The average age of modalities in use at The Toledo Hospital hovers somewhere around 7 years. The oldest piecesacquired about a decade and a half agoare the nuclear medicine cameras. Not many years behind them are the radiography systems.

The other modalitiesMRI, CT, ultrasoundare reasonably current, but with so much of the equipment at or near retirement age, Toledo Hospital encountered some problems linking modalities to the new PACS.

"We solved the problem with the use of [interface] boxes," says Roberta (Bobbi) J. Miller, CRA, radiology administrative director.

Still, she would very much like to see the oldest machines replaced with the newest, state-of-the-art models.

"That will not happen until we determine the time frame for the facility replacement construction project," she says. "If we end up building a new hospital, then we will want to hold off on replacing our older pieces of imaging equipment until move-in. The first phase of the building project is anticipated to begin in 2004. That makes my planning more challenging."

Miller says that, if the project does not begin next year as anticipated, it will become necessary to purchase new equipment in the meantime.

"I will not be able to hold off beyond that point," she says. "I do intend, however, to make sure that the equipment we purchase is capable of easily being moved in the event the new building at some point later on receives a green light."

As for PACS, the equipment is just 2 years old. There are 22 diagnostic workstations (2K x 2K flat-panel monitors), which have been deployed for use by the radiologists and in the ED. Additionally, all of the hospital ICUs and seven of its 30 operating rooms have been outfitted with a slightly lower-resolution clinical workstation. And a technical workstation sits adjacent to each modality.

A deep archive is used for storage. "It is very fastit loads a tape in 11 seconds," says Miller. "In front of the deep archive is a database and in front of that is a 15-month redundant array of inexpensive disks. The longest retrieval of an image from across town is 18 seconds. Most routine, on-campus retrievals are far shorter.

"The soft copy reading learning curve for radiologists was challenging, but now that they are comfortable, not one of them would go back to the world of film-only," Miller notes. "They now believe they are actually doing a better job, especially on examinations with numerous images, such as MRI and CT.

"The remark we hear most often from our referring physicians is how fast the images arrive and how good they look when they get there."

R. Smith