Date: Tue, 19 Jan 1999 17:57:15 -0500

From: Charles Mehlman

Subject: Filmless existence

Have any of your home institutions instituted efforts toward a "filmless existence" and how has it worked out for you???

Here in Cincinnati there is a strong push for a PICTURE ARCHIVING and COMMUNICATION SYSTEM (PACS)= filmless radiology.

The orthopaedic implications would seem to be extensive.

Charles T Mehlman, DO, MPH, Pediatric Orthopaedic Surgery, Cincinnati, Ohio

Reply at: Orthopaedic Trauma Association forum

Date: Tue, 19 Jan 1999 22:49:02 -0400

From: Brian McCardel

We are just launching it in the last few weeks, and I just had my first real contact with the advantages of it tonight. I went to the radiology department to view the films on two patients. The first was an ORIF of a radial head fx that I had just completed. The film was "light", so we brought it up on the box, and then adjusted the window. No more "light".

The second was a patient who had just come in through the ER and I wanted to see his films. Hard copy didn't need to be found. They brought the last 20 patients up on the screen, I selected his name, and scanned through all of them on-line. What a boon!

Finally, we are in the middle of one of the TCI cable modem projects, and expect to be getting high-bandwidth feeds of these images to the house and office by mid-summer. However, templating for joint replacement and fracture planning remains an unknown.

Date: Tue, 19 Jan 1999 20:35:39 PST From: Edward Harvey

Welcome to a very frustrating two to three year period in your career. The decision to change over at our institution was made by the radiologists and the accountants.

There is little benefit to actual patient care. Unless you are fiberoptically connected in clinic and your office where you see patients the speed at which you can review films and decide on patient management is going to markedly slower. Most software is not optimized for bone windows and will really try your patience for review of MRI and CT scans.

Digitized plain films are about 10 MB per shot- with compression you can probably get them into a 1 GB slot. If you want to retrieve them for review in the acute care phase- say the first year of follow-up- then you need to store all these on some kind of platter(hard drive). Well if you look at a moderately busy ortho department you are going to need 50-100MB of space. (Estimate of 5MB pre helical CT , 5MB per MRI and 1MB for plain CT)

The biggest hard drive currently in standard release is an 18 GB drive. To retrieve at any speed you need these in a raid configuration (paired so they swap info). Get a big box for your server- 5 RADI drive assembly is a good start but will need backup for older films.

You need those on a dedicated server for your department so you do not get swallowed in a bandwidth nbottleneck by the rest of the radiology department- so stipulate that the radiology department dumps all msk films into your server each night. Then run your clinic and office terminals from your own LAN server with the imagers on them.

This will save you some of the heartache of relying on radiology to do what is right for your films.

Edward J Harvey MDCM FRCSC, Asst Professor McGill University, Department of Orthopaedic Surgery

Date: Wed, 20 Jan 1999 07:49:57 -0500

From: Kevin Pugh

We are in the process here at the University of Kentucky- and I can tell you that the orthopaedic implications are big, and somewhat painful.

The ICU's and ER are currently filmless. This works well if you have patients in those areas. The problem is when you need to take the patient to the OR. Then, you must have the techs print you a copy of the film. The printers work just as they do for any computer- you can print 1,2,4 or 6 images per page. This makes it almost impossible to template anything.

When the entire system is operational, it will work well. We will be able to pull the films up on a desktop computer, view the film anywhere in the hospital or at home. Multiple users will be able to view the same jacket at the same time.

This is what they are telling us. All I know is that, at the present time in our system's implementation, it is painful.


Date: 1/20/99 9:39AM

From: Kenneth D Johnson

Ditto the comments from McGill! Many problems with viewing the images! Even though the quality is great. Your radiology dept will not want to print film, therefore you will need a special viewing monitor to view each x-ray. Unless of course you have a special paper printer to print a paper copy of the x-ray which may be of questionable quality. You may one day be able to work out an image link through your hospital network to allow access to the radiolgy archive using your lap top which of course means that you have to have access to your hospital's network everywhere you wish to view the x-ray (usually the OR is the problem). This image link is a much bigger problem in that the PACS images (DICOM) are in a format that doesn't like to go to personal computers easily (this is a computer lay person or normal orthopod talking here).

In spite of all this, you had better get ready for this change because it is coming and it behooves us all to become prepared for it ASAP! KDJ