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Stephen Taylor
Editor-in-Chief
Hospital Healthcare Europe
For the radiologist, speed is an important part of the daily routine. Diagnoses need to be made quickly and reliably so that the appropriate treatment may begin. Equally important is the follow-up monitoring of the therapy, and that these results are transferred just as quickly to colleagues in other clinical wards. Such speed and efficiency can only be achieved with a picture archiving and communications system (PACS).
In Germany, Bamburg Hospital’s Institute for Diagnostic and Interventional Radiology and Nuclear Medicine utilises all modern imaging techniques, which are also applied to interventional operations. The Institute processes 100–120,000 images annually, representing around 260 examinations each day – most of which result from MRI and CT.
Streamlined diagnostics
The hospital decided to introduce a PACS to enhance interdisciplinary cooperation between the radiologists and other clinical departments. The system has the crucial benefit that digital images are always available whenever and wherever they are needed. As Brigitte Dippold, quality manager at Bamburg, comments: “Now there’s no need to search for the images, and that saves both time and money – as well as improving the treatment of our patients.” In terms of quality management, process optimisation is an important step towards quality assurance and Dippold considers it “impossible to optimise processes within a radiology department without a PACS”.
The Institute has a total of nine diagnostic stations plus a mammography console, all of which are equipped with RadiForce monitors (EIZO). Each station has three monitors – two diagnostic monitors plus a console for displaying the Radiology Information System (RIS) data – with an integrated digital dictation system for the radiologists to directly input their diagnostic comments.
“With this new system we save an extra one or even two days,” says Dr Hans Schneider, senior physician and joint head of the PACS Task Force. This is all the more important for a modern, cost-conscious hospital, since patients are not factored merely according to the length of stay but also in terms of their diagnosis. “Diagnosis is now considerably faster; we don’t have to search for images,” he continues. “In the past when a colleague phoned and asked to take a look at the thorax, I would reply ‘Where’s the film?’, or ‘Come here and bring the film.’ Now I just go to the nearest console and look at the image for myself. Then I can give my opinion within 30 seconds.” Fast decisions such as these are often critical to the therapy; if a query comes from the intensive care unit as to whether particular action needs to be taken, and the radiologist is immediately able to confirm or rule out the need to operate, then this is obviously beneficial for the patient concerned.
Combined knowledge and experience
The digital distribution of the images also means that if, for example, a physician in outpatients has a question for the surgical department or the senior consultant, then the whole diagnostic team is able to look at the images at the same time – regardless of where they are – and decide if and when to operate. Schneider explains: “Here in our radiology department we don’t train our staff to become pure specialists; any one of the team can analyse 80% of the images.” The PACS, along with the monitors, allows any of the radiologists to access all the images, so that they can diagnose everything – with the added bonus that the department remains flexible in terms of staffing. In addition, physicians are able to define their own user profiles within the system, so that only those images which concern them are displayed, regardless of which station they are using.
The quality of the monitors is of course highly important throughout the entire diagnostics process, as Schneider is all too aware: “There are certain legal requirements to be met, and you have to have a good feeling about the monitor.”
Rapid implementation of a global system
As one of the leaders of the hospital’s PACS Task Force, Schneider was pleased to see how motivated both the radiologists in his team and the clinical physicians were in supporting the fast and smooth implementation of the project. In fact, the introduction of the PACS took just 18 months from the first consultation to its authorised launch. This was made possible by close cooperation with an experienced external consultant, Martin Neumann of MedServ. A rapid implementation is part of MedServ policy; the longer a project takes, the more opportunities arise for hindering factors, and the user acceptance is likely to suffer.
Bamberg Hospital already had an RIS and Hospital Information System (HIS), so an interface to the existing system was an integral part of the contract. Another stipulation was the supply of Thin Film Transistor monitors throughout the hospital. This was therefore a global project, with the hospital management clearly stating that if the monitors were to be implemented in the Institute, then everyone should have them.
The hospital, together with MedServ, was looking for a partner who could provide the whole spectrum of monitors, meeting the various requirements dictated by different workplaces, including the need to operate 24 hours a day, 365 days a year – and with an optimum cost-effectiveness ratio. This is why the decision was taken to use RadiForce monitors. All the relevant monitors with their various specifications were presented to the hospital on one day, allowing the staff involved to actively participate in the decision.
The hospital expects a return on its PACS investment within the next four years. The introduction of the new system entails certain direct financial benefits, such as savings on X-ray film, developer and chemical waste disposal, as well as reducing the space needed for archiving film. There are also the numerous incalculable savings derived from faster access to images and saving time previously spent searching, all of which results in a more relaxed work atmosphere.
HIS/RIS/PACS communication
Bamberg Hospital is linked to the town’s psychiatric clinic, allowing for the transmission of digital data via HIS, RIS and PACS. The system is web-based and designed for further external connections in the future, including teleradiology. The hospital stores all its images digitally, including reconstructions taken from various sections. In line with insurance and legal requirements, the images are stored for between 10 years (accident patients) and 30 years (therapy patients).
The server contains the patient database plus all the images in both compressed and uncompressed form, since compressed files suffice in 98% cases in the periphery. This saves considerably on network traffic and further streamlining the PACS, and is one of the major advantages of the system. All the data is stored twice and in a parallel (redundant) system, completely independent of each other. This protects the data from fire, water or other types of damage. The 1.2 terabyte of storage space is designed in a modular way, and therefore can be extended as desired.
