January 15, 2004

Filmless Imaging The Future At UCSD

By Jeffree Itrich

It won’t be long before children ask their parents what it was like in the old days to see their radiographic studies on tangible film. Although a few will still float around the archive files, studies recorded on film are about to be as obsolete as vinyl 45s and the manual typewriter. No longer will patients have to physically carry films to specialists’ offices, will films get worn out and scratched, will staff have to walk over to radiology to retrieve films and most importantly, will films get lost. Filmless imaging has come to UCSD Healthcare.

UCSD has had PACS, or Picture Archive and Communication System, made by Agfa, since 2000 when the radiology and information technologies departments embarked on Phase One, putting digital modalities such as CT, MRI, ultrasound and nuclear medicine online. Clinicians have become accustomed to looking at PACS online. The university is now actively in Phase Two, putting online non-digital modalities, such as typical x-rays, angiograms, and in the near future, mammography. These traditionally non-digital modalities are where the majority of the work is done, although that too is changing because CT scanners and MRIs can produce 300 slice images in a matter of seconds, the equivalent of 300 films in a non-digital environment.

“This is a way for us to distribute images throughout the whole UCSD Healthcare enterprise,” said Glen Yoshitake, Administrative Director of Radiology. “Our clinicians can view images from their offices, from home, if they’re traveling, and from within the operating rooms. The images are always available.”

Phase Two makes radiology’s PACS accessible to anyone, any time, anywhere, including outside of UCSD and overseas. PACS enables authorized users to access images via the Internet enabling them to make instant care decisions. This final phase took UCSD to a mostly filmless status by the fall of 2003, according to UCSD’s Chief Information Officer, Ed Babakanian. Imaging of all new studies will be digital and accessible online.

Not having films to look at will require physicians to work a little differently, says Yoshitake. In the past physicians reviewed films in a light box, now it will require going online to the Internet, and typing in a password to access the images and radiology report. Much as office personnel placed films in patient rooms for physicians to view during appointments, so can personnel call up the images and reports online for physicians to read before entering patient rooms. By storing and accessing films online the new highly sophisticated system allows numerous people to view the images simultaneously, in the case of a telephone consultation, and permanently eradicates film loss.

Babakanian explains that accessing patient images via the web will work analogously to accessing patient medical information online. Whether in a clinic, office, hospital nursing station, lab or offsite location, the physician signs onto the computer with a special ID and password compliant with patient confidentiality and HIPAA regulations, accesses the browser, identifies the patient and pulls up the image. The process is as quick and easy as linking to PCIS, UCSD’s clinical information system. If the physician is at home or away, PACS can be accessed via the web; within UCSD, the images can be accessed on clinical workstations deployed in outpatient and inpatient areas.

Yoshitake points out that the new system will allow clinicians to manipulate the images, a clear advantage over static film x-rays. Much like operating a camera, viewers will be able to change the contrast and brightness, enhance edges, smooth image graininess and sharpen images for clearer viewing.

Radiology is also seeing major upgrades that equate to cutting edge technology, according to John Forsythe, Manager of Radiology Information Systems, and PACS administrator. They’re adding a number of additional workstations for radiologists and technicians to perform diagnostic functions, and upgrading the main servers. Currently, radiologists have immediate access to 28 days of data stored on the server; they save earlier studies on tape that require 10-15 minutes to retrieve. With the new, more powerful server, radiologists will have immediate access to 32 months of data. Data older than 32 months will be stored on tape.

For patients and specialists who need or want a physical copy of their studies, robotic burners at Hillcrest and Thornton will burn the studies onto CDs that can be read by a standard PC.

Media Contact: Jeffree Itrich (619) 543-6169