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New Jersey lawmakers recently changed state law to require schools to bear the burden of proving, if there is a dispute with parents, that the educational plans they create for students with disabilities are appropriate. The state's action, which follows a similar move by New York state in August, is considered a success by parents and advocacy groups interested in chipping away at the public-policy change made by a 2005 U.S. Supreme Court decision on the issue. In "Schaffer v. Weast", the high court held that the party that has a complaint about an individualized education program--most often, the parents--bears the responsibility of proving that the plan is insufficient. Though "Schaffer v. Weast" decided the burden-of-proof question, it was silent on whether states were free to adopt their own statutes that could place the burden on school districts, regardless of which side was disputing the educational plan.

Transitioning to a filmless department is no easy task, especially at a large academic medical center. At the University of Medicine and Dentistry of New Jersey-New Jersey Medical School, a phased modality integration schedule was implemented to allow the technical and clinical staff to gradually absorb all of the changes to workflow. One-on-one training sessions were designed to prepare radiologists and referring clinicians to access and navigate the in-house picture archiving and communication system (PACS) workstations as well as to view images over the Internet via the PACS Web server. An interdepartmental steering committee was formed to plan deployment of the in-house workstations. A planning committee met on a weekly basis to outline placement of workstations within the Radiology Department, and to redesign the reading room. A user group was created to discuss specific user problems. Of particular interest was the challenge of outfitting a dozen conference rooms with projection systems capable of displaying radiologic images. We distinguished between regular and working conferences. At regular conferences only a few cases are reviewed over the course of an hour and only after the diagnosis has been made at a PACS workstation. In contrast, the surgical and medical intensive care units conduct daily working conferences. At those sessions the images of 20 to 30 patients are reviewed, many of them for the first time, and for each case a definitive diagnosis is expected. During the implementation process, a range of issues came up that limited access of certain studies to radiologists and referring clinicians alike. Even after the initial PACS installation, many studies went unread because of a lack of worklists. Other problems included image ordering for head computed tomography and magnetic resonance imaging. A few of our modalities were not DICOM compliant and needed image capture devices in order to be integrated with the PACS. To our dismay, this was also true of one of our modalities that was supposed to be DICOM compliant. These problems, and the solutions we discovered, are discussed in this paper.