Applied Radiology Featured Article (via radRounds)

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30 SUPPLEMENT TOAPPLIED RADIOLOGY www.appliedradiology.com December 2008

The Internet has revolutionized the

delivery of many products andservices. As a service, radiology

has taken part in the Internet revolution.

For example, radiologists once primarily

worked on-site in hospitals. Today, ambu-

latory care is increasingly common, often

separating the radiologist from the pa-

tient. As a result, remote image interpre-

tation is now routine, and it is common to

distribute soft-copy images across the

healthcare enterprise. These trends create

the need to image-enable thousandsif

not tens of thousandsof desktops

throughout an integrated healthcare net-workmany of which are outside of the

walls of a hospital.

Consumerism is another critical trend

that is being fueled by the Internet. Today

patients have easy access to a wide range

of medical information and are able to

educate themselves about radiology

processes. As a result, they demand a

high level of service, including rapid

turnaround of imaging reports.

Finally, the Internet may also be play-

ing a role in the shortage of radiologists,

as some elect to work in the computertechnology industry. An estimated 380

million radiology procedures will be

performed in 2008, representing an

annual growth rate of 14%. The number

of radiologists is growing at an annualrate of just 1.2%. Under these challeng-

ing circumstances, it is essential that we

maximize radiologist efficiency, so that

the quality of care can remain high.

PACS redefinedIn 1999, a picture archiving and com-

munication system (PACS) was easy to

define. It consisted of a diagnostic work-

station, a list of unread studies, and digi-

tal departmental storage. It was simply a

system that enabled soft-copy interpreta-

tion of images. In essence, the computerreplaced the light box.

Today, defining a PACS is anything

but simple. In addition to remote reading,

we are faced with new imaging modali-

ties that generate very large data sets with

an increasing amount of dynamic and

functional content. As multiple health-

care institutions come together to form

integrated delivery networks, they create

multisite workflow for the radiologist

and others involved in patient care. There

is an increasing amount of information

available to drive workflow and guidedecisionmaking, but it must be navigated

in an efficient fashion.

In addition, with the push toward the

electronic medical record, users are

looking for portable, mineable forms of

data storage. They also want enterprise

access to images and information, not

just in radiology but also in such clinical

areas as cardiovascular medicine, path-

ology, mammography, and others.All of these trends create questions

about what a PACS should look like. As

we consider this question, we should be

thinking about workflow, visualization,

and infrastructure. As an industry, we

must think of a PACS not as a monolithic

system, but rather as a platform and an

infrastructure for storage of data from

multiple clinical areas, as a separate plat-

form for visualization, and as a tool for

overcoming workflow challenges.

IntegrationRadiology studies often traverse

many boundaries. A large hospital may

be served by a single radiology group,

which, in turn, may be covering multi-

ple different large-scale facilities as well

as a small hospital that is struggling to

retain radiology services. The radiology

group may also be outsourcing some of

its work to a nationwide reading service

or so-called super group.

A typical radiologist reads on 6 dif-

ferent PACS systems. This translates into

at least the same number of platforms for3-dimensional (3D) visualization, the

radiology information system (RIS), and

the reporting system. The need for radi-

ologists to switch between various user

interfaces creates both a great challenge

and a great opportunity for integration.

For example, the mandate to maxi-

mize radiologist efficiency creates the

How the Internet isrevolutionizing radiologyAs diagnosis becomes increasingly distributed, the Internet has the potential to improve

efficiency, foster collaboration with clinicians, and enhance communication with patients.

Robert Cooke

Mr. Cooke is Vice President of the

Network Business Unit at FUJIFILM

Medical Systems USA, Inc., Stamford, CT.


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www.appliedradiology.com SUPPLEMENT TOAPPLIED RADIOLOGY 31December 2008

REVOLUTIONIZING RADIOLOGY

opportunity for a new kind of integrated

worklist that takes into account all of the

healthcare sites the radiologist serves and

brings together a variety of tasks ranging

from report signing to peer review to pro-

tocoling of examinations. By drawing

from combined user preferences and

workrule logic, this information can be

presented in a dashboard format for navi-

gation by the radiologist (Figure 1).

Combining diverse systems into a com-

mon worklist/dashboard allows a radiol-

ogist an integrated view of the work he or

she has to perform.

Once the radiologist gets to that work,

it is very important to have the right kinds

of tools available, including advanced

visualization. These tools need to be inte-

grated not only into the PACS for use in

normal day-to-day operations, but alsointo other applications, given that new

kinds of viewing models will be incu-

bated outside of the PACS in many cases.

These tools also need to be distributed,

because diagnosis is now distributed.

Radiologists should not be constrained

by the limitations of the environment in

which they serve. All necessary informa-

tion and tools need to be accessible in a

way that facilitates efficient and ergo-

nomic interpretation. In addition, our

systems must be able to provide, at a

minimum, a collaborative connectionbetween the radiologist and the clinician.

InternetIt is interesting to visualize how all of

these demands might play out in the

future and what impact the Internet will

have (Figure 2). Hospitals may seek a

common infrastructure for radiology, car-

diology, mammography, and other spe-

cialtiesone that integrates images,

structured reports, documentation, and

medication history into a decision support

system. The desire to integrate variousimaging modalities into a common infra-

structure may be a reason healthcare insti-

tutions are looking to replace their PACS.

They may also be looking to replace

their radiology information system and

other technologies as a way not only of im-

proving workflow but also of maintaining

their physician base. Referring physicians

FIGURE 1. A mandate to maximize radiologist efficiency creates the opportunity for a new kind

of integrated worklist that takes into account all of the healthcare sites the radiologist serves and

brings together a variety of tasks ranging from report signing to peer review to protocoling of

examinations. By drawing from combined user preferences and workrule logic, this information

can be presented in a dashboard format for navigation by the radiologist.

FIGURE 2. The Internet is driving re-evaluation of picture archiving and communication sys-

tems (PACS), radiology information systems (RIS), and other technologies as healthcare insti-

tutions seek a common, integrated infrastructure for multiple imaging specialties, as

radiologists seek to gain a competitive edge, and as both seek to enhance relationships with

referring physicians and patients.


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32 SUPPLEMENT TOAPPLIED RADIOLOGY www.appliedradiology.com December 2008

REVOLUTIONIZING RADIOLOGY

may demand online interactive schedul-

ing, order entry, critical results alerts,

advanced visualization, and decision sup-

portand hospitals may seek to provide

these services as a way of retaining their

relationship with physicians.

Certainly radiologists are starting to

invest in technology platforms that help

them gain a competitive edge through

more ergonomic and efficient interpre-

tation, access to prior studies, results gen-

eration, diagnostic visualization tools,

and decision support.

Better communication with patients

is also an important emerging opportu-

nity. Interaction with physicians, educa-

tion, and results reporting can all be

facilitated by the Internet.

ConclusionA unique opportunity exists for our in-

dustry to connect all healthcare stake-

holders through the use of Internet

technology. We must act quickly, as tech-

nology is changing at Internet speed.

As vendors, we must define our goals

and deliver value. We must open our sys-

tems and enable integration opportunities

without creating technology stagnation.

We must continue to collaborate with

stakeholders in the healthcare industry.

We must continue to adapt and exploit

consumer technologies. Perhaps most

important, we must humanize radiol-

ogy by involving the patient, involving

the referring physician, and putting a

human face on the radiology process.

REFERENCES1. Caesy S. Keynote speech: The impact of the

Web on radiologist shortages. Presented at the Dig-

ital X-Ray and PACS: An Educational Forum.

Scottsdale, AZ; February 26, 2005.

2. Forman HP. Radiologists' salaries: Should we

worry? AJR Am J Roentgenol. 2007;189:755-756.

3. Sunshine JH, Meghea C. How could the radiolo-

gist shortage have eased? AJR Am J Roentgenol.2006;187:1160-1165.

4. Meghea C, Sunshine JH. Retirement patterns

and plans of radiologists. AJR Am J Roentgenol.

2006;187:1405-1411.

5. Licurse A, Saket DD, Sunshine JH, et al. Update

on the diagnostic radiology employment market:

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2006;187:W249-W254.

6. Batchelor JS. Rad workload shows double-digit

increase. September 22, 2005. Available on the

Aunt Minnie Web site: http://www.auntminnie.com/

index.asp?Sec=sup&Sub=imc&Pag=dis&ItemId=6

7815. Accessed May 2008.

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Applied Radiology Featured Article (via radRounds)