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Last Updated: Wednesday, 30 May 2007, 09:29 GMT 10:29 UK
X-ray technology in the 21st century
By Emma Wilkinson
BBC News, health reporter

X-ray and CT together on PACS
X-rays and CT can be viewed side by side on a computer screen
Anyone who has ever sprained an ankle or dislocated a shoulder will know the sinking feeling of dread at having to visit a big inner city A&E department.

But what if instead you could visit a local nurse-led minor injuries unit and get an X-ray which can be examined by a radiologist based elsewhere?

Around half the hospitals in England now use a digital system which allows radiologists and doctors to access all images, including CT, MRI and X-ray, on a computer screen.

Doctors and nurses on the wards, A&E or outpatients can view images instantaneously and get a quick second opinion from a radiologist looking at the same image on a screen in their office.

St Mary's hospital in West London have been using the technology for almost a year.

Dr Deborah Cunningham, director of the Radiology Department at St Mary's said their minor injuries unit based in another hospital was "really appreciated" by the local population who didn't want to use the big, rowdy A&E department.

"The nurses can read X-rays but if there is something they don't understand they can ring up and ask us what's wrong and we can look at it immediately."

"That's going to be increasing as major injuries are dealt with in the big main A&E and minor units may not have a radiologist present," she said.

NHS IT

The Picture Archiving and Communication System, or PACS, is part of the controversial NHS IT programme in England.

It is costing 245m to set up five central data stores to file the images in and 775m for the digital technology for producing and viewing the images.

Unlike other parts of the programme, there has been little delay and 244 million images have already been viewed this way.

Nurse examines images on screen
X-ray images can be now be viewed on a computer

Dr Deborah Cunningham said there had been sceptics about their 3.2m upgrade, which was installed by BT, but once PACS was in place, doctors were "overjoyed" with the improvement.

"Junior doctors seemed to spend much of their day looking for X-rays and rummaging through huge piles of films."

She added: "It would be nice to think that in the old system all X-rays were reported in a timely manner but that would be naive."

As well as quick and easy access to images for the most critically ill patients in A&E and intensive care, staff in fracture clinics and chest clinics no longer have to spend hours getting images together - they are available at the click of a mouse button.

The radiology department at St Mary's which process around 250,000 X-rays a year have saved so much space on storage of films they are planning to install a new children's waiting room.

Better diagnosis

The technology also means that repeat X-rays, which were often needed if the film went missing or if the image was not clear enough to make a diagnosis, are rare because radiologists can manipulate the image on screen.

Junior doctors seemed to spend much of their day looking for X-rays and rummaging through huge piles of films
Dr Deborah Cunningham, director of radiology, St Mary's

"We can improve on what the radiographer has done - we can change the contrast, we can magnify it, sharpen the image up," explains Dr Cunningham.

"We can put all the imaging side by side, for example X-ray and CT, and it automatically brings up the last image for the patient so you can compare it without having to go hunt for the file."

It is hoped that the technology makes it less likely patients for patients to fall through the cracks or for a diagnosis to be missed.

Dr Onn Min Kon, consultant chest physician at St Mary's, said the technology was a "big big plus".

"If someone's got a lot of imaging you don't have to fumble through 50 films to find the right one.

"And we don't lose films anymore which was a big issue for a lot of trusts and meant you ended up with an incomplete picture."

He added that a surgeon, oncologist and chest physician could get together to discuss a diagnosis or treatment with the images on a screen in a meeting room or even over the phone from different offices

Success

"It is the one part of the NHS IT programme that has worked," he said

However, he added that some of the software wasn't "intuitive" and not designed with clinicians in mind.

He also has to remember how to use three different systems in the different hospitals he works in.

Old X-rays on a light box
Before digital technology many repeat X-rays were needed

Eventually the plan is to link digital images with the patients electronic record, although there are many hurdles to overcome before this can be realised.

Dr Cunningham says she cannot see a downside to PACS and although there may be problems with the electronic patient record, such as ensuring security, the advantages will ultimately outweigh the disadvantages.

"People are frightened of it but they are not aware of how deficient the system is at the moment."


SEE ALSO
Concerns over NHS IT criticisms
12 Feb 07 |  Health
Q&A: NHS IT upgrade
15 Jun 06 |  Health
GPs dissatisfied with IT system
30 May 06 |  Health

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