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UCLA computers replace traditional film, speed diagnoses.

The future of medical imaging is taking shape at UCLA's Medical Center, where radiologist store images in computers and display them on workstations rather than on traditional film.

In clinical settings such as intensive care, UCLA physicians report that they have improved care by viewing images on computer display stations directly. By comparing new, digitized, on-line images with a patient's previous historical records, physicians speed diagnoses.

According to Dr. H. K. Huang, professor of radiological sciences, UCLA's Picture Archiving and Communications System (PACS) is the nation's largest digital-based imaging system. Huang attributes much of UCLA PACS' success to two advancements in computer technology: high-resolution lowcost imaging Unix-based workstation and networking that enables radiologists to transmit digitized film images throughout the hospital in seconds.

"The advantages of filmless imaging are simple: we never lose images and retrieval time is fast and consistent," says Huang. "Once we digitize an X-ray or transmit CT scans into a digital-based system, physicians and nurses can access them over the network quickly and at any time."

UCLA's system is one of a handful in the world operating on such a large scale. At present, 40% of the radiology department relies on PACS for image archiving. Huang predicts it will be several years before traditional film is phased out at UCLA, but he has no doubt that his department will eventually move to a completely digital-based imaging system.

"In addition to improving access to images, PACS also saves the hospital money in the long run," says Huang. "It's no secret that overseeing archives based on traditional film is cumbersome and costly."

For physicians, comparing new images (such as X-rays) with older images is critical to forming a proper diagnosis. However, with traditional film accessing a patient's file of existing medical images is often a drawn-out process. At hospitals still relying on traditional film, technicians frequently must retrieve older images from a satellite film library located far from the hospital.

"Finding a patient's file at night or during the weekend is often a long shot," Huang says. "However, if the patient's records are tied in with PACS, physicians can count on having a set of images in their hands in less than five minutes."

Filmless radiology

The PACS computer network consists of 35 workstations from Sun Microsystems, ranging from Sparc Station 1s to the older Sun-4 systems. They are linked via Ethernet, FDDI and UltraNet to four SparcServer 490s that store and route data throughout the hospital. PACS uses a database management package from Sybase, along with software developed in-house.

To compress images for efficient, on-line storage, Huang plans to use clinically verified lossy imaging technology, which reduces needed computer storage by a 10-to-1 ratio over traditional storage techniques. For example, a standard chest X-ray requires only 400 kilobytes of storage rather than 4 megabytes.

Huang and his colleagues currently operate eight PACS display stations located in Intensive Care Units and in the radiology department. Each display station features a Sun workstation and 1K or 2K high resolution monitors. Typically, physicians use the first monitor to examine most recent images, while the second is used to page through historical information.

For in-patients, each section typically stores a file of 40 to 50 existing patient's examinations. For out-patients, the system typically stores 600 existing images.

The archiving system automatically records which images a physician examined most closely the first time a file is accessed. The next time, the system only sends those images that are most useful to the physician.

At first, Huang says, some physicians were reluctant to use PACS because they thought the quality and reliability of a computer workstation display might be inferior to traditional film.

"Now," Huang says, "some physician say they can't live without the system.

"Each year," Huang concludes, "our radiology department processes roughly half a million images. It makes sense to store all those images digitally now that we have the technological capability. Judging by the favorable response from physicians here at UCLA, it seems likely that this digital-based approach will become more and more common as time goes by."
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Title Annotation:Health Care; University of California at Los Angeles medical school's use of filmless imaging
Publication:Communications News
Date:Nov 1, 1992
Words:678
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