From the Editor's Notebook

From

the

Editor’s PACS:

E

veryone

who presently

agnostic

radiology

come aITival

an old-timer,

of picture

archiving

practices is about

dito be-

a “geezer’

The

and communication

systems (PACS) and, with it, filmiess radiology has assured the truth of this prediction. And it won’t be long in coming. Someday jacket:’

soon

“film,”

“file room,”

“folder:’

and maybe

even

production

on the monitor

New nying

remarkable

consultations worrisome

son of the accuracy of interpretation for film and monitor displays of sonography is discussed by

PACS demician.

Hertzberg

et al. [11.

saving

a hard copy

an

become

uncomfortable

so

you actually

interpreting

film radio-

the detail just isn’t there and the range

ofdensities

is limited.

In film radiographs

of the

ra-

light. That just is not the case with PACS-plus

tell

you have

“Now

at your

fingertips

the opportunity

magnify

took it down, replaced the film in a folder, and assistants would file the folder away in a large

ite. Admittedly, more variable,

room known as the file mom? Amazing!” “You say people would sign out or even steal

lumbar

the films and you had no backup, could be lost? Hard to imagine!”

so the films

Change of a new

“You say clinicians had to come ogy department to see the images

to the racliolor the house

pected. Some problems can be anticipated while others are more of a surprise. The creation of

back to the patient’s see them? Unreal!” “Reports paper mail

check

the films

floor

were written

that had to be sent around to be filed with the hospital

Filmiess

records? imaging

them

for the clinicians

of all examinations

tients’ medical

out of

schlepp

to on

The detail

spines.

PACS

are often

exquis-

PACS images of the spine are particularly the thoracic and But I’m certain

the images

will

tions

can be troubling. With the adoption technology, problems are to be ex-

The

dom ordering

of image

It would

part.

be nice

These

entry

occasional, displays

to be

seemingly

ran-

orderly

sequence:

matters

are readily

ad-

to many others.

some

made

the switch

to filmiess.

It has been a while had to be refined to workable. Speed and tial concern but, for longer

will have

a problem.

AJR:173, November

1999

unanticipated;

sharp reduction

in coming; the technology make PACS feasible and image quality were of inithe most part, they are no

In fact, the speed

extent,

of image

sultations surprising

for instance,

in the number

of clinical

the con-

as described by Reiner et al. [2]. This reduction is clearly not in the best in-

terest of patient care. The implications reduction

and

potential

ated and discussed

solutions

by Baker

the radiologist

diskette.

who is interpret-

on the monitor

portions

to download

of an examination

Also,

we

need

some

mechanism

are to be reviewed

with students,

lows,

Filmless

and faculty.

to become

in the use of PACS devised

to solve

should

fel-

must

an impediment

and

operations

to

conferor week

residents,

radiology

ing or research. Innovations solutions

the

to a personal

save or access cases for daily teaching ences when the best cases of the day

be allowed

to

not

to teachtechnology

problems

be shared

in

with others.

What better way than publication in the AiR? Experience with PACS is a suitable subject for research improve welcome timers”

and publication. Articles on to how to and how best to use PACS are most at the AiR. Even welcome from “oldsuch as yourself.

Lee F. Rogers, MO Editor in Chief

PA,

of an anatomic

dressed and will undoubtedly be corrected. Other surprises are more problematic and, to

long, everyone

desired

or convenient

in an

In fact, it is a present-day reality for many in practice, and it’s in the pipeline and on its way Before

ing a study

easy

for your files. The best solu-

can be annoy-

the obliques

technical

examinaneeds

to see the images

agreed-upon,

and then

used to. It can be

up previous

Image

systematized.

lateral,

getting

to call

on the monitor.

established,

tion is to enable

PACS

files takes some

ing.

a pipe dream.

and density

time-consuming

by interoffice and pa-

to aid your interpre-

be improved.

charts

Incredible!” is no longer

tation.

an area in question

to

us again how you used to have to take a patient’s film out of a folder to interpret it. And then you

down,

is more

it is not necessarily

and diagnostic

and then physically

or research

make

So much

take too long before

pressionable

the file room,

for teaching

ages,

than their film counterparts.

extremities, portions of the anatomy are often in the dark, which then requires the use of a hot

staff had to come

special problems for the acaa department goes filmless,

better

array of computer monitors in the reading area and shooting the breeze with a gathenng of imstudents

is

“viewer”

amidst

you may be asked,

cases

of clinical

“patient’s

graphs:

medical

presents Once

reduction

in these two articles of your attention.

difficult than might have been anticipated. This begs for an immediate solution. For PACS im-

terms of our long, long past. In a few short years, while

residents,

The

described and worthy

In my own experience, musculoskeletal images of the extremities on PACS are routinely that it doesn’t

diology

Age Radiology

commentary.

and the image quality is often better than that produced on film. And, in this issue, a compari-

and “light box” are going the way of “flat plate:’ “wet reading,” “red goggles:’ and other such seated

is quite

Notebook

of such a are enumer-

[3] in an accompa-

References BS,

I. Hertzberg

Kliewer

PACS in sonography: ing film compared

MA, accuracy

with

monitor

Paulson

EK.

of interpretation display.

et

al. us-

AiR 1999;

173:1175-1179 2. Remer

B, Siegel E, Protopapas

rekidan H, Scanlon on frequency

M. Impact

1 Hooper

F. Gheb-

of filmless radiology

of clinician consultations with radiolo-

gists. AiR 1999:173:1169-1172 3. Baker SR. PACS and radiology practice: enjoy the benefits but acknowledge the threats. AiR 1999173: 1173-1174

1159