Radiology Services

P.A.C.S.: THE FUTURE OF RADIOLOGY IS HERE

 

The radiology department at HSC Medical Center is equipped with a "picture archiving and communication system," also known by the acronym PACS. This system has been in place at HSCMC since 2003. Several years ago, PACS systems were fairly uncommon throughout radiology departments across the country. However, at the turn of this century, the new standard for radiology department information "flow" had certainly become the PACS.

WHAT IS P.A.C.S.?

PACS is basically a series of computers that allow rapid transfer of information between the physician ordering the patient's radiology examination, the radiology technologists (who physically perform a radiology examination such as X-ray, CT, MRI, or ultrasound), the radiologist (the doctor that looks at the radiology examination and renders his/her interpretation), and the typist (who types up the radiologist's examination interpretation).

WHAT'S SO SPECIAL ABOUT P.A.C.S.?

Although the functions and benefits of PACS are quite numerous, the most basic advantage is a more rapid radiology examination report for the physician ordering the radiology test. Usually, the more quickly a patient's physician gets the radiology report, the more quickly some decisions can be made regarding any abnormalities that may be present.

In the pre-PACS era, the typical pathway of information "flow" from the physician to the radiology department and back was somewhat convoluted, and is summarized as follows:

1. The patient visits their doctor. Their doctor orders a radiology test, such as an X-ray, CT, MRI, or ultrasound.
2. The patient goes to the radiology department, and the study is performed. After the test, the patient is sent back home or back to their hospital room.
3. The films are printed onto sheets. The sheets are gathered together into a film "jacket," which contains all (or most) of the patient's previous radiology films and the previous radiology examination reports (which are on paper copies).
4. The entire jacket is delivered to the radiologist.
5. The current study and the pertinent prior studies are located in the jacket, removed, and "hung up" (usually against an array of fluorescent lights on the wall) for study by the radiologist. The prior radiology examination reports are also removed from the jacket and reviewed by the radiologist.
6. The radiologist "dictates" the study results into a microphone and onto a cassette tape. A typist listens to the radiologists' report (after the tape is delivered to them) and types it.
7. The typed report is printed off and sent to the radiologist for approval.
8. The radiologist reads the printed report. If mistakes are detected, then they are corrected, and the report is sent back to the typist for revision. Revised reports are then sent back to the radiologist for re-review. Once the report is satisfactory, the radiologist signs the report.
9. A copy of the report is sent to the patient's doctor for their review.
10. The patient is then seen again by the physician, and the results of the radiology test are reviewed and discussed.

PACS greatly simplifies this arduous process by streamlining much of steps 3 through 8 listed above. Computers replace many other elements in the radiology department. Since the advent of PACS, the need for film jackets, film sheets, cassette tapes, and other items is virtually eliminated from a radiology department. (One side benefit of this is the reduction in "lost" radiology examination results from misplaced/misfiled/"lost" jackets, film sheets, and cassette tapes.)

PACS allows examinations in X-ray, CT, MRI, and ultrasound to be instantly sent to the radiologist's computer screen, so that interpretation can begin only minutes after the exam is done. PACS also allows the radiologist to instantly access the prior radiology examination results and pictures (so that comparisons can be made, if needed). PACS lets the radiologist "dictate" the results straight into a computer, and become instantly available to the typist via their computer, even if the radiologist and typist are miles apart.

Perhaps most impressively, PACS can allow many physicians to look at the radiology examinations on their own patients in their offices, often with an already-typed radiology examination report---often as rapidly as the same day the radiology examination was done.

PACS alleviates some direct burden on patients, as well. Instead of patients receiving bulky copies of their radiology examinations on sheets of film, they can receive a CD with all of the radiology examination pictures on the disk. This is particularly useful if a patient is to be seen at a new or different hospital or physician. (Patients are often told to bring their radiology examination pictures with them when they see a new physician.)

At HSCMC, with PACS, the information "flow" from physician to radiology department and back is greatly simplified from the "old ways" enumerated above. The information "flow" is now as follows:

1. The patient visits their doctor. Their doctor orders a radiology test, such as an X-ray, CT, MRI, or ultrasound.
2. The patient goes to the radiology department, and the study is performed. After the test, the patient is sent back home or back to their hospital room.
3. Within seconds of the test being performed, the pictures are available to the radiologist on their computer screen, along with any prior radiology examination pictures and prior radiology examination reports.
4. The radiologist "dictates" the results into the computer, and the exam is typed by the typist within minutes.
5. The radiologist can immediately access the typed report, make corrections on-the-spot via the computer, and sign the examination report.
6. The radiology examination pictures and report are also immediately available to the doctor that ordered the exam. Decisions regarding the patient based on the radiology examination results can then be made, often on the same day (and sometimes in the same hour) as the examination.

With the help of PACS, patient care becomes more expedient, and communication between the patient, the patient's primary physician, and the radiology department becomes more fluid. With more efficient communication, medical care is improved at all levels. Questions regarding the HSCMC PACS system or other elements of the HSCMC radiology department can be relayed to Craig McDaniels, Director of Radiology, at 501-332-7373.

Dr. William W. Davenport is a board certified radiologist at HSC Medical Center. He is associated with Hot Springs Radiology Services, Ltd., which provides radiology coverage for HSCMC.