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Quantitative evaluation of the quality and efficiency of a filmless radiology department in a fully digital regional hospital

Transition to full digital imaging

Measuring PACS benefits
Peer experience indicated that PACS enabled increased productivity in imaging procedures, as well as improved patient care and patient satisfaction. Three key areas were measured over time (both pre- and post-PACS), analysed and documented: film consumption; number and charges billed for outpatient procedures; and in-patient productivity.

Film consumption

Number and charges billed for outpatient procedures

In-patient hospital productivity

Quantitative evaluation

Radiology department TAT

In general, execution time almost never exceeded the daily work time of 12 hours. On the other hand, referral time before PACS and ASRS was typist-dependent, assuming a characteristic step trend.

TAT decreased with PACS introduction over 60%, even without adding benefits from eliminating transmission time (TT). MRI, CT and radiography exams were studied. It is important to note that the TT from the radiology department to the ward was not taken into account. Before PACS, TT was estimated to be between 8-12 hours, unless the department sent someone to pick up the study (films and report). After PACS implementation, the TT is a matter of seconds.

For MRI scans, the mean TAT decreased from 38.4 hours to 24.9 hours; execution time (ET) did not change much; the mean moved from 2.6 to 2.5 hours. For CT scans, the mean TAT decreased from 29.6 hours to 13.5 hours and the variance decreased from 42.2 to 8.2 hours. In order to understand the improvement in traditional radiography exams, the chest X-ray examination was analysed being one of the most common and standard procedures. The mean TAT decreased from 36.0 to 8.9 hours, the variance decreased from 44.5 to 4.9 hours

High-level business model approach

Detailed business model approach
Seventeen clinical and surgical departments were analysed, ensuring no significant change in the clinical or surgical protocols.


Clinical quality has been increased as a result of the availability of tools to review complex multi-slice CT and MRI studies; the ability to compare several studies of the same patient across different modalities and timeframes; and finally by enabling detailed simultaneous clinical discussions between the referring physicians and radiology teams. A PACS system can simplify and speed up an IT-integrated hospital workflow.

The author
Andrea Nitrosi, Ph.D.
Servizio di Fisica Sanitaria
Arcispedale Santa Maria Nuova
V.le Risorgimento 80,
42100 Reggio Emilia (RE), Italy
Tel. +39-0522-296076 / 296476
Fax +39-0522-296392


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