When you work with the same software application all day long, and with the kind of intensity that radiologists do, you tend to develop some pretty strong opinions about it. In the early days of PACS, many radiologists had a real love-hate relationship with their viewing software. Today’s software seems to have addressed many of the early issues, creating more satisfaction with users. But the users still have a lot to say about it.

Here, we check in with eight radiologists, who are using the latest versions of their respective vendor’s software, on four essential PACS viewing software questions.

1) Ramin Abrahim, MD, is a radiologist with Washington Radiology Associates (WRA), which has six outpatient imaging facilities in Maryland, Virginia, and Washington, DC. He mostly reads musculoskeletal MRI, body CT, and ultrasound—roughly 9,000 studies per year. He says that WRA is making a progressive transition toward being more digital.

Best new bell and whistle?

“I like the triangulation feature for MRI and dynamic slab MIP. In our old PACS, we had to go back and forth to triangulate structures and it left room for errors. This PACS give you a little crosshair that you place in plane on the structure. When you click it, it brings the crosshair into all the other sequences. It’s helpful for figuring out detailed anatomy, pathology, and the extent of disease. Working multiple planes makes it faster.”

New feature you couldn’t live without?

“There are many, but especially the ability to get instant consults by sending links to fellow subspecialists by IM [instant messaging]. It’s proven key in our everyday practice in a multisite clinical setting.”

Best new workflow tool?

“In the worklist, the software lets us graphically designate the status of a study, so we can make the high-priority cases stand out. The system allows us to filter our worklist in many different ways. We can easily divide up the worklist and send studies to the appropriate subspecialists.”

What do you wish the software had?

“The ability to handle bigger studies with comparison. With newer modalities producing larger data-set images, we keep hitting the ceiling limits of the software’s ability to handle them. Of course, this is a losing battle because as soon as the software catches up, new image acquisition technology creates even bigger data sets.”

2) James Busch, MD, is a radiologist and director for informatics and PACS for Diagnostic Radiology Consultants in Chattanooga, Tenn. It serves multiple hospitals and outpatient centers. He reads a wide range of modalities, “everything except PET/CT.”

Best new bell and whistle?

“We’re a multi-entity enterprise-wide solution, so for me, the best new bell’ is the software’s tight integration. It’s a completely integrated voice/RIS/practice management solution. It also has a nice, intuitive smart select tool, so instead of having to right-click on a menu, you hold down the right mouse button and it automatically changes your application. It’s a good time-saver.”

New feature you could not live without?

“The interface streamlines the number of clicks to get the information you need. It cuts down on the time spent doing useless tasks. It gives us more time to do more work or go home to our families.”

Best new workflow tool?

“Portal Rad. It tells us how many examinations we’ve got, what our productivity is, patient ID information. It let us communicate with other physicians on the network.”

What do you wish the software had?

“Better integration with third-party CAD.”

3) Sam Friedman, MD, is a radiologist with Pitts Radiology in Columbia, SC. Pitts provides radiology services to local hospitals. He reads 20,000 studies a year, mostly PET, CT, nuclear, and plain film.

Best new bell and whistle?

“A much cleaner and simpler interface. It doesn’t get in your way when you read. I don’t mind fewer customizations, I just want to read my studies and not have to tweak a thousand options. It’s got a clear worklist designated by colors.”

New feature you could not live without?

“The spine labeling component. It takes 5 seconds to label in one plane, then the labels deploy out to the other planes. Having a limited 3D component is what I need 85% of the time. If I need more, I can use the workstations attached to the scanners.”

Best new workflow tool?

“The worklist. It integrates well with viewing components. I can set it to show only CT or all CRs from two hospitals. It’s very transparent, and it offers good workload balancing so everyone can attack the worklist that’s best for them.”

What do you wish the software had?

“The ability to burn DICOM CDs. Now, if I burn a CD from my workstations, it comes out in JPG 2000, so it’s meant for viewing only. I can’t load it back into any other PACS, including my own.”

4) Henry Hollenberg, MD, is a radiologist and chief technology officer for Total Radiology Solutions in West Monroe, La, which provides imaging and PACS services for several hospitals in the state. He specializes in neuroradiology and reads 25,000 studies a year representing a wide range of modalities.

Best new bell and whistle?

“The global worklist. It lets us see all our different sites at once. Also, the software lets us easily put old studies from the last 5 years on the system. Other software vendors say they can, but in fact it’s not as easy as with [this] PACS. It’s hugely helpful to see the patient’s past history.”

New feature you could not live without?

“Integration between dictation and the PACS platform. I just hit F11 and it comes right up.”

Best new workflow tool?

“Again, it’s the global worklist. We have buttons for all our different sites. The list will show any site or any combo. We can all see what everyone else is doing.”

What do you wish the software had?

“A Master Patient Index. That’s more of a RIS feature, but it makes sense if you have multiple facilities on the same PACS. Now I have to do a manual search for the patient, and there might be two different hospital IDs. I’d like to be able to bring all the old records up. It would be a real convenience.”

5) Robert Lipman, MD, is a radiologist with Straub Clinic and Hospital in Honolulu. An interventional radiologist by training, he reads 12,000 studies per year across a wide range of modalities.

Best new bell and whistle?

“I like the basic foundation of the software. It’s a single, Web-based application. Our current version doesn’t have a lot of the new bells and whistles yet, but I’m looking forward to having them soon.”

New feature you could not live without?

“I like IntelliView. It’s another 3D way of looking at images. It allows me to point in three dimensions, and it will find it no matter what obliquity in the stack it is.”

Best new workflow tool?

“We’re still using paper-based, print requisitions with bar codes. For me, there’s an advantage to paper that most people don’t think about. If you’re using a worklist, there’s a time lag when you click the next case and wait for it to show up. If I have a paper req, I can read the history for those 2 seconds while I wait for the images.”

What do you wish the software had?

“Better image display. When images are displayed that aren’t the same shape as the viewing window—that are horizontal on a vertical window, for example—the window ends up mostly black and doesn’t use the available space efficiently. Also, I don’t like having to look left at dozens of icons. They fill the space where I should have images, and I already know where they are on the keyboard.”

6) Gerald Warnock, MD, is a general radiologist and medical director of EPIC Imaging in Portland, Ore, an outpatient imaging center with multiple facilities. He reads 20,000 studies a year across a broad range of modalities.

Best new bell and whistle?

“Its ease of use and ability to manipulate studies. The reconstructions are very easy to use. So is the window leveling.”

New feature you could not live without?

“Cross-indexing lines from axial to sagittal.”

Best new workflow tool?

“The ability to go paperless. We’re just integrating it with our RIS in the next month or two, then our workflow issues will change greatly.”

What capability do you wish the software had?

“I can look at only two studies at a time. It would be true even if I had additional monitors. It’s especially important with oncology cases where we look at three or four or five CTs all at once.”

7) Kevin McEnery, MD, is associate division head of diagnostic imaging-informatics at Anderson Cancer Center in Houston. He has a subspecialty in musculoskeletal imaging and reads 12,000 CT, MR, and radiography studies a year. All of the studies are hospital based; however, 90% of them is outpatient.

Best new bell and whistle?

TECHNOLOGY RESOURCES

This list identifies the PACS viewing software used by each source:

  • Ramin Abrahim, MD, Merge FUSION Matrix
  • James Busch, MD, Siemens SYNGO
  • Sam Friedman, MD, AMICAS
  • Henry Hollenberg, MD, BRIT
  • Robert Lipman, MD, Fuji Synapse
  • Gerald Warnock, MD, Dynamic Imaging Integrad Web
  • Kevin McEnery, MD, Philips (formerly Stentor)
  • K. Michael Handlon, MD, NovaRad

“There really are no new bells and whistles. The software is very capable in stack-mode imaging. I’m looking forward to the next release, which will integrate multiplanar imaging capabilities. Instant access to studies dating to October 2000 is a huge benefit. There’s no need to wait for restorations of historical studies.”

New feature you could not live without?

“The capabilities to efficiently display historical studies. This is not new but remains the most useful.”

Best new workflow tool?

“My IS group has customized the software with internally created and managed worklists. We are looking into solutions not only to effectively prioritize radiologists’ workflow, but also to increase their effectiveness and efficiency in communicating unexpected findings to the ordering physician or to those involved in the care of a given patient.”

What do you wish the software had?

“Currently, it lacks the capability to directly interpret PET/CT images (image fusion and SUV values) and lacks advanced visualization capabilities (3D, CT angiographic capabilities, virtual colonography, etc).”

8) K. Michael Handlon, MD, is chairman of radiology at Jordan Valley Hospital in West Jordan, Utah. He also is a partner with Utah Imaging Associates in Salt Lake City. A general radiologist, he reads 16,000 studies a year in most modalities (MR, CT, PET, plain film, interventional) at the imaging center and several hospitals. All but one location are on the same PACS.

Best new bell and whistle?

“The absolute winner for us is cross-compatibility among all our hospitals. The PACS gives us the ability to read nearly all our sites from one worklist no matter where we are. It allows us to be paperless and includes patient histories, requisitions, patient ID numbers, etc.”

New feature you could not live without?

“The best feature is one we haven’t tried yet. It’s the ability to install the PACS on top of other PACS. Not all of our hospitals choose to have the same PACS. When a hospital has a different PACS, ours can operate like a super PACS’ where we can have images from those other PACS routed to our server. We haven’t tried it yet, however. We’re planning to put it to the test in July. Hopefully it’ll work.”

Best new workflow tool?

“The collaboration features. All of our radiologists read from one worklist so we can read from multiple sites, see who is reading what at which facility, completely review and dictate. The system creates a database so we can see the productivity of each radiologist as well. But what’s most important about collaboration is that it allows us to have one or two radiologists who are physically in each location and dealing almost entirely with the people interfaces: talking with physicians, answering technologists’ questions, working with patients. And while they’re doing that, our other radiologists are just reading studies. It cuts down significantly on the amount of interruptions, which not only improves efficiency and workflow, but also reduces the risk of errors, which obviously leads to better patient care and is the most important thing.”

What do you wish the software had?

“Deeper and better tech support. I want to be careful to point out that this is not just a factor of the vendor. Their support is in line with other PACS vendors, and in fact, may be better because it’s a smaller company and they often allow us to talk directly with the programmers. We can request features and have actually seen our requests incorporated. However, we’re doing more with their system, pushing it to the limits, than most other users, and so we need tech support that has a greater depth of knowledge than what we’re currently getting. Again, they’re not bad, it’s just that PACS tech support across the board isn’t as good as it could be.”

Tamara Greenleaf is a contributing writer for Decisions in Axis Imaging News.