The Transformational Effects of Informatics on the Practice of Radiology: A Roundtable Discussion

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On October 6, 2009, four physicians gathered in Stamford, Connecticut, to participate in a discussion moderated by Cheryl Proval, editorial director.

imageRobert Lipman, MD,is a radiologist at Straub Clinic and Hospital, Honolulu, Hawaii.
imageTerence Matalon, MD, FACR, FSIR,is chair, department of radiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania.
imageGreg Mogel, MD,is medical director, imaging, at USC University Hospital, Los Angeles, California.
imageAndrew Wells, MD, is a radiologist at Margaret Pardee Memorial Hospital, Hendersonville, North Carolina.


Radinformatics: PACS has turned out to be quite evolutionary in its effect on the way in which radiology is delivered to the marketplace. What have been the greatest positive effects on your radiology service of this ability to move images? What are the limiting factors of the software and technology?

Wells: The greatest positive impact is that the historical priors are available. You have to remember that in the past, the image location was dictated by the physical location of the film, jacket, and report. The cycle time, from image acquisition to reporting with comparison using a result from earlier today or from yesterday, has dramatically improved. That’s a basic, fundamental issue, but it’s very important as a clear advance. The limiting factor is that there’s no perfect delivery platform to get you the clinical information to make that interpretation, but it’s better.

Lipman: PACS multiplies the number of copies of the image that can be seen at any time, which is a very important feature. The radiologist can be interpreting it and the surgeon can be operating on the patient while looking at that same image. To show how important that is, in my system, we have satellite clinics; half of them have CR that gets sent to the radiologists immediately and half of them have film, and the ones that don’t have CR are clamoring for it. They’re asking for stat readings on their films, which is kind of ridiculous because it took a day and a half to get the film to us, but they’re demanding that as soon as it rolls in the door, we read it immediately. What they really want is CR.

Matalon: PACS has had a tremendous impact. Obviously, there’s been a marked ability to improve productivity for the radiologists, and it’s also driven major changes in the subspecialties and how we deliver imaging interpretations. The ability to read remotely has had a big impact on staffing, and it’s also driven what we’re currently seeing, which is subspecialization of image interpretation and the ability to send the image and allow it to be interpreted by the proper person, regardless of where he or she may physically be. The other major change has happened because the images are now digital: The ability to manipulate images is something we didn’t have with film.

Mogel: It’s hard to mention the limiting factors because I find it hard to envision a future of radiology that doesn’t have PACS. To me, PACS and radiology are inherently tied together. There is no separating them anymore. While there are fewer and fewer practices that don’t use PACS, there are almost no new ways of imaging the human body that don’t require you to have digital presentation and storage. It is impossible to imagine imaging in its present form, and certainly in any of its future forms, without PACS.

Its limitations are those inherent in medical imaging: the fact that we’re developing imaging studies that are larger and larger, and more and more complex. Those are the promises and the limitations. The first huge breakthrough that changed everything was the fact that you had the stored image and the clinical information all in one piece. Before PACS, the limitation was that if you lost it, it was gone; only one person could see it at a time, and it was not at the point of care. Everyone had to trudge down to the radiology reading room. To most younger physicians today, this is almost unimaginable because of PACS. The limitations are the same as for any IT: the absence of standards and the tug of war that exists between customization and standardization. Now that we can have images almost anywhere we want at any time, those rare circumstances where we can’t become intolerable.

Radinformatics: Aside from PACS, three other information systems are fundamental to the interpretation of radiology exams: RIS, advanced