Development and Utilisation of a Real-Time Display of Logged in Radiology Information System Users

In radiology departments with multiple geographically separated reporting areas, locating radiologists can be challenging. We have developed an in-house solution to minimise the time spent looking for radiologists utilising near real-time data stored with our radiology information system (RIS). An auto updating Extensible Markup Language (XML) data feed from our RIS provider provides information about users logged into the RIS. It includes user names, their contact details and specialty interests, their location within the department, and a time stamp of last recorded dictation or report verification. The information is then displayed on our internal intranet and on a self-refreshing screen in our main department corridor. In order to estimate time savings made through the tools creation, usage statistics were calculated and combined with assessments of time taken to find a named radiologist prior to the tools implementation. Over the month of April 2009, there were 2,798 hits on the locator page. Radiologists were responsible for 1,248 hits and radiology administration staff for 1,550 hits. The average time for using the tool was calculated at 5 s. Reviewing a roster and calling/paging a radiologist took on average 30 s, and a full walk around of the department took 195 s. Through utilisation of near real-time data available within our RIS system and display of these data in an accessible form, we have developed a tool that has realised savings of up to 16 h of radiologist reporting time per week.     

Radiologist’s clinical information review workstation interfaced with digital dictation system

Efficient access to information systems integrated into the radiologist’s interpretation workflow will result in a more informed radiologist, with an enhanced capability to render an accurate interpretation. We describe our implementation of radStation, a radiologist’s clinical information review workstation that combines a digital dictation station with a clinical information display. radStation uses client software distributed to the radiologist’s workstation and central server software, both running Windows NT (Microsoft, Redmond, WA). The client sytem has integrated digital dictation software. The bar-code microphone (Boomerang, Dictaphone Corp, Stratford, CT) also serves as a computer input device forwarding the procedure’s accession number to the server software. This initiates multiple quaries to available lagacy databases, including the radiology information system (RIS), laboratory information system, clinic notes, hospital discharge, and operative report system. The three-tier architecture then returns the clinical results to the radStation client for display. At the conclusion of the dictation, the digital voice file is transferred to the dictation server and the client notifies the RIS to update the examination status. The system is efficient in its information retrieval, with queries displayed in about 1 second. The radStation client requires less than 5 minutes of radiologist training in its operation, given that its control interface integrates with the well-learned dictation process. The telephone-based dictation system, which this new system replaced, remains available as a back-up system in the event of an unexpected digital dictation system failure. This system is well accepted and valued by the radiologists. The system interface is quickly mastered. The system does not interrupt dictation workflow with the display of all information initiated with examination bar-coding. This system’s features could become an accepted model as a standard tool for radiologists.     

SCAR Radiologic Technologist Survey: Analysis of the Impact of Digital Technologies on Productivity

As medical reimbursements continue to decline, increasing financial pressures are placed upon medical imaging providers. This burden is exacerbated by the existing radiologic technologist (RT) crisis, which has caused RT salaries to trend upward. One strategy to address these trends is employing technology to improve technologist productivity. While industry-wide RT productivity benchmarks have been established for film-based operation, little to date has been published in the medical literature regarding similar productivity measures for filmless operation using PACS. This study was undertaken to document the complex relationship between technologist productivity and implementation of digital radiography and digital information technologies, including PACS and hospital/radiology information systems (HIS/RIS). A nationwide survey was conducted with 112 participating institutions, in varying degrees of digital technology implementation. Technologist productivity was defined as the number of annual exams performed per technologist full-time equivalent (FTE). Productivity analyses were performed among the different demographic and technology profile groups, with a focus on general radiography, which accounts for 65-70% of imaging department volumes. When evaluating the relationship between technologist productivity and digital technology implementation, improved productivity measures were observed for institutions implementing HIS/RIS, modality worklist, and PACS. The timing of PACS implementation was found to have a significant effect on technologist productivity measures, with an initial 10.8% drop in productivity during the first year of PACS implementation, followed by a 27.8% increase in productivity beyond year one. This suggests there is a "PACS learning curve" phenomenon, which should be considered when institutions are planning for PACS implementation.     

Online Error Reporting for Managing Quality Control Within Radiology

Information technology systems within health care, such as picture archiving and communication system (PACS) in radiology, can have a positive impact on production but can also risk compromising quality. The widespread use of PACS has removed the previous feedback loop between radiologists and technologists. Instead of direct communication of quality discrepancies found for an examination, the radiologist submitted a paper-based quality-control report. A web-based issue-reporting tool can help restore some of the feedback loop and also provide possibilities for more detailed analysis of submitted errors. The purpose of this study was to evaluate the hypothesis that data from use of an online error reporting software for quality control can focus our efforts within our department. For the 372,258 radiologic examinations conducted during the 6-month period study, 930 errors (390 exam protocol, 390 exam validation, and 150 exam technique) were submitted, corresponding to an error rate of 0.25 %. Within the category exam protocol, technologist documentation had the highest number of submitted errors in ultrasonography (77 errors [44 %]), while imaging protocol errors were the highest subtype error for computed tomography modality (35 errors [18 %]). Positioning and incorrect accession had the highest errors in the exam technique and exam validation error category, respectively, for nearly all of the modalities. An error rate less than 1 % could signify a system with a very high quality; however, a more likely explanation is that not all errors were detected or reported. Furthermore, staff reception of the error reporting system could also affect the reporting rate.     

Automatic radiologic reporting system using speech recognition

A radiograph report is usually made from an oral dictation by a radiologist, which is then typed. Typing Japanese is rather inconvenient and consumes many hours. In this paper we introduce a computer-assisted reporting system for radiologic images using speech recognition. The hardware of the reporting system consists of a speech recognizer DP-200(NEC) and a personal computer PC-8801 or PC-9801. The DP-200 has the capability of storing 500 different words spoken by a radiologist. At present, three application programs have been designed. These are for the interpretation of a liver scintigram, a bone scintigram and a chest radiograph. Data entry is done by the radiologist at a CRT display terminal in a conversational manner with predefined and predetermined branching. The time required to make a normal report using the liver or bone scintigram system was within one minute. The reporting time was several minutes in the case of an abnormality report. It is suggested that the system is useful for making an imaging report, for constructing the data base for the interpretation of medical images and for the picture archiving and communication system.     

Early Experience Using an Online Reporting System for Interventional Radiology Procedure-Related Complications Integrated with a Digital Dictation System

The absence of user-friendly systems for reporting complications is a major barrier to improving quality assurance (QA) programs in interventional radiology (IR) services. We describe the implementation of a QA application that is completely integrated with the radiology dictation system. We implemented an IR QA process as a module within the electronic medical record and radiologist dictation system applications used at our institution. After a radiologist completes a dictation, he or she must select from a drop-down list of complications before proceeding to the next case. Delayed QA events can be entered using the same applications. All complication entries are sent to a database, which is queried to run reports. During the study period, all the 20,034 interventional procedures were entered in the QA database, 1,144 complications were reported, 110 (9.6%) of which were classified as major. Although majority of the complications (996) were entered at the time of dictation, 148 complications (12.9%) were entered afterwards. All major complications were referred to the IR peer review committee, and 30 of these were discussed in the morbidity and mortality meetings. We studied post-lung-biopsy pneumothorax and chest tube rates and initiated a quality improvement process based on the results.The integration of the IR QA reporting system into the workflow process and the mandatory requirements for completion has the potential to minimize the work effort required to enter complication data, and improve participation in the QA process.     

Quality-of-service improvements from coupling a digital chest unit with integrated speech recognition, information, and Picture Archiving and Communications Systems

Speech recognition reporting for chest examinations was introduced and tightly integrated with a Radiology Information System (RIS) and a Picture Archiving and Communications System (PACS). A feature of this integration was the unique one-to-one coupling of the workstation displayed case and the reporting via speech recognition for that and only that particular examination and patient. The utility of the resulting, wholly integrated electronic environment was then compared with that of the previous analog chest unit and dedicated wet processor, with reporting of hard copy examinations by direct dictation to a typist. Improvements in quality of service in comparison to the previous work environment include (1) immediate release of the patient, (2) decreased rate of repeat radiographs, (3) improved image quality, (4) decreased time for the examination to be available for interpretation, (5) automatic hanging of current and previous images, (6) ad-hoc availability of images, (7) capability of the radiologist to immediately review and correct the transcribed report, (8) decreased time for clinicians to view results, and (9) increased capacity of examinations per room.     

Impact of PACS on Dictation Turnaround Time and Productivity

This study was conducted to measure the impact of PACS on dictation turnaround time and productivity. The radiology information system (RIS) database was interrogated to calculate the time interval between image production and dictation for every exam performed during three 90-day periods (the 3 months preceding PACS implementation, the 3 months immediately following PACS deployment, and a 3-month period 1 year after PACS implementation). Data were obtained for three exam types: chest radiographs, abdominal CT, and spine MRI. The mean dictation turnaround times obtained during the different pre- and post-PACS periods were compared using analysis of variance (ANOVA). Productivity was also determined for each period and for each exam type, and was expressed as the number of studies interpreted per full-time equivalent (FTE) radiologist. In the immediate post-PACS period, dictation turnaround time decreased 20% (p < 0.001) for radiography, but increased 13% (ns) for CT and 28% (p < 0.001) for MRI. One year after PACS was implemented, dictation turnaround time decreased 45% (p < 0.001) for radiography and 36% (p < 0.001) for MRI. For CT, 1 year post-PACS, turnaround times returned to pre-PACS levels. Productivity in the immediate post-PACS period increased 3% and 38% for radiography and CT, respectively, whereas a 6% decrease was observed for MRI. One year after implementation, productivity increased 27%, 98%, and 19% in radiography, CT, and MRI, respectively. PACS benefits, namely, shortened dictation turnaround time and increased productivity, are evident 1 year after PACS implementation. In the immediate post-PACS period, results vary with the different imaging modalities.     

Patient Dose Management Solution Directly Integrated in the RIS: “Gray Detector” Software

On X-ray modalities, the information concerning the dose delivered to the patient is usually available in image headers or in structured reports stored in the picture archiving and communication system (PACS). Sometimes this information is sent in the Modality Performed Procedure Step message. By saving the information inside the Radiological Information System, it can be linked to the patient and to his/her episode/request. A software, “Gray Detector,” implementing different and complementary extraction methods was developed. Query/retrieve on images header, Modality Performed Procedure Step message analysis, or the combination of the two methods were used. In order to avoid erroneous dose-protocol association, every accession number is linked to its unique report code, allowing multiple-protocols exam recognition. The adoption of different methods to extract dosimetric information makes it possible to integrate any kind of modality in a vendor/version neutral way. Linking the dosimetric information received from a modality to the patient and to the unique report code solves, for example, common problems in computed tomography exams, where the dosimetric value related to multiple segments/studies on the modality can be associated by the technician who performs the exam only to one accession number corresponding to a single study/segment. Analyses of dosimetric indexes’ dependence on modality type, patient age, technician, and radiologist were performed. Linking dosimetric information to radiological information system data allows a contextualization of the former and helps to optimize the image-quality/dose ratio, thereby making it possible to take a clinical decision that is “patient-centered.”     

Changes in Technologist Productivity with Implementation of an Enterprisewide PACS

The purpose of this report is to determine what effect filmless operation has on technologist productivity when compared with traditional film-based operation. Retrospective data on technologist productivity was collected from the study institution before and after implementation of PACS using workload reports and payroll records. Departmentwide technologist productivity was defined as the number of examinations per full-time equivalent (exams/FTE) and correlated with local and nationwide standards operating in traditional film-based operations. During film-based operation, technologist productivity was comparable between the study institution and nationwide standards, allowing for the unique examination volumes and modality mix. After implementation of a large-scale PACS, technologist productivity was found to increase 34% above that of national standards and 48% that of the local control site. Implementation of an enterprisewide PACS offers the potential to significantly improve departmentwide technologist productivity when compared with traditional film-based operation.     

Impact of digital radiography on clinical workflow

It is commonly accepted that digital radiography (DR) improves workflow and patient throughput compared with traditional film radiography or computed radiography (CR). DR eliminates the film development step and the time to acquire the image from a CR reader. In addition, the wide dynamic range of DR is such that the technologist can perform the quality-control (QC) step directly at the modality in a few seconds, rather than having to transport the newly acquired image to a centralized QC station for review. Furthermore, additional workflow efficiencies can be achieved with DR by employing tight radiology information system (RIS) integration. In the DR imaging environment, this provides for patient demographic information to be automatically downloaded from the RIS to populate the DR Digital Imaging and Communications in Medicine (DICOM) image header. To learn more about this workflow efficiency improvement, we performed a comparative study of workflow steps under three different conditions: traditional film/screen x-ray, DR without RIS integration (ie, manual entry of patient demographics), and DR with RIS integration. This study was performed at the Cleveland Clinic Foundation (Cleveland, OH) using a newly acquired amorphous silicon flat-panel DR system from Canon Medical Systems (Irvine, CA). Our data show that DR without RIS results in substantial workflow savings over traditional film/screen practice. There is an additional 30% reduction in total examination time using DR with RIS integration.     

"Robo-Rad": an inexpensive user-friendly multimedia report system for radiology.

BACKGROUND AND PURPOSE: The complex information obtained by CT, MR, and ultrasound examinations is often difficult to convey with a written report. Today's multimedia computer technology provides a medium within which the audio and the visual components of a radiologic consultation can be made available simultaneously, with the projected capability of remote access from any personal computer. A system was developed to run on low-end computer systems with image quality adequate for reporting purposes and prudent memory management (each report occupies < 4 MB). With this system-"Robo-Rad"-the image and radiologist are recorded simultaneously while he or she describes and points out (with a mouse) areas of interest. This dynamic report, along with patient data, can be retrieved and viewed by the consulting physician at his/her convenience using a low-end PC or Macintosh computer. MATERIALS AND METHODS: To assess the clinical utility of Robo-Rad, survey responses were solicited from clinical physicians at the Penn State University Hospital (41.5% faculty/fellows, 31.7% residents, 11.8% medical students, 2% clinical nursing; n = 101) during a hands-on demonstration using studies of 35 consecutive inpatients whose CT scans had been dictated into the system. RESULTS: In an average week, the surveyed professionals ordered 3.2 +/- 3.0 CT studies, reviewed 3.8 +/- 3.0 CTs, spent 1.5 +/- 2.0 hours locating Ct studies, and discussed 2.3 +/- 1.9 CT cases with a radiologist. The average time spent discussing a single CT case with a radiologist was reported as 9.4 +/- 5.9 minutes. On a five-point rating scale (1 = not at all to 5 = very much so), respondents indicated that the Robo-Rad report was helpful (4.3 +/- 0.7) and provided clinically important information that would be difficult to convey with current dictation systems (4.2 +/- 0.8). Desire to discuss the case with a radiologist in addition to viewing the Robo-Rad report scored 3.2 +/- 1.0. If such a system were readily available, 91.8% of the respondents indicated that they would use it in addition to the currently available written report and audio dictation system, and 96.6% would use it instead of the current system. Local area network and modems were the modalities of highest interest for remote access (69.3% and 44.6%, respectively). CONCLUSIONS: Judging by these data, the Robo-Rad system would be of benefit to clinicians. It provides a user-friendly, low-cost multimedia radiology report utilizing readily available technology to improve radiologist-clinician communication.     

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.     

Improvement of Report Workflow and Productivity Using Speech Recognition—A Follow-up Study

Speech recognition (SR), available since the 1980s, has only recently become sufficiently reliable to allow utilization in medical environment. This study measured the effect of SR for the radiological dictation process and estimated differences in report turnaround times (RTTs). During the transition from cassette-based reporting to SR, the workflow of 14 radiologists was periodically followed up for 2 years in a university hospital. The sample size was more than 20,000 examinations, and the radiologists were the same throughout the study. A RTT was defined as the time from imaging at the modality to the time when the report was available for the clinician. SR cut down RTTs by 81% and the standard deviation by 83%. The proportion of reports available within 1 h escalated from 26% to 58%. The proportion of reports created by SR increased during a follow-up time of this study from 0% up to 88%. SR decreases turnaround times and may thus speed up the whole patient care process by facilitating online reporting. SR was easily adopted and well accepted by radiologists. Our findings encourage the utilization of SR, which improves the productivity and accelerates the workflow with excellent end-user satisfaction.     

Strategies for Medical Data Extraction and Presentation Part 1: Current Limitations and Deficiencies

Data overload is a burgeoning challenge for the medical imaging community; with resulting technical, clinical, and economic ramifications. A primary concern for radiologists is the timely, efficient, and accurate extraction of imaging and clinical data, which collectively are essential in determining accurate diagnosis. In current practice, imaging data retrieval is limited by the fact that imaging and report data are de-coupled from one another, along with the non-standardized and often ambiguous free text data contained within narrative radiology reports. Clinical data retrieval is equally challenging and flawed by the lack of information system integration, paucity of clinical order entry data, and diminished role of the technologist in providing clinical data. These combined factors have the potential to adversely affect radiologist performance and clinical outcomes by diminishing workflow, report accuracy, and diagnostic confidence. New and innovative strategies are required to improve and automate data extraction and presentation, in a context- and user-specific fashion.     

Radiologist Productivity Analytics: Factors Impacting Abdominal Pelvic CT Exam Reporting Times

The purpose is to determine factors impacting radiologist abdominal pelvic CT exam reporting time. This study was Research Ethics Board approved. Between January 2019 and March 2020, consecutive abdominal pelvic CT exams were documented as structured or unstructured based on application of templates with separate sections for different organs or organ systems. Radiologist reporting location, patient class (inpatient, Emergency Department (ED) patient, outpatient), radiologist fellowship-training, report word count, and radiologist years of experience were documented. Median reporting times were compared using the Wilcoxon Rank-sum test, Kruskal–Wallis test, and regression analysis. Spearman’s rank correlation was used to determine correlation between word count and radiologist experience with reporting time. P?<?0.05 is defined statistical significance. A total of 3602 abdominal pelvic CT exam reports completed by 33 radiologists were reviewed, including 1150 outpatient and 2452 inpatient and Emergency Department (ED) cases. 1398 of all reports were structured. Median reporting time for structured and unstructured reports did not differ (P?=?0.870). Reports dictated in-house were completed faster than reports dictated remotely (P?<?0.001), and reports for inpatients/ED patients were completed faster than for outpatients (P?<?0.001). Reporting time differences existed between radiologists (P?<?0.001) that were not explained by fellowship training (P?=?0.762). Median reporting time had a weak correlation with word count (ρ?=?0.355) and almost no correlation with radiologist years of experience (ρ?=?0.167), P?<?0.001. Abdominal pelvic CT reporting is most efficient when dictations are completed in-house and for high-priority cases; the use of structured templates, radiologist fellowship training, and years of experience have no impact on reporting times.