PHILADELPHIA - With all the attention heaped on PACS these days, one might think digital image management networks are everywhere. Not true: Around 70% of radiology departments in the U.S. still function without them. These institutions often have several digital modalities in use -- CT, MRI, ultrasound, and so forth -- yet they operate without a true PACS environment.
At the June 6 Enterprise sessions of the Symposium for Computer Applications in Radiology, Timothy Kulbago of Marconi Medical Systems in Cleveland demonstrated how the University of Wisconsin Hospital in Madison, WI, implemented a Java-based image and report distribution system in a non-PACS radiology environment, in the process reducing average reporting time from several days to less than an hour.
"A PACS environment doesn't exist everywhere yet," Kulbago said. "What you really want to do is leverage the value and the timeliness of the Internet to serve your customers."
For the team headed by Walter Peppler, Ph.D., medical physics professor at the University of Wisconsin Medical School, this meant creating a system to deliver timely reports and images to referring physicians in a "non-PACS way," Kulbago said.
Armed with a HIS/RIS from SMS of Malvern, PA, a Unix server from Sun Microsytems of Mountain View, CA, digital modalities from several vendors, a 100-MB Ethernet switch, and a Windows-based Java client as building blocks, the team first set out to identify the system's most essential tasks, which included:
- Entering reports
- Entering images
- Marrying reports and images
- Managing the content of transmitted reports
- Maintaining security
Reports were entered in the system using DICOM-normalized results and interpretation management, with DICOM-structured reporting maintained as a future goal. In the absence of RIS and HL-7 environments, reports can be entered manually into the system, Kulbago said.
The system allows DICOM images to be sent to the server from virtually any source, including the modality, the review station, or the archive, according to Kulbago. However, most of the hospital's workflow came from the review stations.
Marrying reports and images was the next major task. Without the luxury of the DICOM modality worklist employed in PACS, the team decided to reference and combine them using accession numbers matched by means of three exam criteria: patient ID, exam date, and time.
"If there was a unique match, we made the wonderful leap of faith that these things belonged together. Strangely enough, that works, and it works a lot of the time," Kulbago said, adding that they erred on the side of caution. Accession numbers can be entered manually for modalities that don't support them, he added.
Key image marking was used to select the images to be sent to referring physicians. For the future, the team has a patent pending on a method of automatically selecting key images based on the report text, he said.
Security measures include the use of user name and password, extensive auditing, and SMIME encryption for all data and e-mail, which is sent outside the system only to physicians in firewall-protected practices, he said. Additional security measures, such as digital signatures and certificates, are in the works.
With creativity -- and without the expense of a PACS -- the components have been joined to create a "contemporary radiology practice," Kulbago said.
"The value of the radiology product increases as it can be more integral in assisting referring physicians in patient care, which is ultimately what it's all about," he said. "We now turn around reports to referring physicians at the University of Wisconsin on the order of a half an hour." The team is now measuring the effects of productivity gains on the practice, he said.
By Eric Barnes
AuntMinnie.com staff writer
June 7, 2000
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