Agfa's healthcare IT solutions meet teleradiology needs of Umbrian hospitals

In June 2005, the Ausl 2 hospital group in Umbria, Italy, launched a teleradiology network in collaboration with Agfa, which supplied all of the technologies for the digital acquisition of images and the management of images on the network, and is based on Agfa’s RIS/PACS (Radiology Information System/Picture Archiving Communications System) and CR (Computed Radiography) solutions for radiology and digital mammography systems in place at the hospital sites.

At the start of June 2005, USL 2 in Umbria inaugurated a diagnostic teleradiology service to link the five centres, the Unified Hospital Facilities of Assisi, Marsciano, Todi, Città della Pieve and Castiglione del Lago and the 2nd-level Intensive Rehabilitation Hospital in Passignano with the diagnostic neuroradiology centre operating at the hospital of Terni. The new teleradiology service was developed in collaboration with Agfa, who supplied all the technologies for the digital acquisition of images and their management on the network.
In June 2005, the Ausl 2 in Umbria launched a diagnostic teleradiology service for emergencies. This service connects the five hospitals of Assisi, Marsciano, Todi, Città della Pieve, Castiglione del Lago, and the Rehabilitation Center of Passignano with the Center for Diagnostic Neuroradiology of the Terni hospital. The new teleradiology service was developed in collaboration with Agfa, who provided all the technologies for the digital acquisition of images and their management on the network.

Teleradiology at the area's service

The Ausl 2 in Umbria, which launched the project in collaboration with Agfa, is a hospital group that serves a population of about 340,000 inhabitants in the largest area of the Umbria region. It has a total staff of about 2,000 employees with over 500 doctors operating within the service. The area served, equivalent to 2,500 square kilometers (1,500 square miles), includes the Perugia hospital and five other hospitals functionally grouped under the Unified Hospital Facilities, where 175 doctors work and an average of about 20,000 patients are admitted every year. The Second-Level Rehabilitation Center in Passignano and two outpatient radiology services, one of which is entirely dedicated to breast diagnosis, work in close collaboration with these sites.

"Teleradiology is an enormous step forward for all medical diagnostics, and the Agfa solutions do not benefit the patients only, they safeguard the presence of smaller facilities across the area and help to protect the activity of the doctors who work there."
Dr. Alessandro Truffarelli, General Manager, Ausl 2

The entire workflow of this major system is digital. The five hospitals of Assisi, Marsciano, Todi, Città della Pieve, Castiglione del Lago and the Rehabilitation Center of Passignano have, in all, two DR Mammo systems for direct computerized mammography, five Agfa CR solutions and three CT scanners. Each site connected to the network has an independent IMPAX system with a server that saves the scans in DICOM format and sends a copy of them, when required, to the neuroradiology center at the hospital in Terni. Image review takes place on IMPAX DS3000 diagnostic display stations, and images can be accessed via a web browser in IMPAX WEB1000.

"Agfa's RIS and PACS have integrated perfectly with our telecommunications tools," explains Alfiero Ortali, Information and Data Communications Technologies Staff Manager, Ausl 2. The wide area networks of Umbria AsNet and ComNet, which connect the hospital facilities in the area with the specialized center in Terni, act as a backbone for Agfa's Elefante.Net RIS and IMPAX WEB1000 applications, which carry diagnostic images and data throughout the network.

"What I have appreciated most of all is Agfa's willingness to move in new directions, sharing the difficulties and solutions developed with us, step by step."
Dr. Amedeo Antoniella, Head of the Diagnostic Imaging Department, Ausl 2

According to staff at Ausl 2, Agfa's solutions ensure efficiency along the digital channel as well as absolute reliability as to the quality of the images sent - one of the most critical aspects of teleradiology technology. "We have carried out numerous tests on the conformance of the quality of the radiological image on departure and on arrival at the DS3000 diagnostic display stations," explains Dr. Fausto Chionne, Manager of the Physical Health Staff Unit at Ausl 2. "The solution has been found to be extremely reliable."

In a maximum time of thirty minutes, the radiological images travel from the network to the neuroradiology center in Terni, where reports are drawn up and sent back to the local doctors, without having to move the patient until the correct diagnosis has been made. Reliability, efficiency and speed are the primary features of the teleradiology service between the two Umbrian public health institutions, which has produced concrete benefits for both the patients and the Ausl 2, including significant savings due to the more effective use of human resources distributed across the area and the possibility of avoiding transfers of patients by ambulance for hundreds of kilometers.

The digital signature

In Italy, there is currently no legislation in place governing the use of remote diagnostic imaging tools. The Ausl 2 project team had to identify and resolve the related legal challenges as they moved forward. "Due to the flexibility of the solution offered by Agfa, our specialists can use the digital signature, to give the reports legal value," says Dr. Chionne.

All radiologists who log on to the network have a Smart Card, the size of a credit card, containing a microchip, which matches the identity of the radiologist with the report sent on the network. This signature means that staff at Terni do not have to worry about the value and the other legal aspects of the digital image reports.

The growth of a partnership

In its first four months of activity, from June to September 2005, the Ausl 2 teleradiology service has been used to successfully report on over 200 CT scans of the head and more than 50 traditional radiological examinations. These numbers are bound to increase with the introduction of an assistance service throughout the weekends, which will be provided through a more efficient use of the professional resources distributed across the area served by the network. The health managers of Umbria also intend to develop mammographic screening across the area for the prevention of breast cancer, by connecting the Agfa mammography systems in place at the hospitals to the digital radiodiagnosis unit in Perugia where four mammographic specialists work full time.

"We have carried out numerous tests on the conformance of the quality of the radiological image on departure and on arrival at the IMPAX DS3000 diagnostic display stations and the solution has been found to be extremely reliable."
Dr. Fausto Chionne, Manager of the Physical Health Staff Unit, Ausl 2

From this point forward, the Ausl 2 teleradiology service will develop in three directions. First, connections will be established with the information systems of other public authorities, such as the Inail site in Perugia, enabling consultation of the images by general practitioners and unification of the archives. "Today, each site has its own IMPAX system and its own archive. The aim for the coming years is to unify the management systems and develop uniform criteria for generating the identification number of each patient. Agfa has already given proof of its reliability in integrating the PACS systems present on the network," says Alfiero Ortali.

"Agfa's RIS and PACS have integrated perfectly with our network facilities already operating in the area."
Alfiero Ortali, Information and Data Communications Technology Service Staff Manager, Ausl 2

The general practitioners, connected in VPN mode over the internet to the central server, may consult the digital radiological reports and images of their patients. Agfa's software will manage the connections and make the images available by generating automatically, or from the files in DICOM standard, copies in JPEG format, which can be viewed on the screens of regular office PCs.

Agfa's contribution

Answering hospital challenges with new technological approaches, such as supporting digital signature for legal challenges, or managing VPN connections for GPs
Provide a completely digital radiology workflow with integrated CR/RIS/PACS solutions
Integrate healthcare IT solutions with existing IT and telecom infrastructure
Test reliability in the field and assure conformity with hospital standards