Full Film-less Ultrasound Imaging Using a Picture Archiving and Communication System.

Piqueras J, Carreño J, Enríquez G, Aso C, and Lucaya J.

Hospital Universitari Materno-Infantil Vall d'Hebron, Barcelona, Spain

We present two years of experience of a film-less pediatric ultrasound unit using a commercial PACS.

Every day 20-24 examinations are performed, 4-10 of them mobile in the neona­tal or pediatric CCU's. Two ultrasonography (US) units (Acuson 128 and Aloka 650) are connected to a CommView PACS (Philips Medical Systems), by video frame grabbers. Image resolution is 660 x 576 pixels (256 gray levels). The adquisition is activated by pressing a footswitch, and is completed in 0.5-1.5 seconds. Mobile examinations are acquired by small frame-grabber devices (RDS Adqui­sition, Agfa-Matrix Instruments, CA) with removable magnetic discs; once back in the department, images are downloaded to the PACS. A diagnostic workstation (DWS, CommView EDWS), equipped with four high resolution monitors, and one gigabyte magnetic disc, is devoted to the ultrasound section. A film laser printer (Kodak KELP) is shared with other DWS. Hardcopies are only printed for slide generation and scientific sessions. The PACS has all modalities connected (computed radiography, fluoroscopy, CT and MRI).

We have eliminated the handling of cassettes and films, saving one hour of nursing time per day. The mean total number of images per examination has risen from 12 to 20, and the number of examinations per day has increased about 10 %. Image quality is as good as conventional hardcopy, being independent of processor problems. Quality control can be checked on screen immediately after the examination. Image zooming, and, window level and width adjustment helps in diagnosis in many cases. Reporting is done always by dictation: A list of undictated examinations is presented, and moving to the following exam is done by a single keystroke. The display of an exam is done in 7-16 sec. Previous examinations of any modality can be retrieved and displayed simultaneously on any DWS. Reports are printed on the original examination request. US exams are archived on an optical disc library. We have suffered several problems: one day of re­ported examinations was lost before optical archiving, after a magnetic disc failure, and three periods of 3-4 days where the system was out of order for repair of PACS subsys­tems.

We conclude that PACS can be successfully applied to US without major technical problems. Similar results can be expected in other radiology environment, where workload and image size are well suited for cur­rent PACS technology.