Evaluation of the Medical Diagnostic Imaging Support system based on 2 years of clinical experience

Abstract

The Medical Diagnostic Imaging Support (MDIS) system at Madigan Army Medical Center (MAMC) has been operational in a phased approach since March 1992. Since then, nearly all image acquisition has been digital with progressively increasing primary softcopy diagnosis used. More than 375,000 computed radiography (CR) images as well as other modality images have been archived. Considerable experience in installation and implementation phasing has been gained. The Iocation and ergonomic aspects of equipment placement were refined with time. The original clinical scenario was insufficiently detailed and additions were made to facilitate smoother and more complete transition toward a filmless environment. The MDIS system effectiveness and performance have been good in terms of operational workload throughput, background operations, and reliability. The important areas regarding reliability are image acquisition, output, display, database operations, storage, and the local area network. Fail-safe strategies have been continually improved to maintain continuous clinical image availability during the times when the MDIS system or components malfunction. Many invaluable lessons have been learned for effective quality assurance in a hospital-wide picture archiving and communication system. These issues include training, operational quality control, practical aspects of CR image quality, and increased timeliness in the generation and distribution of radiographic reports. Clinical acceptability has been a continuous process as each phase has been implemented. Clinical physicians quickly used the workstations soon after the start of MDIS at MAMC. The major advantage for clinicians has been the amount of time saved when retrieving multimodality images for review. On the other hand, the radiologists have been slower in their acceptance of the workstation for routine use. Radiologists need the completed software and hardware implementation to achieve the throughput necessary for a high-volume practice setting in making primary softcopy diagnoses. This is a US government work. There are no restrictions on its use. KEY WORDS: filmless hospital, Medical DiagnosticImaging Support (MDIS) System, picture archiving and communication system (PACS).

Promoting Innovation and Convergence in Military Medicine: Technology-Inspired Problem Solving

“…This clinical need was addressed by an Army officer trained in informatics, Fred Goeringer, and a small ad hoc team of academic and industry collaborators in the Medical Diagnostic Imaging Support (MDIS) project [1,2]. The key product was a standard approach to digitization that evolved into today's international Digital Imaging and Communications in Medicine (DICOM) standards.…”

Introduction to Picture Archive and Communication Systems

“…The concept of a digital image communication and display system was devised in the 1970s, with the initial conference on PACS designs launched in 1982 (Huang, 1999(Huang, , 2003. The U.S. Army Medical Research and Materiel Command installed the first large-scale PACS in the United States called the medical diagnostic imaging support system in 1992 (Smith et al, 1995). Since that time, PACS technology has grown through the support of InfoRAD displays during the Radiological Society of North America (RSNA) annual meetings and other conferences, as well as the establishment of a peer-reviewed journal, the Journal of Digital Imaging, devoted to research in digital technology.…”

Coping with PACS downtime in digital radiology

“…Transfer of all recently acquired images to long-term storage on optical jukeboxes is made from the PACS server after 2 to 5 days (Table 1). 3,4 All plain films are acquired either through com- …”