is Vice President of the Network Business Unit at FUJIFILM Medical
Systems USA, Inc., Stamford, CT.
The Internet has revolutionized the delivery of many products
and services. As a service, radiology has taken part in the
Internet revolution. For example, radiologists once primarily
worked on-site in hospitals. Today, ambulatory care is increasingly
common, often separating the radiologist from the patient. As a
result, remote image interpretation is now routine, and it is
common to distribute soft-copy images across the healthcare
enterprise. These trends create the need to image-enable
thousands—if not tens of thousands—of desktops throughout an
integrated healthcare network—many of which are outside of the
walls of a hospital.
Consumerism is another critical trend that is being fueled by
the Internet. Today patients have easy access to a wide range of
medical information and are able to educate themselves about
radiology processes. As a result, they demand a high level of
service, including rapid turnaround of imaging reports.
Finally, the Internet may also be playing a role in the shortage
of radiologists, as some elect to work in the computer technology
industry. An estimated 380 million radiology procedures will be
performed in 2008, representing an annual growth rate of 14%. The
number of radiologists is growing at an annual rate of just 1.2%.
Under these challenging circumstances, it is essential that we
maximize radiologist efficiency, so that the quality of
care can remain high.
In 1999, a picture archiving and communication system (PACS) was
easy to define. It consisted of a diagnostic workstation,
a list of unread studies, and digital departmental storage. It was
simply a system that enabled soft-copy interpretation of images. In
essence, the computer replaced the light box.
Today, defining a PACS is anything but simple. In
addition to remote reading, we are faced with new imaging
modalities that generate very large data sets with an increasing
amount of dynamic and functional content. As multiple healthcare
institutions come together to form integrated delivery networks,
they create multisite workflow for the radiologist and
others involved in patient care. There is an increasing amount of
information available to drive workflow and guide
decision making, but it must be navigated in an efficient
In addition, with the push toward the electronic medical record,
users are looking for portable, mineable forms of data storage.
They also want enterprise access to images and information, not
just in radiology but also in such clinical areas as cardiovascular
medicine, pathology, mammography, and others.
All of these trends create questions about what a PACS should
look like. As we consider this question, we should be thinking
about workflow, visualization, and infrastructure. As an
industry, we must think of a PACS not as a monolithic system, but
rather as a platform and an infrastructure for storage of data from
multiple clinical areas, as a separate platform for visualization,
and as a tool for overcoming workflow challenges.
Radiology studies often traverse many boundaries. A large
hospital may be served by a single radiology group, which, in turn,
may be covering multiple different large-scale facilities as well
as a small hospital that is struggling to retain radiology
services. The radiology group may also be outsourcing some of its
work to a nationwide reading service or so-called super group.
A typical radiologist reads on ≥6 different PACS systems. This
translates into at least the same number of platforms for
3-dimensional (3D) visualization, the radiology information system
(RIS), and the reporting system. The need for radiologists to
switch between various user interfaces creates both a great
challenge and a great opportunity for integration.
For example, the mandate to maximize radiologist
efficiency creates the opportunity for a new kind of
integrated worklist that takes into account all of the healthcare
sites the radiologist serves and brings together a variety of tasks
ranging from report signing to peer review to protocoling of
examinations. By drawing from combined user preferences and
workrule logic, this information can be presented in a dashboard
format for navigation by the radiologist (Figure 1). Combining
diverse systems into a common worklist/dashboard allows a
radiologist an integrated view of the work he or she has to
Once the radiologist gets to that work, it is very important to
have the right kinds of tools available, including advanced
visualization. These tools need to be integrated not only into the
PACS for use in normal day-to-day operations, but also into other
applications, given that new kinds of viewing models will be
incubated outside of the PACS in many cases.
These tools also need to be distributed, because diagnosis is
now distributed. Radiologists should not be constrained by the
limitations of the environment in which they serve. All necessary
information and tools need to be accessible in a way that
facilitates efficient and ergonomic interpretation. In
addition, our systems must be able to provide, at a minimum, a
collaborative connection between the radiologist and the
It is interesting to visualize how all of these demands might
play out in the future and what impact the Internet will have
(Figure 2). Hospitals may seek a common infrastructure for
radiology, cardiology, mammography, and other specialties—one that
integrates images, structured reports, documentation, and
medication history into a decision support system. The desire to
integrate various imaging modalities into a common infrastructure
may be a reason healthcare institutions are looking to replace
They may also be looking to replace their radiology information
system and other technologies as a way not only of improving
workflow but also of maintaining their physician base.
Referring physicians may demand online interactive scheduling,
order entry, critical results alerts, advanced visualization, and
decision support-and hospitals may seek to provide these services
as a way of retaining their relationship with physicians.
Certainly radiologists are starting to invest in technology
platforms that help them gain a competitive edge through more
ergonomic and efficient interpretation, access to prior
studies, results generation, diagnostic visualization tools, and
Better communication with patients is also an important emerging
opportunity. Interaction with physicians, education, and results
reporting can all be facilitated by the Internet.
A unique opportunity exists for our industry to connect all
healthcare stakeholders through the use of Internet technology. We
must act quickly, as technology is changing at Internet speed.
As vendors, we must define our goals and deliver
value. We must open our systems and enable integration
opportunities without creating technology stagnation. We must
continue to collaborate with stakeholders in the healthcare
industry. We must continue to adapt and exploit consumer
technologies. Perhaps most important, we must “humanize” radiology
by involving the patient, involving the referring physician, and
putting a human face on the radiology process.