A Picture of Health - How technology is enabling a revolution in medical diagnosis.
From high street shopping to healthcare and education, consumers want faster more responsive services in every area of their lives.
Delivering this can require radical changes to the way organisations operate – and the end of some time-honoured traditions. The latest casualty in the drive for better public services is that icon of the accident and emergency ward: the X-ray lightbox.
Superseding them is PACS, the Picture Archiving and Communications System, which is now operational across the whole of the south of England. PACS completes the NHS’s transition to digital X-rays and scanning, a move similar to the shift from 35mm fi lm to digital cameras.
Modernising diagnosis
The change is a big one. For decades, the way X-rays have been developed has scarcely changed: a coated celluloid fi lm was exposed to radiation to produce an image which would be clipped to a lightbox for diagnosis.
Understandably, having only one hard copy of each image introduces enormous potential for error. Last year in the UK, up to 5,000 patient procedures were cancelled due to lost or misplaced X-rays. On top of the cost, this kind of error creates unnecessary stress for emotionally vulnerable patients waiting for potentially life-changing diagnoses.
Even with the advent of new forms of computer imaging, like CAT scanning, in the 1970s, there was still no integrated system of storing and accessing medical scans.
Now, with the last elements of PACS operational, X-ray and other scans can be processed digitally F and then shared electronically. The result is faster diagnosis and an end to lost fi lms – something that’s an essential part of the UK government’s plan that no patient should wait more than 18 weeks between referral and treatment.
Transforming services
Consultant Radiologist at Gloucestershire Royal Hospital, Dr Frank Jewell, explains: “PACS has had a huge impact on the quality of service we can offer as radiologists to clinicians and ultimately patients. Not just in terms of turnaround times for reports but also our ability to be more effi cient with our workloads. The turnaround time in clinics is faster: we can now process in-patient CT scans within 24 hours, which means that the stay in hospital for less acute patients is reducing. The benefi ts we are now experiencing compared to how we previously worked are simply stupendous.”
While this is impressive, the real benefi ts go beyond simply improving effi ciency: PACS leads to better informed decision making.
Improved resolution
At the scanning end, PACS is providing a resolution many times higher than traditional X-ray films, giving clinicians more detailed images that can be viewed and digitally manipulated on high specifi cation PCs for more accurate diagnosis. Electronic storage also gives access to all a patient’s previous scans, allowing detailed historical comparison of scans to monitor the progress of conditions. Finally, with a secure method of remote electronic access, clinicians can instantly seek the advice of specialist colleagues, regardless of their location, creating virtual diagnostic teams.
This should support new ways of working, including homeworking, mobile working and much greater interdisciplinary skill-sharing. Already, there have been examples of PACS enabling lifesaving decisions. Says Dr Michael Creagh, Consultant Radiologist at Ashford and St. Peter’s Hospitals NHS Trust: “One patient was saved after his consultant was able to access medical images of his brain from his laptop at home at 4:15am and diagnose a brain haemorrhage. Within minutes the hospital had a radiologist’s opinion and the patient received a life-saving operation from a neurosurgeon.”
As with any large IT project, deployment is just a milestone in a longer journey. The technology will be refi ned to enable better diagnosis in specialist medical disciplines like mammography.
It may also fi nd use in countries like Spain that have regionalised healthcare systems. Even further down the road is automated scan analysis, something that researchers in the US are already exploring.
