Fall Forum 2000

Fall 2000 Forum: Computers in Radiology

1. Call to Order

The meeting was called to order at 7pm in the Abraham’s Radiology Conference Room of the Brigham and Women’s Hospital (BWH) in Boston. A buffet dinner was provided, courtesy of the MRS and arranged by Emily Sedgwick of the BWH. Christoph Wald spoke briefly about the construct of the RFS and the results of the recent American College of Radiology (ACR) meeting in New York. The MRS sponsor for the RFS Peter Gordon spoke to the group about the need for residents to represent themselves to the ACR and the ability to do so through the RFS.


2. First Speaker
The first speaker was Keith Dreyer, Vice Chairman of Radiology at Massachusetts General Hospital (MGH) and Chief Information Officer for Partners Healthcare. His talk was entitled, “PACS and TeleRad. Just Enough to be Dangerous.”

Dr. Dreyer spoke about PACS, the Internet, web servers and digital image storage and distribution. He discussed that the distinction between practices and groups is the film-based department versus the web-based department (intranet or internet) and the need for image distribution. Film takes time to move from place to place and delays interpretation, whereas PACS decreases the time to report (and thus action by the requesting physician).

A group’s Intranet, although expensive in the outlay, is good for short runs and is protected by a firewall with a “hard shell” (difficult to penetrate from the outside) but unfortunately a “soft center” (few intrinsic safety barriers within the system). One of the newer waves in PACS is the utilization of the Internet (TCP/IP) to confer images for interpretation. This, however, brings up the issues of patient confidentiality, which are addressed by authentication using digital certificates and encryption using a virtual private network concept. Public and private keys are used as authentication tools and the methods of data communication at present are HTTP, DICOM, and HS7.

In terms of web servers, Dr. Dreyer discussed server-side and client-side issues. On the server-side, the information can be compressed to save time and space. There is lossless (e.g., JPEG typically 2:1) and lossy (wavelet typically 20:1) compression. Either may apparently be used without significant loss of relevant radiological data to interpret because limitations to the display at the end-user side and to perception by the human eye obviate the need to display the full dataset. Display issues of resolution, contrast and intensity were discussed.

In the future, the distribution of patient records on CD-ROM may become widely available and then patients could travel with their histories (including images) instead of letters and film; this method is already used at MGH. Dr. Dreyer concluded by noting that digital radiology is our future and the costs are rapidly dropping. He noted that new methods for delivering PACS and TeleRad are being developed all the time.


3. Second Speaker
The second speaker was Matthew Benjamin who is a fourth year diagnostic radiology resident at MGH doing a dedicated focused year in TeleRad and MRI.

Dr. Benjamin encouraged residents who have an interest in computers, PACS or TeleRad to consider a dedicated fellowship. He further noted that since most TeleRad at MGH consists of MRI he is also receiving a lot of MRI experience at the same time.

Dr. Benjamin presented data and a working model of a computer program that he and Dr. Dreyer have been developing that would be a computer-based aide to the interpreting radiologist, providing differential diagnoses, lists, references and pictorial examples. This program is called Radlinks and will be unveiled officially at RSNA 2000 next week. Their goal is to store and categorize cases, display typical diagnoses and provide an expert help to the radiologist.

Dr. Benjamin concluded with his vision of the future. He noted that there will be an increased demand with a decreased number of trained radiologists. We can increase our efficiency (as we have done in the recent past) up to a point. Our classic roles will be detection and diagnosis but we will also take an increasing role in the patient’s work-up and care. He noted that the evolution of radiology revolves around technology and, now, TeleRad. Examples of current topics include licensure and contracting. There may be further separation of “those who perform and those who read” but ultimately the interpreting radiologist is responsible for the quality of the images. He finished by saying that there remains a huge potential for things to change quickly.


4. Discussion
Afterwards, a discussion ensued which included examples of MGH radiologists at home outside Boston and as far away as London, England interpreting radiographs. Dr. Gordon warned against devaluing the radiologist by having no direct interaction with referring physicians.


Minutes respectfully submitted by Mark Mullins.