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Client Profile: Royal Bournemouth Hospital
 Bournemouth Goes Filmless with Aspyra PACS Challenge The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust wanted to increase the access to its radiology images, from within the organisation and for radiologists to access images from remote locations. Solution The organisation chose the AccessNET™ PACS Solution from Aspyra, Inc. to enable them to successfully become a truly filmless environment. Results Even large CT studies (2,000-plus images), can be loaded from anywhere on the hospital network (100 Mbps) at an average speed of 30 images per second. Even laptops using the wireless LAN (11 Mbps) get very acceptable results. The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust chose an Aspyra AccessNET PACS Solution to enable them to successfully become a truly filmless environment. The Trust has 842 beds across two hospitals and serves a population of over 500,000 people. Aspyra devised a unique PACS architecture that married Citrix thin client technology with a clustered server design to provide a powerful and resilient solution that not only satisfied the Trusts' requirements but also surpassed them. Using thin-client technology, the Aspyra MedVIEW application is actually run on the server and not the client. Therefore, only the resulting image is sent across the network to the users computer screen. This dramatically reduces the amount of network traffic, which is often a major consideration when implementing a PACS within an established institution. The clustered server design facilitates both "load balancing," which enables a dynamic management of the resources to maintain an optimum level of performance regardless of the demands put upon it, and provides an exceptional solution for "fault tolerance." Should one part of the system fail, a duplicate component will bridge the problem, meaning the end users' experience will be unaffected. The combination of these technologies has resulted in a unique configuration providing, speed, resilience, access and cost effectiveness. Jon Teece, Radiology PACS manager, lists the following benefits: "We use thin-client technology to deploy images across the Trust. This provides us with tremendous speed. Even very large CT studies (2,000-plus images), can be loaded from anywhere on the hospital network (100 Mbps) at an average speed of 30 images per second. Even laptops using the wireless LAN (11 Mbps) get very acceptable results. The users' computers (for example on the ward, in the clinic or in the operating theatre) can be a relatively low build specification, but still benefit from identical functionality and speed as a full-blown radiologist workstation, as all the number crunching is carried out on the server and not the local computer. As a centre of excellence for cross-sectional imaging, we can archive and recall all the original data. Having upwards of 2,000 images is not uncommon for our CT examinations. However, when using this system there is no need to reconstruct the original data into thicker slices. Neither has it been essential to upgrade the hospital network above 100 Mbps because using a Citrix thin client the network traffic is significantly smaller than with a Web-browser solution. It also means we have a single tier of functionality and performance - so no one is disadvantaged. Voxar (MPR and 3D software) can be used in every radiologist office and numerous seminar rooms (we have 22 licenses in total). This allows us to create reconstructions on demand. Software upgrades are carried out on the central servers, negating the need to visit hundreds of computers across the Trust. And because of the clustered server design there is no scheduled downtime - we can shut down one server and the others maintain a seamless service. With regard to teleradiology, our doctors can connect to the Trust from their homes (through a VPN established by the Trust), and can recall uncompressed images on demand. This works well even on a 33 Kbps connection." Dr. Russell Bull has also experienced significant benefits: "As a clinical radiologist, the key advantage of Aspyra's technology is that it accommodates my work pattern without any compromises. Therefore, I don't have to engage in endless technical discussions about how I should change my workflow to accommodate the technical limitations of PACS - our system does everything I want it to without any limitations. A common session for me would include reporting several 800-plus slice CT studies - using MPR and 3D reconstructions - interspersed with MR studies and numerous plain films. I can do all this effortlessly from my office and can review the same studies on any computer throughout the entire hospital, as well as at home (via a 2 Mbps Internet connection). All of this is achieved without any data compression. I have not seen any other PACS system that is able to distribute large multislice CT datasets across an entire hospital and to home without huge compromises, either in terms of retrieval speed or in terms of limiting the number of slices stored - and thus throwing away data. Our workflow is simple - every image - and every CT slice - is available everywhere with incredibly fast retrieval times." Operational efficiencies that have resulted in real patient benefits have also been realised. Paul Shelton, senior clinical leader comments: "The advent of a filmless hospital has had dramatic benefits on the imaging time for patients in all disciplines. PACS has been a significant factor in increasing throughput on our multi-slice scanners by 38% in the first quarter of this year compared with the same period last year. Most dramatic has been the waiting times for outpatient plain film examinations. Patients regularly experienced waiting times well in excess of an hour, whereas it is now very rare for patients to wait longer than 30 minutes since we went filmless, despite a 6% increase in workload. This reduction in workload is the result of introducing a filmless environment. A recent comment from the senior nurse in orthopaedic outpatients claimed that we now X-ray patients before they are sent. We are all astounded by the increased throughput that PACS has given us, it is way above our expectations". Simon Parvin, Medical Director, summed up that "The implementation of PACS has revolutionised radiology at Bournemouth. As a vascular surgeon making extensive use of the system, X-rays are always instantly and rapidly available as soon as they are acquired, anytime, anywhere, at the press of a button. Gone are the days when we had to wait to review films because they were in another clinic or even another hospital. It is hard to imagine how we managed before." 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