Dose reduction through PACS management

January 16, 2014
by Sean Ruck, Contributing Editor
For IT experts, the list of shows and conferences worth attending has expanded significantly over the past few years. What may come as a surprise is that one show, which premiered in 1914, nearly half a century before the term “information technology” first appeared, has become one of the top shows for IT vendors.

At RSNA this past November, well over half the companies exhibiting were offering some type of IT solution or peripheral equipment or service. Even many OEMs dedicated prime booth space to showcase IT solutions. Among the most prevalent were offerings that worked with PACS, EHR or both.

And it seems some of the rumblings heard in 2012 about cloud services being passé were premature at best. More likely, software programmers and providers were working on their products to get them in shape for release in 2013. Largely, that’s what was specifically on display at the show — or at least being talked about — brand new cloud-based solutions, or substantial updates to existing cloud-based solutions.

Answers to dose reduction
The excitement around cloud-based PACS archiving and retrieval ties into the challenges faced with dose reduction. While updates to hardware and technology and improved staff training can all figure into lowering dose, the fact is, patients are still being exposed to some level of radiation every time they have an imaging procedure.

OEMs do not want their profit-leading modalities cut from hospitals, and hospitals don’t want to pay for equipment that doesn’t improve patient outcomes while still bringing a healthy return on investment. So it follows that there has been a scramble since “dose dangers” hit the public radar to limit dose while touting the benefits of the modalities utilizing it. Meanwhile, companies with non-dose modalities view the concern as an opportunity to position their products as an alternative imaging method (where appropriate). Of significant note is the inroads ultrasound has made for breast imaging, in particular, for dense breast imaging.

OEMs at RSNA this year said that calls for dose reduction are being led by health care providers rather than patients. The general public has moved onto other things, with exceptions being individuals undergoing treatments for health issues that require extensive imaging procedures or for professional athletes who tend to have numerous procedures performed. Regardless of where the demand for lowering dose comes from, the OEMs have listened. Still, the only way to totally eliminate dose exposure from imaging procedures is to either use a different technology or to not call for an imaging procedure at all. It’s the latter that has OEMs intrigued and has made software developers a hot commodity.

Dumping the duplicates
When patient John Smith heads to the hospital for a battery of imaging procedures, the radiologist should be aware of any redundancies in the requested exams. If Mr. Smith is on top of his medical history and understands what he’s going in for and recalls that he already had that imaging exam done recently at another facility, he could alert the radiologist and unneeded exams and unnecessary dose can be avoided. But in reality, it’s a small percentage of patients who are really up-to-speed on what’s been done and what’s being done.

But if the radiologist is able to send out a query for the patient and pull the images needed, all those problems could be avoided. Within the same facility, and to a lesser extent, the same hospital network, that query is relatively easy. But once you go beyond a hospital’s immediate group, the challenge to get the needed information increases dramatically. John Smith, who’s known as Patient 1234 at one facility, is Patient 6789 at another, so searching for results based on patient records is bound to fail. It’s also a given that searching for a patient named John Smith is going to fail unless there’s further identifying factors and once those identifiers are determined, getting all procedures for the John Smith standing before the radiologist should be a goal.

Enter the cloud
By putting together a list of identifiers, new cloud solutions are allowing authorized personnel to pull the image studies for each patient. Entering in John’s first and last name and birth date are the options available for every cloud-based PACS. When you drill down further is where the differences in the software options become obvious. One provider options to specify attributes like weight and height, but those identifiers may not be constant. Others allow the query to utilize the patient’s social security number. Nearly all solutions allow the physician to access the different PACS systems through a single sign-in and the interface is all funneled through the cloud-based system, negating the need for numerous PACS operating interfaces.

Security is handled by only allowing the physician to view information pertinent to the case their involved with. If the radiologist is able to pull information they need from an existing exam, the patient is spared the dose, the patient or their insurance provider is spared the expense and John Smith can be on his way.