KODAK INSTALLS FIRST FULLY DIGITAL RADIOLOGY DEPARTMENT IN
EUROPE
By providing turnkey, open architecture PACS solutions that employ available
hardware and incorporate industry standards such as DICOM, HL7 and CORBA,
Kodak has become a leading single source provider for PACS, CR and teleradiology
systems across Europe.
The latest example of Kodak’s lead in digital imaging is a major, fully digital
installation at the Central Hospital in Slagelse, Denmark. The hospital, to the west of
the island of Sjaelland, midway between the major centres of Copenhagen and
Odense, on the neighbouring island of Fyn, has successfully converted to a
completely digital radiology department with the installation of a PACS (Picture
Archiving and Communications System), supplied by Cemax-Icon, a subsidiary of
Eastman Kodak Company. Slagelse is currently one of few hospitals in the world to
have converted their medical imaging to a completely digital environment and has
thus become a significant European site for Kodak PACS.
In charge of the project and Head of Radiology at the hospital is Dr Mogens Rahbek
who came to Slagelse in 1977. “We started to plan the new department in 1982,” he
explained. “I was aware then of the coming of digital technology and thought it was
the right way to go, so I talked to everyone involved, the doctors, the engineers, even
the architects. There were some doubts, but I was convinced that a digital PACS
system would improve the communication of images. It would allow us to get images
to where they were needed and faster. Film could still get lost.” There was also
pressure to go digital from other clinical departments within the hospital. “When they
saw the quality and flexibility of digital images, they wanted it” explained Dr Rahbek.
Basing the entire digital system around the installation of a RIS/PACS hub, it was
important that the architecture of individual modalities was as open as possible.
Again the need for communication: “We worked very closely with Cemax-Icon to
ensure compatibility” said Dr Rahbek “and we created a specific DICOM application
profile, which grew out of the PACS, as a basis for potential suppliers of modalities.
But the PACS came first.”
The new department was to be a totally new environment, a new building to replace
the original x-ray department built over 60 years ago. Once the final decision was
made by the health authorities in the county of Vastsjaelland, building began in 1996
in four planned phases. “It was always intended to be digital from the start, with the
installation of RIS and PACS,” explained Dr Rahbek. “It was a totally new department
so the budget was available and we expected to be fully digital within 24 months.
This proved a bit optimistic! We’re now fully up and running, but still working together
with Kodak to develop the system.”
Workflow through the Radiology Department begins with the entry of patient details
on the RIS at reception where a unique accession number is created. The hospital
RIS is linked in turn to the Cemax-Icon PACS. Interfacing PACS with the RIS in this
way permanently marries radiology reports with imaging studies and enables
validated patient demographics to be electronically available throughout the network.
The Radiology Department at Slagelse Central Hospital has a staff of 55 including 8
radiologists and 24 technicians with secretarial and administrative support. Images
are captured digitally on CT, DSA, angio, two digital fluoroscopy, four CR and two
ultrasound modalities and stored on a Cemax-Icon Archive Manager Digital Archive.
Radiology studies and reports are rapidly available at the primary reading station,
two conference rooms and at 40 clinical access workstations throughout the hospital,
giving fast access to stored data thanks to the Cemax-Icon Automated Workflow
Management System, a fibre channel connection and ATM network. For security,
once an image is accessed on one monitor, it can be viewed simultaneously on
others, but not amended or updated.
Once captured, images are routed to a central reading room, equipped with four twin
AutoRad monitors, for primary diagnostics. An initial record of each image and
combined patient data from the RIS is sent automatically to the archive as a safety
backup copy. Once that information has been stored, it can be referenced and
accessed against up to 179 different parameters. Dr Rahbek explained: “Storage of
images and patient data together enables the automatic prefetching and routing of
imaging studies. For example, when a radiologist pulls up a study, the folder contains
prior studies and reports, creating an electronic record for that patient. This capability
allows radiologists instant access to comparative data when preparing their
diagnosis. They can also create review lists against a wide variety of parameters. In
fact we have the only system where we can create a review list, then access and
view it at all other review stations. This has greatly increased ease of access and the
flow of information. The system also has automatic logic built in, so an image
produced in one department can be routed automatically to be available instantly in
up to three other appropriate locations without the need to define each destination.”
“PACS has helped to improve efficiency within the radiology department and provide
better service to our entire referring physician and patient base,” went on Dr Rahbek.
“Our radiologists are more productive when reading soft copy images, which means
faster turnround on reports. It is an intuitive, user friendly system. A new doctor,
without digital experience, could be working with the system within a week.”
Initial clinical reports are dictated at the primary diagnostic stage then typed by
medical secretaries. Under Danish law, these initial reports must be reviewed at daily
conferences between the radiologists and referring doctors. The hospital supports
two fully digital radiology conferencing rooms, in which three Cemax-Icon AutoRad
Workstations are connected to ten 1.5kb slave review stations. “This state of the art
soft copy conferencing system makes the most of the conferences that clinicians and
referring physicians regularly have with our radiology staff,” said Dr Rahbek. “It is
fully user friendly. The user can define key images and the system’s hanging
protocol means you can call up the prior image, the most recent and then both for
comparative studies. Prior images are already available automatically.”
“We have regular conference throughout each day,” he continued. “Before PACS we
used film shown on wall mounted light boxes. I would stand with my back to the
doctors who were sitting in rows. A big part of communication is about body
language; we needed to see each other to communicate most effectively. We did
consider a projector and screen method, but the projected images were not as
clinically acceptable as those used for reporting. It was also important for clinical
doctors to view exactly the same image as the radiologists. Now, with the PACS
conferencing system, we sit facing each other in a circle. The clinical quality monitors
are set low on specially designed tables so we can still see each other and
communicate over the top. I retain control of the conference, but we can all share the
same information, at the same quality” he went on.
“The system has also given us the ability to manipulate images and data in a way
that was not possible with film. It has greatly improved group discussion and clinical
decision making. It has brought radiologists closer to doctors and made them an
important part of the discussion process. This is of great benefit to both the doctors
and their patients. Being able to create review lists and prefetch prior examinations
means we can instantly access images and data against a particular parameter to
examine trends or produce comparative data. And having access to two conference
rooms and the primary viewing room means that if a conference overruns, the next
group can begin elsewhere.”
Dr Rahbek went on: “This is still a pilot project. We have worked very closely with
Cemax-Icon since the beginning. Then it was important that they understood not only
how we work, but how we think. We think like doctors, not IT specialists. In order to
understand what we need, it is important to understand how we work. And CemaxIcon did that. We have built the system together. I am very happy with it, but of
course there is always room for further development, so we keep talking, keep
improving and adding functions. For instance, we now have the facility to take and
record measurements directly on screen. This is important in checking the growth of
tumours, or to see if a fracture is mending properly. The speed of change is
constant. We have had problems and solved them together, we’ve always talked to
each other and it’s important that we talk together in future.”
Part of that future is the plan to create a teleradiology link between the system at
Slagelse and four other radiology departments and clinics across Vastsjaelland
County.
Dr Rahbek concluded: “The system is still evolving. It has been a very interesting
project and very hard work at times. We have a very good working relationship with
Kodak and I feel we have built up a very good system. I began in radiology in 1965
and I have seen many changes. But without doubt digital PACS is the best thing so
far.”