1. PACS In Nuclear Medicine Practical Experience from the Cromwell Perspective

2. Agenda Introduction The Cromwell Hospital The Nuclear Medicine Department Making The Change The Challenging Points The Good Points The Next Step Reflections

3. The Cromwell Hospital Situated close to the heart of London, the 150 bedded Hospital was opened in 1981. It is an internationally recognised Centre of Excellence. Our Aims and Objectives are “To make people better in a safe and caring environment, with state of the art equipment, highly trained staff and London’s leading doctors.”

4. Nuclear Medicine Department The Nuclear Medicine Department comes under the umbrella of The Department Of Diagnostic Imaging. The dual headed ADAC Forte Gamma Camera was installed in September 1999. Bone scans Myoview scans Renal scans Thyroid scans Infection Imaging Post Therapy Imaging

5. The Scanning Area

6. The Injection Room

7. Workload - 2004

8. Workload 2005 (YTD)

9. PACS Picture Archive and Communication System Picture: Images are available digitally rather than on film Archive: Images are stored on a computer archive Communication: Allows the transmission of the images to the archive, and from there to the viewing terminals System: Manage the acquisition, storage and distribution of images and reports

10. Broker Internet Intranet Quadrat RIS CD Burner  Wards  Medical offices  Remote PCs Imaging Reception Enter RIS Order Document Scanner Requisition scanned in Radiographer receives patient Rad. chooses exam from worklist Exam is performed Radiographer QC’s exam & Sends to PACS PACS Image ServerPACS Oracle Database Radiologist Views Images and Reports Study Webserver DLT Backup overnight PACS Review Stations For Radiographers, OPD, Wards Laser Film Printer Transcription Prefetching Previous Cromwell Hospital - PACS Workflow

11. Making The Change The Start Printers Network Updates Training Retraining Go-Live Updating the PACS Database

12. Learning Issues How to Use the DICOM Worlist The DICOM Print Window Sending Images To PACS Time Management

13. DICOM Worklist Dicom WorkList Database Patient study information available on RIS is directly transferred to the imaging modality. The records on the system corresponds to the scheduled study entered on RIS. This eliminates errors that can occur when information is manually entered on the system When you select a patient from the worklist the fields in the Patient Information Form are automatically updated. DICOM WorkList Information is embedded into the acquired image object and all image objects obtained as a result of processing the acquired image. The input of patient data is a normal you select the procedure, ID and name. The Atlas server searches the Pegasys database and the DICOM Worklist for patients that match the criteria and then shows the patient List Form. NB. Important that correct study is selected otherwise goes into an area called mismatch on PACS.

17. Cheat Sheets

19. The Challenging Points Cannot view dynamic images on PACS NM Physicians decided that they wanted to see the majority of images displayed white on black. At present by default the images are displayed black/white and we fix this on PACS Difficulty in getting people to change how they do things Clinician Acceptability

20. The Good Points Provide fast, simultaneous access to radiological images on computer terminals throughout the Cromwell Hospital Multiple access to images Reduced errors: naming errors on the modality Patient Centred - Patient can be shown x-rays and magnification can increase understanding of problem. Increased information and comprehension of problem increases compliance with treatment Can view previous studies easily and are if they have been archived they can be retrieved in seconds. Addition of old films when not digital The images can be adjusted on screen for ease of viewing

24. The Next Step PET/CT 2006 In future there will be the potential for Teleradiology, i.e. sending images between hospitals in the UK and overseas. Home Reporting for On-call or Urgent cases

25. Reflections The introduction of PACS (Picture Archive and Communication System) was part of the Hospital’s ongoing commitment to invest in the latest technology, and is in line with government proposals for the implementation of a PACS system throughout the whole of the NHS by 2007.

26. The Past

27. The Present

28. The Future