Radiology goes digital

Science Article

New equipment, proximity at Alliance clinic building improve institutional collaboration, eliminate X-ray film

In the radiology suite of the Alliance clinic building, Lynn Tucker, radiology technologist, adjusts a fluoroscope from the control room while Dr. John Borsa, assistant professor of radiology at the University of Washington, inserts a Hickman catheter in a patient. Photo by Clay Eals

When your doctor sends you to have an X-ray, you can't help thinking that soon he or she will see a sheet of film to diagnose your condition.

But at the all-digital Seattle Cancer Care Alliance department of radiology, X-ray film is a thing of the past.

"With the exception of mammography, the entire department is entirely digital and totally filmless," said Dr. Stephen Marglin, the Alliance's director of radiology and associate professor of radiology at the University of Washington.

While digital modalities are not new, their presence on the Hutch's Day Campus, along with a totally filmless radiology department, represents one of the clearest examples of the changes and advantages brought about by the formation of the Alliance.

The Alliance, whose outpatient clinic opened Jan. 29, is a jointly governed affiliate of the Hutch, UW and Children's Hospital and Regional Medical Center. Its mission is to offer the latest treatments to cancer patients while providing clinical researchers from the parent institutions an opportunity to pursue their work in a close, collaborative environment.

$5 million in equipment

The clinic's state-of-the-art radiology department - which will ultimately serve patients from all three partner institutions - houses more than $5 million in equipment, ranging from X-ray machines to magnetic resonance imaging and computerized tomography, providing technology that allows doctors to literally see inside patients.

Marglin said that while these modalities have existed for years, the Alliance department was designed from the start to maximize the use of available digital technology.

Immediate access

Work stations throughout the clinic building provide physicians with immediate access to radiographic images on their patients, he said. The images are managed and displayed through a secure, privacy-protected system called Picture Archiving and Communication Systems (PACS). The radiology reports also are available on line.

"In addition to viewing images on the work stations, one of the new things we've put in at the Alliance is a voice-recognition system," he said. "As a radiologist dictates his or her report, the words are instantly converted into text that can be viewed by consulting physicians."

On-the-spot images have clear advantages for both doctors and their patients, Marglin said.

"In the past, physicians had to wait to obtain films they requested, whereas now they are immediately available," he said. "In some institutions, clinicians have become accustomed to viewing films before the radiologist has had the opportunity to interpret and report them. As a result, important decisions were made without input from the radiologist. With this new paradigm, the images and the interpretation are designed to arrive almost simultaneously."

For the Hutch, which never has had its own radiology program, much of the advantage provided by the Alliance radiology department is proximate.

"What's really new for us is having these facilities right in the clinic building," said Dr. Robert Witherspoon of the Hutch's Clinical Research Division.

"When we were on First Hill, patients had to travel two or three blocks for X-rays and other radiology procedures," said Witherspoon, also an associate professor of medicine at UW. "Now we just send them downstairs."

And with the digital system, doctors don't even have to leave their desks to view films. Previously, we had to walk the two or three blocks to see the images. We no longer have to set aside time during a busy day to get access to important information - it's all right here."

On-site radiology at the Alliance streamlines a procedure that is standard for Hutch bone-marrow transplant patients and common for many other cancer patients: insertion of a Hickman catheter.

"Before the Alliance, an operating room at Swedish had to be reserved for putting in a catheter," Witherspoon said. "Now the procedure can be done here in the clinic's radiology procedure suite."

The clinic's department of radiology is also equipped with magnetic-resonance imaging and computerized-tomography scanners, both of which allow radiologists and referring oncologists to visualize the body in a series of "slices."

Viewing the digital images from these procedures at the Alliance, Witherspoon said, "is like taking a three-dimensional trip through the body."

An elevator trip away

While many physicians are comfortable interpreting X-rays, he said, analysis of computerized-tomography scans and magnetic-resonance images requires a radiologist's expertise ?now only an elevator trip away.

Both Marglin and Witherspoon noted that the availability of digital files means that images can be viewed simultaneously by multiple doctors to arrive at a diagnosis or make an important clinical decision. UW physicians also have immediate access to these images, providing an easy mechanism for collaboration with doctors at the Alliance clinic, Marglin said.

"For example," he said, "if a patient has a fever and a possible pulmonary infection, I can look at their X-rays at the same time as a pulmonary specialist and an infectious disease specialist."

Marglin said that while PACS technology has evolved over the last 15-20 years, growth was limited because not all modalities were digital and only a relatively small number of institutions had access to necessary equipment.

"What's really moved the process along is the fact that more institutions are becoming totally digital. And we're in the forefront of this evolution."

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EASIER TO INSERT A HICKMAN

Named for its inventor, Dr. Robert Hickman, a long-time pediatrician, nephrologist and member of the medical staff at Children's and the Hutch, the Hickman catheter is used for transfusing chemotherapy drugs and other fluids as well as performing blood draws on patients, to spare their veins from countless intravenous needle sticks.

The minor surgical procedure typically is performed using ultrasound, to locate the intended vessel, and fluoroscopy. The latter is a technique in which a radiologist can visualize an organ or region of the body using X-rays.

When the catheter has been placed, a small amount of a radiographic contrast agent is injected, allowing the radiologist to confirm the position of the catheter. During the procedure, a technician in an adjacent control room adjusts the position of the fluoroscopy machine using a panel of levers, knobs and buttons.

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