Tag: culture

Posted on by

What Was Radiology Life Like Without PACS?

without pacs

I may be dating myself, but I am the last generation that did a radiology residency without PACS. Yes. I lived and breathed the pre PACs era. Some of it was pretty good. And, other parts of it, not so much.

Nevertheless, radiology was very different before hospitals started to add these systems to their networks. So, what are some of the most significant changes I have seen throughout my career when I compare the two eras? What was life like before the advent of PACS? Let’s go through some of the most critical differences in radiology.

Many More Films Got Lost Without PACS

On any given night, you would expect a good percentage of cases to remain in absentia without a dictation. Unsurprisingly, the orthopedic surgery residents would stealthily slip into the reading room when the radiology resident stepped out. And this person would steal the films so that the surgeons could use them for orthopedic surgeries at nighttime. Or, the alternators (the old defunct machines that you might see in the back of a reading room somewhere nowadays) would suck up several films, and they would get lost in the device or even shredded to pieces. Many cases would simply no longer be available for dication either for a delayed period or never. Film loss was just a fact of life. Nowadays, it is only the rare irretrievable case that you will need some help with from the IT folks.

Saw A Lot More Clinicians

Today, our reading rooms fill up with primarily residents and a smattering/skeleton crew of a couple of attendings. Back in the day, the reading room was hustling and bustling. Surgeons, Ob-Gyns, and more would regularly show up to look at their cases with you because they couldn’t look at them themselves on a PACS system. You got to know each clinician by name and personality. It was more than just a tryst in the reading room. Of course, that came with the upside of meeting great physicians and the downside of discovering a few jerks here and there. Nevertheless, the reading was much less of a lonely place. And, you would learn about the final disposition of cases more often because we kept in close contact with our physician brethren.

Had To Produce Your Films For Case Conferences

Have any of you ever encountered a dark room? Back in the day, it was a regular event for radiologists. We would have to develop our copies to present for case conferences. It was a big deal and somewhat time-consuming. But, we all got to know this haven of darkness every so often. It was much more intricate than just downloading a case on PACS or snapping a picture on an iPhone for a presentation on a Powerpoint. These technologies were available but still uncommonly used at the end of the pre-PACS era. It was a pain in the-you-know-what!

Priors Were Less Common

Getting priors was a real pain in the neck back then. We would somehow have to go down to the file room and retrieve them. Therefore, we would dictate many more cases without them because they could be hard to come by. So, you could imagine we lost some specificity and sensitivity in these dictations. And, then, when you did retrieve the priors, you would receive these enormous folders where you had to find suitable films. You would be lucky if you didn’t get a paper cut in the process. (They were much more prevalent back then and hurt like hell!)

Less Windows Available Without PACS

Nowadays, we click a button and re-window a case. Back then, you couldn’t look at the bones if you didn’t have the bone windows on film. So, the techs would print fewer windows to save on film. Often, if the reason for the study had nothing to do with the window, you would not have them available to read. I’m sure we missed tons of osseous lesions!

Keep Lists Of Results On Overnight Cases

Instead of having a PACS system to look cases up, we would have to keep a running tab of the patient studies we read, especially on CT rotation. Clinicians would come down and check out the results on the list and chat with the resident. Every room would have a list of cases from the previous night. Eventually, they would make their way onto the Radiology Information System. But until then, the responsibility was ours to keep tabs on everything in the reading room.

Working From Home, Ha!

And finally, working from home was a figment of one’s imagination. We needed to perform all reads and procedures in-house. Imagine being unable to take off to let the Verizon folks fix something in the house. That was our world. We lived and breathed the hospital in those days!

Radiology Life Without PACS

We lived in a different world back then. Radiology lifestyle and culture have changed dramatically over the years since hospitals have installed PACS. Yes, we had more contact with other physicians, but it came at the expense of many problems. Nevertheless, although mostly better today, some good did happen before hospitals introduced PACS to our world. Would I want to go back to those times? Probably not. But they were a great experience that new radiologists cannot imagine today!

Posted on by

9-11: Now And Then: A Radiologist’s Perspective

9-11

9-11 is one of a few days frozen in time for my generation. For the Baby Boomers, it was also the assassination of JFK and the landing on the moon. But for us, it was this day. Most of us remember exactly where we were and what we were doing at the time on this twentieth anniversary. So, like many, I have been reflecting on my experience, the meaning of 9-11, and how the world has changed. For radiology, in particular, the technologies since that time have significantly evolved. The attitude/culture of physicians and patients have transformed. And, the general sense of security and well-being is no longer the same.

It turns out that on 9/11, I was amid my radiology residency as a 3rd-year resident. And, so I will share my own experiences of what happened while I was working as a radiology resident on that fateful day. And, then I will shift gears toward the seismic changes that we have experienced over the past 20 years in radiology since that day.

My 9-11 Experience

Ironically, that morning, I donned a gown and was helping out with thyroid biopsies on my ultrasound rotation at Rhode Island Hospital. As the procedure ensued, at some point, a medical student walked int0 the room and exclaimed, “An airplane hit one of the world trade centers!” My first thoughts were about how that made no sense. Maybe he had gotten something wrong. So, within a few more minutes, we completed the biopsy, and I walked toward the patient TV area to see for myself. There was a jumble of confusing voices on the TV screen with the pictures of the first world trade center alight with billowing dark smoke. They said that a plane had hit the tower, but no one was certain if it was a terrorist attack or an accident.

Affixed to the TV screen, watching the first trade tower live, all of a sudden, the cameras shifted to the second tower, which was now also on fire. At this initial time, the cameras did not catch the second plane hitting the building. It took some time to figure out that another plane crashed the second world trade center. And, then the secretary called me into the following procedure as I was concerned about friends that I knew that worked near the area in Manhattan. It was a harrowing experience completing the ultrasound procedure, not knowing what was happening in Manhattan at the time.

Eventually, I found out that everyone I knew that might have been in or near the towers was alright. One friend who was a resident physician in medicine had tried to help out downtown, but the officials turned him away. After the incident, some other friends I knew had started their long trek to leave Manhattan from their jobs. And a family member was on the road at the time, nestled in traffic and watching the billowing smoke from the trade centers from afar. Fortunately, that was the closest that I had come to the 9/11 incident.

Nevertheless, the nonstop drumbeat of media reports issuing terrorist threats would continue over the next several weeks and months. And, you could not watch TV the constant replay of the videos of the trade centers. There was a perpetual reminder of the incident for a long time.

Some Of The Changes For Radiologists Since 9-11

Travel– (To And From Conferences)

Most notably for radiologists, the way we travel and getting back and forth to conferences has become a little more involved. 9/11 spurred the development of the TSA. Shampoos and drinks all had to be small in size to get on the plane. Lines have become longer, and we now have to leave much sooner to the airport to get there on time. And, air travelers are a little bit more irritable than ever before, both from the long lines and from thoughts about the terrorist attacks on 9-11.

Technology:

A lot has changed over the past 20 years, yet much has stayed the same. The bare bones of the hardware, including ultrasound, CT, MRI, and PET scans, were available at the time. But, the applications have since multiplied. PET-CT was more of a research tool at the time. It came into its own a few years later. But, FDG was used.

Applications of Technology

MRI and CT

Body MRI and MSK MRI is much more common today than it was back then. Now we order MRIs on all the joints routinely. Back then, it was a bit more sparingly used. Larger institutions were introducing CT applications such as Chest CTA for pulmonary embolism due to the faster speed of the scanners. . Having a sixteen multidetector or more CT scanner was a big deal back then. And only specific experienced radiologists could read them.

PET/ PET-CT

Pet scanner applications were much more limited by medicare/insurance reimbursement. Medicare and insurance companies would only pay for lung cancers, solitary pulmonary nodules, and several other indicators. You had to pay for others out of pocket if you wanted it done. And, as mentioned above, PET-CT and its applications mainly were a research tool with a lot of debate whether it was better than PET!

Ultrasound

We used breast ultrasound primarily for diagnostic purposes at that time. Most institutions would perform breast ultrasounds only sparingly for screening. For better or for worse, screening ultrasounds have become much more part of our culture.

PACs

PACs machines were not yet ubiquitous. Fifty percent of institutions had them back them. And, they were much slower than they are today, with more crashes and less flexibility. (Although not all these issues are resolved!)

General Attitude of Physicians, Patients

Now, this part might be a bit controversial. Some of you might think that what I will describe happened before 9/11. And others might feel a bit differently. But, I believe this event contributed, at least in part, to the tribalistic nature of our society today. Everyone had differing strong feelings about what happened and who was responsible. And everyone retreated to their tribe. Republicans and Democrats became more fixed in their thoughts, unwilling to compromise or hear the other side. And, this event along with social media, was one of the foundations for this shift in attitude and politics. 

Changes After 9-11: A Mixed Bag

Of course, 9-11 and the ensuing days were a rough time. But, some good has happened since. The adaption of new technologies has increased radiology’s footprint in medicine over the past twenty years, probably for the better. Yet, the decreased ease of travel and the new tribalistic attitude of patients and physicians has partially counteracted some positives.

The base notion about 9-11 is that it is one of those days that have shifted everyone’s lives in one way or another. The world and radiology will never be the same!