Radiologist assistants at the Mayo Clinic in the mid-1990s helped make the doctor's life a lot easier: they would hang current and comparison scans the way the radiologist liked, take down transcriptions in real-time and question the doctor if something seemed amiss, track down referring clinicians if there were urgent or unexpected findings and make sure they were followed up on.

And swapping these helpful "Mrs. McGillicuddy's" for picture archiving and communications software and voice recognition programs in the modern digital radiology suite has in some ways been a poor tradeoff, says PACS pioneer Dr. Elliot Siegel.

"It seems we've taken a step back," Siegel, chief of imaging services at the Veterans Affairs Maryland Healthcare System in Baltimore, and a professor at the University of Maryland, said during a talk at the NYMIIS at a Times Square hotel on Monday.

Siegel turned the VA Baltimore into the first filmless U.S. hospital in the early 1990s, and now as the health system looks to replace its original PACS with a next-generation sequel — the new vendor should be announced in a matter of weeks — Siegel thinks current PACS need to get smarter.

Stupid PACS

Siegel said one of the core problems with PACS — and a problem not shared by the radiologist assistants he worked with during his time at Mayo Clinic in Rochester, Minn. — is their inability to learn.

For instance, the way it hangs current and comparison studies is "really, really dumb," he said, as rather than learning from his preferences it requires him to adjust the layout every time.

Also, he experiences this when he starts his day, as his PACS won't let him sign on unless he uses all capital letters for his sign-on name -- something he often forgets to do.

"It keeps asking me questions like, 'Are you sure?' although I've been saying yes to that (issue) for the last 19 years," he said.

Closing the "communication loop"

Possibly one of the biggest issues with PACS is it could be doing much more to help radiologists document that referring clinicians follow up on suspicious findings, Siegel said.

Currently, for as many as one-fifth of cases there's no follow-up even if the doctor acknowledges receipt of the radiology report that contains the follow-up recommendation, he said. While the doctors' decision to not follow up could be medically justified, the radiologist should be able to quickly check if his recommendations slip through the cracks.

And closing the "communication loop" could involve automating a process so radiologists could see if their recommendations — such as a CT scan after a suspicious chest X-ray finding — were actually acted upon.

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