Institutionen för klinisk vetenskap / Department of Clinical Sciences
Abstract
The production of digital images has been well-known within radiology for
many years through its use of modalities such as computer tomography,
ultrasound and magnetic resonance tomography. During the latter part of
the 1980´s a new technology, Picture Archiving and Communication System
(PACS) was introduced making it possible to manage X-ray pictures in
their original, digital form. The changeover from an analogous to a
digital environment was not just a change for the radiology departments;
it was a change which concerned the entire hospital. Osteaux, et al.
(1997) feels that digitalization is the largest change within radiology
since X-ray technology was introduced. However, in order for PACS to be a
successful project, both cultural and organizational changes are
required.
The purpose of the study is to analyze and describe how the professional
role of radiologists and radiographers, work practices and use of the
technology are influenced by the introduction and use of PACS within the
Region of Skåne. The study is longitudinal and based on 119 interviews
with radiologists and radiographers in Lund, the hospitals in Landskrona,
Ystad and Simrishamn and the healthcare centres at Eslöv and Hörby. The
study was performed from 1999 to 2006. During this time, PACS was
implemented at all the units, however at different periods in time. The
purpose was to study the entire digitalization process at all the units.
Data collection and analyses were inspired by Grounded Theory, especially
those techniques such as open interviews, coding and categorization to
allow a reduction of data and a creation of terms to symbolize the
occupational role, work practice and use of new technology during
different points in time of the study. In addition to digitalization the
study focused on trying to understand what the radiologists themselves
felt about the change. This description included three different areas:
the professional occupational role, the diagnostic work and the
technology used.
With the new technology images were always available to all those having
the PACS system. In practice, this meant that there were more discussions
with clinicians and that radiologists changed from doing more individual
work to becoming actors in a networkconsisting of different specialties.
The radiologist also felt an increase in demands for sub-specialization
in this process.
With regards to the diagnostic work, this was described by the
radiologists in 1999 as work which partly required extensive medical
skills but in addition, to its advantage, could include a special ability
in interpreting images which can almost be described as a "form of art".
During the period of changeover when PACS was implemented, the
radiologist felt that the technology itself became more centralized at
the cost of the diagnostics. In time the focus was transferred back to
the diagnostics while the radiologists saw the advantages of e.g. the
availability of having access to image material.
The radiologist felt secure in using the analogous technology. Analogous
films were tangible. Digital PACS images could be manipulated. The
radiologist felt uncertain as to when the manipulation of images was
"optimal". This uncertainty was reduced with time.
Along with the focus on digitalization, the study tried to find how the
radiographers felt about digitalization and the use of PACS. This
description included three different areas: the occupational role, the
image-producing practices and the technology used.
When the study began in 1999 and PACS was implemented, the radiographers
were very positively inclined towards the change. They saw possibilities
of filling the occupational role with new activities, such as quality
review of images for diagnosis and being personally able to complete
examinations. The needs for exposure skills decreased. In reality this
meant an increased risk because the patients were exposed to
unnecessarily high doses of radiation. It was discovered that "sluice"
area with the developing machine as its centre had disappeared. No one
had previously thought of its being a central meeting place for
communications and radiologists. With time, the exposure parameters
became once again more central to the professional role of the
radiographers, however this time with a focus on patient safety.
To begin with, the radiographers saw great possibilities in the
introduction of new work routines using PACS, since the images were
available to everyone who had the PACS system. The opinion at the larger
clinics was that the work method with PACS was adapted to the old
analogous routines. It was discovered that the discussions within the
work groups for the implementation had focused on the technology. It was
realized that discussion on changes in work methods and organization
should have been started much earlier.
It took many years before a new work method was successfully found
through new and more open network configurations. As a contrast, the
smaller departments had implemented work routines when PACS was
implemented and its use was started.
In the digital context and the new technology the natural breaks at the
sluice disappeared, creating an experience of an increase in stress.
Another concern which also arose during the years was that the technology
became more and more imaginary making it hard to understand errors when
they occurred
