Branching out with filmless radiology

Texas Children's Hospital, a 456 bed pediatric hospital located in the Texa s Medical Center, has been constructing a large-scale picture archiving and communications system (PACS), including ultrasound (US), computed tomograp hy (CT), magnetic resonance (MR), and computed radiography (CR). Until rece ntly, filmless radiology operations have been confined to the imaging depar tment, the outpatient treatment center, and the emergency center. As filmle ss services expand to other clinical services, the PACS staff must engage e ach service in a dialog to determine the appropriate level of support requi red. The number and type of image examinations, the use of multiple modalit ies and comparison examinations, and the relationship between viewing and d irect patient care activities have a bearing on the number and type of disp lay stations provided. Some of the information about customer services is c ontained in documentation already maintained by the imaging department, For example, by a custom report from the radiology information system (RIS), w e were able to determine the number and type of examinations ordered by eac h referring physician for the previous 6 months. By compiling these by clin ical service, we were able to determine our biggest customers by examinatio n type and volume. Another custom report was used to determine who was requ esting old examinations from the film library. More information about imagi ng usage was gathered by means of a questionnaire. Some customers view imag es only where patients are also seen, while some services view images indep endently from the patient. Some services use their conference rooms for cri tical image viewing such as treatment planning. Additional information was gained from geographical surveys of where films are currently produced, del ivered by the film library, and viewed. In some areas, available space dict ates the type and configuration of display station that can be used. Active participation in the decision process by the clinical service is a key ele ment to successful filmless operations. Copyright (C) 1999 by W.B. Saunders Company.