Advanced software applications and surgeons’ ability to conduct more precise, image-enabled and image-guided procedures make access to images in the OR increasingly important. Facilities are expanding and implementing PACS and displays that allow for easier image distribution, while accommodating a variety of needs from their different surgeons.
Palmetto Health, a three-hospital health system in South Carolina, implemented IMPAX PACS from Agfa HealthCare in 1999. Within a couple of years, they made PACS accessible in all operating suites. Surgeons use PACS images during all types of procedures. “Generally, they bring up the study and the most appropriate images and have them on display so that they can look and scroll through them if they need to,” says Carrie Boothby, IT manager, clinical applications. The surgeons who prefer to drive the PACS themselves during a procedure use keyboard covers and plastic bags over the mouse.
Some of the operating rooms use PACS workstations on carts on which users can view true DICOM images. Because space is often at a premium in the OR, the carts allow for more flexibility, Boothby says. They also can be rolled from room to room. Renovations currently underway at the Baptist, Columbia campus will equip every operating suite with wall-mounted PACS viewing capabilities.
Most of the ORs have dual displays, although Boothby says some orthopedists have requested 42-inch plasma screens. However, current large screens affect image quality, so Boothby says they plan to wait for more hardware manufacturer improvements.
Meanwhile, the organization is looking at templating capabilities for orthopedics as well as working on more integration between cardiology and radiology services. A big goal is improving imaging access for heart surgery because that is such a big growth area. The system has a freestanding heart hospital and is feeling a push from the cardiology environment, she says.
The renovations will equip each OR with monitors viewable from any position and more flexible controls to allow for adjustments. “Improving our accessibility improves workflow within the OR suites,” she says. The renovations also will help the facility accommodate growth. “We find that with new and improved processes, it’s good to equip the rooms with the latest and greatest technology.”
Options and flexibility
Halifax Medical Center in Daytona Beach, Fla., implemented Unity PACS from DR Systems in 2003. The operating rooms went live with PACS about 60 days later. The biggest challenge, says System Administrator Bill Kazee, is that the surgeons all look at the films differently. Neurosurgeons, for example, prefer to hang up 8 to 12 films and scan all of them. Orthopedic surgeons generally look at one sheet of film.
The solution, he says, was to provide a mix and match of options. During phase one of implementation, dual monitors were wall-mounted in the ORs to allow for as much real estate as possible. The team addressed each physician group’s needs: Neurosurgeons got a quad bank of monitors on a mobile cart while orthopedists and other surgeons got dual-monitor carts. Some surgeons like the carts because they can be rolled to either side of the operating table or wherever is easiest for the surgeon to see them. The goal was for the surgeon to never have to leave the table.
Most of the rooms have multiple 20-inch monitors which allows for more “ability to divide and conquer that exam” by providing, for example, axial images on one screen and post-processed images on another. Initially, Kazee installed wall-mounted monitors in the rooms. However, he learned that the surgeons preferred the ability to move their viewing station to various locations.
During surgery, the physician will either manipulate the station before scrubbing in or have a circulator drive the cart for him, Kazee says. If the surgeon wants to zoom in on a certain image, the circulator can drive the software. Every OR already had a circulating nurse not involved in the table field. Once a case is brought up on a monitor, they don’t need very advanced skills to alter images. The involvement of the circulator during a procedure was provided to the surgeon as a result of the workflows demanded of the surgeons at other facilities where they have to leave the sterile field to manipulate the image data. “It really made sense to us to implement the product like this, as why force the surgeon to leave the table field in a demanding procedure