The Application of the Epub of Medical Image Film in a CT Workflow
 
Authors:
Shu-Feng Fan, MD, Taizhou Hospital, Wenzhou Medical College; Zhe Xu, PhD; Gao Jun Teng, MD
 
Hypothesis:
The application of the Epub of Medical Image Film (EMIF) enriches the data contents of image storage, improves the efficiency in image reviewing and film print resource usage, and enhances the integrality of the quality control process.
 
Introduction:
The core concept of the EMIF is the consistency of the presentation state of the image and its associated data, and the way to handle the image in the radiology department workflow, for both softcopy and hardcopy of the image. The investigation and research has been performed on clinical effects of EMIF in CT workflow. The improvement in the efficiency of several clinical routine processes is observed.
 
Methods:
The EMIF is fully implemented under the DICOM standard and the IHE framework. The Key Image associated with the Presentation State is the image and its display methods that possess important clinic significance, forming the core of the softcopy domain of the EMIF. The title of the DICOM Key Image Notes object contains comments regulated by the quality control policy, making it suitable within the infrastructure of the quality assurance system of the hospital. The “hardcopy film print on demand” server forms the center of the EMIF in the domain of hardcopy images. With the “film print on demand” server, DICOM film print requests are queued in the server. These requests can be replayed, or repeatedly replayed, from this server on a needed-basis. In order to determine the effect of the EMIF in CT workflow, consecutive 10,000 CT hardcopy film prints were randomly selected with and without the EMIF application in the PACS, respectively, and a statistical comparison was performed with these two groups of data. The role of the EMIF in the traditional hardcopy film application, the clinic practice and the integrality of the quality control data archived in PACS/RIS were investigated.
 
Results:
For the consecutive 10,000 CT hardcopy film prints with and without the EMIF application respectively, the counts of wasted films are 3 vs. 2 sheets due to a hardware problem, 0 vs. 4 sheets owing to a mishandling, and 1 vs. 5 sheets because of an image layout mistake. Reissuing films for lost films and other special needs were 11 vs. 12 sheets. The average time for reissuing films for one patient is 4.36±1.36 vs. 16.67±7.04 minutes (t=0.94, p 0.01). The EMIF with key images and annotations has offered more convenience for clinic viewing and reviewing. The integrality of the quality control data archived in PACS/RIS were enhanced ( 2= 320.835 P 0.01). The application of EMIF in PACS/RIS prolongs radiologists’ reporting time by about 2 minutes per study, while it reduces the turn-around time of the image re-read procedure. It also increases the consistency of the interpretation and enriches the archive of quality evaluation materials (P 0.05), decreases the consumption of hard-copy films, and improves the quality and efficiency of doctors’ routine work.
 
Figure 1

Figure 1 Film Electronics Program
 
Figure 2

Figure 2 EMIF in PACS/RIS
 
Figure 3

Figure 3 Clinical Workstation Interface
 

PACS image display has three display modes: Epub of film, key images and original images. The doctor can choose any of them to view. He/she can set the default display mode.
 
Discussion:

With modern imaging technologies, high-resolution and large-scale multiple-frame image exams have constantly produced heavy image data flow in a radiology department. However, this medical image data typically has more than 90% negative images with negligible clinical significance. In a clinical work, different doctors, trainees, and other professional personnel, repeatedly observe these images. With the constantly increasing number of images, this repeatedly performed routine observation would waste more and more time dealing with these negative images. The application of Key Image Notes and Presentation State in EMIF helps avoid unnecessary wasted time in the repeatedly performed image review procedure.

In China, it is a routine work to print hardcopy films for patients. A traditional workflow allows modalities, doctors, and technicians to send the DICOM Print request to a film laser printer from anywhere. Films are printed before the arrival of the patient. With the application of the EMIF, these DICOM Print requests are queued in a “Film Print on Demand” server. This allows a film to be printed after a patient arrives and requests for it. In addition, the server keeps track of the way the film is printed, realizing the consistency of the printed film.
 
Conclusion:
The EMIF application in clinical healthcare can help enhance the function of PACS/RIS, and improve the quality and efficiency in CT routine work.
 
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