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Purpose: A prospective evaluation before and after the introduction of PACS should evaluate the level of acceptance by the referring physicians and indicate possible weaknesses., Materials and Methods: In a hospital with 816 beds, questionnaires were sent to all referring physicians before and after the introduction of PACS to inquire how the physicians deal with radiological images., Results: Without PACS, 62 % of the referring physicians spent up to one hour per day searching for radiological images. With PACS, 52 % needed less time to find the correct images. 63 % believe that the radiological image demonstration is more informative due to PACS. The possibility to view radiological images was criticized by 29 % of the referring physicians at the ambulatory units and 34 % at the wards. Before PACS, the service of the department of radiology was considered to be very good by 20 % of the physicians. After PACS, this value increased to 31 %. 93 % of the physicians questioned would recommend the introduction of PACS to other hospitals., Conclusion: Digital image distribution that takes into account the demands of referring physicians can achieve high acceptance and improve workflow. The quality of the computer monitors in the operating rooms, wards and ambulatory units should be improved.

Purpose: Analysis of costs for vascular radiological interventions on a per patient basis and comparison with reimbursement based on GOA (Gebührenordnung für Arzte) and DKG-NT (Deutsche Krankenhausgesellschaft-Nebenkostentarif)., Material and Methods: The ten procedures most frequently performed within 12 months were evaluated. Personnel costs were derived from precice costs per hour and estimated procedure time for each intervention. Costs for medical devices were included. Reimbursement based on GOA was calculated using the official conversion factor of 0.114 DM for each specific relative value unit and a multiplication factor of 1.0. The corresponding conversion factor for DKG-NT, determined by the DKG, was 0.168 DM., Results: A total of 832 interventional procedures were included. Marked differences between calculated costs and reimbursement rates were found. Regarding the ten most frequently performed procedures, there was a deficit of 1.06 million DM according GOA data (factor 1.0) and 0.787 million DM according DKG-NT. The percentage of reimbursement was only 34.2 (GOA; factor 1.0) and 51.3 (DKG-NT), respectively., Conclusion: Reimbursement of radiological interventional procedures based on GOA and DKG-NT data is of limited value for economic controlling purposes within a hospital.

Aim: Planning a PACS (Picture Archiving and Communication System) with the aim of a filmless hospital. The service for the referring physicians should be optimised., Methods: Statistical analysis of data from the RIS (Radiological Information System), customer survey, workflow analysis and cost effectiveness analysis was the basis for planning the PACS., Results: The calculated data quantity of the institute is 6.2 gigabyte per day or 1.7 terabyte per year. The referring physicians wanted to have the examination in 93% of the cases on the same day. For 53% of the cases remote studies were necessary for reading. Only 2.3% of these pictures were older than two years. The organisation of the department makes it necessary to have access to the examination of all modalities from each diagnosis workstation., Conclusions: Due to specific attributes of the institute, a fast nearline archive, a clustering of the diagnosis workstations and a DiCOM based picture distribution were planned.

Purpose: Experimental and clinical evaluation of a digital flat-panel X-ray system based on cesium iodide (CsI) and amorphous silicon (a-Si)., Methods: Performance of a prototype detector was compared with conventional screen-film radiography (SFR) using several phantom studies. Foreign bodies, fractures, osteolyses, and pulmonary lesions were analyzed. Additionally, 120 patients were studied prospectively, resulting in 400 comparative X-ray studies. The flat-panel detector was exposed with standard dose and with a dose reduction of up to 75%. Detector size was 15 x 15 cm, pixel matrix was 1 x 1 k with a pixel size of 143 microns. Modulation-transfer function was determined to be 18% at the maximum spatial resolution of 3.5 lp/mm., Results: The diagnostic results achieved with the digital detector were similar to those of conventional SFR, even at reduced radiation exposure. A potential for dose reduction was observed: 50% with respect to osteoarthrosis and fractures, and 75% for determining bony alignment., Discussion: This new technology can be used in thoracic and skeletal radiography. A significant dose reduction is possible, depending on the suspected disease.

Background/aims: Early cognitive disturbances in patients with cirrhosis (Ci) are difficult to assess. Therefore, we evaluated the role of topographic auditory evoked cerebral potentials (P300-EP)., Methodology: Prospective longitudinal study., Setting: Tertiary clinical care institution., Participants: 45 patients with cirrhosis were compared to 22 healthy subjects., Main Outcome Measures: Hepatic Encephalopathy (HE) was assessed using the clinical grading, standardized psychometric tests, and auditory evoked P300-EP by multichannel EEG recordings., Results: In the patients, the mean P300 peak latency was significantly increased (386.7 +/- 26.7 versus 318.6 +/- 22.2 ms in controls, p < 0.00001). Even in patients with cirrhosis but no HE (n = 18) the P300 peak latency was abnormally prolonged (> 384 ms) in 8 cases (44%). In addition, P180 peak latency was significantly longer in patients with liver cirrhosis as compared to controls (p = 0.021). The maximal P300 amplitude was significantly lowered in patients with liver cirrhosis in the frontocentral and central cortical regions (FZ: p < 0.008; Cz: p < 0.04). Liver function and etiology of liver disease were not related to the increased peak latencies of the P300 and P180 peaks., Conclusions: P300-EP is a sensitive measure to detect functional cognitive impairment in cirrhotic patients with subclinical HE and clinically apparent HE. Typical changes include latency prolongation and decreased central peak amplitude. Some 40% of patients with no clinical evidence of HE and normal psychometric tests show abnormal results during P300 testing, which is likely to reflect early impairment of cognitive function. Auditory evoked P300 potentials are more sensitive than psychometric testing alone.