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From the time we started archiving outpatient data, a total of 185,880 images in 8,440 series have been stored into the PACS (status on July 18, 2005).The data stored originate from multiple modalities. Most data intended for second opinion originate from computed tomography (CT) and magnetic resonance (MR) (Fig 2). Besides these two, ultrasound (US) and computed radiography (CR) are also very common modalities. Other modalities found on the CD-Rs, included in the REST group, are secondary capture (SC), external camera photography (XC), nuclear medicine (NM), x-ray angiography (XA), positron emission tomography (PT), structured reports (SR), radiographic imaging (RG), digital radiography (DX), mammography (MG), other (OT), and radiofluoroscopy (RF).Fig 2Fig 2Overview of the number of images (a) and series (b) stored into the PACS for second opinion.The same holds true for external data: most images stored originate from CT and MR although, when looking at the series, CR also is a major contributor (Fig 3).Fig 3Fig 3Overview of the number of images (a) and series (b) stored into the PACS as external data.Approximately 80% of the images and 74% of the series is stored for second opinion; the remaining images and series are stored for reference to external material. This results in a required storage space of 83 GB for the second opinion (PACS and web server storage) and 27 GB for the external data (web server only storage) for the first year.Seventeen questionnaires, originating from 10 different departments, were returned to our department. Altogether, these departments provide an average of 76 CDs per week. The mean (median) scores were 3.6 (4) for handling time, 3.4 (4) for archival of 2nd opinion data, 3.8 (4) for archival of external data onto the web server (EPR), and 4.5 (5) for the overall performance of the procedure (Fig 4). The percentage of no response on the different questions were 6%, 24%, 24%, and 24% for handling time, archival second opinion, archival external data, and satisfaction compared to reading CDs, respectively. The main reason for nonresponse to one of the two archival options was that the department does not use that particular option. Four respondents did not fill out the overall satisfaction question.Fig 4Fig 4Mean and median scores for the different questions.After elimination of the nonrespondents, the percentage per rating category was determined (Fig 5). Most ratings were good to excellent with 38% good and 54% excellent for the overall satisfaction with the new method compared to using CDs. Only handling time and the archival of second opinion were rated as “not so good” by 13% and 15%, respectively. The bad rating was given by 6% for handling time, 8% for archival of second opinion data, and 8% for archival of external data. None of the respondents rated the overall satisfaction as bad.Fig 5Fig 5Distribution of the answers over the different categories without the nonrespondents.Go to:DiscussionThe use of CD-ROMs for the distribution of image data is widely accepted. However, every hospital, which receives patient information from multiple centers, will experience problems with the different viewers used. In a previous publication,1 the current solution was described. However, an evaluation of the use of this new solution was not yet available. In this study, we performed this evaluation to determine the viability of this method in our institution. Results show that user satisfaction is very high, although some improvements can be made.The question arises whether the external data should be stored into the PACS, because we are not obliged to store these data. However, for integration into the normal workflow, it is a requirement to provide the data to the physicians in an easy manner. This very question led us to decide to only store data that have a radiological report attached to it (second opinion) into the PACS. Other data—which are only for review and therefore not likely to be used later—are automatically deleted approximately 2 years after the storage on the institutional web server.Although the overall satisfaction is shown to be high when compared to the situation where CDs had to be read, results for the different procedures show that the current set-up has some limitations.First, the complete process is rather time-consuming and requires a lot of traffic of CDs around the hospital. A CD is received from another hospital by one of the departments in our institution, then sent to the radiology department with a request to read the data into the PACS or web server, whereupon the content is uploaded, and finally the CD is returned to the requesting department if indicated on the form.Second, reports and information other than DICOM images are not yet included into the process. Some vendors already include radiological reports on their CDs in text files in different formats. These files are not yet supported by our procedure. Ideally, the files should be read and stored into the radiological information system by using an HL-7 message.Third, because of staff shortage all data on the CDs are stored entirely into the PACS under one accession number. This can cause difficulties in finding the right study of the right date because the complete history of a patient acquired in another hospital that is available on the CD will be stored under a single accession number. More ideal, but even more time-consuming than the current procedure, would be a process that stores all studies from the CD with different accession numbers.Current research is focused on the automation of some of the steps in the process to eliminate some of the problems that arise.Go to:ConclusionAlthough some improvements can be made, the storage of study data from CDs from outpatients into the PACS and the web server already provides for an existing need. Using this service, physicians can access the data with ease and familiarity; user satisfaction with the provided solution is high.
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