Image archiving system: For better patient care
Medical images are at the heart of healthcare. Over the years, they have provided not only a non-invasive way to detect the most complex of diseases but have also helped in evaluating patient’s health conditions. We discuss the existing image archiving system, which ensures better patient safety.
Image archiving system, also known as Picture Archival and Communication Systems (PACS) are systems for digital storage, transmission and retrieval of radiology images. PACS have both software and hardware components. These systems interface with imaging modalities and acquire digital images from the modalities. Images are then transferred to a review workstation for viewing and reporting. The PACS viewer software is installed on the workstation to receive and display the radiology images. Images are then archived into storage for retrieval at a later time. The PACS system also manages the storage of these radiology images. In order for PACS systems to work across different modalities and workstations in a seamless manner, there are imaging standards that have been defined and need to be followed by all PACS systems and by the modalities interfacing with PACS systems. DICOM is the standard for medical imaging.
The technology today Image archiving systems have been available in the market for over a decade now. With increasing maturity of technology and the changing work environment, the role of PACS is evolving – today PACS alone is no longer the standard, as integrated Radiology Intelligence System (RIS)-PACS-workflow platforms are required to meet the demands of overworked radiologists. PACS today is web-based, permitting access from outside the hospital and facilitating teleradiology, which represents a paradigm shift in the working of radiology departments. The concept of a RIS, as represented by TeleradTech’s Radspa, refers to a completely integrated RIS-PACS-workflow, which enables automatised intelligent routing of studies to the appropriate radiologist, tracking of performance data and collaboration tools, is an example of such an advancement. PACS today is a different entity than it was when first introduced into the market, and those exploring it should be aware of the newer features and benefits that this cutting-edge technology provides.
As PACS systems have evolved, their overall impact on patient care has also become more significant. As of today the means by which PACS enables better patient care are as follows:
1. By enabling better clinical decision making
The primary impact that PACS has on patient care is in terms of permitting better clinical decision making by allowing clinicians the benefit of having critical imaging information prior to planning/prescribing any treatment. This is facilitated by PACS in three ways
By permitting clinicians instant access to their patients’ images: A clinician can, while sitting in his/her outpatient clinic, have ready access to the images of the patient sitting across the table with the click of a mouse. This is of value from the standpoint that the clinician no longer has to depend purely on the radiology report but can also leverage his/her understanding of the clinical situation in further assessing the radiograph or scan.
Access to prior images: Instant access to the patient’s prior images is enabled by PACS and is of great value in evaluating response to treatment or progression of disease, particularly helpful in the infectious disease or oncologic scenario.
3D post-processing and surgical planning: Thin client systems today allow 3D post-processing of images on an enterprise PACS. This is of great value in permitting planning of surgery and endovascular surgery and is therefore of greatest benefit to clinicians who practice either open surgery or endovascular therapy. Thus, the clinician can review the entire post-processed study including ‘on the fly’ images of such techniques as virtual bronchoscopy or colonoscopy, further aiding in planning of subsequent endoscopic intervention.
2. By facilitating physician-radiologist communication
An additional benefit of PACS lies in facilitating better communication between the clinician and radiologist. This no longer requires both to be in the same room as collaborative platforms exist, which enable virtual discussion. A secondary benefit lies in enabling radiologists to conveniently consult each other and obtain second opinions from radiologists in other locations, thereby enhancing the quality of interpretation.
3. By reducing reporting time
Rapid interpretation: Emergency care is primarily benefitted by PACS, which allows instant image viewing. Web-based PACS in particular, coupled with broadband connectivity, and today with mobile handheld devices such as the iPAD, allow for viewing of images by radiologists and clinicians at anytime from anywhere. Instant diagnosis is therefore possible and immediate treatment can be delivered, which obviously improves the quality of emergency care being delivered.
4. By decreasing healthcare costs
A major benefit of PACS to the community lies in its capacity to decrease healthcare costs, which can indirectly benefit the patient by way of reducing medical expenses. This is by way of:
Reduced film costs: As PACS is based on digital imaging, the cost of X-ray film is essentially eliminated. Also decreased is the repeat rate of radiographs, given that digital imaging allows for post-processing, which allows a greater latitude in exposure settings, so that even images that are sub-optimally acquired can have their quality improved so that repetition is not required. Film loss is also eliminated by the use of PACS as the images remain in a permanent archive, which is also a significant cost savings to both the institution as well as to the patient. Finally, an additional role of PACS is to eliminate the cost of film processing, which can be a significant benefit to high volume departments.
Reduced storage costs: The large film storage rooms of yesteryear are now history and have been replaced with compact server rooms on which the PACS is hosted.
5. By increasing radiologist productivity, efficiency and accuracy
In an era of global radiologist shortages, any tool that improves radiologist productivity has direct impact on patient care by decreasing the patient waiting time for reports. PACS has been shown in various studies to increase radiologist productivity. The result of this is that the reporting process is shortened allowing the radiologist to interpret more examinations. In a 5-year study conducted at Santa Barbara Hospital in Orange County California, the radiologist productivity was seen to increase by 39 per cent over 5 years since PACS was implemented, analysing objective radiologist productivity parameters such as Work Relative Value Units (WRVU). Moreover PACS lends itself to ancillary technologies such as structured formatted reporting and voice recognition, which are independently known to enhance radiologist productivity.
6. By enhancing the quality of interpretation and analysis
This is facilitated in two ways:
Subspeciality interpretation: The interpretation of the corresponding specialty scan by a subspecialist (eg, neuro, cardiac or paediatric) is typically superior to that by a general radiologist. PACS facilitates subspecialty interpretation by allowing filtered worklists to deliver only those cases to the radiologist that he or she is best qualified to interpret.
Workstation review: As stated, the quality of the digital radiographic image is inherently superior to traditional film viewing on a lightbox. Both false-positive and false-negative results are greatly reduced using PACS.
7. By promoting improved patient safety
In the current era where radiation dose continues to creep up due to the increasing utilisation of medical imaging, PACS affords us a means for tracking patient cumulative dose, provided that the PACS serves as the repository for all imaging undergone by an individual patient. Safeguards such as radiation dose alerts can be created to prevent violation of the As Low As Reasonably Achievable (ALARA) principle. Also, as discussed digital imaging and PACS has an added value in terms of reducing the repeat rate of radiographs, by permitting postprocessing, also keeping patient radiation exposure within reasonable, acceptable and safe limits.
8. By facilitating the creation of teaching archives
The only manner in which the healthcare system can progress and the quality of patient care improves is by training the newer generation of radiologists and with ongoing training of currently practising radiologists. Both are greatly facilitated by PACS.
The future PACS today has already delivered considerable value to the healthcare enterprise, and greatly enhanced the level of patient care. In summary, PACS represents an exciting phenomenon within the healthcare enterprise, and is an innovative use of technology to directly benefit patients and enhance the quality of healthcare delivery. Sitting at the cusp of the horizon where healthcare and IT meet, it has elegantly delivered the Roentgenographic image into the new millennium and beyond.
- Dr Arjun Kalyanpur
MD, DABR, Chief Radiologist/ Chief Pusher
Teleradiology Solutions, Bengaluru