CLEVELAND - The ability to distribute digital images to referring physicians is seen as a key benefit of PACS networks. But what if images need distributing before the PACS is installed?
The M. D. Anderson Cancer Center in Houston got to find out. Faced with the opening of a new faculty office building across the street from the main center in late 2000, MDACC needed a means of providing these clinicians with access to images. Rather than speed up its ongoing PACS implementation plan to meet the need, MDACC chose to install an application service provide-based image distribution service (Stentor, South San Francisco, CA).
"We decided it was too risky to accelerate the (PACS) project to meet this institutional need," said Dr. Kevin McEnery.
After scans were completed at the imaging modalities, they were sent to both the enterprise archive as well as to a PACS archive (which was being pre-populated in preparation for a planned conversion to soft-copy interpretation). Although clinicians were able to gain Web-based access to the enterprise archive from their clinic, office, or home using a virtual private network (VPN) connection, radiologists performed traditional film-based interpretation.
At MDACC, images are integrated into the institution's electronic medical record, which also provides access to radiology reports, pathology and laboratory information, and transcribed clinical notes. Clinicians did not have to wait until the radiology report was generated before viewing the images, however, McEnery said.
Dedicated soft-copy review stations were provided only to the emergency department and intensive care units, with remaining clinicians gaining desktop access. Clinicians still had access to film, if they wanted it.
To assess clinician satisfaction with the system, MDACC researchers examined image storage and clinician study retrieval logs from June 1 to August 8, 2001. During the period, 24,887 studies were stored on the server. Of these, 12,458 (50.1%) were subsequently reviewed, McEnery said. Only initial views of a study were tallied.
By modality, computed radiography studies were viewed 64.7% of the time, while digital radiography (DR) studies were accessed in 45.7% of the cases. CT, MRI, and ultrasound exams, were viewed in 53.8%, 55.9%, and 18.2% of the cases, respectively.
MDACC also reports high anecdotal evidence of clinician satisfaction with the system. And since the study period, utilization has continued to increase, McEnery said.
"There isn't a plateau in sight for the utilization of the system by clinicians, even though the number of studies being produced by the radiology department has been relatively static," he said. "The department is already experiencing the 'PACS' effect of decreased physician visits to the department. Clinicians never come down because they're looking at the images on the computer screen."
And with the exception of orthopedic or thoracic units, MDACC believes that widespread deployment of gray-scale monitors will not be required when the institution converts to an enterprise-wide filmless environment, McEnery said.
"Desktop LCD monitors may be adequate (for referring physicians), especially with availability of the integrated reports," he said.
Ultimately, the digital image distribution initiative places MDACC on solid footing for conversion to an enterprise-wide filmless environment, he said.
"We expect that we will have a non-traumatic conversion to soft-copy interpretation," he said.
By Erik L. RidleyAuntMinnie.com staff writers
May 3, 2002
Related Reading
Can PACS be too much of a good thing?, May 2, 2002
Proper training can reduce errors in PACS implementation, July 4, 2001
PACS Roundtable, Part I: PACS executives offer market update, glimpse into future, February 19, 2001
Copyright © 2002 AuntMinnie.com
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
