Radiologists' productivity in the interpretation of CT scans: a comparison of PACS with conventional film

OBJECTIVE: We compared radiologists' times in the interpretation of CT using hardcopy films with the interpretation using a soft-copy picture archiving and communication system (PACS) computer workstation. MATERIALS AND METHODS: One hundred CT examinations were selected at random and reviewed by four board-certified radiologists experienced in soft-copy interpretation. We performed time-motion analysis to determine the total time required to display, interpret, and dictate the individual findings of CT using conventional hard-copy interpretation on a viewbox and soft-copy interpretation, using a four-monitor high-resolution (2048 x 1536 pixel) workstation. RESULTS: Time-motion analysis showed a reduction of 16.2% in the overall time required for soft-copy interpretation of CT compared with that of film. Time savings with soft-copy interpretation were observed for all four participating radiologists. The benefit of soft-copy interpretation was increased for examinations in which there were comparison studies. CONCLUSION: We found that soft-copy interpretation of CT using a PACS workstation requires less time than interpretation using conventional film hung on a viewbox. The transition to filmless imaging has the potential to improve radiologists' productivity and report-turnaround time.     

Picture archiving and communication systems lead to sustained improvements in reporting times and productivity: results of a 5-year audit

AIM: To evaluate the impact of picture archiving and communications systems (PACS) on reporting times and productivity in a large teaching hospital. MATERIALS AND METHODS: Reporting time, defined as the time taken from patient registration to report availability, and productivity, defined as the number of reports issued per whole time equivalent (WTE) radiologist per month, were studied for 2 years pre- and 3 years post-PACS installation. Mean reporting time was calculated for plain radiographs and specialist radiology techniques [computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and nuclear medicine]. Productivity, total department workload, and unreported film rates were also assessed. Pre- and post-PACS findings were compared. RESULTS: Between 2002-2006 the number of radiological patient episodes increased by 30% from 11,531/month to 15,057/month. This was accompanied by a smaller increase in WTE reporting radiologists, from 32 to 37 (15%). Mean reporting times have improved substantially post-PACS, plain radiograph reporting time decreased by 26% (from 6.8 to 5 days; p=0.002) and specialty modalities by 24% (4.1 to 3.1 days; p<0.001). Radiologist productivity has increased by 18% (337 films to 407 films/WTE radiologist/month). Unreported films have decreased from 5 to 4% for plain radiographs and are steady for specialty modalities (< 1%). In most areas improvements have been sustained over a 3-year period. CONCLUSION: Since the introduction of PACS, reporting times have decreased by 25% and the productivity improved by 18%. Sustained improvements are felt to reflect the efficiencies and cultural change that accompanied the introduction of PACS and digital dictation.     

The iPad as a mobile device for CT display and interpretation: diagnostic accuracy for identification of pulmonary embolism

Recent software developments enable interactive, real-time axial, 2D and 3D CT display on an iPad by cloud computing from a server for remote rendering. The purpose of this study was to compare radiologists' interpretative performance on the iPad to interpretation on the conventional picture archive and communication system (PACS). Fifty de-identified contrast-enhanced CT exams performed for suspected pulmonary embolism were compiled as an educational tool to prepare our residents for night call. Two junior radiology attendings blindly interpreted the cases twice, one reader used the PACS first, and the other interpreted on the iPad first. After an interval of at least 2 weeks, the cases were reinterpreted in different order using the other display technique. Sensitivity, specificity, and accuracy for identification of pulmonary embolism were compared for each interpretation method. Pulmonary embolism was present in 25 patients, ranging from main pulmonary artery to subsegmental thrombi. Both readers interpreted 98 % of cases correctly regardless of display platform. There was no significant difference in sensitivity (98 vs 100 %, p?=?1.0), specificity (98 vs 96 %, p?=?1.0), or accuracy (98 vs 98 %, p?=?1.0) for interpretation with the iPad vs the PACS, respectively. CT interpretation on an iPad enabled accurate identification of pulmonary embolism, equivalent to display on the PACS. This mobile device has the potential to expand radiologists' availability for consultation and expedite emergency patient management.     

PACS--clinical experience at UCLA

Implementation of picture archiving communication systems (PACS) at UCLA began with the evaluation of the systems in Pediatric Radiology, one of the 11 sections of the Department and the Coronary Care Unit, one of the 14 ICU's in the Hospital. We have now completed PACS development for all CT's and MR's which allows communication between a newly developed outpatient facility, the hospital, and the remote research facility in addition to Pediatric Radiology and the Coronary Care Unit. The following are some of the advantages of PACS from a clinical standpoint: (a) Conferences with clinicians have been more effective by spending more time on each case, but less total time for each conference; (b) Clinicians are satisfied with PACS at the remote site, but it is clear that the radiologists' interpretation must accompany the images; (c) PACS allows for the development of interactive teaching of the students; (d) PACS allows for a new method of radiology practice by analyzing the image and providing a more comprehensive, quantitative consultation, otherwise not possible with analog systems.     

Factors influencing the success of academic radiologists in publishing research

To guide changes that might improve radiologists' research productivity, we surveyed 1400 members of the Association of University Radiologists. We evaluated the impact of influences related to background, education, training, attitudes, and practice environment on 558 respondents' frequency of research publication. Attending medical school, obtaining radiology training, and practicing at an institution among the 20 with the highest amount of research funding was associated with the highest research productivity in academic practice. Taking a radiology research fellowship, regularly attending research seminars, and association with a research mentor during training were also associated with higher career productivity. Virtually all aspects of the academic practice milieu, and particularly having time set aside for research, were significant influences on radiologists' frequency of publication. Men published research more frequently than women. This phenomenon appears related to women being afforded fewer research experiences during radiology training and a greater concern on the part of women about obstacles that hinder their doing research. These data might be employed to guide changes that would improve the selection and nurturing of individuals likely to be productive in research.     

Evaluation of radiological workstations and web-browser-based image distribution clients for a PACS project in hands-on workshops

The methodology and outcome of a hands-on workshop for the evaluation of PACS (picture archiving and communication system) software for a multihospital PACS project are described. The following radiological workstations and web-browser-based image distribution software clients were evaluated as part of a multistep evaluation of PACS vendors in March 2001: Impax DS 3000 V 4.1/Impax Web1000 (Agfa-Gevaert, Mortsel, Belgium); PathSpeed V 8.0/PathSpeed Web (GE Medical Systems, Milwaukee, Wis., USA); ID Report/ID Web (Image Devices, Idstein, Germany); EasyVision DX/EasyWeb (Philips Medical Systems, Eindhoven, Netherlands); and MagicView 1000 VB33a/MagicWeb (Siemens Medical Systems, Erlangen, Germany). A set of anonymized DICOM test data was provided to enable direct image comparison. Radiologists (n=44) evaluated the radiological workstations and nonradiologists (n=53) evaluated the image distribution software clients using different questionnaires. One vendor was not able to import the provided DICOM data set. Another vendor had problems in displaying imported cross-sectional studies in the correct stack order. Three vendors (Agfa-Gevaert, GE, Philips) presented server-client solutions with web access. Two (Siemens, Image Devices) presented stand-alone solutions. The highest scores in the class of radiological workstations were achieved by ID Report from Image Devices (p<0.005). In the class of image distribution clients, the differences were statistically not significant. Questionnaire-based evaluation was shown to be useful for guaranteeing systematic assessment. The workshop was a great success in raising interest in the PACS project in a large group of future clinical users. The methodology used in the present study may be useful for other hospitals evaluating PACS.     

Accuracy of interpretation of CT scans: comparing PACS monitor displays and hard-copy images

OBJECTIVE: The purpose of this study was to determine the relative diagnostic accuracy of radiologists in the interpretation of CT scans using a computer workstation in comparison with using film. MATERIALS AND METHODS: Four board-certified radiologists with extensive soft-copy experience interpreted 117 CT scans in four anatomic regions using films displayed on an alternator and images displayed on a four-monitor workstation. The radiologists were asked to interpret the scans in their usual fashion and were aware that both the time required to review the study and the accuracy of the reports were being assessed. The radiologists' diagnostic impressions were compared with those of a consensus panel and scored for accuracy. RESULTS: Soft-copy interpretation using computer workstations was found to produce statistically significant improvement in combined measurements of sensitivity, specificity, and overall accuracy for chest, brain, and chest-abdominal CT scans compared with film interpretation. CONCLUSION: PACS (picture archiving and communication system) offers radiologists the potential for improved accuracy in CT interpretation compared with traditional film-based interpretation.     

Resident vs. attending interpretation of on-call studies: clinical impact

Purpose: This study was performed to determine whether significant changes to patient treatment plan or outcome result from discrepancies between on-call radiology residents and follow-up attending radiologists in their interpretation of examinations. Methods: For 70 days we recorded on-call radiology residents' readings of all computed tomography and ultrasound examinations performed in our institution and the follow-up attending radiologists' readings of these same examinations. A chart review was performed to determine whether interpretation discrepancies changed the treatment plan and clinical outcome. Results: Eight-hundred thirty-four examinations met the study guidelines. The overall discrepancy rate was 5.16 %. Of these discrepancies, 6.98 % affected the treatment plan (0.36 % of all 834 studies) and none affected the clinical outcome. Conclusion: Where there is a discrepancy between interpretation of computed tomography and ultrasound after hours by on-call radiology residents and follow-up readings by attending radiologists, this discrepancy has no significant effect on the immediate or long-term care of patients.     

Increasing radiographer productivity by an incentive point system

Because of a very low technologist productivity in their Radiology Department, the authors describe a Productive Point System they developed and implemented to solve this personnel problem. After establishing the average time required to perform all exams, point credits (one point for every ten minutes utilized) were assigned to each exam performed, thereby determining an index of production. A Productive Index of 80% was considered realistic and was the equivalent of 192 points for a 40-hour work week. From 1975 to 1978 personal productivity increased from 79% to 113%. This resulted in an average yearly fiscal savings of over $20,000.00 for this three-year period. There was also a significant improvement in exam efficiency and quality, job attitude, personnel morale, and public relations. This program was highly successful because technologist acceptance and cooperation was complete, and this occurred mainly because the system supports the normal occupational goals and expectations of technologists.     

Detection rates in pediatric diagnostic imaging: A picture archive and communication system compared with a web-based imaging system.

OBJECTIVE: This prospective study assesses whether there are differences in accuracy of interpretation of diagnostic images among users of a picture archive and communication system (PACS) diagnostic workstation, compared with a less costly Web-based imaging system on a personal computer (PC) with a high-resolution monitor. METHODS: One hundred consecutive pediatric chest or abdomen and skeletal X-rays were selected from hospital inpatient and outpatient studies over a 5-month interval. They were classified as normal (n = 32), obviously abnormal (n = 33), or having subtle abnormal findings (n = 35) by 2 senior radiologists who reached a consensus for each individual case. Subsequently, 5 raters with varying degrees of experience independently viewed and interpreted the cases as normal or abnormal. Raters viewed each image 1 month apart on a PACS and on the Web-based PC imaging system. McNemar tests were used to compare accuracy of interpretation across both imaging systems. Confidence intervals (CIs) were calculated for differences in the proportion assessed incorrectly on the PACS, compared with the Web-based PC imaging system. RESULTS: There was no relation between accuracy of detection and the system used to evaluate X-ray images (P = 0.92). The total percentage of incorrect interpretations on the Web-based PC imaging system was 23.2%, compared with 23.6% on the PACS (P = 0.92). For all raters combined, the overall difference in proportion assessed incorrectly on the PACS, compared with the PC system, was not significant at 0.4% (95%CI, -3.5% to 4.3%). CONCLUSION: The high-resolution Web-based imaging system via PC is an adequate alternative to a PACS clinical workstation. Accordingly, the provision of a more extensive network of workstations throughout the hospital setting could have potentially significant cost savings.     

The digital imaging workstation

Picture archiving and communication systems (PACS) are expected to convert film-based radiology into a computer-based digital environment, with associated cost savings and improved physician communication. The digital workstation will be used by physicians to display these "soft-copy" images; however, difficult technical challenges must be met for the workstation to compete successfully with the familiar viewbox. Issues relating to image perception and the impact on physicians' practice must be carefully considered. The spatial and contrast resolutions required vary according to imaging modality, type of procedure, and class of user. Rule-based software allows simple physician interaction and speeds image display. A consensus appears to be emerging concerning the requirements for the PACS workstation. Standards such as the American College of Radiology/National Electrical Manufacturers' Association Digital Imaging and Communication Standard are facilitating commercial applications. Yet much careful study is needed before PACS workstations will be fully integrated into radiology departments.     

Use of a PACS Embedded System for Communicating Radiologist to Technologist Learning Opportunities and Patient Callbacks

ObjectiveThis study aimed to determine effect of modality, care setting, and radiology subspecialty on frequency of diagnostic image quality issues identified by radiologists during image interpretation.MethodsThis Institutional Review Board-exempt retrospective study was performed 10/1/18-6/30/20 at an academic radiology practice performing 700,000+ examinations annually. A closed-loop communication tool integrated in PACS workflow enabled radiologists to alert technologists to image quality issues. Radiologists categorized communications as requiring patient callback, or as technologist learning opportunities if image quality was adequate to generate a diagnostic report. Fisher's exact test assessed impact of imaging modality, radiology subspecialty, and care setting on radiologist-identified image quality issues.Results976,915 imaging examinations were performed during the study period. Radiologists generated 1,935 technologist learning opportunities (0.20%) and 208 callbacks (0.02%). Learning opportunity rates were highest for MRI (0.60%) when compared to CT (0.26%) and radiography (0.08%) (p<0.0001). The same was true for patient callbacks (MRI 0.13%, CT 0.02%, radiography 0.0006%; p<0.0001). Outpatient examinations generated more learning opportunities (1479/637,092; 0.23%) vs. inpatient (305/200,206; 0.15%) and Emergency Department (151/139,617; 0.11%) (p<0.0001). Abdominal subspecialists were most likely to generate learning opportunities when compared to other subspecialists and cardiovascular imagers were most likely to call a patient back.ConclusionsImage quality issues identified by radiologists during the interpretation process were rare and 10 times more commonly categorized as learning opportunities not interfering with a clinically adequate report than as requiring patient callback. Further work is necessary to determine if creating learning opportunities leads to fewer patients requiring repeat examinations.     

医学影像学信息系统工作站配置方案的探讨

目的：探讨适合国情的医学影像学信息系统工作站配置方案及实现方式。方法：工作站逻辑上分别医学影像存储与传输系统（PACS）工作站和放射学信息系统（RIS）工作站。PACS工作站包括CT和MR影像诊断、常规X线影像诊断，以及高分辨灰阶显示等3类工作站组成；RIS工作站则根据其用途分为诊断报告、登录、报告打印与分发、管理等多种功能类别。结果：影像诊断报告工作站采用单机双屏构型，物理地集成PACS和RIS的影像诊断过程的操作。CT、MR等低像素影像诊断过程配置对角线17in(1in=2.54cm）彩色显示顺作为操作界面，常规X线影像诊断操作则采用21i彩色或灰阶肖像式显示器配置，对于未涉及影像操作的工作站类型，如IRS登录、报告分发、管理等，全部采用普通PC机实现。结论：满足医学影像诊断的基本需求并符合节约投资的要求是进行医学影像学信息系统工作站规划所遵循的基本原则，单机双显配置可以成为医学影像学诊断工作站构型设计的首选方案。     

PACS for multi-slice CT--seamless integration implementing 3D and 4D workstations

A PACS system for data management in multi-slice CT examination was upgraded using interactive 3D and 4D workstations and network computing technology. We categorized the original PACS (CT-PACS) as follows: (1) a fault-tolerant system linked with the hospital information system (HIS) and radiology information system (RIS); (2) an interactive network system using a workstation with real-time 3D and 4D reconstruction; (3) a system for research and development of software for 3D image analysis on the CT-PACS system. Because of the use of cooperative diagnostic supporting tools, no major problems occurred in daily clinical practice or research and education. In conclusion, CT-PACS with real-time 3D and 4D workstations was found to be helpful to radiologists and researchers in reading and analyzing large volumetric data.     

通过工作列表实现数字化网络各系统之间患者信息的一致性

目的 实现图像存储与传输系统(picture archiving and communication system，PACS)、放射学信息系统(radiology information systems，RIS)、影像设备之间患者检查信息的一致性。方法 我院引进GE Signa 1．5T磁共振、数字乳腺，Agfa数字X线摄影、计算机X线摄影及GE CT等数字化医学设备。GE PACS是英文系统，所以前期医院在未解决信息一致性时只通过PACS对检查影像进行保存，通过PACS系统中简单的信息管理工作，并没有真正意义上的worklist。2个月后，我院采用国际上先进的解决方法即通过医学数字成像及通讯(digital imaging and communication in medicine，DICOM)标准的工作列表(worklist)的方法实现信息的一致性。在RIS系统中将患者中文信息转换为英文信息，保存并为worklist提供患者的英文信息。结果 我院在集成PACS和RIS的2年多时间以来，通过worklist来保证RIS与影像设备患者检查信息的一致性，取得了非常好的效果。在所有诊断工作站上，诊断医生通过中文RIS系统，对病人的信息进行编辑、修改、产生。结论 通过worklist实现PACS、RIS、影像设备之间患者检查信息的一致性是可行的。     

Diagnostic imaging of elbow injuries inthe throwing athlete

The elbow is a complex joint that connects the arm with the forearm. Injuries to the elbow in the throwing athlete aregenerally caused by acute trauma or repetitive stress. Diagnostic imaging of the elbow ranges from plain radiographs to magnetic resonance/arthrography. Because of the complex nature of the joint, a good history of the patient and physical exam should be obtained in an attempt to tailor the imaging workup for each individual. Most acute traumatic injuries can be diagnosed with plain radiographs. Computed tomography and magnetic resonance imaging (± intra-articular contrast) are generally obtained to confirm suspected pathology from the patient's history and physical exam. This article will discuss several pathologic conditions and will attempt to show the findings seen on the appropriate imaging modality. Where it is possible, the mechanism of injury will be described and correlated with the imaging findings.     

The role of sonography in abdominal trauma: The European experience

Abdominal trauma may be a life-threatening entity. Whereas computed tomography (CT) seems to be the major noninvasive diagnostic tool for evaluation of abdominal trauma in the United States, sonography is the modality of first choice in the majority of European hospitals. Sonography has replaced diagnostic peritoneal lavage for detecting or excluding intraperitoneal free blood. We advocate sonography for any polytrauma patient in the trauma emergency room (TER), because it is a quickly performed, repeatable, and inexpensive imaging modality, serving as a decision-maker in the TER and enabling the avoidance of unnecessary CT. We strongly believe that radiologists should make full use of the potential of ultrasound in the TER. Radiologists should have access to, and experience with, CT as well as sonography, allowing an unbiased decision as to which modality is adequate to answer the specific questions raised by different trauma patients. This article defines the role of sonography in the TER and compares it with CT.