Workstation state-of-the-art

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The various components of a radiology workstation are in a period of flux as to what types of applications and approaches are considered state-of-the-art. An overview of the current best practices, considering all of the options, was presented by Barton F. Branstetter IV, MD, assistant professor of radiology and otolaryngology, University of Pittsburgh Health Systems, at SIIM 2007 today in Providence, R.I.

Regarding the data that needs to be available to a workstation, there are different approaches such as storing images in a distributed model where the studies needed for review are kept on the workstation itself. Another model is a centralized one where items are called up as needed. The latter model is really where it’s at when it comes to storage now because of the evolution of technology which has “important ramifications for centralized storage model.” Technology drivers include improved bandwidth at facilities, advances in just-in-time delivery, compression, data streaming, and Ethernet to desktop.

Regarding the software environment used in a department, an “open use” approach is prominent because it allows access to the internet and other benefits, rather than a “lock-down” system which grants users access only to information within the department. Open systems also widen possibilities for performing alternative tasks, decision support, teaching, and reduced frustration and perceived distrust on the part of radiologists. In truth, opening up to the web does open the flood gates of potential attack from computer viruses and other problems, but these risks seem minimal compared to the benefits, he said.

Worklists are another important tool because they enable a department to filter pertinent cases, “prevent radiologists from duplicating reads on the same report,” provide dictation status reports, and enable dynamic prioritization of emergency department and Stat reads.

Most importantly, Branstetter said, “A worklist should be able to drive the subtle decisions” faced by a radiologist throughout the day.

Of the laundry list of choices that need to be made for other applications and approaches within a department, he offered the following assessments:

  • Dictation software – state-of-the-art is to have this software integrated with PACS and to go with a paperless workflow;

  • Speech recognition: the most common choice now is to have a combination of pure speech recognition software combined with a Correctionist. Though this choice is based on preference of radiologists, and some prefer the speed of a pure speech recognition software;
  • Simple workstation interfaces are top choice currently because they offer a “a logical mental framework so that a radiologist does not have to ask where” the functionality is that he/she needs, he said, because they address base-case functionality, decrease distraction, and provide “low visual effort controls;”
  • Of the many integrated support software options -- radiology-specific patient data; decision support; communication tools (preliminary reports, physician contact information); urgency scoring (helps to determine the next action for data depending on urgency); and workflow monitoring tools (dashboards) – none is pulling ahead as a leader. “Although these are important aspects in radiology workflow” none of them is yet truly a state of the art, but rather all are important but no one is a clear leader, he said;
  • PACS/RIS –  a integrated system is the current model which offers the advantages of worklist control, integrated clinical data, prior reports, and data lifecycle management;
  • With the exception of advance visualization workstations, should a radiologist be looking for a high-end or off-the-shelf model? According to Branstetter: off-the-shelf is the preference because of the trend towards thin client use, web interfaces, centralized storage models, and, of course, the significantly lower cost; and
  • Last but not least: Displays: state-of-the-art is actually using both color and B &W, with most facilities opting for two B &W and one color to show rare cases where color is needed. As for pixel requirements, though mammography reads might require 5 megapixels (MP), most other uses are feasible with 2-3 MP monitors.