A London, Ont. radiology facility has opened the first fully integrated filmless independent radiology facility in the region.

London X-Ray Associates received about $800,000 from the provincial government and raised about $700,00 from its 13 radiologists for the project.

Dr. Peter

Bennett, managing partner at the facility, says the move will increase efficiency by 30 per cent, as well as decrease the number of repeat X-rays required and, therefore, patient exposure to radiation.

“”Now technicians can do their own quality assurance at the console,”” says Bennett. “”Once that’s done, the radiologist also has the opportunity to window and level the image. We are able to tease the maximum amount of diagnostic information from every image provided for us. That is probably the most obvious way to reduce the number of exposures required.””

The centre is using Siemens’ Radiology Information System/Picture Archival and Communications System (RIS/PAC) and Kodak computed radiology software.

Bennett explains that with the digital system, images are recorded on a cassette rather than on the traditional film, which must be developed. The cassette is then inserted in a digital reader, which outputs the image. Images can be viewed on the centre’s special high-luminance, grey-scale Simomed monitor and burned onto a CD for patients to take to their doctors.

Although the digital system will pose electronic storage issues for the facility, it will reduce the amount of physical space required, says Bennett. Under Ontario law, health care facilities are required to store adult X-rays for three years.

“”That’s a huge issue for hospitals,”” says Bennett. “”We put through probably more than 100,000 cases a year. Now we can store three years of images on our system on a machine smaller than a desk.””

Another issue is that of privacy and security. According to Bennett, London X-Ray Associates is in the process of setting up a Web server which will allow physicians to access reports and images online via a secure server.

“”It’s a question of coming up with the money for software licences and putting it together,”” says Bennett.

The only kind of X-rays the centre isn’t taking digitally is mammographies. That’s happening elsewhere in the country, however.

Two Canadian hospitals – Toronto’s Sunnybrook and Women’s College Hospital – have been participating in the U.S.-government-funded National Digital Mammography Archive project for the better part of the last decade.

Also involved are the University of Pennsylvania and the University of Chicago, Sunnybrook medical physicist Gord Mawdsley told a media briefing at IBM’s Thomas J. Watson Research Lab in upstate New York Tuesday.

Canada is involved due to its development of detectors for digital mammography, Mawdsley said.

But the digital breast cancer screening project won’t expand to involve other health care facilities until all the bugs are worked out – and that’s not for at least another year, says Mawdsley.

“”When I hear someone say the product is ready to sell next week, I always say hold on, have you worked out every kink and bug because we’ve gone through a long set of growing pains.””

While digital mammography is now fairly well-accepted by the medical community, the system — who are working with IBM to develop a North America-wide electronic medical record data grid and repository — is not yet perfect, Mawdsley says.

Part of the problem is the sheer quantity of data the system generates: each image is typically anywhere from 8-32 MB in size, and radiologists usually require not only the four current images, but those from the previous years as well.

“”There are huge volumes of data to be stored and radiologists have the attention span of my five-year-old,”” says Mawdsley. “”If it’s not right there they go on to the next thing.””

The benefit to hospitals who participate in the grid computing project to share digital mammographies is that they don’t have to invest individually in the hardware and software required for a digital imaging system, he adds.

“”One of the key features of grid systems is they’re capable of handling a large number of multiple sites,”” says Mawdsley. “”It’s an extraordinarily cost-effective way of propagating solutions in health care because the single rare resource you can’t find is a really good IT group in every hospital; that doesn’t exist.””

As well, there is an application called teaching, training and evaluation which allows resident radiologists to do much of their training online, without having to have a senior radiologist looking over his or her shoulder.

In order for health care facilities to buy into the system, however, notes Robert Hollebeek, a team member at the University of Pennsylvania, grids have to be as easy to use as electricity.

“”The image is of a wall plug,”” he says. “”You don’t worry about the power plant when you plug something in. In the hospital it’s a very busy environment, people are overloaded and they have no patience for things that don’t work.””

For more on the National Digital Mammography Archive, please see the upcoming issue of Technology in Government.

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