X ray imaging goes digital

In all probability, the advantages of digital radiography outweigh
the disadvantages. But I caution about a disadvantage not mentioned by Ng
and Rehani*. The speed of processing digital radiography puts pressure on
the reporting radiologist to report more promptly.

When the referring doctor knows that x-ray films take some hours to
be developed, assessed and reported on, allowance is made for those
processes.

The knowledge that digital radiography is instantaneously available
to the radiologist will, I suspect, lead to increasing pressure for more
prompt reporting, increasing the risk of error. This is analogous to a
well-recognised problem with e-mail correspondence: the speed of
communication has diminished the care formerly taken with typed letters.

*Ng, KH and Madan, M Rehani MM, X ray imaging goes digital,
2006;333;765-766 BMJ

Competing interests:
None declared

In their review Professors Kwan Hoong-Ng and Madan Rehani have
identified important considerations for hospitals intending to introduce
an all digital imaging system for their radiology x-ray departments. The
"plain film" investigation (i.e. chest, abdomen,extremities etc) is still
the most common examination in all x-ray departments occupying some 80% of
the imaging workload. Throwing out film and introducing digital imaging
systems is very attractive. Getting rid of film casettes and photo-
processing opens up valuable department space and the speed of image
production can easily double patient through-put; the increased expense
for "going digital" is well justified for this reason alone. Yes, there is
a danger of increasing patient dose in order to produce impressive image
quality but this can be prevented if an effective radiology management
system is in place.

Competing interests:
None declared

The authors do discuss the high cost of digital xray imaging systems
in their editorial. The signficantly higher cost of converting an analog
department to a digital department as well as installing the required PACS
and RIS systems is a major obstacle to implementation of digtial imaging
in most hospitals and imaging centres. It is true that costs have
decreased somewhat over the last few years but they still remain very high
and as many departments are run as revenue centres and not cost centres
,it is often difficult to justify the huge capital costs required to
convert to digital imaging. For a greenfield site or new departments it is
perhaps easier to justify or for departments that are run as cost centres
, which often do not have to jutify their captial costs. Increased
productivity that comes with installation of digital sytems is very
diffcult to quantify in practice, and it often requires creative financial
accounting such as including the cost of the the systems with the cost of
new scanner purchases,as the latter are revenue generating, to allow
financial justification of these systems.However digtial imaging is here
to stay because of all its advantages, and all departments will eventually
be fully digital in the the medium to long term, inspite of the high
capital costs.

Competing interests:
None declared

Sir, I read with interest this article “X-ray imaging goes digital”.
As with all changes in the delivery of healthcare, Picture Archiving and
Communication Systems (PACS) have advantages and disadvantages. Advantages
are both tangible and intangible and revolve around cost, increased
efficiency, and improved patient care. The tangible benefits are most
easily understood by accountants and hospital administrators. However, in
the long run the intangible benefits probably represent the greatest
advantage and are most easily understood by busy practicing
physicians.Tangible benefits of a film less radiology department include
cost savings related to decreased use of film and less money spent for
processing, storage, and handling.(1,2)
Intangible benefits primarily involve increased efficiency and improved
patient care. PACS allow immediate access to imaging studies by attending
physicians, consultants, and radiologists simultaneously.This greatly
reduces the amount of time needed to track down imaging studies.(3,4)

First among the disadvantages of PACS is equipment cost. Although the
initial investment is daunting, it often can be justified in the long term
because of increases in productivity and other benefits.

Another inevitable disadvantage involves the potential for system
failure. No system, including conventional methods, is flawless or immune
to malfunctions. Although PACS problems may be more apparent to the user,
conventional radiology departments also face many opportunities for
breakdowns in systems, albeit less visible ones.
A tendency for less interaction among radiologists and other physicians in
institutions using PACS is another potential disadvantage.

In Summary: The technology is now available to run a practice almost
paper free. It is theoretically possible to store clinical notes,
photographs, radiographs, and study models on disc, and refer or consult
online. It is important that advances in technology are accepted and the
benefits that they produce utilized in order that clinical practice and
patient care continue to improve.

References:
1) Duerinckx AJ, Grant EG. Cost of PACS and computed radiography in the
United States. (Letter) Radiology 1998;208(2):554-5
2) Flagle CD. Economics of PACS: a cost benefits analysis. J Digital
Imaging 1998;11(3 Suppl 1):237
3) Reiner BI, Siegel EL, Hooper FJ, et al. Effect of film-based versus
film less operation on the productivity of CT technologists. Radiology
1998;207(2):481-5
4) Gale DR, Gale ME, Schwartz RK, et al. An automated PACS workstation
interface: a timesaving enhancement. AJR Am J Roentgenol 2000;174(1):33-6

Competing interests:
None declared