Picture archiving and communication system in Hokkaido University Hospital: Advantage and disadvantage of HU-PACS chest roentgenogram images in the outpatient clinic

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Abstract
A new Hokkaido University picture achiving and communication system (HU-PACS) has been in clinical use in the outpatient clinic at HU Hospital. To evaluate the quality of the cathode-ray tube (CRT) monitor images, we compared the detectability of line shadows in the chest roentgenogram images on the CRT monitor with those on the computed radiography (CR) film. We randomized chest roentgenograms from 20 patients who were admitted to the outpatient clinic with pulmonary disease. Two physicians, whose speciality is chest roentgenogram diagnosis, checked whether they could recognize a horizontal fissure line (hairline) on the posteroanterior view and a minor fissure line and major fissure lines on the lateral view. Only 30% of hairlines were recognized on CRT monitor as compared with 65% on CR film. On the lateral view, only 68% of major fissures and 53% of minor fissures on CRT monitor were recognized as compared with 89% and 79%, respective on CR film. Furthermore, it was somewhat difficult to follow entire lines on some of the CRT monitor images. Clinically, the greatest advantage of the PACS is immediate availability of images, including chest roentgenogram, chest computed tomography (CT) and magnetic resonance imaging (MRI). PACS is also convenient for consulting colleagues in other departments. Unfortunately, the quality of the image on the CRT monitor is not yet good enough to visualize line shadows and small solitary lesions on the chest roentgenogram image. Recent advances in high technology have been so rapid, however, that higher resolution CRT monitors will be available soon.

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