limited but growing. This article aims to summarise current literature and thinking in this difficult area.     

Motor imagery: if you can't do it,you won't think it

Since long, motor imagery has been recognized as a method for studying motor representations. In the last few years, important advances regarding the use of motor imagery have been made. In particular, issues concerning the functional equivalence between imagery and action have been addressed, and how equivalence affects the use of imagery to study motor representations. In this paper, we review recent findings in order to highlight the current state of knowledge about motor imagery and its relation to motor action. Three topics are discussed: (i) the imagery perspective, (ii) task complexity, and (iii) the importance of physical experience. It is shown how theses factors are closely related and how previous studies may have underestimated to what extent these factors affect the interpretation of results. Practical implications for imagery interventions are considered. It is concluded that if you cannot perform an action physically, you cannot imagine it in a way that is necessary for a high degree of functional equivalence.     

Visit, revamp, and revitalize your business plan: Part 2

The diagnostic imaging department strives for the highest quality outcomes in imaging quality, in diagnostic reporting, and in providing a caring patient experience while also satisfying the needs of referring physicians. Understand how tools such as process mapping and concepts such as Six Sigma and Lean Six Sigma can be used to facilitate quality improvements and team building, resulting in staff led process improvement initiatives. Discover how to integrate a continuous staff management cycle to implement process improvements,capture the promised performance improvements, and achieve a culture change away from the "way it has always been done".     

Revisit, revamp, and revitalize your business plan: part 3

Managing with financial statements is discussed, including fundamental definitions and conventions related to this process such as an income statement and a balance sheet. Balanced scorecards and dashboards can be used to measure progress and to communicate achievements. Steps taken to defining data using KPIs, sourcing data, and structuring the scorecard are outlined. A core part of managing with financial statements is understanding how to drive the business and engage the staff using balanced scorecards.     

Rationing and health care reform: not a question of if, but when

Evidence-based medicine and rationing have been increasingly discussed in the context of health care reform recently. Both concepts are frequently the source of heated debate, leading to polarization of different health care practitioners and public parties. In some public arenas, rationing has become a dirty word. The term evidence-based medicine is perceived as being used as a "cover" for rationing. However, rationing is widespread, whether explicit or implicit, and exists within health care. Evidence-based medicine (or imaging) and rationing overlap considerably, and it looks like both are here to stay, given the current state of developed-world health care systems and the proposed reforms. The authors review these entities and argue that evidence-based medicine (or imaging) is one form of health care rationing. Rationing already occurs, and it is important that it be done in a way that provides the greater good for the majority. This article reviews the history of rationing and evidence-based medicine, the reasons evidence-based medicine and rationing are necessary, examples of rationing that already exist (economic), proposed forms of rationing (age based), the need for physicians (radiologists) to be at the forefront of any rationing efforts, and the basis (cost and comparative effectiveness research and evidence-based medicine) and principles of physician decision rationing (optimum outcome-based rationing) in the context of proposed health care reforms.     

Revisit, revamp and revitalize your business plan: Part 4

A best practice for all imaging leaders working on a management development program should be to invest enough time to complete a detailed planthatsetsgoals, objectives, step targets, landmarks, and a timetable for their achievements. Keys to success for a management development program include no surprises, active participation, and preparation by both the facilitator and the managers involved. A successful management team will have trained staff and lean processes mapped and documented, as well as be comfortable in a coaching, delegating, and consensus management style.     

Revisit, revamp and revitalize your business plan: part 1

The diagnostic imaging department has a pivotal role within the hospital and its pillar services. Understanding this role and also understanding the population served helps to further define and justify the "what" and "why" of the business plan. Understand the market capacity and how market needs can be satisfied. Develop a "go-to-market" strategy, which is the part of the business plan where it is decided how to share that message with the market. In the aftermath of healthcare reform and the economic recession, investing in new imaging technology has never been under greater scrutiny. A three step process for developing support is provided.