CDs can be a headache for PACS administrators. The ubiquitous disks can be associated with organizational challenges, burning problems, privacy complications and DICOM glitches. However, a combination of thoughtful policies, software and hardware can help ease the pain.
1. Get CDs early
Making efforts to get CDs prior to a procedure can provide administrators time to address problematic CDs—such as those with specific proprietary formats—says Ted Blade, PACS manager at Providence Health & Services in Portland, Ore. The strategy often requires collaboration between departments.
"If a surgeon is going to use a CD, we try to get it in advance, so we know the day of the surgery those images will be available," says Blade. "We have to work with surgeons, so CDs don't arrive on the day of surgery."
2. Cut back
Overall, simply cutting back on the use of CDs can minimize problems. At Providence, policies are relatively strict about their use, says Blade. "All mobile media that you can pour data on or off have to be encrypted," he says. "We have turned off the ability to burn CDs on all PCs in our facilities, so nobody can extract data that they shouldn't."
Additionally, Providence limits the amount of data on a CD. The name of the patient and the exam are included, "but that's about it," he says. "There is no medical record number or other information."
3. Consider a server with DICOM morphing
At Denver Health Medical Center, PACS administrators improved upon a tedious process of importing CDs. The organization trimmed an 11-step process that took up to 30 minutes to four steps and several minutes by implementing a server-based PACS, according to Vince Doyle, a former medical imaging manager with the system.
"We averaged about 15 to 20 percent failure to import CDs," he says. "I received plenty of pages in the middle of the night because the CD had a DICOM standard format issue, even though it was technically fine."
Denver Health's server automates DICOM morphing on nonclinical tags. It keeps tags in conformance with the system's formatting rules and enables faster reads without failure. Additionally, the system follows the hospital's standards in CD imports and automatically forwards CD images to the enterprise PACS.
4. Import kiosks
Denver Health installed CD import kiosks with a program that allows physicians to insert a CD and import studies in its emergency department. The kiosks send entire CDs through the server and import them as if sent by a remote facility. The system improved workflow across the image exchange chain, Doyle says.
5. Proprietary in, DICOM out
To keep data at a manageable size, Providence uses an internal proprietary format to exchange patient exams within the hospital system. Data are entered in DICOM format and then converted to a proprietary format, which reduces the burden on PACS and streamlines the internal transfer process.
|On the Horizon|
|The RSNA Image Share Project—created in 2009 with a $4.7 million contract with the National Institute of Biomedical Imaging and Bioengineering—aims to build a secure, patient-centric medical imaging sharing network that allows patients to access their data through a web-based personal health record, without relying on CDs.
The network, which shares images and reports, is implemented at five pilot institutions: Mount Sinai Medical Center in New York City; Mayo Clinic in Rochester, Minn.; University of California, San Francisco; University of Chicago Medical Center and University of Maryland Medical Center in Baltimore.
The participating hospitals inform patients about personal health record accounts that allow them to retrieve, review, archive and share medical images and reports through secure internet connections. A 72-hour waiting period is built into the process, allowing physicians to prepare to discuss findings with their patients. Eventually, researchers plan to develop direct transfer of images for immediate access.