Enhanced visualization processing: Effect on workflow

Rationale and Objectives. Soft-copy viewing of digital radiographs allows f or image processing to improve visualization of anatomy and lesions, but it can take more time than film-based viewing. Enhanced visualization process ing (EVP) was developed to increase the latitude of an image without reduci ng the vital contrast, potentially reducing the need for the radiologist to manipulate images. This study examined the influence of processing radiogr aphic images with EVP on workflow in a picture archiving and communications system (PACS). Materials and Methods. Portable computed radiographic chest images were obt ained and processed either with EVP or without. A security camera with a vi deocassette recorder was positioned above the PACS workstation. Four radiol ogists reviewed the images during their normal work schedule. The current d iagnostic image was used to determine if the case contained EVP or non-EVP images. The videotapes of the sessions were reviewed to determine diagnosti c viewing times and how zoom and/or window and level manipulation was used. Results. Viewing time was significantly longer for the non-EVP than the EVP cases. The difference occurred with all readers. Window and level manipula tion was used on 35% of the EVP and 41% of the non-EVP images. Zoom was use d on 64% of the EVP and 69% of the non-EVP images. Average time spent using zoom and window and level manipulation was significantly shorter with the EVP than with the non-EVP images. Conclusion. EVP of chest images displayed on PACS monitors significantly im proved work-flow as measured by viewing time. EVP decreased use of window a nd level manipulation and zooming and the amount of time each one was used.