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Introduction
Utilization of PACS and direct digital radiology has resulted in better techniques of handling information, speed of processing information, quality information processing and better radiological services. Digital Radiography and PACS have transformed the way image data and information is handled in the medical field. The combination of the two has allowed the radiologist in the current environment to perform their duties more effectively and faster through provision, handling, processing and transmission of data in the relevant formats. The purpose of this research is to analyze and compare the research literature generated on the field of PACS and Direct Digital Radiology. The historical perspective and the development, as well as the correlation of the two fields are discussed in this paper, which also will discuss the advantages as well as the disadvantages of the aforementioned two. The research tries to answer two major research questions: Firstly, has, and how have the two transformed radiology in the medical field? How do the two fields relate to one another and what are the developments as well as the challenges encountered in the two fields? The questions will be analyzed by consideration of the available literature review from various authors. The articles involved in this paper have been selected on the basis that they deal with the issues being dealt with and provide important information to answering the research question. It is hypothesized that both PACS and Digital Radiology have transformed the medical field, as well as contributed in the improvement of quality service rendered to patients. In addition, the two are related to one another in that they handle digital image data and information.
Literature Review
Digital medical imaging is achieved through a system of technologies termed as Picture archiving and communication (PACS). The source of the images used in the PACS include the CT, MRI, ultrasound (US), nuclear medicine (NM) among others. PACS act to transmit the images and the information from the aforementioned sources (among others) and transmit them to other remote locations over networks. These are then displayed and viewed in multiple locations simultaneously, in computer workstations. The operation also allows storage of this data into tape and optical disks (digital media). Digital radiology (Direct) on the other hand represents a transition to handling and dealing with digitized information in radiology. Therefore, while PACS involve the transmission, communication and processing of the image data and information, Digital radiology refers to the whole set of technology involved in the utilization of digitized information.
Discovery, History, Advantages and Disadvantages
PACS was started as a technology under research for storage devices, network technology, display monitors and existing computer engines. Academic medical centers became the first institutions to implement this technology in informatics laboratories, biomedical engineering, and radiology departments.
PACS emerged as systems which provided more efficient communication between providers, led to decreased time on report retrieval and resulted in emergency care. PACS were very expensive during the initial stages of implementation because of a number of reasons. For instance, highly-priced storage devices and high spatial resolutions that were very expensive were being utilized in the process. There was difficulty in the utilization of PACS resulted, for example because there was no or poor interfacing of PACS to other data stores and therefore there was duplication of large amounts of relevant data contained in other medical information systems that were isolated with PACS. Other disadvantages included poor implementations of workflow or folder manager concepts of image data management options because PACS were not interfaced to radiology or hospital information systems.
Workflow and patient throughput has improved with the utilization of digital radiography as compared to the use of traditional film radiography or computed radiography (CR) (May, David & Doreen, 2000). PACS systems have led to increased productivity, which has partly been the result of elimination of manually intensive tasks involved in the production, distribution of films, and the consulting of clinicians (Luigi, Guy, David, Pierre, & Jacques, 2008). PACS have also led to the saving of time (Akram, William, Salaheddin, Ramesn, & Brendan, 2000). The provision of information in concise and convenient format was important in radiology. Digital radiology emanated with improvement of processing techniques such as ease of availability of information in digital form which enhances folder management. This allowed for enhancement of consultations, differential diagnosis, and examination management among other operations. The technology resulted in reduced costs, faster times, and emergency care among other advantages. Decision support application, outcome analysis and CAD have emanated with the utilization of digital radiology. Direct Digital radiology has facilitated storage of information, and this has enabled the utilization of historical data for treatment of patients. Direct Digital radiology has provided for the application of digital imaging information for research purposes and comparison and review of cases. Digital radiology has availed a very good position for the management of medical information through a variety of software. These software include those which allow the communication of different systems through defined protocols, and those that allow manipulation of data to other systems, for example COBRA. Digital information and images may be obtained from a variety of sources, namely, digital radiography (DR), ultrasound scanners, computed tomography (CT) as well as scanners such as the nuclear magnetic resonance (NMR) scanners. The problem of archiving digital diagnostic imaging data and its management continues to grow with the shift of technology from analog to digital systems. Specifically, one of the problems in the handling of this information is related to cost. Another problem already synthesized includes the amount of data that will be handles. Large amount of data results into more problems of handling. For example, it has been estimated that the amount of data that would be generated and archived daily in the field of digital imaging is about 254.8 MB to 502.7 MB in a radiology department of University-Hospital serving a 614 bed. The hospital encounters a large population of outpatients. There is more than one modality that has been utilized in digital diagnostic imaging. These include digital radiography, ultrasound, and nuclear medicine and computed tomography. Apart from the well known storage formats which include disc storage and magnetic tapes, the type of information may be stored in form of multiformat video film recording (Dwyer, Arch, Norman, Larry, Kyo, Erral, Solomon, David, Stanton, Hilton, William, Mark & Susan, 2000).
Management of digital data and information in imaging has been tried by the use of two types of technologies, namely, standard computer peripheral devices such as magnetic tapes and discs, as well as raster gray scale multiformat video film recorders. The problem of managing digital information occurs even with PACS. Apart from the challenge of management of digital imaging information, there have emerged other challenges with the use of the two technologies, such as problems of image quality, overuse, radiation doses, productivity, and need to acquire new skills. There has been focus on ethical and legal issues surrounding the use of teleradiology (BMJ, 2006).
Conclusion
In conclusion, PACS and Digital Radiography have led to increased efficiency and quality offered in hospitals because of improved handling of digital data and information. Specifically, these technologies have led to improvement of handling digital rather than analogue image data and information which has resulted in faster processes and improved quality, while PACS have facilitated the transmission and the sharing of this information and data. Better patient outcomes as well as efficient patient management have resulted with utilization of digital radiography for X-rays and other forms of imaging, due to improved turnaround times (Reiner, Siegel, Hooper, et al., 1998; Inamura, Umeda, Harauchi, et al., 1997; Cook, Hansen, Breitweser, 1997; Byan, Weatherburn, Watkins, et al., 1998) to the requesting clinician (Pathi & Langlois, 2001). Increase or continual usage of PACS and Direct Digital Radiology will cause the transformation of the career of the radiologist to make them become informaticists in the health care industry, and become more directly involved in the triage and management decisions for the patient. In addition, management of patient data has been improved with the use of intelligent systems provided by PACS (Arenson, Katherine, David, & Robert, 2000). There have been a number of challenges encountered with the two types of technologies; specifically, handling of large amount of information has been a challenge. The rise in cost in the handling of information has also been another challenge, while other challenges revolve around requirement of new skills, issues of radiation doses, overuse, and image quality among others.
References
Akram, T., William, T., Salaheddin, M., Ramesn, N., & Brendan, H. (2000). Significant savings in radiologic report turnaround time after implementation of a complete picture archiving and communication system (PACS). Department of Radiology. Dublin: W.B. Saunders Company.
Arenson, R., Katherine, A., David, A., & Robert, G. (2000). Computers in imaging and health care: Now and in the future. Journal of Digital Imaging, Vol. 13. (4): 145-156
Bryan, S., Weatherburn, G., Watkins, J., et al., (1998). Radiology report times: Impact of picture archiving and communication system environment. AJR Ara J Roentgenol. 170: 1153-1159
BMJ. (2006). X-ray imaging goes digital: Digital imaging brings benefits but also demands changes in ways of working. BMJ, Vol. 333.pp.765-766
Cook, F., Hansen, M., Breitweser, J., (1997). Optimizing radiology in the new picture archiving and communication system environment. Journal of Digital Imaging, 10 (3), Supp. 1: 165-167
Dwyer, S., Arch, T., Norman, M., Larry, C., Kyo, L., Erral, L., Solomon, B., David, P., Stanton, R., Hilton, P., William, A., Mark, T., & Susan, F. (2000). Cost of managing digital diagnostic images for a 614-bed hospital. Journal of Digital Imaging. W.B. Saunders Company.
Inamura, K., Umeda, T., Harauchi, H., et al. (1997). Time and flow study results before and after installation of a hospital information system and before clinical use of a picture archiving and communication system. Journal of Digital Imaging, 10: 1-9
Luigi, L., Guy, P., David, A., Pierre, R., and Jacques, L. (2008). Impacts of PACS on dictation turnaround time and productivity. Digital Imaging.Vol.19 (1): 92-97
May, G., David, D., & Doreen, D., (2000). Impact of Digital Radiography on clinical workflow. Journal of Digital Imaging.Vol.13 (2), 1: 76-78
Pathi, R., & Langlois, S. (2001). Evaluation of the effectiveness of digital radiography in emergency situations. Flinders Medical Center.
Reiner, B., Siegel, L., Hooper, J., et al., (1998). Effect of film-based versus filmless operation on the productivity of CT technologists. Radiology, 207: 481-485
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