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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

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


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.

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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may demand online interactive schedul- Conclusion REFERENCES

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