This article describes an application for capturing, delivering, and

tracking urgent radiology exam results. Urgent exam findings are entered using

a Web form embedded within the Picture archiving and communication system

(PACS) display station. The findings are then accessible via soft copy using

the PACS display stations, hospital information system (HIS) terminals, or

wireless-enabled personal digital assistants (PDAs) or via hard copy printouts

that are generated automatically or on demand. Additionally, quality control is

performed on those findings entered by radiology residents and fellows, the

results of which are used for both performance tracking and educational

activities. The application was developed using Sun Microsystems' Java

programming language. The Java Message Service (JMS) was used to manage the

delivery of findings. JMS provides a robust, flexible framework for exchanging

messages between disparate applications. The application is now used for all

urgent exams; completely replacing the original paper-based system. The use of

JMS provides the necessary level of reliability needed by this

application.

This paper describes the authors' experience with integrating an

existing database-driven teaching file with the RSNA (Radiological Society of

North America) Medical Imaging Resource Center [MIRC). MIRC is the product of

an RSNA-sponsored initiative to enable medical institutions to share their

electronic medical content (images, text, and multimedia) by creating a

distributed repository accessible from the Internet. An existing

database-driven teaching file, developed by the authors and used extensively by

the University of California San Francisco (UCSF) Department of Radiology since

1998, was retrofitted to include an interface for handling broadcast queries

initiated by a MIRC query service. These queries take place through the

exchange of XML documents via HTTP. After all the storage services have

responded, the results are collated by the query service and presented to the

user. The teaching file and MIRC interface were developed using the 4th

Dimension Relational Database Management System (RDBMS). The integration

process primarily involved mapping the "MIRCdocument" schema to the teaching

file's schema, translating the actual MIRC query into the internal query

language of the database and extending the access control mechanisms of the

teaching file to allow public access. A working implementation of the interface

required only 3 days of development time, with refinements taking place over

several months. Interface development was greatly aided by MIRC's use of

well-established Internet standards. This project has demonstrated the

feasibility of implementing a MIRC interface on an existing teaching file

server.

The aim of this study is to determine if network-enabled personal digital assistants (PDAs) can be used to facilitate the timely delivery of urgent radiological exam results by reducing the interval from when the radiologist's initial interpretation is available to when it is first viewed by an emergency department (ED) physician. A web- and Java message service (JMS)-based application was built to replace the original fax-based wet-read procedure. The new system allows radiologists to enter wet-reads from the picture archiving and communication system (PACS) display station and to track discrepancies between the wet-read and final report. It also notifies the ED physicians when exam results are available via the PDAs and permits them to view the full text of the wet-read and final reports from the devices. The new system is compared to the original procedure with the results showing improvements with the wireless method. Furthermore, feedback from a qualitative survey of PDA users was positive, suggesting that PDAs may provide one means for accessing urgent clinical data at the point of care.