PACS Influence the Technologist s Work JAVAD GHASEMI ,BS ,MRT Deputy Education OF Iranian Radiographic sciences association (IRSA) - EUROPACS SOCIETY MEMBER Mohammad Fathi, BS , MRT Head of Imaging Informatics Committee OF Iranian Radiographic sciences association (IRSA)

Diagnostic imaging departments have a dual mission : 1- maintain the highest quality 2- consistency of patient care while maximizing efficiency and productivity.

3-5 TECHNOLOGIST : 1 RADILOGIST The primary focus of productivity enhancements has been on technologists.

EXAMINATION TIME: A- Film-Screen Radiography (CONVENTIONAL) B-Film-Screen Radiography( DAY LIGHT SYSTEM) C- Filmless Computed Radiography

Common Steps for Film-Screen and Filmless Computed Radiography : 1. Review requisition (paper or electronic). 2. Escort patient to radiography room. 3. Position patient and acquire images.

Film-Screen Radiography (CONVENTIONAL) 1. Place exposed film in pass box. 2. Develop film images, remove film from cassettes, place film images into conventional processor, refill empty cassettes with new film, replenish film bin if empty. 3. Complete paperwork (historical and demographic information). 4. Remove film images from processor. 5. Review images for quality control.

6. Annotate images and obtain repeated images as needed. 7. Collate film images and paperwork. 8. Pull patient master film jacket from file room. 9. Pull pertinent comparison film images and reports from film jacket. 10. Submit un reviewed films for radiologist interpretation.

Film-Screen Radiography( DAY LIGHT SYSTEM) 1. Place exposed film cassettes into daylight processor. 2. Complete paperwork (historical and demographic information). 3. Remove film images from daylight processor. 4. Refill empty cassettes with new film. 5. Review processed film images for quality control.

6. Annotate images and obtain repeated images as needed. 7. Collate film images and associated paperwork. 8. Take completed study to file room for radiologist interpretation.

Filmless Computed Radiography 1. Place computed radiographic images into plate reader. 2. Enter unique case information into computer and open electronic folder for patient examination. 3. Review computed radiographic images on PACS workstation and edit as needed. 4. Verify examination electronically and close folder.

Film-Screen Radiography (CONVENTIONAL) TYPE VIEWS NO. TIME (MAIN) CHEST 2 164 10.8 SPINE 3-5 83 13.9

Filmless Computed Radiography TYPE VIEWS NO. TIME (MAIN) CHEST 2 183 7.4 SPINE 3-5 160 8.6

Store The DICOM Store service is used to send images or other persistent objects (structured reports, etc.) to a PACS or workstation.

Storage commitment The DICOM storage commitment service is used to confirm that an image has been permanently stored by a device (either on redundant disks or on backup media, e.g. burnt to a CD).

Query/Retrieve This enables a workstation to find lists of images or other such objects and then retrieve them from a PACS.

Modality worklist This enables a piece of imaging equipment (a modality) to obtain details of patients and scheduled examinations electronically, avoiding the need to type such information multiple times (and the mistakes caused by retyping

Modality performed procedure step A complementary service to Modality Worklist, this enables the modality to send a report about a performed examination including data about the images acquired, beginning time, end time, and duration of a study, dose delivered, etc. It helps give the radiology department a more precise handle on resource

Technologist Note: Labeling (SPINE) Time of sequence Patient history , Type of contrast media Dose ,rate & volume of CM

Printing The DICOM Printing service is used to send images to a DICOM Printer, normally to print an "X-Ray" film. There is a standard calibration (defined in DICOM Part 14) to help ensure consistency between various display devices, including hard copy printout or paper.

DEVELOPER FIXER WASH DRY WATER - SOLVENT

DARKROOM PROCESSING & CHEMISTRY

PROCESSOR PROBLEM FIXER RETENTION

FILMLESS VS FILM/SCREEN FILM these can not be modified once processed If copied lose quality Digital print from file no loss of quality

POST PROCCEING Technologist must choose technical factors (mAs & kvp) to optimally visualize anatomic detail The selection of processing algorithms and anatomical regions controls how the acquired latent image is presented for display HOW THE IMAGE LOOKS CAN BE ALTERED BY THE COMPUTER EVEN WHEN BAD TECHNIQUES ARE SET

POST PROCESSING :1

POST PROCESSING :2 Edit Annotation Measurement Zooming Reversing Marker.

Post Processing In CT

cor mpr

min-mip

min-mip

Off-line media (DICOM files) It describes how to store medical imaging information on removable media. Except for the data set containing, for example, an image and demography, it's also mandatory to include the File Meta Information.

DICOM transmission Patient CD DICOM file HTML WEB BASE

CONVENTIONAL RADIOGRAPHY VIEWING OF X-RAY FILM IMAGES

Internet VPN Digital Images Archive Database and Workflow Engine Workstations Remote Remote Facilities

Portable imaging

QUALITY CONTROL

Radiological departments are changing rapidly due to the implementation of digital images and PACS (Picture Archiving and Communication Systems).

Digital imaging is not the end all, cure all for imaging problems. It is still technologist dependent.

To Produce Quality Images For Conventional Projection or Digital Radiography: The same rules, theories, and laws still apply and can not be overlooked

FFD/OFD (SID/SOD) Inverse Square La Beam Alignment Tube-Part-Film Alignment Collimation Grids Exposure Factors: KVP, mAss Patient Position

It is still technologist dependent.

THANKS