How the Internet is
revolutionizing radiology
As diagnosis becomes increasingly distributed, the Internet has the potential to improve
efficiency, foster collaboration with clinicians, and enhance communication with patients.
Robert Cooke
T
he Internet has revolutionized the
delivery of many products and
services. As a service, radiology
has taken part in the Internet revolution.
For example, radiologists once primarily
worked on-site in hospitals. Today, ambu-
latory care is increasingly common, often
separating the radiologist from the pa-
tient. As a result, remote image interpre-
tation is now routine, and it is common to
distribute soft-copy images across the
healthcare enterprise. These trends create
the need to image-enable thousands—if
not tens of thousands—of desktops
throughout an integrated healthcare net-
work—many of which are outside of the
walls of a hospital.
Consumerism is another critical trend
that is being fueled by the Internet. Today
patients have easy access to a wide range
of medical information and are able to
educate themselves about radiology
processes. As a result, they demand a
high level of service, including rapid
turnaround of imaging reports.
Finally, the Internet may also be play-
ing a role in the shortage of radiologists,
as some elect to work in the computer
technology industry. An estimated 380
million radiology procedures will be
performed in 2008, representing an
Mr. Cooke is Vice President of the
Network Business Unit at FUJIFILM
Medical Systems USA, Inc., Stamford, CT.
30 ■ SUPPLEMENT TO APPLIED RADIOLOGY
annual growth rate of 14%. The number
of radiologists is growing at an annual
rate of just 1.2%. Under these challeng-
ing circumstances, it is essential that we
maximize radiologist efficiency, so that
the quality of care can remain high.
PACS redefined
In 1999, a picture archiving and com-
munication system (PACS) was easy to
define. It consisted of a diagnostic work-
station, a list of unread studies, and digi-
tal departmental storage. It was simply a
system that enabled soft-copy interpreta-
tion of images. In essence, the computer
replaced the light box.
Today, defining a PACS is anything
but simple. In addition to remote reading,
we are faced with new imaging modali-
ties that generate very large data sets with
an increasing amount of dynamic and
functional content. As multiple health-
care institutions come together to form
integrated delivery networks, they create
multisite workflow for the radiologist
and others involved in patient care. There
is an increasing amount of information
available to drive workflow and guide
decisionmaking, but it must be navigated
in an efficient fashion.
In addition, with the push toward the
electronic medical record, users are
looking for portable, mineable forms of
data storage. They also want enterprise
access to images and information, not
just in radiology but also in such clinical
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areas as cardiovascular medicine, path-
ology, mammography, and others.
All of these trends create questions
about what a PACS should look like. As
we consider this question, we should be
thinking about workflow, visualization,
and infrastructure. As an industry, we
must think of a PACS not as a monolithic
system, but rather as a platform and an
infrastructure for storage of data from
multiple clinical areas, as a separate plat-
form for visualization, and as a tool for
overcoming workflow challenges.
Integration
Radiology studies often traverse
many boundaries. A large hospital may
be served by a single radiology group,
which, in turn, may be covering multi-
ple different large-scale facilities as well
as a small hospital that is struggling to
retain radiology services. The radiology
group may also be outsourcing some of
its work to a nationwide reading service
or so-called super group.
A typical radiologist reads on ≥6 dif-
ferent PACS systems. This translates into
at least the same number of platforms for
3-dimensional (3D) visualization, the
radiology information system (RIS), and
the reporting system. The need for radi-
ologists to switch between various user
interfaces creates both a great challenge
and a great opportunity for integration.
For example, the mandate to maxi-
mize radiologist efficiency creates the
December 2008
 REVOLUTIONIZING RADIOLOGY

opportunity for a new kind of integrated

worklist that takes into account all of the
healthcare sites the radiologist serves and
brings together a variety of tasks ranging
from report signing to peer review to pro-
tocoling of examinations. By drawing
from combined user preferences and
workrule logic, this information can be
presented in a dashboard format for navi-
gation by the radiologist (Figure 1).
Combining diverse systems into a com-
mon worklist/dashboard allows a radiol-
ogist an integrated view of the work he or
she has to perform.
Once the radiologist gets to that work,
it is very important to have the right kinds
of tools available, including advanced
visualization. These tools need to be inte-
grated not only into the PACS for use in
normal day-to-day operations, but also
FIGURE 1. A mandate to maximize radiologist efficiency creates the opportunity for a new kind into other applications, given that new
of integrated worklist that takes into account all of the healthcare sites the radiologist serves and
brings together a variety of tasks ranging from report signing to peer review to protocoling of
kinds of viewing models will be incu-
examinations. By drawing from combined user preferences and workrule logic, this information bated outside of the PACS in many cases.
can be presented in a dashboard format for navigation by the radiologist. These tools also need to be distributed,
because diagnosis is now distributed.
Radiologists should not be constrained
by the limitations of the environment in
which they serve. All necessary informa-
tion and tools need to be accessible in a
way that facilitates efficient and ergo-
nomic interpretation. In addition, our
systems must be able to provide, at a
minimum, a collaborative connection
between the radiologist and the clinician.

Internet
It is interesting to visualize how all of
these demands might play out in the
future and what impact the Internet will
have (Figure 2). Hospitals may seek a
common infrastructure for radiology, car-
diology, mammography, and other spe-
cialties—one that integrates images,
structured reports, documentation, and
medication history into a decision support
system. The desire to integrate various
imaging modalities into a common infra-
structure may be a reason healthcare insti-
tutions are looking to replace their PACS.
They may also be looking to replace
FIGURE 2. The Internet is driving re-evaluation of picture archiving and communication sys-
their radiology information system and
tems (PACS), radiology information systems (RIS), and other technologies as healthcare insti-
tutions seek a common, integrated infrastructure for multiple imaging specialties, as other technologies as a way not only of im-
radiologists seek to gain a competitive edge, and as both seek to enhance relationships with proving workflow but also of maintaining
referring physicians and patients. their physician base. Referring physicians

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REVOLUTIONIZING RADIOLOGY
may demand online interactive schedul-
ing, order entry, critical results alerts,
advanced visualization, and decision sup-
port—and hospitals may seek to provide
these services as a way of retaining their
relationship with physicians.
Certainly radiologists are starting to
invest in technology platforms that help
them gain a competitive edge through
more ergonomic and efficient interpre-
tation, access to prior studies, results gen-
eration, diagnostic visualization tools,
and decision support.
Better communication with patients
is also an important emerging opportu-
nity. Interaction with physicians, educa-
tion, and results reporting can all be
facilitated by the Internet.
32 ■ SUPPLEMENT TO APPLIED RADIOLOGY
Conclusion
A unique opportunity exists for our in-
dustry to connect all healthcare stake-
holders through the use of Internet
technology. We must act quickly, as tech-
nology is changing at Internet speed.
As vendors, we must define our goals
and deliver value. We must open our sys-
tems and enable integration opportunities
without creating technology stagnation.
We must continue to collaborate with
stakeholders in the healthcare industry.
We must continue to adapt and exploit
consumer technologies. Perhaps most
important, we must “humanize” radiol-
ogy by involving the patient, involving
the referring physician, and putting a
human face on the radiology process.
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