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THE IMPLEMENTATION OF RADIOLOGICAL PACS (PICTURES ACHIEVING COMMUNICATION SYSTEM) IN A PRIVATE HOSPITAL: A CASE STUDY OF RADMED DIAGNOSTIC CLINIC VICTORIA ISLAND LAGOS

ABSTRACT

The aim of this study was to develop wireless Picture Archiving and Communication System (PACS) device and to analyze its effect on image transfer from portable imaging modalities to the main PACS server. Many hospitals have adopted the Picture Archiving and Communication System (PACS) for effective handling of medical images. With the advent of PACS in a filmless hospital environment, there is an increasing demand for rapid or immediate access to patient images. In most hospitals, clinicians and radiologists can only retrieve relevant images and patient information via workstations with fixed locations using restricted local networks. Many hospitals now have access points for wireless communications. In the wireless local area network (LAN) environment, the need for interface between PACS and the wireless network has increased. However, past studies have mainly focused on retrieving PACS images using the wireless network. If the wireless network is used in the transfer of images to PACS, it could help shorten the time interval for image transport. The aim of this study was to develop a wireless PACS device for rapid delivery of DICOM modality worklist from the PACS server and images to the PACS server and to analyze its effect on image transfer from portable imaging modalities to the main PACS server.

CHAPTER ONE

INTRODUCTION

1.0      INTRODUCTION

Radiology is a branch or specialty of medicine that deals with the study and application of imaging technology like x-ray and radiation to diagnosing and treating disease. Radiology also uses imaging technology such as Radiography, Magnetic Resonance Imaging (MRI), Nuclear medicine, ultrasound, computed tomography (CT), and positron emission tomography (PET) to see within the human body in order to diagnose diseases and abnormalities.

Radiology is sometimes referred to as radioscopy or clinical radiology. Clinical radiology refers to the use of radiology to diagnose or treat injury. Radiology is a key part of clinical practice across a wide range of medical disciplines. It is usually the best, minimal invasive way of diagnosing, treating or monitoring disease and injury.  

Radiological information System (RIS) is a networked software suite for managing medical imagery and associated data. An RIS is especially useful for managing radiological records and associated data in a multiple locations and often used in conjunction with a picture achieving and communication system (PACS) to manage workflow and billing.An RIS has several basic functions:

Patient management: An RIS can track a patient’s entire workflow within the radiology department, images and reports can be added to and retrieved from electronic medical records (EMRs) and viewed by authorized radiology staff.

Scheduling: Appointments can be made for both in and out patients with specific radiology staff.Patient tracking: A patient’s entire radiology history can be tracked from admission to discharge. The history can be coordinated with past, present and future appointments.Results reporting: An RIS can generate statistical reports for a single patient, group of patients or particular procedure.Film tracking: An RIS can track individual films and their associate data.  Billing: An RIS facilitate detailed financial record-keeping electronic payments and automated claims submission.

PACS (Picture Archiving and Communication System) is a computer-based system used to transfer, store, display and manage medical images and associated text data. A PACS presumes the use of softcopy/digital medical images, typically but not always in DICOM format.

In the early 1970s  at the University of Arizona, Dr. M. Paul Capp and Sol Nudelman, PhD, Organize a digital imaging group that works to develop the first digital subtraction angiography   (DSA) device – the first clinical application of digitally derived images.In Mid 1970s Professor Jean-Raoul Schrrer pioneers a medical information display system at the Geneva University Hospitals in Switzerland, which would have broad implication for later PACS development. The system, called DIOGENE, collects and display patient information on computer monitors. A bank of telephone operators would type in information that would show up on the screens.

At a minimum, a PACS consist of an archive device for image storage, database and workflow management software, and diagnostic display stations for interpreting physicians. A PACS can also incorporate brokers (also called gateways) that are used to communicate with other systems (such as modalities or a HIS/RIS), display stations for non-diagnostic images review, and dictation/report management software.  Some image-producing modalities such CR (Computed Radiology) and DR (Direct Radiology) devices are considered to be PACS components as well. Film digitizers may be used to converts film-based images into digital images for storage in a PACS, and printers can be used to produce hardcopy for situations where softcopy access is not convenient. Basically a PACS provides the ability to electronically Input Images and data from (digital) modalities, Distribute images and data to PC’s and workstations, Read on Computer display (diagnostic and clinical), Store (Both long and short term) images, Transmit (to other areas or off-site)

1.1      BACKGROUND TO THE STUDY

Over the years, the trend in technology as tremendously increase workflows in hospitals especially in the radiology departments, but Radmed Diagnostic Clinic is not fully moving with the trend, this is most seen as a set-back in the Clinic, which brings about an unsatisfactory state of affairs in the radiology department of the clinic.

The clinical application of X-rays and the birthof radiology followed Roentgen’s 1895discovery in a matter of days. This rapid transferof basic scientific knowledge and technology tomedicine coincided with a period of greattechnological development and social change inthe Western world. As radiology begins itssecond century, technological progress combinedwith social and political upheaval createsa similar environment of uncertainty andpromise. Although the outcome of the changescurrently in progress cannot be predicted, it isclear that the second century of radiology willbe very different, but probably no less exciting,than it’s first, offering both change andopportunity.

Several factors will contribute and, in manycases, compete for influence in the changes thatwill define the second century of radiology. Rapid and dramatic progress in imaging andimaging-related technology will continue,matching and perhaps outpacing the developmentsof the 1970’s, 1980’s and 1990’s. Today’sgrowing trend toward less invasive imageguidedintervention will extend well beyond themethods currently available. It will contributeto improved quality of life and greaterproductivity, and provide higher value for itscost. These changes will be moderated andperhaps compromised by reordered social andeconomic priorities. Limits will be imposed bysociety on the amount of resources that can beallocated for health care. In this changingenvironment, radiology will succeed only to theextent that it can provide patients, clinicians,and bureaucrats with high value in solving theproblems of medicine in the 21st century. Inmeeting this challenge, radiology finds manyopportunities for success.

1.2      STATEMENT OF PROBLEM

Radiology might be thoughtof as a “two-thirds way” diagnostic technology. Advancedimaging now provides striking images of clinicalproblems, in many cases far superior to what can be seenby the naked eye. The steady growth of technical improvementsin these mature technologies has enabledremarkable insight of images from advanced imaging modalitiessuch as CT and MRI, as well as fusion imagery ofmetabolic processes.

Although radiologic diagnosis has become sufficientlydeveloped to eliminate much exploratory surgery, it isstill not developed sufficiently to avoid triggering costlyfollow-up studies. Because imaging cannot determine inmany cases how much clinical risk is embodied in apotentially threatening finding, today’s advanced imagingexaminations still generate excessive cost and patientanxiety.

The recent trends in technology cannot be overlooked in radiological application. I became interested in bringing solution to common challenges in the Radiological departments of Radmed Diagnostic Clinic Victoria Island and its three other branches outside Victoria Island.

Therefore the following challenges will be examined;

    (i)            Cost of transporting X-films for reporting from other branches of Radmed Diagnostic clinic to the Headquarter in Victoria Island

  (ii)    Printing of hardcopies of X-ray films even when not necessary,

(iii)  The performances of Radiologist/Radiographers while using manual way of transporting films compared to using PACS.

(iv  Cost implication of buying X-ray films,

  (v)   Time expended during processing of films

1.3      OBJECTIVES OF STUDY

The objectives of this study are to;

(i)  achieve all Dicom (Digital Imaging and Communication in Medicine) Images on a central server

(ii)  ease the sending X-ray Images of patient from the head quarter to all other branches (Agege, Ikeja, Ipaja)

(iii)  eliminate hardcopies of X-ray films and digitizing the Hospital

(iv)  implement a central Server and Network to all consulting doctors’ computer system in Radmed Diagnostic clinic Victoria Island Lagos with all other consulting doctors’ of Radmed Diagnostic Clinic computer systems outside Victoria Island.

Therefore this project is about the implementation of Radiological information System (RIS) in Radmed Diagnostic Clinic and all its 3 other branches in Lagos, using an application software platform called Charrua.

1.4      SIGNIFICANCE OF STUDY

This project will help in improving efficiency by automating radiology workflow, this is achieved by removing barriers between images and information, which decreases report turnaround time and significantly refines service to patients and referring physicians

1.5      SCOPE/LIMITATION OF STUDY

The project can be implemented in both Government and Private Hospitals but it focuses on internetworking of several locations and transmission of Images and data through wireless and wired means just within Radmed diagnostic clinics and its three other branches.

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