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Cost pressure is one of the main drivers for the organizational and technological changes in healthcare. The self-conception of hospital radiology in Europe will change from the image of a functional unit towards the image of a service provider for patients and referring physicians. University hospitals with their specific sourcing structure might be less affected by this development than privately owned facilities. Private practices on the other side have been in a competitive situation since years. Process optimization is necessary to transform a radiology department into a high-performance and cost-efficient organization. The examples provided above show the performance differences existing today. The intense exchange of ideas between organizations, accompanied by continuous measurement and comparison of performance parameters, can lead to the creation of a knowledge base for radiological processes. This is essential for the further development of clinical care plans, and in addition provides the industry with valuable input for future products. [ABSTRACT FROM AUTHOR]

Frequently, traditional cost effectiveness models based on film savings and other productivity improvements indicate that an investment in PACS is difficult to justify. This paper offers a new evaluation perspective based on Real Option Theory that has been applied successfully in other industries. Other than the traditional savings centric model, it allows to account for managerial flexibility, risk, expansion opportunities, increased market share and other "intangible" key metrics. It is based on the consideration that an initial investment may create opportunities for future investments, e.g. by way of expansion. The additional value associated with such real options uncovers the embedded value of the initial investment and may often favor an investment scenario where the traditional savings based approach falls short. In the following, the valuation of a real option and its application to various PACS investment scenarios (option to wait, option to expand, option to learn) are discussed. [ABSTRACT FROM AUTHOR]

After 12 years of using a digital radiology system, people's expectations during the planning phase have been confirmed. Its use rationalises processes in imaging diagnostics and contributes substantially to increasing quality and productivity in the core business of the hospital. However, the manifold improvements and advantages of digital radiology, its ease of use, and the fascinating innovation itself lead to an increase in expectations and demand. Rapidly increasing numbers of referrals and service demands from the clinical sector may soon annihilate any financial gains achieved through digital systems. The implementation of digital systems therefore should be accompanied by controlling referrals (medical controls, diagnostic standards, etc). [ABSTRACT FROM AUTHOR]

In the radiological department today the majority of all X-ray procedures on chest and skeletal radiography is performed with classical film-screen-systems. Using digital luminescence radiography (DLR or CR, which stands for computed radiography) as a technique has shown a way to replace this 100 year old procedure of doing general radiography work by acquiring the X-rays digitally via phosphor screens. But this approach has faced criticism from lots of radiologists world wide and therefore hasn't been overall implemented except in the intensive care environment. A new technology is rising based on the use of so called flat panel X-ray (FD) detectors. Semi-conducting material detects the X-rays in digital form directly and creates an instantaneous image for display, distribution and diagnosis. This ability combined with a large field of view and — compared to existing methods — excellent detective quantum efficiency represents a revolutionary step for chest and skeletal radiography and will put basic X-ray-work back into the focus of radiological solutions. This paper will explain the basic technology of flat panel detectors, possible system solutions based on this technology, aspects of the user interface influencing the system utilization and versatility as well as the possibility to redefine the patient examination process for chest and skeletal radiography. Furthermore the author discusses limitations of the first systems, upgrades for the installed base and possible scenarios for the future, e.g. fluoroscopy or angiography application. [ABSTRACT FROM AUTHOR]

As described in the previous sections, post processing of S-CT offers challenging possibilities for Radiology including LTS imaging and assessment. The inherent information of S-CT can be displayed in different ways to the referring clinician in order to facilitate optimal patient management. Modern information technology and affordable computer hardware allow for new ways of data exchange and interaction between hospital departments. By using internet technology, asynchronous, interactive access to results of imaging and post processing can be provided. For imaging of LTS many facettes of the anatomy can be shown in order to provide a road map for therapeutical decisions. Looking at all these possibilities together, it is safe to say that a digital revolution is taking place in Radiology. [ABSTRACT FROM AUTHOR]

It must be the aim to be able to judge the whole joint cartilage in an examination of the joint in the sense of a virtual arthroscopy. The examination must be possible in an acceptable time frame and with a satisfyingly high resolution. The cartilage should be visualized in a two-dimensional, map-like presentation in regard to localization and extension of the defect. This is the only way to include potential cartilage injuries, to localize them, to apply a standardized surgical procedure and to document the results in follow up studies. Therefore it is, on the one hand, the transplantation of cartilage and, on the other hand, the three-dimensional imaging of cartilage that can both lead to an optimization in the therapy of arthrosis. To construct cartilage models from MRI examinations presents a future possibility in the sense of biomechanic analysis and the calculation of finite elements (Vachum Project, http://www.ulb.ac.be/project/vakhum/index.html). [ABSTRACT FROM AUTHOR]

At present, because of the lack of an EU-wide standard, every computerized solution based on email is an isolated, individual solution, and will have to be adjusted to any new standards that are enacted. The MAGDA-LENA guidelines, products, and use concepts of the service providers involved require that the above prerequisites be met and that additional quality criteria, particularly in the field of data security, be satisfied. Rules and responsibilities for such ‘Certification' are currently in preparation. [ABSTRACT FROM AUTHOR]

Therapeutic action itself, must always be directly carried out by a physician who must be responsible for it; this also applies to therapeutic telemedicine. The consultant physician gives advice (as a consultant) to the acting physician who is and remains responsible for his actions as the executor of the measure. The former physician gives his advice through the media of telecommunication. Ideally, all patients seeking medical advice should have a face-to-face consultation with a physician, and telemedicine should be restricted to situations in which a physician cannot be physically present within a safe and acceptable time period. Teleconsultation is only meaningful if it provides more service for the patient. For this purpose it is important to create the basic preconditions for this technology so that it does not deprive its users of the law (freedom) of action. Socially as well as legally, a physician's action is characterized by immediacy, which should not be jeopardized by this technology. Only if this requirement is fulfilled can "networked medicine" develop to optimize medical diagnosis and therapy for the benefit of the diseased individual. If telemedicine becomes an end in itself, then the medical profession will have failed. [ABSTRACT FROM AUTHOR]

The fragmentation of Austria's healthcare system makes networking healthcare providers an essential task in future healthcare provision. Under this central challenge, a multitude of initiatives have been started. In the areas of pharmacy, neurosurgery, radiology, administration, care, and patient documentation, essential progress has been made. Further steps initiatives are already in the project stages. By systematically applying modern project management methods in the IT area, new foundations were created for Austria's healthcare sector, which enable a successful expansion of communications. Essential for success have been standardisation of several working tools, linkage of dispersed identification registers, and the creation of a central register of partners. [ABSTRACT FROM AUTHOR]

People's desire is quite simple: They want to stay as healthy as possible. The aim of healthcare is to help make this desire a reality. Innovations have substantially supported healthcare providers' in their efforts to increase the quality of care. To continue to make significant improvements — even under difficult socioeconomic circumstances — healthcare must now become more process-oriented throughout the complete care process, i.e. from early detection to cure. Modern information and communication technology, i.e. eHealth, is the key to optimize processes within the entire healthcare system and to provide higher quality care at less cost. Quantifiable proven outcomes that clearly demonstrate the efficiency of eHealth are being realized. Action and co-operation between all healthcare players is necessary to structure and enable healthcare in a way that allows all people to benefit from the tremendous potential for progress that information technology offers to healthcare. [ABSTRACT FROM AUTHOR]

The demonstration of the functional results obtained by EBT with respect to pulmonary and cardiac function clearly demonstrate the progress which was achieved by shortening of the exposure time and by increasing the number of images per second. The simultaneous visualization of pulmonary and cardiac structures without overlapping reveals especially to be advantageous in comparison to projection radiography, giving the possibility to evaluate simultaneously the morphological determinants of pulmonary and cardiac function. These widely unexpected extremely positive EBT results till the year of 1998 in the early recognition of functional organ disorders encouraged and forced the manufacturers to look for further improvement of conventional CT and MRI technologies. The present progress and developments in the area of EBT, of fast multi-volume multi-slice CT technology and in fast MR imaging techniques (diffusion, perfusion) are so dramatic that in the very near future these methods will completely revolutionize and change the approach of disclosing, proving and staging of functional and morphological changes in most of the human organs. This will cause a complete change of the understanding of present radiology and present radiologists and will require profound knowledge of physiology and pathophysiology with direct access to treatment and to modeling of organ diseases combined with new forms of interdisciplinary collaborations. [ABSTRACT FROM AUTHOR]

The production of reports by means of speech recognition has become daily routine at our department. It works flawlessly and stable, and has so far proved itself with more than 500.000 reports of one or multiple examinations. The system is easy to operate and does not force users to change their dictation styles significantly. Above all, doctors can dictate reports as quickly as before, and if necessary produce final reports independently of a secretary's or transcriptionist's time schedule. The productivity of our secretaries has increased while working conditions have improved significantly. This technology has drastically shortened the time until completion of our reports, which means better service for our customers (patients and referring physicians) and raised the quality of our department's work. Acceptance is excellent, both by radiologists and secretaries. We are convinced that speech recognition is state-of-the-art technology right now. [ABSTRACT FROM AUTHOR]

From theoretical considerations based on properties of the human visual system under ideal viewing conditions, together with the limitations of the complex scenario of realistic diagnostic workplaces, it can be concluded that state of the art reporting workstations equipped with high quality electronic displays fulfill the requirements for adequate image presentation in digital radiology. As discussed above softcopy reading involves interaction with the reporting workstation and thereby differs from reading hardcopy films. For all imaging modalities but especially for sectional imaging reporting from monitors offers new ways to access information contained in the acquired image data. The key to optimize electronic image presentation on radiologists' workplace is integration of high quality hard- and software components considering all relevant factors influencing perception of the observer. [ABSTRACT FROM AUTHOR]

Technologies used for PACS have made tremendous progress within the last decade. The article shows trends and discusses cost, availability and clinical requirements for image storage, primarily based on RAID. Strategies for image data migration are following. In closing, the application of network technologies to image management is explained. [ABSTRACT FROM AUTHOR]

Most medical images are stored in databases, and creation, expansion, and integration of these archives has become central to advancement in many fields, including radiology, pathology, and dermatology. Image archives are important for clinical practice, education, and research in medicine. Clinical imaging modalities, such as digital radiography, computed tomography, ultrasonography, PET/SPECT, optical and magnetic resonance imaging produce large amounts of data that are managed, archived, and reported using picture archiving and communications systems (PACS) in an integrated healthcare enterprise (IHE) infrastructure. However, typical PACS and IHE systems are closed to ensure privacy, security and confidentiality. These systems are organized to support image interpretation and viewing transactions, with limited capabilities for population-based research or integration of ancillary data. Sharing of clinical medical image databases is relatively uncommon, despite the widespread prevalence of open public archives for other types of biological data, especially in genomics and proteomics. Current medical image archives are surveyed, and several applications are identified. The limitations of current systems are discussed, especially metadata creation and integration of heterogeneous data sources. Some of the most important future trends are delineated. [ABSTRACT FROM AUTHOR]