Biomed Imaging Interv J 2006; 2(3):e41
© 2006 Biomedical Imaging and
Radiologists in the IT era: Saitama experience
S Tsukuda*, MD, K Inoue, MD, A Heshiki, MD
Department of Radiology, Faculty of Medicine, Saitama Medical University, Moroyama, Japan
In recent years, intra-hospital computerisation including
picture archiving and communication system (PACS) and electronic medical chart
system (EMCS) has been rapidly introduced in Japan. The current system has,
however, encountered many problems, such as, storage format of images, quality
of diagnostic monitors, and compatibility of PACS and EMCS introduced by
multi-vendors. In 2003, Saitama Medical University Hospital introduced PACS and
EMCS, which can prevent inconsistency and loss of medical care information and
can be linked to provide high quality medical care. This paper describes how
radiologists should be involved in a hospital information system as specialists
of PACS, based on our experience. � 2006 Biomedical Imaging and Intervention
Journal. All rights reserved.
In recent years, there has been rapid intra-hospital
computerisation in Japan due to the growth of information technology (IT). Current
circumstances are, however, such that while there are highly advanced
hospitals, there are also hospitals that rely on conventional manpower. It is
believed that IT introduction in medical care, to the extent of what is
considered full-scale and practical, has just begun. This paper describes how
radiologists should be involved in a hospital information system withina
chaotic IT scenario in hospitals and describes problems with the PACS/EMCS
currently in operation.
In Japan, the introduction of PACS, which began in the
1980s, initially involved incorporation of a radiology information system (RIS)
in a network associated with medical imaging devices, such as, CT and MRI
machines. Afterwards, instances of the introduction of PACS in combination with
electronic medical charts increased because of the improved connectivity of
testing equipment. This improvement was a result of the introduction of DICOM
standards and national measures to introduce IT.
By 2001, PACS had been introduced in 1,178 facilities in Japan.
The number rapidly increased to 2,342 facilities in 2003 . PACS
implementation encountered problems with storage format due to the large
amounts of image data produced and the quality of images distributed. Today, a
storage format with lossy compression is often chosen because of limitations on
storage media, and many facilities distribute reference images to individual
departments. In such instances, low-quality images are displayed on
low-image-quality terminals. Proceeding with medical care while referring to
these images is extremely risky, and it also carries the potential of medically
related lawsuits. Currently, however, installing high-image-quality diagnostic
monitors in every department is impossible because of the excessive cost
involved. Therefore, diagnosing lossless images with high-definition monitors
in radiology and ensuring simultaneous distribution of diagnostic reports and
reference images is absolutely essential. This will ensure the quality of
medical care while minimising unessential network traffic .
Based on these concepts, PACS was fully introduced at the Saitama
Medical University Hospital in 2003 and, subsequently, EMCS was introduced in
January 2005 (Figure 1). Therefore, medical images, such as, plain films and
results of CT, MRI, ultrasound exams, and endoscopy can be referred to on
electronic medical charts (Figure 2). The quality of monitors in electronic
chart terminals used by individual departments is not sufficient for diagnosis,
thus image assessment based on electronic charts is only for reference. A
radiology specialist will then drafts a report based on all of the images
produced on a high-quality monitor linked directly by a dedicated line to a
server and distributes it to each department within the shortest possible time
delay. A clinician lists a patient�s test results with an electronic chart
terminal, which then enables immediate reference to images and diagnostic
reports. This introduction of EMCS and PACS can prevent the inconsistency and
loss of medical care information and can be linked to provide advanced medical
care more efficiently. For radiologists, advantages of the introduction of PACS
and electronic medical charts are as follows. There is no need� to locate films
to interpret, remove them from the film jacket, and view them in order on a
film viewer as was done before, and the time available for image interpretation
has increased . Previous exams and other diagnostic and imaging information required
for interpretation can be easily referred to and compared (Figure 3). Easier to
understand reports can be provided by attaching diagrams to images. More
accurate diagnosis and measurement are possible because of the 3D image
processing features of image interpretation terminals. Despite these
advantages, however, there are some problems. Electronic medical charts lack
the readability of conventional paper medical charts and drop in speed as a
result of large amounts of access requests. In addition, keyboard entry takes
time, reducing the time spent with the patient and the amount of medical care
information listed in the documents, such as, diagnostic referrals.
Introduction of faster terminals and networks and extra features for use in
keyboard entry and speech-recognition systems is needed.
Figure 1 PACS diagnostic workstations
at the Saitama Medical University Hospital.
Figure 2 PACS at Saitama
Medical University Hospital.
Figure 3 Multimodality
images may be displayed simultaneously.
Considering current conditions from a radiologist�s
perspective, images that must be handled by radiologists are increasing
exponentially, primarily as a result of the introduction of multidetector row
CT. The current shortage of manpower is irrefutable. In this IT era, providing
computer-assisted diagnostic applications as a standard on diagnostic terminals
is one means of reducing the burden on diagnosticians and ensuring the quality
of medical care. In the past, computer-assisted diagnosis was primarily
intended for plain films and mammography, but recently, lesion detection in
multi-cross-sectional images, such as, CT has also been attempted . These
may serve as a means of tackling the increase in image information.
PACS, which is expected to expand further in the future, has
a problem with compatibility. Currently, PACS and EMCS introduced by individual
medical facilities are multi-vendor, and the reality is that most of the
systems are not fully compatible. Radiographic images retain some degree of
compatibility and connectivity because of the DICOM  format, but information
on EMCS is particular to each medical facility. In the future information must,
to some extent, be standardised and shared between PACS and EMCS. At the same
time, however, the protection of personal information and security of data
transmission must not be neglected.
In this IT era, radiologists must play a leading role in the
introduction and the implementation of information systems, including PACS. They
must also be responsible for the quality of information that flows within the
system. In addition, as a part of intra-hospital computerisation, images
undiagnosed by a diagnostic imaging specialist must not be distributed to
individual departments without being checked by a radiologist. Even in this era
of PACS, real-time involvement in medical care is the role of the responsible
radiologist. To that end, it is essential to have diagnosticians who can efficiently
handle large numbers of images and possess skills to handle 3-dimensional
images that will definitely increase in the future.
Report of medical equipment in Japan 2004. Data book series by monthly journal Shiniryo. 2004. (in Japanese).
Perfect filmless and paperless university hospital: excellent operation of four years. Shiniryo 2005;Aug:46-8. (in Japanese).
Hospital information system and picture archiving communication system. Shiniryo 2005;Aug:53-5. (in Japanese).
Li Q, Li F, Suzuki K, et al. Computer-aided diagnosis in thoracic CT. Semin Ultrasound CT MR 2005; 26(5): 357-63.
NEMA. DICOM Homepage [Web Page]. Available at http://medical.nema.org/.
| Received 17 January 2006; received in revised form 24 July 2006; accepted 11 August 2006
Correspondence: Department of Radiology, Saitama
Medical University, Japan. Tel: +81-492-76-1265; Fax: +81-492-95-8003;
Please cite as: Tsukuda S, Inoue K, Heshiki
Radiologists in the IT era: Saitama experience, Biomed Imaging Interv J 2006; 2(3):e41
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