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EVALUATION OF FILM ARCHIVING METHODS IN TWO FEDERAL HEALTH INSTITUTIONS IN ENUGU STATE

ABSTRACT

The aim of this research is to evaluate the archiving efficiency in the National Orthopaedic Hospital Enugu (NOHE) and the University of Nigeria Teaching Hospital (UNTH) Ituku-ozalla. It is a prospective study that evaluates the archiving procedures used in the two Federal institutions.

The result showed that National Orthopaedic Hospital Enugu and  University of Nigeria Teaching Hospital encountered 2.1317% and 1.5625% loss of radiographs respectively within the duration of this research.

To improve the archiving procedure in the two federal institutions, standard techniques must be practiced.

 

TABLE OF CONTENTS

TITLE PAGE

ACKNOWLEDGEMENT

ABSTRACT

LIST OF TABLES

LIST OF FIGURES

TABLE OF CONTENTS

CHAPTER ONE

INTRODUCTION

  • BACKGROUND OF STUDY
  • STATEMENT OF PROBLEM
  • OBJECTIVE OF THE STUDY
  • SIGNIFICANCE OF THE STUDY
  • SCOPE OF STUDY

1.6 LITERATURE REVIEW

CHAPTER TWO

THEORETICAL BACKGROUND

2.1   FILM ARCHIVING

2.2    MANUAL FILM ARCHIVING METHOD

2.2.1   MINIATURIZATION OF RADIOGRAPHS

2.2.2    ADVANTAGES OF MINIATURIZATION

2.2.3    DISADVANTAGES OF MINIATURIZATION

2.2.4    ADVANTAGES OF MANUAL FILM STORAGE METHOD

2.2.5    DISADVANTAGES OF MANUAL FILM STORAGE METHOD

2.3   DIGITAL FILM ARCHIVING METHOD

2.3.1    IMAGE ARCHIVAL AND BACKUP

2.3.2    IMAGE ACQUISITION SUBSYSTEM

2.3.3 FILM DIGITIZATION

2.4    STORAGE OF RADIOGRAPHIC IMAGES

2.4.1    SHORT TERM DATA STORAGE

2.4.2    LONG TERM DATA STORAGE

CHAPTER THREE

RESEARCH METHODOLOGY

3.1   RESEARCH DESIGN

3.2    SOURCES OF DATA

3.3   METHOD OF DATA COLLECTION

CHAPTER FOUR

DATA ANALYSIS AND PRESENTATION

4.1    DATA ANALYSIS

4.2 DATA PRESENTATION

CHAPTER FIVE

5.1     DISCUSSION

5.2     SUMMARY OF FINDINGS

5.3    CONCLUSION

5.4     RECOMMENDATION

5.5    AREAS OF FURTHER RESEARCH

5.6    LIMITATIONS OF STUDY

REFERENCES

APPENDIX

 

CHAPTER ONE

INTRODUCTION

  • BACKGROUND OF STUDY

The radiology department is one of the departments in a hospital that provide medical care and a wide range of diagnostic services such as computer tomography, magnetic resonance imaging, ultrasound, mammography, radionuclide imaging and conventional x – ray services used in patient care. The major recording medium used in image acquisition and archiving is the x- ray film which are usually placed in file jacket and stored in shelves1.

While poor storage condition will hasten this deterioration process, good storage procedure will increase the shelf –life of the films. Poor storage condition and ageing are indicated by a decrease in the archival permanence and contrast of the image2. The radiographs are stored in shelves in rooms free from gases such as formaldehyde, hydrogen sulphide, hydrogen peroxide and ammonia as they tend to reduce the archival permanence2. The radiographs are filed in shelves either according to patient x – ray number, hospital number, region of body examined or imaging modality used or a combination of any of the types. This helps in serial arrangement of they can easily be retrieved. In addition to importance of proper film archiving for easy retrieval, it is also important for educational purposes for training medical student in the field of radiology, medico legal cases, conducting researches and in policy making in the department.

Due to advances in technology, some departments currently use archiving system known as Picture Archiving and Communication System (PACS). This acquires, manipulates, transports and stores radiographic images digitally. The introduction of PACS has made it possible for radiographers and other hospital personnel to efficiently archive and retrieve patient’s radiographs without much difficulty3.

Patient’s radiographs are very important in diagnosis and treatment therefore must be properly archived so that they are not misplaced or lost and can easily be retrieved. This work is aimed at evaluating the film archiving methods in two federal health institutions in Enugu State.

  • STATEMENT OF PROBLEM
  • The film archiving techniques in University of Nigeria Teaching Hospital Enugu and National Orthopaedic Hospital Enugu have not been evaluated
  • From observation, there have been difficulties in retrieving patient radiographs and the reasons have not been ascertained
  • From observation, there have been incidence of loss of patient’s radiograph and the reasons have not be ascertained
    • OBJECTIVE OF THE STUDY
  • To compare the archiving technique used in the two hospitals
  • To ascertain the reason for loss of radiographs and reason for difficulties in retrieving patients radiographs
    • SIGNIFICANCE OF THE STUDY
  • The result of this study will provide information that will help policy makers on how to improve the efficiency of the archiving system in radiology departments.
  • The result of this study will provide information on ways of reducing loss of radiographs
  • The study will reveal the importance of film archiving
    • SCOPE OF STUDY

The research study will be conducted in the radiological departments of two federal health institutions in Enugu State; the National Orthopaedic Hospital Enugu (NOHE) and University of Nigeria Teaching Hospital (UNTH) Ituku - ozalla

1.6 LITERATURE REVIEW

One of the main activities of a hospital radiology department is supplying reports of radiology opinions, interpretation of medical image and storing of the various radiological images where they can be easily retrieved for continued management of the patient4.  The detection of x-rays is based on various methods.  The most commonly known methods are photographic plates, photographic films in cassettes, rare earth screens and photostimulable phosphors5.  Regardless of what in recording the image, they all categorized as “image receptors” (IR).  Photographic films largely replaced the photographic plates in the radiology department to record and archive radiological images.  It has become a major recording medium used in film archiving in the radiology department of developing countries6.   These radiographic films are stored in shelves in rooms free from gases such as formaldehyde, hydrogen sulphide, hydrogen peroxide and ammonia as they tend to reduce the archival permanence2.  Langer S.7 on his work on a goal based benefit analysis for film verses filmless radiology departments, stated that radiographic films should not be stored above recommended 210c (700f). Brenner8, in his work on film handling and storage proposed that radiographic films could be handled safer if the equipment for processing the films are serviced, the rollers and sprockets should be cleaned occasionally and the magazines properly cleared and checked.  A Kodak publication9 in film care stated that scratches present in radiological films are virtually impossible to eliminate but they can be minimized by reprinting with a liquid gate printer that hides base scratches and some light emulsion scratches, rewashing the film for light emulsion scratches and lacquering (“or publishing”) base scratched films.

 

Many investigators have reported inefficiencies in the operation of a conventional film radiology department.  There have been difficulties in retrieving patient radiological images due to poor storage technique and management10.  Haschke11    in his work on film rejection in a conventional radiology department reported that most radiology department using film archiving method has lost up to 15% of their radiological images due to storage methods. Ricky k12 in a work on reducing patient time observed that continuous education on medical staffs might be an effective way of improving documentation of radiology records.

 

Due to advances in technology, some radiology department have started making use of a new film archiving and system known as picture archiving and communication system (PACs) that requires, manipulates, transports and stores radiographic images digitally3.  Since early nineteen various institutions has been running projects together wish industrial partners to study the application of film digitalization in the radiology department.  The central idea is to increase improvement and reliability of radiographic images by means of digitalization and computer based handling and evaluation. Chonn13 in his work on evaluating the importance of picture archiving and communication system reported that the picture archiving and communication system provides continuous image management and display service using a digital computer system patient images are displayed on video monitors and provides an atmosphere where radiologist, radiographer and other primary care physicians may easily review diagnostic images from several different imaging modalities (projection radiography, computed tomography ultrasonography and magnetic resonance imaging).

 

Dick14 in his work on the computer based medical record stated that filmless radiology department has the potential of reducing patient wasting time that in often associated with retrieved and delivering of medicine imaging studies.  Introducing digital radiography has lead to reduction to number of reports, unnecessary radiation dose to patient and reducing patient wasting and also a reduction in rejected film15.  Peer16 in his work on comparative reject analysis in conventional film screen and digital storage radiography revealed that in the conventional department, the main reason for rejection was “exposure” and others (that in problems relating to film handling and positioning of patient) and the main reason in a digital department was just “positioning of patient”.  One of the aims of digital archival of films in to easily store and deliver high resolution images with minimal loss of diagnostic information17.  Mankorich18 highlighted that loss of radiological films are unacceptable and translates into loss or revenue for the department and also affects the quality of the patient care.  Wealtherborn19 in his work on the effect of a picture archiving and communication system in diagnostic hospitals observed that images stores in a PACS system are not lost or misfiled hence many radiology departments has adopted the PACS system to secure and increase the efficiency of the services delivered.

 

A good picture archiving system delivers any pre-fetched image to the screen within 2-10 seconds.  This will seem an irritatingly long delay as we become used to the system but it is probably quicker than the time taken to sort through an x-ray pocket containing ore than 8 films20.  The picture archiving and communication system eliminates the 10m or unavailability o images for individual patients, but if the system was to fail, it could cause a whole outpatient clinic to be cancelled.  Nockemann21 in his work on radiographic testing said that the development of high resolution digitalization system allows the electronic handling of radiographic films.  It has also aided in digital archiving of the radiological images.

 

Digital medical images are typically stores locally on a picture archiving and communication system for easy retrieval.  It is important as required by most institutions that facilitates have a means of recovering images in the event of an error or disaster, while each facility is different, the goal in image backup in to make it automatic and easily to retrieve when needed22. Lowe23 in his work on multimedia electronic medical record observed that radiographic images could be stored in removable media (such as hard drives, DVD or other media that can hold nay patient images) that is physically transferred offsite or could be stored using the internet by encrypting the images during transmission.

 

Choplin24 on his work on computer assisted radiological reporting system revealed that clinicians requesting a procedure need to know the radiographic results within the same day and in urgent cases immediately in order to decide or the best possible medical action, if the films are not quickly received, it causes frustration to the clinician and delay in health service delivered.  The first concern expressed by clinicians is whether the image quality retrieved is adequate most doctors who are familiar with PACS find it eases diagnosis because of the ability to window and zoom into the area of interest.

 

Zecherpel25 in his work on film digitalization systems analyzed that the problems on archiving huge number of digitized radiographs are the amount of data to be handled in a convenient way.  This problem has been reduced by lossless data compressive of the radiological images.  Artifacts caused by compression algorithms are not acceptable.

Picture archiving and communication system archives and networks are just another large computer system as those used in industries and other institutions.  Provided they are designed carefully with no single point of failure and provide with routine checking the output will always be high26.  A PACS is a hospital wide computer system not a radiology system.  There would be problems if the radiology department acquires PACS without the consultation of the hospital information technology department27.  All PACS systems should be bought as a hospital-wide system, so the team should include computer personnel, non-radiology clinicians as well as radiology staff.  The inclusion of non-radiology clinicians in the project team will improve the chances of the system delivering a decent service to the wards, clinics and theatres.

 

Picture archiving and communication system is replacing hard copy based means of managing medical images such as film archives with the decreasing price of digital storage, PACS provide a growing cost and space advantage over film archives in addition to instant access to previous archived images at the same instiution3. When PACS has been installed, it is vital to guard against a total system failure as a hospital cannot function without an imaging service.  System failure most times in unlikely to occur and to cause emergency treatment to stop since each image recording can operate independent of the main system and ensure immediate access to the image.  A minimal film printing facility is usually retained so that images required urgently in the wards can still be printed in cases where the picture archiving system is faulty.

Fischer29 in his work on guidelines for cost effective implementation of PACS stated that the installation of a hospital wide picture archiving and communication system (PACS) is expensive.  Even though the price of the computer hardware and software has decreased dramatically over the years the cost of implementing a comprehensive PACS is still quite high.

The development of a multimedia electronic record system (MEMRS) and picture archiving and communication system (PACS) promises new opportunities to significantly reduce the routine use of film as the medium for viewing and archiving radiological images.  The effect of this change to digital media in physicians and radiological staff, work-flow and the perceived value and utility of medical images is an area of ongoing investigation30.

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