Radiology capital asset management

Radiology administrators are expected not only to take on the ultimate accountability for meeting the needs and challenges of present day-to-day operations, but also to plan for the future. Computer Aided Facility Management (CAFM), as a tool, enables radiology managers to obtain up-to-date data to manage their services. Using Autocad on a unix-based minicomputer as the graphical base generator and integrating information from a MUMPS-based minicomputer, the CAFM process can define areas to be studied for productivity and life cycle costs. From an analysis of radiology service, management was able to make solid judgement calls for equipment replacement and facility project renovation to effectively manage radiology resources.     

Radiology engineering at the Albany Medical Center: five year's experience.

A Radiology Engineering program was initiated in the Department of Radiology at the Albany Medical Center, Albany, New York, in the summer of 1981. The program has been successful in attaining its goals of containing costs, providing minimal equipment downtime, and giving high-quality service. This report presents the job functions and duties that the department found necessary to provide this level of service. In addition, two techniques for managing malfunction and service reports, techniques for scheduling PM's and service calls, and software management tools that assist the department with service are described.     

Using Standardized Lexicons for Report Template Validation with LexMap,a Web-based Application

An enormous amount of data exists in unstructured diagnostic and interventional radiology reports. Free text or non-standardized terminologies limit the ability to parse, extract, and analyze these report data elements. Medical lexicons and ontologies contain standardized terms for relevant concepts including disease entities, radiographic technique, and findings. The use of standardized terms offers the potential to improve reporting consistency and facilitate computer analysis. The purpose of this project was to implement an interface to aid in the creation of standards-compliant reporting templates for use in interventional radiology. Non-standardized procedure report text was analyzed and referenced to RadLex, SNOMED-CT, and LOINC. Using JavaScript, a web application was developed which determined whether exact terms or synonyms in reports existed within these three reference resources. The NCBO BioPortal Annotator web service was used to map terms, and output from this application was used to create an interactive annotated version of the original report. The application was successfully used to analyze and modify five distinct reports for the Society of Interventional Radiology’s standardized reporting project.     

An Audio/Video Reporting Workflow to Supplement Standardized Radiology Reports

Radiology studies are inherently visual and the information contained within is best conveyed by visual methodology. Advanced reporting software allows the incorporation of annotated key images into text reports, but such features may be less effective compared with in-person consultations. The use of web technology and screen capture software to create retrievable on-demand audio/visual reports has not yet been investigated. This approach may preempt potential curbside consultations while providing referring clinicians with a more engaged imaging service. In this work, we develop and evaluate a video reporting tool that utilizes modern screen capture software and web technology. We hypothesize that referring clinicians would find that recorded on-demand video reports add value to clinical practice, education, and that such technology would be welcome in future practice. A total of 45 case videos were prepared by radiologists for 14 attending and 15 trainee physicians from emergency and internal medicine specialties. Positive survey feedback from referring clinicians about the video reporting system was statistically significant in all areas measured, including video quality, clinical helpfulness, and willingness to use such technology in the future. Trainees unanimously found educational value in video reporting. These results suggest the potential for video technology to re-establish the radiologist’s role as a pivotal member of patient care and integral clinical educator. Future work is needed to streamline these methods in order to minimize work redundancy with traditional text reporting. Additionally, integration with an existing PACS and dictation system will be essential to ensuring ease of use and widespread adoption.     

Development and implementation of the Veterans Administration’s multihospital radiology information system

Unknown to most radiology professionals, the Veterans Administration (VA) is implementing an automated radiology information system as an integrated component of its Decentralized Hospital Computer Program. The basic design has been evaluated and refined over the past 5 years. It is now becoming available in all 172 VA medical facilities. Radiology services are provided in a complex management and fiscal environment. The primary purpose of the information system is to improve the efficient processing, performance, and reporting of requests for radiologic consultations and procedures. The automatic capturing of demographic and medical statistics will provide local and national managers more complete data with which to plan future financial, equipment, and personnel requirements. The VA radiology module has the potential to influence the shape of all future systems, commercial and public. This report describes the development of this radiology information system, its current status, and its potential impact on the largest health care system in the country. The module serves as an example of what can or should be expected from the radiology portion of a comprehensive medical information management system.     

The process of converting to a near filmless operation at the University of Utah,Department of Radiology

The Department of Radiology at the University of Utah Health Sciences Center has made the transition from a traditional film-based department to a near filmless operation. The University of Utah is a large teaching hospital and the transition from film in an educational facility will be discussed. This transition has had its difficulties and its success is dependent on the support of departmental leadership and hospital administration. We have had more than 100 years of experience with film, and current procedures were efficient given the limitations of the medium. While motivated by the traditional reasons for moving to a picture archival and communications system (PACS), such as film savings, unavailable films, and faster reports, we found the intangibles to be the larger issue, as well as a source for the largest benefits. This report will discuss the implementation process and the affect it had on all areas of the hospital, including its impact on hospital physicians, radiologists, file room personnel, and technologists. Procedure changes to the flow of patients, film, and electronic images will also be described. This process cannot be viewed as a onetime change, but must be viewed as a continuous process as areas of improvement are identified and new and improved technologies are developed.     

Neptune: an environment for the delivery of genomic medicine

PurposeGenomic medicine holds great promise for improving health care, but integrating searchable and actionable genetic data into electronic health records (EHRs) remains a challenge. Here we describe Neptune, a system for managing the interaction between a clinical laboratory and an EHR system during the clinical reporting process.MethodsWe developed Neptune and applied it to two clinical sequencing projects that required report customization, variant reanalysis, and EHR integration.ResultsNeptune has been applied for the generation and delivery of over 15,000 clinical genomic reports. This work spans two clinical tests based on targeted gene panels that contain 68 and 153 genes respectively. These projects demanded customizable clinical reports that contained a variety of genetic data types including single-nucleotide variants (SNVs), copy-number variants (CNVs), pharmacogenomics, and polygenic risk scores. Two variant reanalysis activities were also supported, highlighting this important workflow.ConclusionMethods are needed for delivering structured genetic data to EHRs. This need extends beyond developing data formats to providing infrastructure that manages the reporting process itself. Neptune was successfully applied on two high-throughput clinical sequencing projects to build and deliver clinical reports to EHR systems. The software is open source and available at https://gitlab.com/bcm-hgsc/neptune.     

Surgical pathology accessioning and management on a multiuser hard disk microcomputer system

We have developed an inexpensive, microcomputer-based, multiuser hard disk system for surgical pathology that uses a commercially available word processor and data base manager, linked together by several BASIC programs written by us. System functions include keyboard input of patient demographic data and specimen information, word processing with the generation of preliminary and final surgical reports, on-line access to the surgical pathology data base, generation of daily secretarial and histology log sheets, and computer-assisted SNOMED coding. Successful implementation of this system has produced greater efficiency and productivity in the surgical pathology department at a reasonable cost.     

A computer system for biomedical equipment maintenance reporting

Biomedical equipment maintenance and repair activities involve an increasing amount of paperwork and report generation. A computer system is described that collects the necessary data on-line for accuracy and efficiency. The system can generate various reports relating to repair history, spare parts usage and preventive maintenance scheduling. It is implemented on a time-sharing minicomputer, and can reduce substantially the time spent by biomedical engineers in documenting their activities.     

Developing an Automated Database for Monitoring Ultrasound- and Computed Tomography-Guided Procedure Complications and Diagnostic Yield

Monitoring complications and diagnostic yield for image-guided procedures is an important component of maintaining high quality patient care promoted by professional societies in radiology and accreditation organizations such as the American College of Radiology (ACR) and Joint Commission. These outcome metrics can be used as part of a comprehensive quality assurance/quality improvement program to reduce variation in clinical practice, provide opportunities to engage in practice quality improvement, and contribute to developing national benchmarks and standards. The purpose of this article is to describe the development and successful implementation of an automated web-based software application to monitor procedural outcomes for US- and CT-guided procedures in an academic radiology department. The open source tools PHP: Hypertext Preprocessor (PHP) and MySQL were used to extract relevant procedural information from the Radiology Information System (RIS), auto-populate the procedure log database, and develop a user interface that generates real-time reports of complication rates and diagnostic yield by site and by operator. Utilizing structured radiology report templates resulted in significantly improved accuracy of information auto-populated from radiology reports, as well as greater compliance with manual data entry. An automated web-based procedure log database is an effective tool to reliably track complication rates and diagnostic yield for US- and CT-guided procedures performed in a radiology department.     

Quantitative Computed Tomography (QCT) as a Radiology Reporting Tool by Using Optical Character Recognition (OCR) and Macro Program

The objectives are (1) to introduce a new concept of making a quantitative computed tomography (QCT) reporting system by using optical character recognition (OCR) and macro program and (2) to illustrate the practical usages of the QCT reporting system in radiology reading environment. This reporting system was created as a development tool by using an open-source OCR software and an open-source macro program. The main module was designed for OCR to report QCT images in radiology reading process. The principal processes are as follows: (1) to save a QCT report as a graphic file, (2) to recognize the characters from an image as a text, (3) to extract the T scores from the text, (4) to perform error correction, (5) to reformat the values into QCT radiology reporting template, and (6) to paste the reports into the electronic medical record (EMR) or picture archiving and communicating system (PACS). The accuracy test of OCR was performed on randomly selected QCTs. QCT as a radiology reporting tool successfully acted as OCR of QCT. The diagnosis of normal, osteopenia, or osteoporosis is also determined. Error correction of OCR is done with AutoHotkey-coded module. The results of T scores of femoral neck and lumbar vertebrae had an accuracy of 100 and 95.4 %, respectively. A convenient QCT reporting system could be established by utilizing open-source OCR software and open-source macro program. This method can be easily adapted for other QCT applications and PACS/EMR.     

Progress report on the Bethesda System

The 2001 Bethesda System is a uniform system of terminology for reporting results of pap smears. It is acknowledged by most cytopathologists worldwide as a standard for cervical cytology reports. In France, several national surveys have confirmed its current utilization. However, more specific analysis have shown that the Bethesda System may be routinely modified by individual laboratories or even individual cytopathologist working within the same department. The aim of this progress report was to emphasize the importance of fully understanding the Bethesda System and applying it in a rigorous and standardized way.     

Microcomputer assistance in clinical monitoring of intracranial pressure

Intracranial-pressure (i.c.p.) monitoring has been shown to provide valuable information in the care of patients suffering acute head injury. Continuous recording of i.c.p. is essential due to the rapidly changing characteristics that are encountered, but this produces an overwhelming quantity of data when performed for several days. Methods of data reduction are therefore desirable to aid identification of significant features, and may even reveal aspects of the i.c.p. which are not apparent from the raw data. This paper describes a bedside microcomputer-based monitoring system which automatically acquires i.c.p. data, and periodically compresses them into histograms of pressure. The histograms are displayed to the nursing staff. The microcomputer forms one limb of a distributed computer network which centralises major computing resources on a minicomputer. Both primary and processed i.c.p. data are transmitted to the minicomputer for storage and offline investigation.     

A synoptic reporting system for peripheral blood smear interpretation

Web-based synoptic reporting systems have been shown to improve efficiency, reduce turnaround time, and decrease reporting errors in reports of surgical pathology specimens and hematologic neoplasms and bone marrow. No such system has been previously described for the reporting of peripheral blood smears. We developed a Web-based synoptic reporting system composed of a knowledge base encompassing 150 peripheral blood smear report templates covering a wide range of findings. This system was used at our institution, The University of Texas Medical School at Houston, by pathology residents under the supervision of an attending pathologist to generate peripheral blood smear reports. This system was found to produce a significant reduction in typographic errors with decreased turnaround time and improved accuracy. This synoptic reporting system can help practicing pathologists and pathology trainees to draft a complete and concise report.     

Digital image display station performance requirements based on physician experience with a prototype system

The authors report on observations of and interviews with physicians using a prototype digital image display and reporting station. While the users generally agree that image quality is clinically satisfactory, they are unanimous in their opinion that improvements in the man-machine interface are required before case review by this mechanism is clinically acceptable in a production environment. A model image and information user interface is presented. It was developed in answer to the needs of radiologists and referring physicians operating in the imaging department of a community acute-care facility. In such an environment images and related information must be communicated quickly and often simultaneously to different parts of the department and hospital. The user interface with the management system and the management system itself must address the varied functions and the needs of both the medical and clerical staff. Image enhancement processes, for example, must be restricted to those that quickly provide significantly more perceivable diagnostic information. Little-used processes that may occupy significant portions of the display and the console's computing power must be trimmed or eliminated.     

The advantage of using a synoptic pathology report format for cutaneous melanoma

Aims:  Although the synoptic format is being increasingly used for primary cutaneous melanoma pathology reporting, no study assessing its value has yet been reported in the literature. The aim was to determine whether the use of synoptic reports increases the frequency with which pathological features that may influence prognosis and guide management are documented.
Methods and results:  Melanoma pathology reports ( n  = 1692) were evaluated; 904 were in a synoptic format [671 Sydney Melanoma Unit (SMU) reports and 233 non-SMU reports] and 788 were non-synoptic (184 SMU reports and 604 non-SMU reports). Reports ( n  = 1354) from 677 patients who had both a SMU report and a non-SMU report were compared. Almost all features were reported more frequently in synoptic than in non-synoptic reports ( P  < 0.001). No significant differences were found in the frequency of reporting the main pathological features between SMU and non-SMU synoptic reports. Synoptic reports were more frequently used by SMU (78%) than by non-SMU pathologists (28%).
Conclusions:  This is the first study to provide objective evidence that synoptic pathology reports for melanoma are more complete than non-synoptic reports (regardless of whether the reports are generated within or outside a specialist melanoma centre). All synoptic reports should include the facility for free text, be tailored to individual institutional requirements and be updated regularly to be of maximal value.     

Computer printing and filing of microbiology reports. 2. Evaluation and comparison with a manual system, and comparison of two manual systems.

A manual system of microbiology reporting with a National Cash Register (NCR) form with printed names of bacteria and antiboitics required less time to compose reports than a previous manual system that involved rubber stamps and handwriting on plain report sheets. The NCR report cost 10-28 pence and, compared with a computer system, it had the advantages of simplicity and familarity, and reports were not delayed by machine breakdown, operator error, or data being incorrectly submitted. A computer reporting system for microbiology resulted in more accurate reports costing 17-97 pence each, faster and more accurate filing and recall of reports, and a greater range of analyses of reports that was valued particularly by the control-of-infection staff. Composition of computer-readable reports by technicians on Port-a-punch cards took longer than composing NCR reports. Enquiries for past results were more quickly answered from computer printouts of reports and a day book in alphabetical order.