CONTINUING QUALITY IMPROVEMENT PROCEDURES FOR A CLINICAL PACS

The University of California at San Francisco (USCF) Department of Rad iology currently has a clinically operational picture archiving and co mmunication system (PACS) that is thirty-five percent filmless, with t he goal of becoming seventy-five percent filmless within the year. The design and implementation of the clinical PACS has been a collaborati ve effort between an academic research laboratory and a commercial ven dor partner. Images are digitally acquired from three computed radiogr aphy (CR) scanners, five computed tomography (CT) scanners, five magne tic resonance (MR) imagers, three digital fluoroscopic rooms, an ultra sound mini-PACS and a nuclear medicine mini-PACS, The DICOM (Digital I maging and Communications in Medicine) standard communications protoco l and image format is adhered to throughout the PACS. Images are archi ved in hierarchical staged fashion, on a RAID (redundant array of inex pensive disks) and on magneto-optical disk jukeboxes. The clinical PAC S uses an object-oriented Oracle SOL (systems query language) database , and interfaces to the Radiology Information System using the HL7 (He alth Languages 7) standard. Components are networked using a combinati on of switched and fast ethernet, and ATM (asynchronous transfer mode) , all over fiber optics. The wide area network links six UCSF sites in San Francisco. A combination of high and medium resolution dual-monit or display stations have been placed throughout the Department of Radi ology, the Emergency Department (ED) and Intensive Care Units (ICU). A continuing quality improvement (CQI) committee has been formed to fac ilitate the PACS installation and training, workflow modifications, qu ality assurance and clinical acceptance. This committee includes radio logists at all levels (resident, fellow, attending), radiology technol ogists, film library personnel, ED and ICU clinician end-users, and PA CS team members. The CQI committee has proved vital in the creation of new management procedures, providing a means for user feedback and ed ucation, and contributing to the overall acceptance of, and user satis faction with the system. Well developed CQI procedures have been essen tial to the successful clinical operation of the PACS as UCSF Radiolog y moves toward a filmless department. Copyright (C) 1998 by W.B. Saund ers Company.