Digital imaging has assumed a primary role at our institution
with the recent implementation of a computed radiography (CR)
system that we believe improves the diagnostic quality of the
images and speeds distribution of radiology reports.
The University of Texas Medical Branch at Galveston (UTMB) is a
950-bed facility that performs 250,000 radiology procedures
throughout the hospital system each year. The department of
radiology routinely performs 600 to 800 studies per day.
The first phase of the CR project had a clear mission: to
develop a system that could handle the workload of the ER and
outlying clinics, while reducing the potential for lost films.
Kodak's Health Imaging division joined us in developing a pilot
program by putting their CR technology products to the test.
This test program set the groundwork for instituting an imaging
system with an eye toward long-term cost reductions and increased
productivity. Our immediate goal was to improve efficiency and
eliminate lost films. Our ultimate goal is to gradually expand the
current project and integrate other digital modalities, such as MRI
and CT, and implement digital viewing and a central archive to
store and retrieve these images. Because the planned medical
viewing stations support DICOM 3.0, we expect to network and view
all digital modalities on these workstations.
Distinct digital advantage
Digital imaging offers distinct advantages over traditional
radiography. Digital images are processed and sent over a local
area network to a diagnostic workstation. Radiologists analyze the
displayed image and send their report, along with the image, to
pertinent departments. The digital workflow eliminates the need to
physically move film images, reducing transport and processing time
from hours to seconds. Studies cannot be misplaced or misfiled
because they are stored digitally.
When the Kodak Digital ScienceTM computed radiology system 400
came on line in our ER, the lost or unreadable film rate dropped
from 57% to 2%. The CR system also allows a wider contrast range
than radiographic film. This expanded exposure range reduces the
need for repeats due to improper technique or other variables.
Clinicians can access the images as a soft copy on their review
workstations and their reports on the radiology information systems
The initial success we experienced with our digital imaging
system paved the way for phase two: expanding the network to cover
the entire hospital complex and other outpatient facilities.
As we expanded the application of the CR system, we
institutionalized the project, forming a team comprised of
representatives from the hospital administration, the radiology
department, physicians from multiple departments, clinicians,
information services, and our local area network administrators.
Additionally, the manufacturer became an integral part of that team
and worked closely with us to match our needs with appropriate
Through regular meetings, a clear understanding of the
requirements of each department was established. Our motto became
"tell me what we can do to make this work." We decided to put the
system on an isolated network. Compatibility issues for the capture
devices in the different areas of the hospital were worked out.
With the decentralization of the department and the new remote
sites, the CR system began to show its value in alleviating demands
and reducing turnaround time. These days radiologists, working
at diagnostic workstations, can support the needs of multiple
clinics without having to travel to each site.
Within the UTMB complex in Galveston, turnaround times for
reports have decreased dramatically-in some cases, from weeks to
hours. At the first outpatient facility, the radiologist's report
is often delivered to the requesting doctor within 15 to 30
minutes, utilizing CR, MedSpeak, and IDXRAD.
The most recent site about to join our system is the primary
care outpatient clinic (PCOC). The PCOC is located 20 miles from
Galveston, in Texas City. Previously, a courier service was used to
collect and deliver film studies. It could easily take a day or
more for physicians to receive a report. Now, the image can be
read, analyzed and returned within minutes.
In the near future, we will be expanding our CR system to
include 10 additional workstations to support our affiliation with
the Texas Department of Criminal Justice (TDCJ). Currently, inmates
from all over the state have to be transported to UTMB for
radiology needs. When the computed radiography system is fully
operational, these inmates will be examined at remote sites, and
their images can be captured and transmitted electronically to us
for professional analysis. This telemedicine system will reduce the
need and the expense of transporting inmates and film studies.
Improvements in patient care
Traditionally, the only way to augment viewing a radiographic
film image was with a hotlight or occasionally a magnifying glass.
Using the imaging software available today, radiologists are able
to manipulate the brightness and contrast of the image, reverse the
image, and use a virtual "magnifying glass" with varying powers of
magnification to enhance the image and increase their ability to
make an accurate diagnosis.
Initially there was concern that the workstations would not have
sufficient resolution needed to view hairline fractures and
minutia. However, improvements in diagnostic-level monitors have
quelled these concerns. In fact, radiologists report that the
high-resolution diagnostic monitors (and the system's sophisticated
processing software) allow them to detect subtle details both in
bone and soft tissue.
Training was available during the implementation phase of the
system, and taking advantage of this option helped our radiologists
and technologists apply the equipment to its full potential. Within
a few weeks, radiologists were commenting on their success in
finding injuries that would have been difficult or impossible to
see on a traditional radiographic film image.
Our next phase is to implement a digital archival system.
Currently the archive consists of a library of traditional analog
film records. Digital files are printed on film by laser printers
and kept in a hard-copy format. However, when the computed
radiography system is completely integrated, output of traditional
hard copy studies will be eliminated, except for mammography. All
current and future images will be stored in the digital archive,
though existing film images will be continue to be maintained for
appropriate time periods.
We anticipate an 80% reduction in consumables when we have
converted to a digital imaging system, with projected savings of
more than $1 million a year in related expenditures. The medical
image and information library will be incorporated into the PACS
system so that past studies can be accessed either through a
workstation connected to the RIS or directly to the diagnostic
workstations. When this system is on-line, diagnostic images will
be readily available without the need for travel to a storage
Many of the savings are intangible at this point. However we
have already improved efficiency of both physicians and
technologists, reduced the labor and expense of repeat films and
search time for missing films, and expedited visits for the
Each phase of the CR system has brought with it an increase in
efficiency that will ultimately result in significant cost savings.
By instituting digital imaging technology, UTMB utilizes
state-of-the-art radiology imaging to provide the highest quality
of patient care while reducing costs and increasing efficiency.
Dr. Swischuk is Medical Director of Pediatric Radiology and Mr.
Reyes is Director of Radiology Services at the University of Texas
Medical Branch at Galveston in Galveston, TX.