Medical image management

Teleradiology in Europe

The new concept of teleradiology is centered on the consideration that it involves management of medical information rather than the simple transmission of diagnostic images from one location to another. Teleradiology must therefore be able to contribute to the seamless integration of the digital environment in which medical data are managed throughout and beyond the hospital, generating value added services for the patients as well as prospective economical benefits for the institution. In this perspective the evolution of telecommunication with the spectacular success of mobile telephony and Internet will play and increasingly important role, by allowing further development in the exchange of multimedia medical information on a regional as well as international level. However, new responsibilities are being given to the radiologists, who must take all necessary technical and organizational actions in order to avoid that the digital management of data may endanger the confidentiality and the integrity of patients' data.

Clinical assessment of Hokkaido University PACS

The paper describes the hardware and software used in the Hokkaido University picture archiving and communication system (HUPACS), which has been in use for the past two years. An evaluation of the system is also included. Fuji computed radiography completely replaces conventional X-ray radiographs, and 10:1 data compression is routinely employed. The PACS LAN is connected to the hospital information system through the main-frame computer and it is linked, not only to the radiology department, but also to the outpatient clinics. Image data have been steadily stored in the optical disc library, which contains more than 200,000 images. The original image can be accessed within 1 min. Image quality on a cathode ray tube (CRT) is clinically acceptable. Nevertheless, the transfer time of a newly made image is prolonged in some cases, during periods of heavy usage of the system. During scheduled radiology conferences, image reading tends to take more time on a CRT than on film. An improvement in the ease of operation of the workstations is necessary for full acceptance of CRT diagnoses. Generally speaking, however, HUPACS is working well and is appreciated by most of the clinicians.

Cost containment and computerized medical imaging. Meeting one another's needs?

Today, computers are used in several important and fast-growing medical imaging modalities, such as digital subtraction angiography, positron emission tomography, magnetic resonance imaging, nuclear medicine, and diagnostic ultrasound. The ultimate test for the computer in medical imaging will be its ability to replace traditional film-based radiography as the mechanism for displaying, communicating, and storing imaging information. This transition will require radiologists and other imagers to accept information in digital form. The speed of that acceptance depends on the economic incentives of the health care system. These are changing as a result of cost containment, which is moving away from fee-for-service toward bundled payment. The increase in capitated health plans will encourage the development of digital radiography systems that realistically trade-off the perceived quality needs of radiologists with the costs of producing and operating such systems.

Imaging technologies. Iconoclasts among the images

High technology developments in diagnostic imaging raise a number of issues that are disturbing. New developments do not always favor greater diagnostic efficacy since fads, marketing promotion, and entrepreneurs can distort medical goals. New advances disseminate rapidly in affluent societies before formal benefit evaluations are completed. We suggest that digitization of radiography must be critically assessed, and simplicity of equipment design should be promoted. Though medical and economic factors can provide guidelines for policy making, the ultimate priority decisions are political in nature.