Viewing Images in the OR

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Access to images during surgery benefits surgical outcomes. PACS images displayed on CRTs and flat-panel monitors, mobile fluoroscopic digital imaging systems for interventional and surgical imaging and image-guided surgery systems provide physicians with precise, detailed information to shorten procedure time and improve outcomes. At the same time, filmless operation in the OR does not occur without some challenges - PACS isn't designed for OR workflow, rooms are not always ready for computer installation and cost related issues may hinder hardware options.

Surgeons typically review images outside the operating room (OR) prior to surgery for pre-procedural planning. Specialists such as orthopedic and vascular surgeons and neurosurgeons frequently use images during a case as a "guide." And intraoperative imaging provides precise, detailed information of body structures and is many times used in urology work, hardware positioning, placing pacemakers and other internal devices. Portable x-ray units have been the option for producing these images, but portable fluoroscopy and image-guided surgery (IGS) systems are the growing alternative for intraoperative imaging.

Image viewing changes substantially with the implementation of digital technologies, particularly with the integration of PACS (picture archiving and communications systems). For example, when a healthcare organization installs PACS in radiology, they won't reap the complete benefits of the system if some departments - such as the ICU, ER and the OR - continue to print film. Since these departments all have their own unique workflow, implementing PACS is a time-intensive process that requires planning, ingenuity and persistence.

Perhaps the first question that department heads, section chiefs and surgeons ask themselves when bringing images into the OR via PACS: how will surgeons view the images? Surgical areas are already small and house a lot of equipment. Hospitals also have multiple rooms to outfit, so oftentimes hardware selection is restricted by tight budgets and the variety of specialists and their particular needs. Choices typically include commercial wall- or boom-mounted monitors and/or mobile carts. East Alabama Medical Center (EAMC) in Opelika chose the latter when it rolled out its McKesson Corp. Horizon Medical Imaging PACS in the OR.

The facility is filmless for 95 percent of all the activity in surgery using a wireless network. The only wire from the mobile cart? The electrical cord. A total of six carts are used for the 11 surgery suites and two of the carts have dual monitors, with the remaining four having one. "The one- or two-monitor configuration was a concern for some surgeons who were accustomed to hanging up to five or six sheets of film for a surgical case," says Radiology Administrator Melinda Johnson. "However, after utilizing the one- and two-monitor configuration, they have been quite satisfied with the results."

EAMC planned to implement PACS in the OR within two months of going live in the remainder of the hospital. "In the interim, we purchased a mobile cart and located it in the OR suite for the purpose of training surgery staff," explains Johnson "However, since we decided to utilize McKesson's web product in the OR, the surgeons quickly found that they were familiar with the application [because it was the same application that they were accustomed to on the floor and in their offices]."


The amount of images used in the OR varies among surgical specialties. For example, ophthalmologists and general surgeons may not look at images as much as orthopedic and vascular surgeons. As a result, the number of surgeons who will access the PACS significantly impacts hardware selection and configuration. "In the beginning, we identified surgeons who look at images prior to or during their cases," says Joyce Himes, director of radiology at Ball Memorial Hospital, a 350-bed facility in Munice, Ind.

Radiology at Ball Memorial has been using Eastman Kodak Co. Health Imaging Division's DirectView PACS system 5 since the beginning of the year. The last area to roll out PACS was the OR. Himes says they first installed Kodak's DirectView Web Distribution product so that physicians could view images in their offices and throughout the facility. Next, the hospital rolled out six mobile carts with 19-inch monitors - four carts with one monitor, two with two monitors. "We evaluated the process of viewing images in the OR suite to