EVALUATION OF THE MEDICAL DIAGNOSTIC-IMAGING SUPPORT SYSTEM BASED ON 2 YEARS OF CLINICAL-EXPERIENCE

The Medical Diagnostic Imaging Support (MDIS) system at Madigan Army M edical Center (MAMC) has been operational in a phased approach since M arch 1992. Since then, nearly all image acquisition has been digital w ith progressively increasing primary softcopy diagnosis used. More tha n 375,000 computed radiography (CR) images as well as other modality i mages have been archived. Considerable experience in installation and implementation phasing has been gained. The location and ergonomic asp ects of equipment placement were refined with time. The original clini cal scenario was insufficiently detailed and additions were made to fa cilitate smoother and more complete transition toward a filmless envir onment. The MDIS system effectiveness and performance have been good i n terms of operational workload throughput, background operations, and reliability. The important areas regarding reliability are image acqu isition, output, display, database operations, storage, and the local area network. Fail-safe strategies have been continually improved to m aintain continuous clinical image availability during the times when t he MDIS system or components malfunction. Many invaluable lessons have been learned for effective quality assurance in a hospital-wide pictu re archiving and communication system. These issues include training, operational quality control, practical aspects of CR image quality, an d increased timeliness in the generation and distribution of radiograp hic reports. Clinical acceptability has been a continuous process as e ach phase has been implemented. Clinical physicians quickly used the w orkstations soon after the start of MDIS at MAMC. The major advantage for clinicians has been the amount of time saved when retrieving multi modality images for review. On the other hand, the radiologists have b een slower in their acceptance of the workstation for routine use. Rad iologists need the completed software and hardware implementation to a chieve the throughput necessary for a high-volume practice setting in making primary softcopy diagnoses.