It is almost a commandment of installing PACS and moving to a less-film environment that it is necessary to work with clinician groups early on to bring them on board the electronic imaging bandwagon. The common way is to create "champions" in the various departments who become PACS advocates and then lead their colleagues through the conversion.

But some radiology PACS managers resort to "tricks of the trade" to edge clinicians in the proper direction.

At the Baltimore VA medical center, imaging chief Eliot Siegel, MD, made clinicians who showed up at the film library after the PACS was deployed fill out a form detailing why they needed the film. When that time-consuming task was inadequate, the remaining film seekers were asked to write a short essay on why they wanted the film. "We wanted a graduated scale of difficulty for getting film," Siegel says. "By the time the essay came out, we had essentially eliminated most of the demand."

At Massachusetts General Hospital, radiology chairman James Thrall, MD,  employed a strategy that is becoming common at other institutions. "Give them film, but don't take it back," Thrall says. "Let them throw it away. It would be cheaper to print the case again than to do all the handling steps to take it back. When they see it pile up, they realize what a pain in the neck it is.

"Another thing I've done from time to time to persuade a hospital administrator about the benefits of going filmless," says Thrall, "is to go to the library and find five or six fat folders of film. I hand that to them. I try to make them carry it around for a little while. It's the stuff from which epiphanies come when they compare that 20 pounds to an instant workstation."

G. Wiley