Andriole KP et al. 2002 "Workflow assessment of digital versus computed radiography and screen-film in the outpatient environment."

Andriole KP, Luth DM, Gould RG. Workflow assessment of digital versus computed radiography and screen-film in the outpatient environment. J Digit Imaging 2002;15 Suppl 1:124-126.
"An objective assessment and comparison of computed radiography (CR) versus digital radiography (DR) and screen-film for performing upright chest examinations on outpatients in presented in terms of workflow, productivity, speed of service, and potential cost justification. Perceived ease of use and workflow of each device is collected via a technologist opinion survey. Productivity is measured as the rate of patient throughput from normalized timing studies. The overall speed of service is calculated from the time of examination ordering as stamped in the radiology information system (RIS), to the time of image availability on the picture archiving and communication system (PACS), to the time of interpretation rendered (from the RIS). A cost comparison is discussed in terms of potential productivity gains and device expenditures. Comparative results of a screen-film (analog) dedicated chest unit versus a CR reader and a DR dedicated chest unit show a higher patient throughput for the digital systems. A mean of 8.2 patients were moved through the analog chest room per hour, versus 9.2 patients per hour using the CR system and 10.7 patients per hour with the DR system. This represents a 12% increase in patient throughput for CR over screen-film, which is statistically significant; and a 16% increase in patient throughput for DR over CR, which is not statistically significant. Measured time to image availability for interpretation is much faster for both CR and DR versus screen-film, with the mean minuts to image availability calculated as 29.2 +/- 14.3 min for screen-film, 6.7 +/- 1.5 min for CR, and 5.7 +/- for DR. This represents an improved time to image availability of 77% for CR over screen-film, 80% for DR over screen-film, and 15% for DR over CR. These results are statistically significant (P < 0.0001) for both CR over screen-film and DR over screen-film but not statistically significant for DR over CR. A comparison of the digital technology costs illustrates that the high cost of DR may not be justifiable unless a facility has a steady high patient volume to run the device at or near 100% productivity. Both CR and DR can improve workflow and productivity over analog screen-film in a PACS for delivery of projection radiography services in an outpatient environment. Cost to justification for DR over CR appears to be died predominantly to high patient volume and continuous rather than sporadic use patterns."
"To compare the workflow, productivity, speed of service, and potential cost of the two digital modalities, namely CR versus DR, for performing a two-view upright chest examination."
Tools Used
Type Clinic
Primary care and specialty care
Other Information
This study took place at two locations: the University of California San Francisco (UCSF) Ambulatory Care Center and the Mt. Zion Community Hospital.
Type of Health IT
Radiology information system (RIS)
Picture archiving and communication system (PACS)
Type of Health IT Functions
Imaging devices were integrated into the PACS systems, allowing them to utilize modality worklist link features "for automatic association of patient demographic information with image data." They also could use digital imaging and communications in medicine (DICOM) and auto-sending features.
Workflow-Related Findings
"Patient throughput is higher for the digital systems with which a mean of 10.7 patients were moved through the DR chest room per hour and 9.2 patients per hour for CR, versus 8.2 patients per hour for the analog device."
Average time to image availability improved for both CR and DR over screen-film. "The mean [m]inutes to [i]mage [a]vailability +/- the standard deviation was calculated as 5.7 +/- 2.5 minutes for DR, 6.7 +/- 1.5 minutes for CR and 29.2 +/- 14.3 minutes for screen film."
The technologists rated the DR system as "Much Better"...than film for all areas (including speed, performance and ease-of-use) except for reliability for which the average rating was...[b]etween "Better" and "Much Better" than film." They gave the CR system ratings of "better" to "much better" than screen-film for all categories.
"Fifteen X-ray technologists with experience on either CR or DR unanimously preferred the digital modalities over the film-based chest unit."
Study Design
Only postintervention (no control group)
Study Participants
Study participants included imaging technologists at UCSF Ambulatory Care Center and Mt. Zion Community Hospital.