CD Burners & Beyond: 5 Tips for Optimizing Image Sharing
In radiology, obtaining the image is only part of the job. Radiology departments and practices also need to be able to share images with referring physicians and patients. It’s an essential function in a state of transition. During the decades-long transition from film to digital to cloud-based image sharing, the majority of images are (and will be) shared via CD or DVD.

Working with CDs can be a challenge, says Mony Weschler, MA, director of clinical ancillary systems and emerging health IT at Montefiore Medical Center in New York City. There may be issues with the embedded viewer, image format and more. Several strategies can ease the burden:

1. Know your needs

While some providers burn CDs straight from PACS, this approach can be hit or miss in terms of quality, according to Nicole Fennell, imaging informatics manager at Southwest Diagnostic Imaging in Scottsdale, Ariz. Discs burned directly from PACS may not conform to DICOM standards, which could make importing the images difficult and in some cases, impossible, for the recipient.

“If all systems produced CDs in a straight DICOM format that could be imported into other systems, it would make the world a lot easier as far as sharing outside images,” says Fennell.

If a PACS isn’t able to produce CDs of acceptable quality, facilities can turn to a CD burner that provides the needed functionality. That’s what Memorial Hospital at Gulfport in Gulfport, Miss., did when it purchased burners for its main facility and two off-site imaging centers, says Griff Van Dusen, PACS administrator. He says providers should look at price and burning speed when purchasing a burner. An economical, but relatively slow, system may not be such a good buy in the long run if it eats into efficiency.

2. A CD with a view

Looking beyond the specifications of the burning device, Van Dusen also stressed the importance of having an easy-to-use viewer. Physicians don’t like interacting with multiple user interfaces and want to know how to get to the images right away, he says.

Discs produced by burners from healthcare technology vendors have embedded viewers, but with all of the different vendors on the market, every CD could have a different viewer with a slightly different interface. Van Dusen says his organization decided to use a locally installed viewer that can display images from any DICOM-formatted CD to have a single, unified program throughout the hospital, rather than rely on the embedded viewer on each disc.

Southwest Diagnostic Imaging uses the same strategy. The reason is straightforward: Referring physicians wanted a familiar system. “We like the consistency,” Fennell says. “The system works in most operating system environments, which is important as far as outpatient imaging goes, because we don’t control our referrers’ systems.”

3. Ease of use & the enterprise

Having a consistent, uncomplicated viewer simplifies image sharing for the referring physician, but ease of use also needs to be considered for any staff who create CDs/DVDs. This is particularly true for specialists outside of radiology who don’t have extensive experience with image management.

Bette Pommerleau, a speech pathologist at Merrimack Valley Hospital in Haverhill, Mass., explains that having an easy-to-use system for producing DVDs helps her and her colleagues when they produce DVDs of modified barium swallow studies.
Speech pathologists are not tech-savvy, she says. Twenty years ago, the fluoroscopy scans that examine the oral cavity and function of swallowing would be recorded by a VCR, with a simple tape recorder from an electronics store used for dictation. DVDs have become standard, but without an integrated system, having to manually record the images to disc can lead to human error.

Merrimack’s current system for acquiring and viewing barium swallow studies has an attached DVD burner, which streamlines and speeds the process.

4. The importance of the import

Memorial Hospital turned to the same vendor that provided its viewer for software that allows images to be imported off the CD and sent to PACS or mammography workstations. The system is a hit with referring physicians. “If it’s not installed on a computer, we hear about it pretty quickly,” says Van Dusen.  

Importing may seem to be a matter of making image access more convenient, but it could have other ramifications. A study published in the March issue of the American Journal of Roentgenology demonstrated that when outside images were imported into a facility’s PACS, rather than left on the CD for viewing, those patients were far less likely to undergo repeat imaging. Only 11 percent of patients whose images were imported underwent repeat imaging, compared with 52 percent of patients who had outside images on CD that weren’t imported.

“Now that we’ve realized [repeat imaging] harms patients in more ways than it benefits them, there’s a lot more pressure to share those studies,” says Weschler. This is easier said than done, as importing images from a CD into PACS can require multiple steps and some massaging of the information.

5. Beyond the CD

Just as film gave way to CDs, physical discs eventually may be replaced by cloud-based models. Montefiore Medical Center works with a cloud-based image sharing service to better manage images, and first deployed the program in the cardiology department.

When evaluating cloud-based image-sharing services, providers need to assess ease of use and the viewer, says Weschler. Physicians who are not used to working with images should have a streamlined user interface that is not overly complicated or frustrating.

“No light viewer is going to have the tools to do in-depth echocardiography, but there have to be basic tools so physicians can look at the patient and the heart and play clips at 30 frames per second,” he says.

Montefiore’s cloud-based service allows different providers to be set up as contributors to the system without a virtual private network or point-to-point network. These contributors can send Montefiore images through the cloud without relying on a CD. On the receiving end, the service allows for one-touch import of those images into the PACS.

One reason for the assortment of image-sharing systems is that health information exchanges (HIEs) aren’t quite ready to shoulder the full load of image sharing. It is possible, however, that image-sharing services could help enable HIEs, according to Weschler. Rather than inundating an HIE with images, links that direct users to an image stored with a cloud-based service could be shared across an HIE.

Once a method for cloud-based image sharing becomes the standard, health imaging will be able to leave CDs, and physical media in general, behind.

In the interim, employing these strategies can take the sting out of CD management. HI