1.1 Introduction
PACS (Picture Archiving and Communication System) is a computer-based system used to transfer, store, display and manage medical images and associated text data. A PACS presumes the use of softcopy/digital medical images, typically but not always in DICOM format. Radiology is a branch or specialty of medicine that deals with the study and application of imaging technology like x-ray and radiation to diagnosing and treating disease. Radiology also uses imaging technology such as Radiography, Magnetic Resonance Imaging (MRI), Nuclear medicine, ultrasound, computed tomography (CT), and positron emission tomography (PET) to see within the human body in order to diagnose diseases and abnormalities. Radiology is sometimes referred to as radioscopy or clinical radiology. Clinical radiology refers to the use of radiology to diagnose or treat injury. Radiology is a key part of clinical practice across a wide range of medical disciplines. It is usually the best, minimal invasive way of diagnosing, treating or monitoring disease and injury.
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Limitations of the Study and Definition of technical terms.
1.2 Background of Study
Over the years, the trend in technology as tremendously increase workflows in hospitals especially in the radiology departments, but Radmed Diagnostic Clinic is not fully moving with the trend, this is most seen as a set-back in the Clinic, which brings about an unsatisfactory state of affairs in the radiology department of the clinic.
The clinical application of X-rays and the birth of radiology followed Roentgen’s 1895 discovery in a matter of days. This rapid transfer of basic scientific knowledge and technology to medicine coincided with a period of great technological development and social change in the Western world. As radiology begins its second century, technological progress combined with social and political upheaval creates a similar environment of uncertainty and promise. Although the outcome of the changes currently in progress cannot be predicted, it is clear that the second century of radiology will be very different, but probably no less exciting, than it’s first, offering both change and opportunity. Several factors will contribute and, in many cases, compete for influence in the changes that will define the second century of radiology.
Rapid and dramatic progress in imaging and imaging-related technology will continue, matching and perhaps outpacing the developments of the 1970’s, 1980’s and 1990’s. Today’s growing trend toward less invasive image guided intervention will extend well beyond the methods currently available. It will contribute to improved quality of life and greater productivity, and provide higher value for its cost. These changes will be moderated and perhaps compromised by reordered social and economic priorities. Limits will be imposed by society on the amount of resources that can be allocated for health care. In this changing environment, radiology will succeed only to the extent that it can provide patients, clinicians,and bureaucrats with high value in solving the problems of medicine in the 21st century. In meeting this challenge, radiology finds many opportunities for success.
Radiological information System (RIS) is a networked software suite for managing medical imagery and associated data. An RIS is especially useful for managing radiological records and associated data in a multiple locations and often used in conjunction with a picture achieving and communication system (PACS) to manage workflow and billing.An RIS has several basic functions:
Patient management: An RIS can track a patient’s entire workflow within the radiology department, images and reports can be added to and retrieved from electronic medical records (EMRs) and viewed by authorized radiology staff.
Scheduling: Appointments can be made for both in and out patients with specific radiology Staff. Patient tracking: A patient’s entire radiology history can be tracked from admission to discharge. The history can be coordinated with past, present and future appointments. Results reporting: An RIS can generate statistical reports for a single patient, group of patients or particular procedure.
Film tracking: An RIS can track individual films and their associate data. Billing: An RIS facilitate detailed financial record-keeping electronic payments and automated claims submission.
In the early 1970s at the University of Arizona, Dr. M. Paul Capp and Sol Nudelman, PhD, Organize a digital imaging group that works to develop the first digital subtraction angiography (DSA) device − the first clinical application of digitally derived images.In Mid 1970s Professor Jean-Raoul Schrrer pioneers a medical information display system at the Geneva University Hospitals in Switzerland, which would have broad implication for later PACS development. The system, called DIOGENE, collects and display patient information on computer monitors. A bank of telephone operators would type in information that would show up on the screens.
At a minimum, a PACS consist of an archive device for image storage, database and workflow management software, and diagnostic display stations for interpreting physicians. A PACS can also incorporate brokers (also called gateways) that are used to communicate with other systems (such as modalities or a HIS/RIS), display stations for non-diagnostic images review, and dictation/report management software. Some image-producing modalities such CR (Computed Radiology) and DR (Direct Radiology) devices are considered to be PACS components as well. Film digitizers may be used to converts film-based images into digital images for storage in a PACS, and printers can be used to produce hardcopy for situations where softcopy access is not convenient. Basically a PACS provides the ability to electronically Input Images and data from (digital) modalities, Distribute images and data to PC’s and workstations, Read on Computer display (diagnostic and clinical), Store (Both long and short term) images, Transmit (to other areas or off-site).
1.3 Statement of Problem
Radiology might be thought of as a “two-thirds way” diagnostic technology. Advanced imaging now provides striking images of clinical problems, in many cases far superior to what can be seen by the naked eye. The steady growth of technical improvements in these mature technologies has enabled remarkable insight of images from advanced imaging modalities such as CT and MRI, as well as fusion imagery of metabolic processes.
Although radio logic diagnosis has become sufficiently developed to eliminate much exploratory surgery, it is still not developed sufficiently to avoid triggering costly follow-up studies. Because imaging cannot determine in many cases how much clinical risk is embodied in a potentially threatening finding, today’s advanced imaging examinations still generate excessive cost and patient anxiety.
Therefore the following challenges will be examined;
- Cost of transporting X-films for reporting from other branches of Radmed Diagnostic clinic to the Headquarter in Victoria Island
- Printing of hardcopies of X-ray films even when not necessary,
- The performances of Radiologist/Radiographers while using manual way of transporting films compared to using PACS.
- Cost implication of buying X-ray films,
- Time expended during processing of films
1.4 Aim and Objectives of the Study
The aim of the study is to design and implement a Radio-logical pictures Achieving Communication System (PACS) in a Private Hospital. In achieving this aim, the following specific objectives will were set out as follows to design and develop an application software that will:
- Achieve all DICOM (Digital Imaging and Communication in Medicine) Images on a central server
- Ease the sending X-ray Images of patient from the head quarter to all other branches (Agege, Ikeja, Ipaja)
- Eliminate hard copies of X-ray films and digitizing the Hospital
- Implement a central Server and Network to all consulting doctors’ computer system in Radmed Diagnostic clinic Victoria Island Lagos with all other consulting doctors’ of Radmed Diagnostic Clinic computer systems outside Victoria Island.
Therefore this project is about the implementation of Radiological information System (RIS) in Radmed Diagnostic Clinic and all its 3 other branches in Lagos, using an application software platform called Charrua.
1.5 Significance of Study
This project will help in improving efficiency by automating radiology workflow, this is achieved by removing barriers between images and information, which decreases report turnaround time and significantly refines service to patients and referring physicians.
This study will be of immense benefit to other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.
1.6 Scope of Study
The study focuses on the Design and Implementation of Radio-logical PACS (pictures Achieving Communication System) in a Private Hospital
1.7 Limitations of the Study
During the course of this study, many things militated against its completion, some of which are:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Establishment Policies: Establishment policies posed a serious limitation as most staffs are not ready to release information needed for this project work. There were lots of information needed from the staffs of this institution to enhance the study which took them time to release or they did not release at all for security purposes, hence the scope was reduced.
- Research material: availability of research material is a major setback to the scope of the study.
- Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet).
1.8 Definition of Terms
- Management: It is the co-ordination of all the resources of an Organization through the process of planning, Organization, directing and controlling
- System: Physical component of a computer that is used to perform certain task.
- Data: Numbers, Text or image which is in the form suitable for Storage in or processing by a computer, or incomplete information.
- Information: A meaning full material derived from computer data by organizing it and interpreting it in a specified way.
- Input: Data entered into a computer for storage or processing.
- Output: Information produced from a computer after processing.
- Information System: A set of interrelated components that collect (or retrieve), process, store and distribute information to support decision making and control in an organization.
Computer: Computer is an electronic device that accepts data as Input, processes data and gives out information as output to the user.
