Consistently ranked as one of the best hospitals in the country, the University of California, Los Angeles (UCLA) Medical Center serves more than 300,000 people each year from around the world. To assist with diagnosis and care, the busy department of radiological sciences performs more than 250,000 diagnostic radiological and nuclear medicine procedures annually at four different sites.

What may not be apparent on first observation, however, is that UCLA Medical Center has been both a pioneer and standard-bearer in developing PACS technology. Efforts to create a PACS solution began in 1983, when few other U.S. medical institutions even thought about the possibilities of digitized diagnostic images. By 1990, UCLA was using one of the first clinically successful PACS in the country.

As the medical center prepares to open a new 1.05 million square-foot hospital in 2005, the fourth PACS upgrade is under way. The upgrade includes implementation of newly designed, state-of-the-art radiology workstations.

Making the Best Choice

Our PACS processes, displays and archives all images generated by the department of radiological sciences, including radiography, fluoroscopy, ultrasound (including color Doppler), CT and MRI. The 49 faculty radiologists also offer specialized services in breast imaging, cardiovascular radiology, emergency radiology, endovascular therapy, gastrointestinal radiology, genitourinary radiology, head and neck radiology, musculoskeletal radiology, neuroradiology, pediatric radiology, thoracic radiology and ultrasonography.

Both the quantity and the variety of work the department generates demands the best displays available to ensure optimal patient care. Therefore, the medical center's PACS team worked closely with staff from the department of radiological sciences to ensure an exceptionally thorough selection process. Five Dome C3 dual displays from Planar Systems Inc., Beaverton, Ore., and displays from two other vendors were evaluated over a three-week period.

"We created a scoring system and evaluation write-up," says Sandy Johnson, RT, clinical manager of PACS at UCLA. "We scored the displays on sharpness, brightness, flicker, angle of view and glare."

Building on a Strong Foundation

As professor and vice chair of information systems for the department of radiological sciences, I worked closely with the medical center and Planar for almost 14 years on digital image quality -– from collaborating on the vision to delivering on new solutions.

The relationship between UCLA and Planar has been mutually beneficial as well as enduring. Our workstations benefited from the company's state-of-the-art technology, and the displays improved during the process. Planar has adapted well to the specific needs of medical imaging in compliance with the high quality and brightness requirements for replacement of traditional film-based image interpretation.

Streamlining Quality Assurance

UCLA Medical Center has workstations in all of our radiology reading rooms, subspecialty areas and 15 intensive care units at four sites. Maintaining the proper DICOM conformance (standard and required display calibrations) for 140 displays, which is checked weekly or biweekly, presents a huge logistical and resource challenge.

The flat-panel displays are equipped with built-in software, called Dome CXtra™, that allows PACS administrators to monitor and ensure the proper calibration of each display from one workstation. Each display communicates when it needs to be recalibrated, and an administrator can correct most problems remotely.

Instead of the traditional puck used for monitor calibration, our system uses a device embedded in the back of each monitor that calibrates the workstation. Software on each workstation sends the calibrations of each monitor to a central workstation.

The software is based on Simple Network Management Protocol, a commonly used protocol that makes integrating the software into existing networks relatively easy. In addition, quality assurance options that use protocols specific to their displays typically require dedicated servers; our system, which does not require a dedicated server, has a significant impact on the affordability of the overall display solution.

Improving Clinical Practice

The ease and efficiency with which UCLA Medical Center can now ensure the DICOM calibration of every display dispersed throughout the enterprise has also had an impact on clinical care. Consistently accurate calibration and image clarity lead to fewer mistakes and clinical care delays.

For years, we have had problems with quality control in this area. When the technologists used film, they looked at the film and re-shot the diagnostic image if it was poor. In the digital world, the technologists need quality control stations to verify image quality.

We have now deployed quality control stations across the enterprise as part of our new PACS. Almost all of the stations are equipped with Dome C3 displays. In addition, the capacity to remotely monitor display calibration with the software increases the overall quality of the images obtained by technologists in different sections in all four sites of the medical center. This has greatly improved quality control at the technologist level.

Quality assurance and sleek design have also made it possible for many other medical areas – intensive care units, the emergency room and other clinical departments – to deploy the displays. All the clinical areas continue to require higher quality images. The flat panels enable us to hang them on the wall in very busy areas, which is helpful.

The new, nearly 600-bed facility will combine the operations of UCLA Medical Center, UCLA Neuropsy-chiatric Hospital and Mattel Children's Hospital at UCLA. When the doors open in 2005, the facility will have a fully integrated, state-of-the-art digital information system serving all areas of patient care.

— Osman Ratib, MD, PhD, FAHA, is professor and vice chair of information systems in the department of radiological sciences at the David Geffen School of Medicine at UCLA and spearheaded UCLA's PACS strategy and development. Questions and comments can be directed to editorial@rt-image.com