There is one thing to keep in mind when digitizing an echocardiography lab - there is no one way to go about it. Managing dynamic images such as digital echocardiograms is a complex task, coupled with multiple questions. Will we still produce videotapes? Will every echo exam be digital? Will other departments have access to our image repository? Aside from learning how other hospitals have done it, the answers boil down to finances, personal preference and the image and information management system itself.
A GROWING TREND
Digitizing echo labs is on the rise - and it has a long way to go as only 10 percent of U.S. labs are currently digital, so says the American Society of Echocardiography. ASE surveyed to find out how echocardiography programs utilize digital information management techniques to supply cardiologists with digitized loops of echo images for review on a computer monitor, as opposed to the conventional approach of reviewing videotaped images on a VCR/TV monitor system.
|Peace of Mind: There is plenty to keep in mind when digitizing an echo lab|
|Do an on-site visit See it before you buy it, recommends Geoffrey Rose, MD, director of the cardiac ultrasound laboratory at the Sanger Clinic, part of the Carolinas Heart Institute at the Carolinas Medical Center, N.C. "First thing you do is go to a place that has already done it. It's a small world and people will tell you what worked for them and what didn't." How to acquire the image "One has to make a decision on how to acquire the digital images," says Alan Katz, MD, director of medical information technology at St. Francis Hospital. "We believe there is an advantage to gating the imaging - to acquire it by two second intervals or even better, by gating it to the EKG, so you see one or two cardiac cycles over and over again." Read digitally Physicians must be comfortable reading images in digital loops as opposed to videotapes. "This is related to the criticism generated in the field that digital echocardiography is so sonographer dependent," poses Katz. "I maintain that the study is extremely sonographer-dependent from the beginning." IT Support "You need a reliable IT resource to help you with networking because there will be glitches such as ports that close and IT conflicts," explains Katz. "It is not reasonable to assume that everything will work 100 percent." Take your time "You have to be careful and not set the bar too high," relays Rose. "When somebody is still reading echo off a videotape on a television and dictating it into a telephone, don't start talking about comprehensive reading stations that allow you to read nuclear images simultaneously."|
"Videotape is not a medium that is designed forever and ever," says Geoffrey Rose, MD, director of the cardiac ultrasound laboratory at the Sanger Clinic, part of the Carolinas Heart Institute at the Carolinas Medical Center, N.C. "It's true they will last several years and that's the general standard that people will hold on to data. But they are bulky and expensive to store. And again, when you want to look at an old study, it's probably not accessible to you because it is in remote storage somewhere. When you have things digitally stored, they are potentially more retrievable."
The advantages of going digital in echo outweigh conventional methods: digital echos have greater image quality; allow clinicians simultaneous access to the same study; facilitate easy comparison with prior studies; and allow non-linear study review and post-acquisition image processing.
So with a healthy list of advantages, why have so few echocardiography laboratories taken on this endeavor? "In radiology you can make a financial case from day one: if you go digital, you don't have to develop film," says Alan Katz, MD, director of medical information technology at St. Francis Hospital, a 431-bed heart center in Roslyn, N.Y. "In echocardiography, we are competing with videotapes, which are as cheap as can be at this point. So the financial argument is not easily made. As media has gotten less expensive - CDs, DVDs, RAID drives - the financial case has become much more clear," explains Katz.
Katz knows first hand about the financial benefits of a digital echo program. St. Francis Hospital recently installed an Encompass cardiology image and information management system from Heartlab Cardiac Solutions of Westerly, R.I.
"There are a couple of reasons why we have saved money," suggests Katz. "We are a very busy heart center,