53 electronic forms were completed of which 43 unique submissions (7 radiology groups sent 2 or more answers).
There are 91 hospitals in the Netherlands,
of which 8 academic.
Eight unique answers were submitted by academic radiologists and 36 by peripheral radiologists,
meaning that 100% of the academic and 43% of the non-academic radiologists responded,
of which the majority work in training hospitals (Figure 1,
Table 1).
|
Type of hospital
|
Number
|
Percentage
|
|
Academic (employed)
|
8
|
18%
|
|
Non-academic,
free,
training
|
13
|
30%
|
|
Non-academic,
employed,
training
|
4
|
9%
|
|
Non-academic,
non-employed,
no training
|
17
|
39%
|
|
Non-academic,
employed,
no training
|
2
|
5%
|
Table 1: Demographics of participating radiologists and hospitals
1.
Systems
Agfa and Carestream PACS are the most widely implemented digital image archiving systems (PACS) and radiology information systems (RIS) (Table 2).
In most of the hospitals (82%) PACS and RIS are fully integrated.
Integration of PACS with the electronic patient record (EPR) has been established in only 25% of hospitals,
which in most cases are non-academic.
All participants use speech recognition systems,
the dominant system being G2 Speech using the SpeechMagicTM technology of Nuance (70%).
|
PACS
|
number of systems |
|
Agfa
|
11
|
|
Carestream
|
8
|
| Sectra |
8 |
| Philips |
6 |
| Oldelft |
5 |
|
Fuji
|
2
|
|
GE
|
2
|
|
Siemens
|
2
|
|
Total
|
44
|
Table 2: Type of PACS
2.
Teleradiology and image transmission
Most radiologists are able to view images at their homes (84%),
a facility which is most often only used in on-call situations where reporting is done the day after (77%) (Figure 2,
Table 3).
A minority of only 3 respondents (7%) has a fully integrated workstation at home with reporting facilities.
In most situations where a second opinion/expert opinion is wanted images are sent by conventional mail using a DVD (77%) (Table 4,
Figure 3).
Only 9% of the respondents are able to use a secured digital network for image distribution between hospitals.
A large majority of the participating radiology groups expresses the desire to be able to transfer images digitally to other hospitals (93%) (Figure 4).
For 68% any secured digital network connection complying with IHE-standards is the preferred type of connection.
16% Gives preference to an XDS-type of network,
but it should be mentioned that only 43% of the respondents know what XDS means.
In only one academic hospital images are currently being outsourced for primary readings using (extra-mural) teleradiology (Figure 5,
Table 5).
Almost one quarter of all participants acknowledges to be willing to use teleradiology in the future,
and 55% is not outsourcing nor considering to do this.
It’s not very clear however whether the expressed desire to do teleradiology relates to the ability to outsource or rather the to interpret images from elsewhere.
The most likely reason for this ambiguity is the fact that word “teleradiology” was not sufficiently defined in the questionnaire.
|
Only for examinations in on-call situations,
without report
|
34
|
77%
|
|
Diagnostic image interpretation and reporting,
equal to hospital workstation
|
3
|
7%
|
|
Not possible
|
3
|
7%
|
|
Other
|
4
|
9%
|
Table 3: Teleradiology: are you able to view and/or report images at home? (See Fig.
2)
|
We send a DVD to the radiologist using mail
|
34
|
77%
|
|
We send the most relevant images using e-mail
|
3
|
7%
|
|
We use a dedicated image transmission network
|
4
|
9%
|
|
Other
|
3
|
7%
|
Table 4: Image transmission for second opinions.
How can radiologists in your hospital obtain a second opinion elsewhere? (See Fig.
3)
|
We outsource examinations for primary readings using teleradiology
|
1
|
2%
|
|
We don’t outsource using teleradiology
|
24
|
55%
|
|
We report on images coming from elsewhere and are paid for it
|
4
|
9%
|
|
We don’t do teleradiology but would are seriously considering to use it
|
10
|
23%
|
|
Other (*)
|
5
|
11%
|
Table 5: Do you use teleradiology? (see Fig.
5)
(*) “Other” means:
- second opinions with payment included in DRG fee (1)
- only intra-mural teleradiology (between different locations of same organisation) (1)
- no teleradiology,
no plans (3)
3.
PACS- and IT-management
In most hospitals (61%) an agreement exists between the radiology unit (RVE-unit) and the hospital IT-department,
the first being responsible for the PACS and the latter for the network.
In 9% of the hospitals both PACS andnetwork are managed and controlled by the radiology department,
and in 18% the hospital-wide IT-department takes care of both PACS and network.
Some respondents also mention an active involvement of the PACS vendor in the management (8%).
However only 45% of the radiologists is aware of the existence of a Service Level Agreement (SLA) between the radiology department and the IT-department,
and 54% states that there is no SLA,
or not that they know of (Table 6).
As regards collaboration between the IT-department and radiology-unit (RVE) opinions are equally divided: 41% responds that it is tedious to downright bad and 41% indicates to have a smooth cooperation (Table 7).
When asked whether radiologists are sufficiently involved in the procurement and management of PACS or other radiology-related IT system,
a majority confirms this (68%),
but slightly less than a third (29%) believe that radiologists have inadequate involvement.
|
yes
|
20
|
45%
|
|
no
|
16
|
36%
|
|
Don’t know
|
8
|
18%
|
Table 6: Does your department has an SLA with the IT-department?
|
Excellent collaboration
|
18
|
41%
|
|
Rather difficult collaboration
|
15
|
34%
|
|
Bad collaboration
|
3
|
7%
|
|
Other *
|
8
|
18%
|
Table 7: How is the collaboration between radiologists and IT-department?
(*) “Other” means:
- Reasonable
- Sometimes lack of knowledge
- Varies strongly
- Promise much but don’t do much
4.
Knowledge of informatics and interest of radiologists in IT
Slightly more than half of respondents believe that radiologists are insufficiently aware of radiology-related IT systems and that they should increase attention to developments in this field (57%).
In addition,
72% believe that the Society (NVvR) should devote more attention to the subject of radiology-related IT systems and developments.
Three quarters of the participants think that a website and / or forum related to the topic of PACS and IT issues should come about under the auspices of the Society (NVvR).
5.
Structured Reporting
Almost all participants are familiar with the concept of Structured Reporting (98%) and 11% indicate that they are already using it (Table 8).
39% Is seriously considering to make use of SR over time.
Standard reports however are already being utilised by 50% of the respondents for various types of examinations,
mostly for breast imaging (36%).
Not one radiology group is already using SR with integration of a coding system such as 
RadLex or SNOMED CT [1,
2].
|
Never heard of it
|
1
|
2%
|
|
Heard of it,
but that’s it
|
21
|
48%
|
|
Yes we already use it in our department
|
5
|
11%
|
|
Yes we will probably use it in the near future
|
17
|
39%
|
Table 8: Do you know what Structured Reporting means?
6.
Teaching Data Base
Currently most teaching file systems are created within the existing PACS (43%),
only 16% is using a homemade system and 23% indicates not to have any teaching file system.
Only 3 radiology groups (7%) indicate to have purchased a commercially available system.
Half of all respondents (50%) agree that a nation-wide interactive teaching file system should be created,
36% however don’t consider this as useful.
