CD and DVD burners are now ubiquitous in the medical imaging market and CDs have become a de facto solution to archiving and distributing medical images for patients and physicians across multiple specialties and modalities. Three facilities share the benefits.


Increasing functionality

FirstHealth of the Carolinas, a network of three North Carolina hospitals, including Moore Regional, Montgomery Hospital and Richmond Memorial, and 15 primary-care facilities, has seen significant cost-savings since switching from film to CDs for patient and physician image distribution. The health system uses the PacsCube CD/DVD burner system from DatCard to keep up with the 210,000 imaging procedures done each year across the network. 

On average, the FirstHealth processes 23 studies per day at a cost of roughly $10, says David Quinlan, PACS administrator for the health system. That’s a significant savings compared to the $162 it would cost for film to reproduce the same number of studies, says Quinlan. “We have seen significant cost-savings and time savings—we can do something else while waiting for a CD to burn.”

PacsCube takes DICOM images and studies and records them onto CD/DVD, embedding a lite DICOM viewing tool so images can be viewed from any Windows-based PC. Discs are then labeled with patient and study demographics, facility logo and an audit trail identifier, says Quinlan. With PacsCube, the hospital has gained more functionality, he says, and can now span CDs for large studies.

“Every CD burner has different functionalities and one of the biggest drivers for us is to be able to burn images from a 64-slice CT,” he says. “We are now able to span CDs to accommodate full data sets and can split at the series level or the study level.” Quinlan says it is a manual decision by the end user to use a CD or DVD. PacsCube supports 700MB CD-R and 4.7GB DVD-R.

The automatic labeling that PacsCube provides is another functional benefit for the network. “Every CD has the patient name and study taken from the PACS and burned directly onto the disc—the less a person touches it, the less chance for error there is. It is very much a simple solution that is quite effective,” says Quinlan.


Driving quality

“It about quality, not retention,” says Jeff Broz, operations director of Imaging Applications, at Alegent Health System in Omaha, Neb. “It doesn’t matter how expensive it is—if the quality is there, that is what should drive the decision.” Alegent uses the eXpedo XR2 system from Sorna to answer the call from physicians and patients for images on the go.

Broz says the decision to use the XR2 was fairly easy since they had been using other Sorna CD/DVD systems, such as the XR1. They upgraded to the XR2, a newer model, because the company came out with a design that completely changed the robotics. “The new systems are much more self-contained, much less complex and very stable. The media are as well—in four years we have not sent a bad disc out of here,” which he says is a “huge positive for the company. We do not want to be sending things out that are causing problems for the physicians or the patients.”

The XR2 prints labels with patient information directly on the disc using an inkjet printer. To minimize space requirements, an LCD and a six-key keypad are integrated into the server which in turn fits directly on top of the robotics system. The ability to burn the reports as well as the images onto the discs was an important and necessary addition, says Broz, so that when the physicians are using the viewer and manipulating the images, they can reference the final interpretation as well. “We send the studies that we need to burn to the burner and it automatically determines, based on size, whether to use a CD or a DVD,” he says. The storage capacity for the CDs is close to 700 MB and once the XR2 has reached that capacity, it will split the study at the series or study level to span multiple discs.

“You are only as good as the laser that burns it and the media that you are writing to,” Broz says. He says Alegent uses CDs recommended by Sorna that are pre-labeled for ink jet printers so a user “can just grab the CD and burn it.” It’s important to use a label because “the back side of a CD is much more sensitive than the bottom side,” Broz says.

“We want to make sure that if we send something out that is in a patient’s jacket, that it is going to be there for several years.”

Alegent keeps an audit trail by checking out the discs through the hospital system’s radiology information system (RIS) to the patient or the referring physician just to make a catalog of what has been done.


User-friendly design

Kaiser Permanente is a nonprofit health plan headquartered in Oakland, Calif., serving the healthcare needs of members in nine states and Washington, D.C. It encompasses Kaiser Foundation Health Plan, Kaiser Foundation Hospitals, and the Permanente Medical Groups across different regions of the United States, including northern California, which has a membership of 3.2 million. Five months ago, 17 hospitals in the Kaiser network in northern California began using PACSGEAR MediaWriter for patient and physician image distribution throughout 32 medical centers and 416 medical offices which include 13,729 physicians.

According to R.L. Kennedy, technical director of Imaging Informatics at Kaiser, the network, which uses the Philips Healthcare iSite PACS for storage and archiving, needed a CD/DVD burner system that was user-friendly and could be customized to each radiology file room.

“Each of the 17 northern California hospitals has two ‘digital’ radiology file rooms—an inpatient and outpatient where most CD requests are processed at each hospital,” Kennedy says. He adds that the network currently has about 150 people who process the requests—people who are not “technical,” he says, and need something easy to use. With the Media Writer, a user can “export and label CD/DVDs compatible with more than 25 modalities with a single click.”

Typically, a patient requests a CD from the file room clerk. Once the patient provides a release, we copy the images from PACS to create the CD, he says. It takes about 15 minutes to locate the images and create each CD. 

“For external requests, the viewer is included on the CD, so all they need is a PC with a CD reader,” Kennedy says. The system also has a built-in printer that labels customizable information for patient privacy. The MediaWriter has the ability to add the corresponding report, but the current Kaiser back-end systems do not support this. “We’re looking to add this capability with our new RIS in the future,” he says.