U.K. survey finds satisfaction with PACS, but issues linger

Sep 28, 2010

While the overwhelming majority of U.K. clinicians are satisfied with PACS, a number of thorny issues still need to be addressed, according to research published in the September issue of the European Journal of Radiology.

A research team led by See Ling Tan of Heartlands Hospital in Birmingham, U.K., found that more than four out of five surveyed clinicians felt that PACS was beneficial to their work and would recommend the technology. However, lack of training, downtime, and poor monitor quality were cited as detracting factors in the multicenter study.

To identify the main advantages and disadvantages of PACS, the study team sent questionnaires to 1,518 clinicians in seven U.K. National Health Service (NHS) Trusts. The survey included 12 questions, and users were asked to answer with responses ranging from "strongly disagree" to "strongly agree" (Eur J Radiol, September 2010, Vol. 75:3, pp. 406-410).

The questions covered the following topics:

Experience with viewing digital images
Percentage of time using PACS for viewing
Whether the clinician also worked in a hospital that did not have PACS
Types of digital images viewed
Training to view digital images
The number of days PACS was totally unavailable in the past 12 months
Whether PACS provides satisfactory images
Whether digital images were better than the hard-copy images
The advantages of PACS compared to the old hard-copy system
Whether PACS has positively benefited their work
Whether PACS, overall, is better than hard copies
If they would recommend a digital imaging system to another hospital/colleague

Respondents were also able to provide free text comments at the end of the survey.

Of the 286 responses received from the survey, 111 (39%) were from medical specialties, 96 (34%) were from surgeons, 32 (11%) were from radiologists, and 47 (16%) were from other specialties.

Half utilized PACS alone for viewing radiological images and had used it between two and five years. Eighty-three percent believed PACS benefited their work, while 79% thought that PACS was better than hard copies. Also, 83% would recommend PACS.

In other findings, one-third of the respondents reported that they worked at another hospital that did not have a PACS. Also, 75% viewed more than five radiographs a week; nuclear images were the least frequently viewed, according to the researchers.

Sources of dissatisfaction

The primary area of dissatisfaction among respondents related to poor images due to low-quality monitors, according to the researchers. This complaint wasn't as evident, however, in trusts that had invested in high-quality monitors.

"It could be argued that the monitors in areas other than radiology do not need to be of diagnostic quality, since the images will have been reported by a radiologist, and they are only being reviewed by other clinicians," the authors wrote. "However, many images are not reported by radiologists at the time that the images are first viewed, or ever. This includes images seen out of hours, [at medical admissions units], and in specialties which report their own images."

Training was also a cause for concern. Only 55% of respondents had received training to view digital images; 58% of these considered their training to be good or excellent. Of those who did not receive training, 71% said training was not offered to them.

"This seems to contrast with the comments from the PACS managers that training is offered to all medical staffing on induction and ad hoc," the authors wrote. "Some mentioned that the uptake of clinicians is low, probably due to work commitments."

Radiologists were the most likely to be trained, with 81% reporting they had received training.

Downtime also emerged as an important issue, with 20% of respondents reporting that the PACS network was nonfunctioning more than seven days each year.

A few respondents also said that there were not enough image stations, forcing clinicians -- especially on ward rounds -- to go back and forth to different stations to view images.

"This issue may be addressed either by installing portable monitors for use on ward rounds, or changing the way images are reviewed during a round, possibly by viewing all images prior to the ward round," the authors wrote.

Based on their survey, the authors recommended that training be offered to all PACS users. "This should include a mechanism for training locum staff and those who do not start during the usual periods," they wrote.

Also, PACS images used for diagnostic purposes should be viewed on diagnostic-quality monitors and in suitable light conditions, according to the authors. In addition, they suggested that monitors should be available in all clinical areas -- including clinic rooms and meeting areas -- to allow for ready discussion of images.

By Erik L. Ridley
AuntMinnie.com staff writer
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