The Final Frontier: Meeting Image Demand in the OR

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hiit040405.jpgHistorically, the OR has been one of the last departments to deploy PACS. In the early days of PACS, hospitals delayed OR deployment because technology was not ready to meet surgeons’ complex needs. But that has changed for facilities with insight, innovation and a good game plan.

“The OR [has been] the most difficult area to meet PACS needs,” confirms Michael Cloutier, manager, technical services at Catholic Medical Center in Manchester, N.H. Bobbi Miller, director of radiology at Toledo Hospital in Ohio, admits the OR was a PACS concern because some hospitals never succeed with the filmless OR.

But the era of the filmless OR has arrived. And with it, hospitals face a dizzying array of viewing options geared to the OR — carts and wall-mounted or boom-mounted displays of multiple sizes and resolutions, special mouses and keyboards for image manipulation and practical solutions that meet the needs of the sterile field.

Indeed, PACS is in the midst of a sea change with many sites pushing the OR to the leading edge of deployment. For starters, the technology to support digital image viewing in the OR exists. Secondly, many hospitals are learning from the missteps of pioneers. Ken Kelly, director of radiology at Jordan Hospital in Plymouth, Mass., says facilities can fail to achieve filmlessness through a lack of foresight. Institutions must blanket the floors, including the OR, with monitors for image viewing, says Kelly.

But monitor size, resolution and placement are just part of the filmless OR equation. The hospital must determine if new network drops are necessary and access the viability of wireless for primary viewing or redundancy. At the nitty-gritty level, the team needs to develop a system for handling CDs from outside institutions (and other PACS vendors).

This month, Health Imaging & IT visits with a few sites that have effectively deployed PACS in the OR to learn about their successes and challenges.

Step one: The surgeon survey

Everyone in radiology and IT knows that transitioning to digital imaging is a challenge. The OR is no exception. “It is a challenge to transition from looking at images on a viewbox located outside of the sterile field to viewing digital images that may be closer,” Barry Castle, PACS project manager at Oakwood Health System in Dearborn, Mich.

Hospitals use multiple tactics to sell surgeons on digital viewing and design a solution to meet their needs. At Delnor Hospital in Geneva, Ill., PACS Administrator Brian Daily held a monitor “bake-off” and surveyed the hospital’s 42 surgeons about their needs. Most decided on dual, cart-mounted NEC 2 megapixel (MP) color monitors and dual, cart-mounted Double Black Imaging’s WIDE 3 megapixel (MP) black-and-white monitors as the preferred option for viewing images stored on the Amicas Vision Series PACS.

Leslie Beidleman, PACS administrator at St. Vincent Hospital/Mercy Medical Center in Toledo, Ohio, used cookies and coffee to lure surgeons to a conference room to evaluate equipment. Jordan Hospital IT staff stepped into surgeons’ shoes, visiting the OR to gain a bird’s eye view of viewing needs and ensure that all angles and logistics such as navigating the logistics of the sterile field were covered in the digital plan.

The surgeon survey typically leads to a fairly uniform solution for viewing digital images: mobile carts (aka COWs or computers on wheels) or wall-mounted monitors, but boom-mounted displays are becoming increasingly popular. As the hospital assesses the pros and cons of various viewing vehicles, it must make another tough decision: monitor size and resolution.

Carts, walls and booms: Pros and cons at a glance

COWs can be placed anywhere in the OR, says Miller. Toledo Hospital relies on seven Philips Medical Systems Inturis PACS workstations mounted on AFC Industries carts. The hospital has encountered one challenge that points to the success of the approach. Surgeons kept stealing carts because the hospital didn’t fully anticipate image demand upfront. When Jordan Hospital underestimated its cart needs, surgeons continued to request film. The upshot is to complete a realistic estimate of the number of carts needed to serve ORs.

A few sites opt for a 1:1 ratio of carts to OR suites, but many find that they can manage with a ratio closer to the 1:2 range. Factors to consider include other viewing solutions; a hospital with a few wall-mounted displays needs fewer carts and the surgical mix as not all surgeries require images.