Navneet Singh MD, Presenter: Nothing to Disclose

Richard Aviv MBBCh, FRCR, Abstract Co-Author: Nothing to Disclose

Alan Rowland Moody MD, Abstract Co-Author: Nothing to Disclose

Sean Symons, Abstract Co-Author: Consultant, Bayer AG

PACS were introduced in the late 1990’s. Arguably, when first installed, PACS improved radiologists’ efficiency. However, advances in CT and MR scanners have led to studies with an increased number of higher resolution images; reducing efficiency. CT and MR are the mainstays of modern radiology, consume most of the radiologists’ time, and are the most expensive studies in terms of compensation. Our hypothesis is that any increased efficiency originally afforded by PACS for CT and MR interpretation has been mitigated by the increased number of images.

Our PACS was fully operational by July 1999. We compared the number of images per CT and MR study during two one-week periods: the first full week in a PACS environment, July 4 to 10, 1999; and January 29 to February 4, 2012, the last full week before this research began. The body part imaged was noted. All images that the radiologist was expected to view, including reformations, were included. Images acquired solely for post processing, such as CT perfusion raw images, were excluded.

In 1999, the mean number of CT and MR images per study was 109 and 122, respectively. In 2012, the mean number of CT and MR images per study was 774 (710% increase) and 639 (524% increase), respectively, statistically significant increases. The number of images per study increased for all body parts (Table 1). The volume of studies increased from 364 to 1093 for CT (301% increase), and from 115 to 431 for MRI (375% increase) (Table 2).

The 2012 numbers reflect modern radiology with advanced high resolution CT and MR scanners. Various other studies have shown radiologist efficiency gains when PACS is first implemented of 0 to 100%, most in the 10 to 20% range. Such efficiency gains were arguably true in the late 1990’s when PACS was introduced. Since then, our number of images per study has increased by 710% for CT and by 524% for MR, mitigating even the most liberal theoretical efficiency gains originally afforded by PACS. Any potential efficiency gains due to PACS have already been maximally appreciated. It is expected that further continued advances in CT and MR scanners will reduce efficiency.

PACS originally improved radiologists' efficiency. However, the increasing number of images per study has reduced efficiency. This should be considered when determining radiologist compensation.

Singh, N, Aviv, R, Moody, A, Symons, S, Increased Cross-sectional Imaging Workload for the Radiologist in the Era of Picture Archiving and Communication Systems and Advanced CT and MR Scanners.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12022076.html