The organizational implications of medical imaging in the context of Malaysian hospitals

This research investigated the implementation and use of medical imaging in the context of Malaysian hospitals. In this report medical imaging refers to PACS, RIS/HIS and imaging modalities which are linked through a computer network. The study examined how the internal context of a hospital and its external context together influenced the implementation of medical imaging, and how this in turn shaped organizational roles and relationships within the hospital itself. It further investigated how the implementation of the technology in one hospital affected its implementation in another hospital. The research used systems theory as the theoretical framework for the study. Methodologically, the study used a case-based approach and multiple methods to obtain data. The case studies included two hospital-based radiology departments in Malaysia. The outcomes of the research suggest that the implementation of medical imaging in community hospitals is shaped by the external context particularly the role played by the Ministry of Health. Furthermore, influences from both the internal and external contexts have a substantial impact on the process of implementing medical imaging and the extent of the benefits that the organization can gain. In the context of roles and social relationships, the findings revealed that the routine use of medical imaging has substantially affected radiographers’ roles, and the social relationships between non clinical personnel and clinicians. This study found no change in the relationship between radiographers and radiologists. Finally, the approaches to implementation taken in the hospitals studied were found to influence those taken by other hospitals. Overall, this study makes three important contributions. Firstly, it extends Barley’s (1986, 1990) research by explicitly demonstrating that the organization’s internal and external contexts together shape the implementation and use of technology, that the processes of implementing and using technology impact upon roles, relationships and networks and that a role-based approach alone is inadequate to examine the outcomes of deploying an advanced technology. Secondly, this study contends that scalability of technology in the context of developing countries is not necessarily linear. Finally, this study offers practical contributions that can benefit healthcare organizations in Malaysia

Managing technological change in a military treatment facility: a case study of medical diagnostic imaging support (MDIS) system

Picture archiving and communication system (PACS) represents an enormously expensive technological innovation in digital imaging which has the potential to alter the way in which radiology is practiced. The purpose of this thesis is to provide a better understanding of the requirements for PACS technology and the implementation of information systems in medical facilities. The objective of PACS technology is to improve access to radiographic images and reports throughout medical facilities while decreasing the cost of image production and storage. Medical Diagnostic Imaging Support (MDIS) system is the military tri-service project to install PACS in selected U.S. military medical treatment facilities (MTF) in an attempt to create a totally filmless environment. This thesis includes a case study of the implementation of the MDIS system at Madigan Army Medical Center and the change management issues that surround the introduction of an information system in a health care organization. The issues brought forth in this study are derived from two change models in the implementation of information systems.http://archive.org/details/managingtechnolo1094542869U.S. Navy (USN) authorApproved for public release; distribution is unlimited

Curriculum guide to teach computed radiography at El Camino College

The purpose of the project was to design a curriculum guideline for educators to teach computed radiography. This project can be used as a stand-alone course, or integrated into existing radiologic technology courses

New technology in radiological diagnosis: An investigation of diagnostic image quality in digital displays of radiographs

Digital radiology is undergoing rapid evolution. Its objectives can be summarized as the creation within the modern radiology department - and indeed within the entire hospital - of a harmonious, integrated, electronic network capable of handling all diagnostic radiological images, obviating the need for conventional film-based radiology. One of the limiting factors in the introduction and exploitation of digital technology is the issue of image display quality: if electronic display systems are to be widely used for primary radiological diagnosis, it is essential that the diagnostic quality of the displayed images should not be compromised. From the perspective of the practising radiologist, this study examines the performance of the first two commercially available digital radiological display systems to be purchased and installed in a British hospital. This work incorporates an extensive observer performance investigation of image quality from existing 1024- and 1280-line display systems, and suggests that displayed images digitized at a pixel size of 210?m show a significant reduction in diagnostic performance when compared with original film. Such systems appear to be unsuitable for primary radiological diagnosis of subtle lesions. Some of the physical properties of such systems, some relevant methodological issues, and the relationship between image quality and other factors influencing the development acceptance and implementation of digital technology, have also been investigated; the results are presented. This is a controversial subject, and conflicting views have been expressed in the British literature concerning the issue of whether or not the technology is now ready for total system implementation; the view of this author is that careful testing of display systems, and of every other component of digital networks, should precede their entry into clinical use

Artificial intelligence in diagnostic imaging: impact on the radiography profession

YesThe arrival of artificially intelligent systems into the domain of medical imaging has focused attention and sparked much debate on the role and responsibilities of the radiologist. However, discussion about the impact of such technology on the radiographer role is lacking. This paper discusses the potential impact of artificial intelligence (AI) on the radiography profession by assessing current workflow and cross-mapping potential areas of AI automation such as procedure planning, image acquisition and processing. We also highlight the opportunities that AI brings including enhancing patient-facing care, increased cross-modality education and working, increased technological expertise and expansion of radiographer responsibility into AI-supported image reporting and auditing roles

The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence

Introduction: Radiology was founded on a technological discovery by Wilhelm Roentgen in 1895. Teleradiology also had its roots in technology dating back to 1947 with the successful transmission of radiographic images through telephone lines. Diagnostic radiology has become the eye of medicine in terms of diagnosing and treating injury and disease. This article documents the empirical foundations of teleradiology. Methods: A selective review of the credible literature during the past decade (2005?2015) was conducted, using robust research design and adequate sample size as criteria for inclusion. Findings: The evidence regarding feasibility of teleradiology and related information technology applications has been well documented for several decades. The majority of studies focused on intermediate outcomes, as indicated by comparability between teleradiology and conventional radiology. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include reductions in patient transfer, rehospitalization, and length of stay.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140295/1/tmj.2016.0149.pd

Future developments and trends in use of picture archiving and communication systems

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University London.Objectives: This study identifies modern information technologies that can improve the clinical practice of Picture Archiving and Communication Systems (PACS) and determines the approaches that are needed to improve the functionality of current PACS to provide better next generation PACS and to improve the future of radiology practices and workflow with future PACS generations. Method: A parallel mixed method approach was adopted including qualitative method (semi-structured interviews), quantitative method (questionnaire survey) and observation of online discussion groups on PACS. Five databases were searched to find salient literature, including Science Direct, Springer Link, Scopus, CINAHL Plus and Google Scholar. Six radiologists were interviewed and questionnaires were collected from 120 radiologists. Four online discussion groups related to PACS were monitored via LinkedIn. The data were analysed thematically using the thematic analysis method. Finally, a focus group was held with a separate group of radiologists to validate the findings. Results: Eight themes emerged from the thematic analysis of the data: (1) limitations of traditional PACS; (2) user needs and requirements that can increase PACS functionality; (3) Web based solutions of PACS; (4) PACS on mobile phones; (5) Vendor Neutral Archive (VNA); (6) full integration of voice recognition in PACS; (7) backup solutions for the system and (8) continuous training for PACS users. Discussion: With the development of healthcare information and communication technology (ICT) and with the increased demands of the radiologists to expand PACS usability, traditional PACS must be updated to follow the changes. Modern technologies can provide better solutions to enhance the functionality of current PACS. The next generation of PACS can fulfil the future requirements of users. This study considers the issues between the needs and requirements of the users of a PACS system in the future and the developing solutions in ICT and the PACS industry. Moreover, highly developed PACS systems with advanced features will have a direct impact in changing and improving radiology workflow. Accordingly, a model has been developed that proposes new features for the next generation PACS system, which may be applied to the next generation radiology practice. The model was validated with the focus group and, by using a separate group of radiologists in another country, was determined to be generalisable. Conclusion: It is widely recognised that traditional PACS must be updated to adopt recent advances in ICT. This research has identified themes that, when incorporated, will enhance the functionality of PACS and radiology workflow and provide better quality clinical practice. The findings from this empirical research can be used: as recommendations to vendors; for technology development; and by medical institutes to consider aspects when undertaking implementation of PACS and training future radiologists. Keywords: 'Picture archiving and communication system’, PACS, Future trends, next generation, Organisational efficiency, Productivity, Clinical practice, Ubiquitous.Ministry of Health, Government of Kuwai

Optimisation of the digital radiographic imaging of suspected non-accidental injury.

Aim: To optimise the digital (radiographic) imaging of children presenting with suspected non-accidental injury (NAI).;Objectives: (i) To evaluate existing radiographic quality criteria, and to develop a more suitable system if these are found to be inapplicable to skeletal surveys obtained in suspected NAI. (ii) To document differences in image quality between conventional film-screen and the recently installed Fuji5000R computed radiography (CR) system at Great Ormond Street Hospital for Children, (iii) To document the extent of variability in the standard of skeletal surveys obtained in the UK for suspected NAI. (iv) To determine those radiographic parameters which yield the highest diagnostic accuracy, while still maintaining acceptable radiation dose to the child, (v) To determine how varying degrees of edge-enhancement affect diagnostic accuracy. (vi) To establish the accuracy of soft compared to hard copy interpretation of images in suspected NAI.;Materials and Methods: (i) and (ii) Retrospective analysis of 286 paediatric lateral spine radiographs by two observers based on the Commission of European Communities (CEC) quality criteria, (iii) Review of the skeletal surveys of 50 consecutive infants referred from hospitals throughout the United Kingdom (UK) with suspected NAI. (iv) Phantom studies. Leeds TO. 10 and TO. 16 test objects were used to compare the relationship between film density, exposure parameters and visualisation of object details, (iv) Clinical study. Anteroposterior and lateral post mortem skull radiographs of six consecutive infants were obtained at various exposures. Six observers independently scored the images based on visualisation of five criteria, (v) and (vi) A study of diagnostic accuracy in which six observers independently interpreted 50 radiographs from printed copies (with varying degrees of edge-enhancement) and from a monitor.;Results: The CEC criteria are useful for optimisation of imaging parameters and allow the detection of differences in quality of film-screen and digital images. There is much variability in the quality and number of radiographs performed as part of skeletal surveys in the UK for suspected NAI. The Leeds test objects are either not sensitive enough (TO. 10) or perhaps over sensitive (TO. 16) for the purposes of this project. Furthermore, the minimum spatial resolution required for digital imaging in NAI has not been established. Therefore the objective interpretation of phantom studies is difficult. There is scope for reduction of radiation dose to children with no effect on image quality. Diagnostic accuracy (fracture detection) in suspected NAI is generally low, and is not affected by image display modality.;Conclusions: The CEC quality criteria are not applicable to the assessment of clinical image quality. A national protocol for skeletal surveys in NAI is required. Dedicated training, close supervision, collaboration and consistent exposure of radiologists to cases of NAI should improve diagnostic accuracy. The potential exists for dose reduction when performing skeletal surveys in children and infants with suspected NAI. Future studies should address this issue

Learning by doing : radiographers' knowledge and learning strategies in the digitized healthcare environment

The aim of this thesis was to inform the field of radiography of changes related to the digital image production process, by understanding how radiographers perform tasks and apply knowledge as well as learning strategies in work practice. The method of this study adopts a qualitative ethnographic approach, using participant observation of and semi-structured interviews with radiographers at six Swedish hospitals. In total, 37 radiographers were interviewed, 25 of whom were observed. The interviewees were divided into two categories, novice radiographers working one year or less, and experienced radiographers working five years or more. The thesis classified the radiographers’ work as the: 1) Planning phase, 2) Performance phase, and 3) Evaluation phase. Blackler’s theory of knowledge components was applied to identify properties of knowledge. The results illustrated that the introduction of PACS did not simply entail the transfer of data and information from the analogue to the digital world, but also new activities, new ways of communicating, new responsibilities, new decision–making routines, new image processing and new technological knowledge for the radiographers. The thesis also illustrated that the radiographers applied their knowledge in different ways. Some radiographers applied their knowledge in a more reflective way, while some more routinely. They used embrained knowledge when planning X-ray examinations in a static or flexible way, and when viewing film/images they checked or analyzed them. Encoded knowledge was required for using various kinds of documentation in a reflective or a critical reflective way. Embodied knowledge was called for when action had to be taken in an automatic or problem-solving way. Further on, results showed the differences between novice and experienced radiographers’ learning strategies. Novice radiographers applied the following learning strategies together with critical thinking in the planning and evaluation phase: Memorization combined with logical reasoning and inquisitiveness, open-minded and focused observations, selective reading, and information-seeking. They communicated through active and attentive listening, asking questions, receiving information and feedback, discussing problems, and speaking aloud to themselves. In the performance phase they applied doing combined with flexibility, repetition combined with perseverance, and finally, imitation. Experienced radiographers applied the following learning strategies together with critical thinking in the planning and evaluation phase: Memorization combined with logical reasoning, prediction and contextual perspective, reflective discrimination on focused observations, selective and validated reading, and information-seeking. They communicated through listening in an analytical and critical way, answering questions and providing feedback, and discussing problems. In the performance phase they applied: Visualization combined with intellectual integrity, doing combined with creativity, repetition combined with perseverance and finally, experimentation combined with confidence and intuition. The conclusion of the research showed that the role of the radiographer and knowledge requirements have changed in four principal areas: 1) Communication in work, 2) Image processing, 3) Image quality assurance, including sending patients home, and 4) Decision making. The radiographers used embrained, encoded and embodied knowledge, and they applied knowledge in different levels as routine actors or reflective actors. The difference between routine, novice radiographers and reflective, experienced radiographers respectively was the way in which they applied their knowledge and learning strategies combined with critical thinking. It was important to identify the differences in how radiographers applied knowledge and learning strategies, because this may yield possibilities for fostering the transition from novice to experienced radiographers. The more reflective profile has become even more important in the digital environment as work is more independent and offers greater responsibilities. Consequently, radiographers’ tasks have become more demanding and highly scientific

Department of Radiology-Annual Executive Summary Report-July 1, 2003 to June 30, 2004

85 page Department of Radiology Annual Executive Summary Report, July 1, 2003 to June 30, 2004, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States