PACS: Importing Outside CDs Cuts Back on Repeat Imaging

The following article was written by Michael Lu, M.D., UCSF Radiology Resident.

We recently published a study confirming that healthcare information technology can effectively curb imaging utilization.  The results from the study, “Reducing the Rate of Repeat Imaging: Import of Outside Images to PACS” appear in the March issue of the American Journal of Roentgenology.

Many of our patients have had a previous imaging workup (e.g. CTs, MRIs, etc.) performed at other institutions.  Access to these diagnostic images is critical for clinical decision making.  Typically, patients bring their images on compact discs (CDs).  However, these CDs are easily lost or damaged. Due to limitations of CD-ROM drive speed and size of the studies (often hundreds of megabytes), viewing the CD can be cumbersome and consume a large portion of the clinic visit.  In extreme cases, the CD is not compatible with the clinic computer and cannot be viewed at all.  For these reasons, patients are sometimes re-scanned, which exposes the patient to unnecessary radiation, cost, and delay to treatment.

At UCSF, our solution is to upload these outside CDs to our hospital computer system, so that they are available to all of our physicians with a fast, familiar interface.  We call the upload process “importing” because it requires multiple checks to confirm that the images go to the correct patient record.  We call the radiology computer system “PACS (Picture Archiving and Communications System)”.

In our study, we found that patients who imported their CDs to PACS were nearly five times less likely to have repeat imaging than patients who did not.  This effect persisted after controlling for potential confounders including extent of disease and location of referring hospital.  These findings suggest that importing outside imaging to PACS can effectively reduce repeat imaging.

Patients come to UCSF because of the recognized experience of our surgeons, oncologists, and other clinical specialists.  What is less well-recognized, though equally important, is the expertise of the other physicians who work behind the scenes, such as Radiologists and Pathologists.  Uploading the images to PACS allows them to be viewed by all of the physicians involved in the patient's care.  Upon review of the outside images, it may become clear a second imaging study is necessary to guide treatment.  However, in many cases the imaging that is already available is sufficient.  When the patient returns for surveillance imaging after treatment, having the original images for comparison can be indispensable for differentiating recurrence from benign post-treatment changes.

In conclusion, we found that importing outside CDs to PACS reduces repeat imaging.  This is an important example of how information technology can reduce healthcare costs and improve patient care.

For more information and addition details on this research, please see here.