Automated scheduling of radiologic procedures.

The dramatic advances in radiology have increased the number and type of machines and of daily performed exams. Consequently, workload and management organization problems have also markedly increased. Automated, computerized scheduling of radiologic exams is certainly a step forward in a modern rational management of a Diagnostic Imaging service: the relationship with the patient is improved with the optimization of care delivered and of the radiologist's work, who with the new technology is able to rapidly consult the previous exams as well as the list of exams to be performed. The advances in health care information technology imply communications at a distance. From each ward of the hospital, requests for radiologic exams can be automatically scheduled or kept on a dynamic waiting list for automated input in future work shifts. Via the same system, reports (and also radiologic images) can by rapidly transmitted to the wards. At the "Università Cattolica del S. Cuore" from several years, an integrated information system has been implemented for management of patient data, exams and care delivered. Radiology represents one of major departmental systems of the network for the number of machines installed and the amount of information supplied. The system will be soon able to store images from all digital and nondigital machines, and visualize on dedicated workstations the images of ongoing exams or stored previous ones.

Excellence in diagnostic imaging service management.

The identification of promoting factors of excellence improvement in radiology service management means to clearly assess how the different aspects of the service are managed. The key elements for intervention are sharply differentiated according to the service managerial level. The approach to continuous improvement should be a useful tool of assessment even when all its potentialities have been exhausted and new promoting factors are necessary to move to the subsequent stage.

Management of radiologic archive in a diagnostic imaging department.

One of the major and demanding problems in the management of a modern department of Radiology is undoubtedly the organization of a radiologic archive. Its management has been increasingly difficult in last years both for the increase in procedures and the number of radiologic exams. At the Radiology department of UCSC, since some years, this problem has been tackled. Major objectives have been identified in focusing on responsibilities, global management and planning of radiologic film retrieval and archiving integrated with health care activities (scheduling of admissions and exam appointments, reporting, discharge). Based on these assumptions, the archive has been divided into 3 sections, each dynamically integrated with the others. The 3 archives should be integrated with RIS and supported by information technology. RIS is considered the starting point of the process. In fact the system ensures communication to the archiving workstation and to the radiology room of patient admission and consequent execution of the exam which involves image production. This user-friendly procedure enables consistent information between RIS and archiving system and correct association of images to the patient medical report, for subsequent consultation.

Planning and scheduling radiologic exams.

Planning and scheduling of radiologic exams represent one of the crucial aspects in the performance of Diagnostic Imaging service, whose optimal management should lead to optimal efficiency and exploitation of technological and professional resources. A Diagnostic Imaging service with agreed and scheduled exams for customers achieves a more adequate, precise planning of the activity with optimum productivity of radiology rooms and anticipated workload assessment.

Information management of a department of diagnostic imaging.

It is well-known that while RIS allows the management of all input and output data of a Radiology service, PACS plays a major role in the management of all radiologic images. However, the two systems should be closely integrated: scheduling of a radiologic exam requires direct automated integration with the system of image management for retrieval of previous exams and storage of the exam just completed. A modern information system of integration of data and radiologic images should be based on an automated work flow management in al its components, being at the same time flexible and compatible with the ward organization to support and computerize each stage of the working process. Similarly, standard protocols (DICOM 3.0, HL7) defined for interfacing with the Diagnostic Imaging (D.I.) department and the other components of modules of a modern HIS, should be used. They ensure the system to be expandable and accessible to ensure share and integration of information with HIS, emergency service or wards. Correct RIS/PACS integration allows a marked improvement in the efficiency of a modern D.I. department with a positive impact on the daily activity, prompt availability of previous data and images with sophisticated handling of diagnostic images to enhance the reporting quality. The increased diffusion of internet and intranet technology predicts future developments still to be discovered.

Normal uterus and uterine malformations.

The uterus is well visualized with sonography with the definition of its morphofunctional characteristics and the physiologic variations in relation to hormonal stimuli. With high frequency endovaginal and intrarectal probes, anatomical details are optimal. Color Doppler enables the study of blood flow in the pelvic vessels and supplies functional information. Hysterosalpingography is the most accurate method for the study of the uterine cavity and the evaluation of tubal patency. In the study of uterine malformations, sonography represents the procedure of first choice, able to diagnose anomalies of fusion and development of müllerian ducts. In cases of dubious or ascertained malformations, hysterosalpingography is mandatory to complete the sonographic findings.

Diagnostic imaging in cervical incompetence.

Cervical incompetence is defined as an abnormal dilatation of the cervical canal at the body-neck junction with no pain or blood loss and in the absence of uterine contractile activity. Cervical incompetence is the frequent cause of abortion in the second trimester and premature delivery, with adverse fetal prognosis. Usually, three causative factors are considered: traumatic, constitutional, dysfunctional. While in multiparous women the medical and remote obstetric history poses the diagnostic suspicion, in primigravidae, in the absence of previous risk factors (traumas, malformations, etc) early diagnosis may allow prompt treatment with a better prognosis. Hysterosalpingographic (tunnel-shaped cervix or appearing as an inverted sac, diameter of internal uterine orifice) but especially sonographic findings (cervical length, dilated endocervical canal, tunnel-shaped internal uterine orifice, herniation of the amniotic sac into the endocervical canal) represent the most significant radiologic signs. The radiologist should be able to recognize the typical imaging of this condition to select the patients who should undergo serial controls in time since the start of the second trimester of pregnancy, or to indicate a suitable treatment based on sonographic signs suggestive for incompetence identified before the clinical exam. This is the present correct approach while waiting for future clinical and technological developments of three-dimensional sonography and MRI which will be able to detect those changes in cervical connective structures responsible for incompetence and still not identified by any imaging procedure.

Radiologic imaging of the fallopian tubes.

Aim of the present article is to illustrate the radiologic findings which afford the most reliable diagnosis with hysterosalpingography, in the evaluation of tubes in infertile patients. Based on the more regular anatomical patterns with details of minor anatomical variants, a common cause of infertility, the signs of the various types of tubal obstruction, are examined. The nature of the latter is not always organic: the implementation of simple albeit often resolutive technical devices as change of position or the use of more sophisticated but well-tolerated maneuvers as the interventional ones, may help detect normal patterns hidden by false (functional) obstruction. Careful analysis of tubal morphology down to the obstructed portion allows the identification of true pathologic patterns, making this exam even more valid in the diagnostic approach to the infertile patient.

Radiology information systems (RISs): state of the art and new perspectives.

The Diagnostic Imaging Department plays a crucial role in the hospital structure, essentially due to the critical importance of its activities at the clinical as well as the organizational level. Moreover, its structure is complex and susceptible of changes in the course of time. Thus Radiology Information Systems (RISs) have acquired a specific relevance within Hospital Information Systems (HISs). The major requirements of a Diagnostic Imaging Department and the developmental course, RISs have followed in time to meet them effectively and efficiently, are reported. The main problems of the present situation and the trend of the future development of RISs are considered.

Standardization of digital radiologic images.

The need for uniform digital formats of radiologic images obtained from the human body by the various methods (CT, MRI, DF, DSA, NM) is felt by both the manufacturers and the radiologists since a long time. The ACR-NEMA standard was initially established to overcome this problem, however it was not fully satisfactory. Its up-dated version, DICOM 3 seems a more successful approach to the solution of the problem. The rationale on which DICOM 3 is based, the main guidelines with some reference to the various parts of the new standard, are analyzed. Its advantages as well as disadvantages are considered in view of a future complete integration of data and images of a radiology department within a hospital information system. In the appendix, a list of DICOM components and addresses where to find the original documentation are supplied.

DREAM: integrated image and traditional data management.

Main objectives and characteristics of computerized radiological image handling in a radiology department, homogeneously integrated with other information typologies, are discussed. The extension of the present DREAM system to image handling functionalities is in progress. The activities are based on the collaboration between the "Università Cattolica del Sacro Cuore (UCSC), Istituto di Radiologia". Hopital Cantonal Universitaire de Genève-Centre d'Informatique Hospitalier (HCUG) and Gesi aiming at the integration of "Osiris", image handling information system implemented by HCUG with DHE middleware implemented by Gesi and UCSC which represents the functional and information core of the entire information system. The initiative is part of "Synapses" project, partially supported by the European Union DG XIII within the program of information technology applications in health care.