Case Studies

Enterprising Practice Phases in PACS to Continually Advance Imaging Services

Author: Brian Hannon, Project Manager, Salem Radiology, 23 Stiles Road, Salem, NH

Complacency does not breed success. Today’s competitive environment requires planning and foresight to excel in the delivery of medical imaging services. Capital equipment and information technology (IT) investments must pass two critical tests: Will it positively impact patient care and also create a more efficient and effective workplace. Achieving these two goals implies implementing change with a minimum of disruption. 

At Salem Radiology (Salem, NH), our core values dictate the delivery of patient care in a safe, educated and efficient manner.   Our mission has become more challenging as medical imaging and IT converge. The development of advanced imaging technologies, such as digital mammography, digital ultrasound, MRI and multi-slice CT virtually dictate the utilization of a digital infrastructure to gain optimal use of these systems as well as the fulfillment of our mission.

Robert Hannon, MD, and Robert Schall, MD, opened Salem Radiology’s first office in 1976 with one X-ray unit. In 1983, at the cusp of the diagnostic imaging revolution, the main office moved to its current location, where growth would not be limited by four walls. Today, Salem Radiology employs eight radiologists, 3 Radiology Practitioner Assistants, 80 employees and owns three imaging centers to serve the diagnostic imaging needs of the Merrimack Valley Region of northeastern MA and southern NH. Our main office occupies over 8,000 square feet of space with three computed radiography (CR) X-ray rooms, ultrasound, full-field digital mammography (FFDM), bone densitometry and most recently, 64-slice computed tomography (CT). The other imaging centers are in North Andover and Methuen, MA. Our doctors staff the radiology department at Caritas Holy Family Hospital, Methuen, MA, and the Merrimack Valley MRI center, located on the hospital campus.

A Phased PACS/RIS Implementation

In 2001, Salem Radiology decided to respond to the continued demand for outpatient imaging. They also recognized the need to move to a digital infrastructure with the future goal of going filmless.

At the same time, medical imaging was at the forefront of the multi-slice CT revolution. After we held numerous discussions with the hospital administration, Caritas Holy Family became the first site outside of Boston to install a four- and eight-slice CT in the Spring of 2002.  Concurrently, we began our search for a mini-PACS or teleradiology solution, which we knew was necessary to read the volume of images that multi-slice CT would generate. Our needs were very specific: we required the services of a PACS vendor who could provide a single modality mini-PACS, yet with the storage and bandwidth capacity necessary for multi-slice CT; could integrate with our proprietary administrative IT solutions; and could sustain us throughout the path to a full-blown PACS servicing multiple digital modalities. A further benefit would be to replace our order entry system.

This search led us to BRIT Systems (Dallas, TX), a leading technology company that provides custom, turnkey solutions for PACS, RIS and teleradiology. When we initially installed BRIT’s Mini-PACS (Roentgen Files with The Radiology Workbench), our expectation was that the hospital would be installing a fully networked PACS. For a variety of reason, the fully networked PACS was delayed until October 2005.

For three years, BRIT served as the only PACS between our radiology group and the hospital, and did an outstanding job handling up to 100 multi-slice CT studies each day, which can generate thousands of images. During this time, the Mini-PACS became a shared service between our facility and the main hospital where the CTs were located. I was extremely pleased with the product, reliability and occasional service upgrades that gave our Mini-PACS full-PACS capabilities.

Overlapping this period was our investment in FFDM. We recognized the need to offer digital mammography to the local community or risk losing those patients to another facility that offered FFDM, even if the patient had to travel long distances. In June 2004, Salem Radiology installed a GE Senographe 2000D and mammography reading station.  We turned to BRIT Systems to handle the archiving of images, and once again they demonstrated skills beyond expectation. We decided to keep all raw and processed digital mammography images along with CAD (provided by iCAD), and BRIT created the necessary storage infrastructure to help us accomplish this without a single blip in the existing system. In fact, I rely upon the expertise at BRIT Systems for their advice in following the ACR’s storage guidelines.

The third imaging and IT project at Salem Radiology was the installation of 64-slice CT, the “holy grail” of imaging. This major undertaking was two-fold; acquisition of the VCT (GE Healthcare) and migration to a full-blown integrated RIS/PACS system. When we purchased the VCT in April 2006, Salem Radiology was only the second outpatient center in New England to install a 64-slice CT scanner.

I turned to BRIT Systems, which again seamlessly upgraded our existing system and storage infrastructure and retooled it to encompass full multi-modality PACS capabilities. This also became the perfect time to upgrade X-ray to CR. Today, our facilities are completely digital and currently migrating to a filmless environment within our facilities. The only film processing will be to satisfy the needs of referring physicians who cannot access digital images.

As impressive as BRIT’s phased PACS implementation was the company’s integration of our administrative IT systems into a fully integrated, bi-directional, brokerless RIS/PACS. As a privately-owned organization, many of our administrative solutions were proprietary, “home-spun” solutions that continued to evolve. Integration was not a simple task, yet BRIT again stepped up to the challenge.

Today, BRIT’s database has become the centerpiece of our digital infrastructure with systems on the front- and back-end. BRIT’s RIS/PACS handles our worklist, order management, image display and management and all storage and disaster recovery requirements.

BRIT is more than just an application services company. For Salem Radiology, BRIT also serves as a consultant and IT network and infrastructure provider. With BRIT’s solutions and guidance, Salem Radiology has also evolved into a leading diagnostic imaging provider for our community, further enabling the advancement of medicine that lets us fulfill our charter to provide high-quality patient care in a safe environment.

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