Successful CD imports lead to lower image utilization

By Erik L. Ridley, AuntMinnie.com staff writer

April 19, 2011 -- Hospitals may not enjoy dealing with those ubiquitous CDs that come with patients transferred to their emergency departments, but if they can import the images into their PACS, chances are they'll probably perform fewer imaging studies, according to research published online in Radiology (April 19, 2011).

A team from Brigham and Women's Hospital found that patients who had their images successfully imported from CDs had a 17% decrease in subsequent imaging utilization in the 24 hours after import, compared with those whose CD images could not be imported. And in an additional comparison with a historical control group, the study team found that importing images from CDs yielded a 29% reduction in post-transfer use of CT in the emergency department (ED).

Brigham and Woman's Hospital began importing clinical images off CDs in 2008 as part of a mandate to provide more efficient care to its ED transfer patients, said lead author Dr. Aaron Sodickson, PhD.

Seeking to test the hypothesis that importing CDs would yield a significant decrease in repeat imaging and, therefore, reduce overall imaging utilization in the first 24 hours after patient transfer, the researchers retrospectively compared imaging utilization in two cohorts: one that had successful import of their patient CDs and another that did not, Sodickson told AuntMinnie.com. Other members of the research team included Dr. Jonathan Opraseuth and Dr. Stephen Ledbetter.

As part of their CD import protocol, attempts to import images to the institution's PACS network (Centricity, GE Healthcare) occurred in 1,487 consecutive ED transfer patients between February 1 and August 31, 2009. Images were imported using a commercial software application (Open LiteBox, ETIAM).

Patient demographics were gathered via the institution's electronic medical record. Through queries of the facility's RIS (IDXrad, GE), the researchers extracted subsequent imaging rates during the first 24 hours following image import. Exams related to procedures such as angiography, fluoroscopy in the operating room, and other image-guided procedures were excluded.

In addition to detailed evaluation of the successful-import and unsuccessful-import cohorts, the team also compared ED CT utilization in the successful-import group with a historical control group of 254 consecutive patients who had transferred to their ED with CDs between August 2007 and January 2008 (a period in which CD import procedures had not yet been implemented).

Of the 1,487 image import attempts, 1,161 (78%) were successful. Use of a non-DICOM image file format or CD malfunctions produced unsuccessful imports, according to the researchers.

The mean imaging utilization rate of 2.74 exams per patient in the successful-import group was 17% lower than the mean of 3.30 exams per patient in the failed-import group (p < 0.001).

The difference was also statistically significant when analyzing only CT studies.

Mean number of CT exams per transfer patient within 24 hours
Successful-import group Failed-import group Historical control group
Overall inpatient CT scans 1.19 1.41 --
CT scans in the ED 0.84 0.99 1.18

In other findings, the 1,161 patients with successful CD importation had a total of 2,221 exams imported, for a mean of 1.91 exams per import. Of these, 68% included CT images, 49% included radiography, 8% included MR, and 4% included ultrasound.

More than one exam was imported in 572 (49%) of patients, and 29% included two or more imaging modalities.

The 22% failure rate for importing external CDs also demonstrates the need for streamlined universal protocols and standards for communicating and transferring medical information between hospitals, according to the authors.

"Ultimately, implementation of universal electronic medical records, image repositories, or robust image transfer networks would streamline image transfer between various sites and would obviate the current need to send CDs with transfer patients," they wrote.

In the meantime, however, CDs are likely to be the most common method of transferring images for the foreseeable future, according to the researchers.

"Importing these images into the PACS adds value to patient care by reducing costs, streamlining care, and improving resource utilization," they concluded. "Reducing CT utilization has the added safety benefits of decreased exposure to ionizing radiation and to intravenous contrast materials."


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