System creates teaching files with little workflow interruption

Several schemes already available to create and distribute digital teaching files fail to allow radiologists to generate these files at the PACS workstation without interrupting routine workflow.

A more ideal approach that integrates the creation of teaching files into routine clinical workflow with minimal interruption is described in a recent paper (Radiographics 2007;27(1):269-275).

"The advantage of using the clinical trials service over other authoring systems is the need for minimal user intervention, because data already present in the DICOM header can be automatically inserted into teaching file cases," said Dr. Amilcare Gentili of the radiology department at the University of California, San Diego-Thorton Hospital and San Diego Veterans Affairs Medical Center.

Gentili's method uses MIRC (Medical Imaging Resource Center) software from the RSNA for creation, storage, and distribution of teaching file cases. MIRC open source software is available free from the RSNA.

Now, when radiologists select an interesting case on the workstation, they can write the diagnosis in the "Study Comments" box usually used for wet reads and send the case to the MIRC site directly from the PACS.

"Since this process requires typing only the diagnosis and a few clicks to transmit the image, it does not significantly impact workflow," Gentili said.

Gentili's system has proven popular with staff radiologists.

"Since we configured the MIRC server to automatically create teaching file cases, the number of teaching file cases submitted to our section's MIRC server has increased from one case a month to one case a day," he said.

The images repository is used for lectures and publications by faculty and by residents during their musculoskeletal rotation.

He admits the system has limitations. It can create only a simple teaching file. Any further editing is left to the authoring service of the MIRC server.

Also, unlike other teaching file systems, Gentili's does not include any editing tools to edit, rotate, crop, or enlarge images. Other teaching file systems, such as RadPix and RadXtreme, not only include image editing tools, they allow users to connect to PowerPoint in order to convert MIRC documents to PowerPoint format and vice versa.

Gentili said his system has been tested only on the hospital's Agfa PACS, but since it uses standard DICOM features, he saw no reason it should not work with other PACS.

"In order to use our system, a PACS needs to be able to edit the DICOM 'Study Comments' field and transmit DICOM images to other DICOM storage service class providers," he said.