Electronic Teaching Solution For an Electronic Radiology Department

By Boris Zavalkovskiy, Patrick Liu, MD, and Catherine Roberts, MD, Mayo Clinic Scottsdale

Zavalkovskiy.Boris@MAYO.edu

The radiology department at Mayo Clinic Scottsdale started moving towards soft copy
interpretation in 1997, and by 1999 the vast majority of the clinical practice was using electronic
image distribution throughout the enterprise. Despite clinical success in moving to the PACS
environment, we still found it necessary to copy images to PowerPoint presentations for
conferences and teaching files. PACS systems have poor functionality for adding textual
information and discussions to cases, categorizing cases by pathology, database searching, and
importing non-DICOM images. As our practice became more adapted to the electronic
environment, we realized the need for a robust electronic radiology teaching file system.
In 2000, we started to search for a commercially available electronic radiology teaching file
system. We desired a comprehensive, scalable system that had a user-friendly interface for
authoring interesting and instructive cases, could be utilized in a number of different teaching
aspects, and could be easily integrated into our existing electronic environment for case sharing
among three major medical centers across our wide area network.

We found that several medical centers had independently created their own teaching file
programs, but none of these were commercially available or broadly applicable to all PACS
systems. While the major PACS vendors were well-positioned to develop integrated teaching file
solutions, they have yet to introduce any such product.

After evaluating several vendors, we purchased the MyPACS teaching file system from McKesson Medical Imaging Group - Seattle
in February of 2003. Full deployment of the system and training of the physicians was
completed by July of the same year.

MyPACS provides a web-based authoring tool that allows users to create teaching files with very
little effort. When a radiologist encounters an interesting study on the PACS, he or she can
quickly add the images and text to the teaching file server. Users can later visit their cases and
enter more detailed discussions. Authors can keep cases private, make them available to all
users, or share them with a specific group of users. The system supports the peer-review
process, allowing cases to be certified by qualified personnel. Cases can be retrieved via fulltext
search, or through structured queries on selected attributes. Users may turn on Training
Mode to view cases as unknowns and reveal case text and images in stages. Cases can be
categorized by anatomy and pathology, and organized in web-based folders. The system is easy
to use and hierarchically organized, with navigational aids and online documentation. The server
runs behind the firewall, allowing patient identifiers to be entered into cases, which is useful for
follow-up studies. Authorized users can publish anonymized cases to a publicly accessible
teaching file server on the web.

Historically, the majority of the radiological teaching files were created exclusively by
radiologists and consisted of film copies of radiological images. Penetration of digital
photography and computer applications into the clinical environment has recently enabled nonradiology
physicians as well as radiologists to create multimodality teaching files that contain
radiology images, pathological slides, video clips, commentary, and other supporting
documentation.

Since the deployment of MyPacs teaching file system in July of 2003, other clinical specialties
outside of the radiology department, such as orthopedic surgery, pathology and general surgery
have started contributing teaching cases and images.

Our colleagues in the radiology departments of Mayo Clinic Jacksonville and Mayo Clinic
Rochester faced many of the same issues as us, and were also looking into electronic teaching
file solutions and independently evaluated number of vendors in the market. Realizing the great
potential of a multi-institutional teaching file system, the other two Mayo practices tested and
agreed to adopt the teaching file solution deployed at Mayo Clinic Scottsdale across wide area
network (WAN). Initial concerns regarding the performance of the system using a central
database situated in Scottsdale, as well as scalability of the product, were addressed with
extensive in-house testing, we Currently we are in gradual process of adding new users and
providing training at all Mayo campuses. At this writing we have 114 registered users, expected
to grow to over 400 toward the end of the year. 1073 cases have been contributed by the clinical
practices in Mayo foundation, and we anticipate that several thousand new cases will be created
by the end of the year. The system currently manages more then 4267 images in its database.
We are carefully monitoring performance of the system as it scales itself to growing numbers of
users across our three campuses as well as growing numbers of cases. At this time we have not
experienced any performance degradation.

The system allows two types of access: registered users (users that have ability to contribute and
author cases) and anonymous users (users that do not have accounts on the system but allowed to
review public cases in the teaching file depository). In the past 3 months, the system has been
accessed by the registered users 2209 times and by the anonymous users 5855 times, for a total
of 8064 sessions.

We have found that the MyPACS system is very instrumental in formal education of medical
students, residents and fellows rotating through our radiology departments. The web-enabled
interface to the teaching file solution provides great comfort for authoring as well as for teaching
and reference. The teaching file system can also serve as a method for presenting and storing
inter-departmental conferences because of its ability to accept all formats of digital media
(dicom, jpeg, tif, gif, mpeg, etc), as well as Powerpoint presentations and web links. MyPACS is
currently being used for musculoskeletal tumor and mammography radiology-surgery-pathology
conferences.

In conclusion, the MyPACS system improves teaching opportunities in the electronic
environment of the radiology today and helps us to fulfill our educational mission.