Prospective study of a PACS: information flow and clinical action in a medical intensive care unit

To prospectively compare efficiency and outcome of a standard film-only system with those of a digital picture archiving and communication system (PACS).

The film-only system, which used either analog film or computed radiography (CR) hard copy, was compared with a PACS, which used CR images displayed on a multiviewer in the radiology department and a workstation in the medical intensive care unit. A random sample of nonroutine, bedside chest radiographs was studied.

Within 20 minutes of completion of radiography, 246 of 328 (75%) of the images were available at the workstations; it took 1.8 hours for 238 of 317 (75%) of the images to be displayed on the multiviewer. When the workstation was used, the staff did not access the image information earlier, but clinical actions were initiated more promptly in response to imaging findings. Consultation with radiologists decreased from 507 of 561 (90%) images with hard copies to 70 of 249 (28%) with the workstation.

Use of a PACS improves the delivery of chest images, facilitates the initiation of clinical actions, and decreases input by radiologists.