BEAMING IMAGES

RADIOLOGY PACS IMPLEMENTATION- THE ROAD TO A

FILMLESS ENVIRONMENT

MembersRobert E. Henkin, MD, Mary Olson, MD, Robert H. Wagner, MD, Denise Punka, James Halama, PhD, John Tu,

MD, Art Krumrey, Tess McCoo, James Ryva, Mario Ayala, Gary Stevens,

Renee Abelarde, Ron Price

Opportunity for Improvement

Radiology operation has shifted from a primarily hospital based operation to a combination of hospital, out-patient and multi-satellite. Hard-copy films were no longer serving the demand for viewing the study in various locations at the same time. Due to manual distribution of films, there was a significant risk for losing or misplacing them making it unavailable for review, reading or copying.

Most Likely CausesMulti-disciplinary physician practice

requires the films to be reviewed by multiple physicians in various locations on the same day

Transport of films from site to site was a manual process which takes time and sometimes contributes to the loss of films

Lost film sometimes cannot be reconstructed and this causes non-read of films, repeat procedures and bad service to clinicians

The network served by the department is dispersed into a large geographical area such that manual distribution of films no longer serves the needs of the operation

Solutions implementedReplaced old X-Ray equipment with DR and

CRsPurchased & implement a PACS systemPurchased CR plates for small satellites Integrated modalities and the PACSIT arranged access to images via web-browser &

worked with Dr. Tu’s group to post images & results in the EMR

Deployed PACS viewing workstations in strategic areas

Designed QA processes to monitor key steps

Radiology PACS

PACS ? What is PACS?PACS stands for Picture Archival and

Communication System. It is a technology that allows images from procedures (CT Scan, Nuclear Medicine, Diagnostic X-Rays etc) to be stored in digital form in a computer (central archive). The images can then be accessed by various users such as a Radiologist to interpret the study or an attending physician to look at the pictures and to view the report. Images can be viewed using a special workstation or on a regular PC via a web-browser.

PACS Deployment-LUMC

PACs Workstations are in

Main Reading RoomCT Reading RoomNeuro Reading RoomNuclear MedicineUltrasoundSpecial Procedures

Reading RoomEROR-Physician Lounge

PACS Deployment-LOC, Cancer Center, Satellites

Outside of the hospital we installed workstations in;

LOC-RadiologyWomen’s Health RadiologyLOC-Ortho ClinicLOC-Ambulatory SurgeryCancer CenterOrland Park Primary CareOak Brook Imaging Center

ResultsPACS implementation facilitated

interpretation of studies by making the images readily available. The number of cases in “complete” but not read status declined significantly.

Studies in "Complete" Status

0.00

0.50

1.00

1.50

2.00

2.50

3.00

US NM MRI Specials(Neuro/Vasc.)

Specials-Neuro Diag CT

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% ofStudiesJune2003% ofStudies(Nov2003)

Tu

rna

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nd

Tim

e (

Ho

urs

)

Completed Test to Final Report

Jun 0

2

Jul 0

2

Aug 02

Sep 0

2

Oct 0

2

Nov 02

Dec 0

2

Jan 0

3

Feb 0

3

Mar

03

Apr 03

May

03

Jun 0

3

Jul 0

3

Aug 03

Sep 0

3

Oct 0

3

Nov 03

Dec 0

3

Jan 0

4

Feb 0

4

Mar

04

0

20

40

60

80

100

120

Mean = 73

Mean = 36

Mean = 20

Implemented Voice

Recognition

technology

Implemented PACs

Average Report TAT is less than 1 day

Radiology PACS

PACS workstations were deployed in all major sites of operation in addition CR plates were purchased for smaller satellites so that images taken from those areas can still be “read” and archived on PACS

Due to technology restrictions Mammography is not yet on PACS

Conclusion

Images can now be viewed concurrently in multi-locations

Achieved goal of being “filmless”. Note the new LOC is built with this in mind

Addressed problem of unavailability of films

Increased patient & physician satisfaction

Increased availability of images- web , EMR

Film security- prevent loss & mirror archive

Positive impact on report turnaround time

Implemented QA process on workstation performance

Radiology embarked on a collaborative effort to implement PACS, a new technology to store and distribute images across the health system. This project resulted in tremendous improvement:

Next StepsExpand QA processes to cover Computerized Radiography and Digital Radiography operations to ensure optimum quality of images sent to PACS.