Eitaro Nishihara

Preliminary time-flow study : comparison of interpretation times between pacs workstations and films

Toshiba Hospital installed a PACS and RIS in the diagnostic imaging department along with a hospital-wide HIS in May 1993. Our PACS includes three diagnostic workstations each of which is provided with six monochrome CRT monitors. The diagnostic workstations have been used as the primary tools for interpretation of almost all radiographic images. The actual image interpretation time was measured for diagnostic workstations (237 examinations) and for conventional hard-copy films (219 examinations) for CR, CT, and MRI. The difference in interpretation times between diagnostic workstations and films was not significant. With regard to image interpretation time, diagnostic workstations are thought to be acceptable for practical image reading.

Control Method for Preloading With Priority Information in an Integrated Radiology Information System/Picture Archiving and Communication System

More than 10 years has passed since the concept of picture archiving and communication systems (PACS) was first proposed. A great deal of effort has been expended to make PACS suitable for routine use in clinical settings, but only a few systems are currently used in this manner. A major reason is the lack of the assurance of throughput equivalent to that of a conventional system based on order sheets and analog films. In this report, two techniques to increase throughput have been introduced and studied. The first is the preloading of data elements from the various information systems and the PACS. The second is the use of the priority information to rank order the examinations placed on the list for interpretation. We have applied these techniques to an actual system and have measured the distribution of time for processing examinations. These two techniques appear to make PACS useful in routine practice, because most of the urgent cases were interpreted within the target time of 40 minutes.

Clinical evaluation of newly developed CRT viewing station: CT reading and observer's performance

The clinical performance of the new viewing station with six CRT monitors (17-inch, 1,024 x 1,280) was evaluated. In the primary interpretation of CT images, time measurements were carried out for eight radiologists. No significant differences in reading time existed between CRT and film in 3 of 4 readers in head CT series, and in 2 of 6 readers in body CT series. Compared with the previous system, the new prototype system achieved an approximately 30% decrease in reading time in both head and body CT studies and could reduce mental and eye fatigue.

Implementation and evaluation of workflow based on hospital information system/radiology information system/picture archiving and communications system

The purpose of this presentation is to review and evaluate computerized workflow of selected sites that have integrated systems of the hospital information system (HIS), radiology information system (RIS), and picture archiving and communications system (PACS). We then focus on some essential points of integration of those systems, such as avoiding multiple entries of patients demographic data, prefetching current and previous images to the correspondent workstations, and workflow management. To realize them by integrating multiple subsystems such as HIS/RIS/PACS integration, there must be exchange of the workflow control information, and consistency of the information between subsystems.

Toshiba General Hospital PACS for routine in- and outpatient clinics

The Toshiba General Hospital introduced a departmental RIS/PACS (Radiology Information System/Picture Archiving and Communication System) in the radiology department in May, 1993. It has been used routinely since that time. In order to provide efficient means for clinicians to find and read many images, the system has been expanded to the neurosurgery and urology clinics and wards since May, 1995, and five image referring workstations now provide digital images to clinicians. In this paper we discuss an algorithm for image migration, one of the key issues to accomplish the expansion to outpatient clinics successfully, and propose the WYWIWYG (what you want is what you get) image transfer logic. This is the logic used to transfer images that physicians require refer without increasing the traffic between the image server and referring workstations. We accomplish the WYWIWYG logic by prioritizing exams the physicians have not yet viewed and by finding historical exams according to the modality, anatomy, and marking. Clinicians gave us comments from their first use of the system and suggested that the PACS enables clinicians to review images more efficiently compared to a film-based system. Our experience suggests that it is a key to the effective application of PACS in outpatient clinics to incorporate consideration patterns of clinicians on the migration algorithm.

Radiology information system/picture archiving and communication system architecture to assist daily practical reading at the Toshiba Hospital

We have developed integrated RIS/PACS system which supports examination, interpretation and management in the diagnostic imaging department. The purposes of the system is offering a mean to support immediate and chronological comparative reading without film file transportation. The system was installed to the Toshiba hospital in Tokyo in May 1993, concurrent with a renewal of the hospital facilities.