AJR: Filmless transition complex, requires planning and teamwork

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Transitioning from a film-based imaging department to a filmless practice is a huge undertaking, with success coming to departments using established standards, appropriate change management practices and coordinated by a team of representative stakeholders, according to an article published in the April issue of the American Journal of Roentgenology.

“There is a tremendous learning curve in the move from a hard-copy film environment to a filmless environment,” wrote Steve G. Langer, PhD, and colleagues from the Mayo Clinic in Rochester, Minn. They detailed considerations with regard to technology, workflow, maintenance and cultural preparation.


The authors outlined a few basic questions that must be asked by the department, including identifying the functional imaging needs. Those managing the transition will need to look at the current film image quality control (QC) process, and determine whether that process can be mapped to a digital workflow or if changes are needed.

“For example, if the current film QC process is centrally managed for efficiency and continuity purposes and the department wants to maintain this central process, there needs to be a discussion with the modality and PACS vendors to route studies to a central quality assurance workstation,” wrote Langer et al.

Another issue for filmless departments is interoperability. Vendors may use proprietary formats or applications, and if these are not supported by other vendors, problems can arise.

“Interoperability is a key workflow component for successful electronic environments. Without component interoperability, additional human tasks are needed and the workflow is less efficient.”


Departments transitioning to a filmless environment need to look at workflow from end-to-end, beginning with the ordering process. Patient and exam order data should be communicated from institutional systems to the radiology department through software applications which don’t require radiology personnel to manually re-enter data multiple times. This leads to errors and slows workflow. Likewise, PACS should be coupled with speech recognition to help drive efficiency.


Film-based departments must determine whether their support staff can transfer their skills to a new filmless environment, or whether new training or staff are needed. Users, including radiologists, technologists, file room staff and desk personnel, also will need to be given the skills they need to manage the new system.

Since the different imaging components are often not all supported by a single vendor, the authors suggested determining who is responsible for what equipment during the purchasing and contracting process before any documents are signed.

Cultural preparation

A conversion to a filmless environment can only succeed with the early involvement of users in planning and decision making, according to Langer and colleagues. Early adopters and leaders should work to mitigate others’ fears and figure out how users would like to be trained.

“A key requirement for filmless conversion is teamwork. There are many areas of expertise within the institution and utilization of that expertise by the conversion team greatly simplifies the tasks at hand. Conversely, failure to heed input from all stakeholders (consumers and support staff) almost certainly guarantees a difficult transition,” concluded the authors.