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X-ray films now a thing of the past as medical imaging goes high-tech

Radiologists’ routine of gazing at dark images clipped on a wall-board and illuminated for easy reading is all but out of the picture at Advanced Medical Imaging.

Silverdale-based AMI launched PACS — Picture Archiving and Communication System — last month and stopped producing film for 95 percent of the medical imaging it does.

Internally, any new X-ray, CT (Computerized Tomography) scans and other images are now stored on a server with 2 terabytes of long-term archiving space.

Another terabyte of memory in the newly installed Microsoft cluster of servers allows for quick retrieving of the AMI images over the Internet — locked away in a secure PACS gateway linked to AMI’s own Web site.

Last week, AMI began distributing user names and passwords to area physicians who want to be able to look at the medical images they request with AMI.

Every one of the doctors receives reports, but a few also want to see the images themselves, said Kurt Newcomer, AMI administrator. Those doctors now have the option of accessing all the images they’ve requested for any of their patients on the Internet.

Printing out the images has not been entirely eliminated and is available by request, but AMI is promoting the advantages of viewing and storing the images electronically — on the server or copying them on a CD.

“Our goal is to get as many people on the electronic or CD (system) as possible,” Newcomer said.

In the old system, when a doctor requested to see AMI’s images, the film originals would be transported to that physician’s office. Sometimes, the printout was misplaced or delayed in the process.

Archiving the images on a server instead of printing them out and filing them away in cabinets at one of AMI’s three offices in Silverdale and Bremerton makes for less storage space and faster service. The same image can now be viewed in multiple locations at the same time, and if two physicians want to consult each other, they can access the same image on their respective computers “and they’re both looking at originals,” Newcomer explained.

“It’s a big improvement for patient care in that sense for the difficult cases when they need a second set of eyes,” he added.

Using Sectra software, the AMI archiving image system allows doctors to invert an image, alter its brightness, zoom in and out, enhance the resolution and measure actual size distances on — for instance — an X-rayed hand.

While film remains the diagnostic-quality version of medical images, the electronic images’ resolution can be enhanced to make for better viewing.

Doctors will likely use PACS predominantly to access their patients’ records of X-rays, CT scans and other AMI-produced images to show them to a patient for educational purposes.

“Most clinicians in the community will not be using it to diagnose because our radiologists will have read it already,” Newcomer said.

AMI radiologists can view the CT scans in three dimensions when using Sectra and make their diagnosis of those and X-rays on sets of three high-resolution monitors.

PACS is not a new way of keeping medical images. The Doctor’s Clinic and Harrison Medical Center both have been using variations of the system. AMI’s radiologists who work at Harrison are familiar with Sectra, a Swedish company’s program for medical imaging. Thanks to a fiber cable connecting the Silverdale and Bremerton AMI locations, the radiologists can download an image from the server “as fast as if they were down the hall,” Newcomer said.

The medical images are hardly the few-hundred kilobyte JPEG photos Internet surfers zip through e-mail in a matter of seconds. An X-ray is about 8 megabytes large and a CT scan can be around 20 megabytes and can be time-consuming to download.

For doctors outside the AMI intranet, a minimum of 256 DSL connection is recommended.

The switch from film to PACS has turned out to be a revenue neutral venture for AMI. Savings from film, chemistry to develop the images, maintenance of the printed-out archives, jackets to store the film in, labor to transport the film between AMI’s and doctors’ offices have evened out the expenses for the new software and fiber cable installation.

AMI is digitizing its old film archives into the PACS so that new and old images for the same patient can be compared on a computer screen.

“It’s a system with lots of redundancy built in which makes it virtually impossible to lose an image,” Newcomer said.

Within a year, he added, AMI hopes to include mammography, which requires higher resolution electronic images, in its digital archives.

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