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radiology , sonography , MRI , CT , imaging , diagnostic imaging , X-ray , Xray , dosemetry , interventional radiology , ARRT
FEATURE STORY 07/01/2001
Author: Julia Elliott  
RT Integrates Computer Radiology System
Michael Dolan, RT(R) has been working at the Frankford Hospital in Philadelphia, Pennsylvania since 1984 and is using his experience to enable the 46 employees that report to him every day, to be the best they can be. As Chief Tech and Radiology Supervisor, Dolan is able to provide patient care and still be involved with the technology that goes with it. Together with Tom Stride, Radiology Information Systems Manager, Dolan hopes to integrate a CR (Computer Radiology) system that will provide the cutting edge in technology as part of their quest to make their department technology the best in the area that they serve.

Dolan first became interested in the area of medicine while in high school, when a "very good biology instructor made the field seem interesting." During his years, at Father Judge High School for Boys, the instructors gave Dolan and his classmates "a very good respect for life." Dolan says "they taught us you need to value all life, and they instilled in us that 'a good man is a man who can make life better for others.' The experience of biology and the interest in medicine led me to a choice of either nursing or radiology." As Dolan explains why he chose radiology; "With radiology, you spend time with a number of patients, and your are involved in the diagnosis and treatment." When he got into the field, he was impressed, saying, "What I found was that radiology was a blend of art and science. When you deal with any type of the imaging modalities, there is a technical component, but there is also the aesthetic ability to look back at a study and say that it has some quality as art."

Having performed every possible task involved in the radiology department, Dolan can identify with each one of his employees, because he has been there. He enjoys having his own department and carrying out administrative duties, "but when I get to be involved in patient care, I thoroughly enjoy being in the operating room." Dolan explains that his position allows him to do both. He knows the details that go with each service that his department provides, and he uses that knowledge to encourage his employees to meet the demands to increase productivity and service by means of technology. "I believe that we have an outstanding track record. I work on keeping my staff content and happy through 'creative shift arrangements' that allow the general technologists the ability to go into other areas such as CAT scan, or special studies so they can learn another skill." Dolan explains that this not only aids the technologists, but the department as well. "A good supervisor or administrator is someone that can enable his people to rise to the best of their abilities and not be threatened by his technologists wanting to gain more knowledge" Being in this position himself, Dolan presents a good example of how determination and hard work can result in success.

The Frankford Health Care System (FHCS), that Dolan works for is part of the Jefferson Health System, which has been the main provider of medical services to residents of Northeast Philadelphia, since the original facility opened in 1903. Today it serves a population of 800,000 through three campuses - Frankford, Torresdale, and Bucks County - which provide inpatient and outpatient care, and three outpatient clinics. The 379-bed Frankford Hospital is a Level 2 Trauma Center that handles more trauma cases than any other hospital in the Philadelphia area.

Within five miles of each other, Dolan spends most of his time at the Torresdale campus, and makes weekly trips to the outpatient centers as he oversees the day-to-day operations and patient flow. He maintains quality patient care and participates in planning with other departments' personnel to provide maximum patient care. He also interprets and implements departmental policies and procedures and carries out all necessary training, while overseeing quality assurance. When necessary, he evaluates new equipment, maintains required records in all areas as directed by the department manager, and supervises student technologists.

Although the FHCS is not a full teaching hospital, it does have learning programs, being affiliated with teaching universities through the Jefferson Health System. They often send interns and residents through Frankford as part of their learning experience. Dolan says, "We are a growing, non-profit, community hospital. We focus on providing high quality patient care, exceptional customer service and focus on education and personal development and try to exceed in providing preventive healthcare."

"We have a relationship with Holy Family College (HFC) where we provide the clinical instructions for their students under our supervision." Because of his position, Dolan is a member of HFC's advisory board and is part of the admissions committee, which reviews any candidate wishing to participate in the program, and is on the education committee, where he helps develop curriculum.

FHCS itself has grown rapidly since Dolan joined the staff. " Technologically, we have remained on the cutting edge of medical imaging services. Personally, my encounter here includes going from direct patient care, one-on-one, to a position where I affect how care is provided to all patients," rather than just dealing with one patient, Dolan now oversees the care of all patients who come through the doors. "Due to the concentration of population in this location, this ER alone sees more patients than any other trauma center in the Philadelphia County, with a large percentage of them being motor vehicle accident victims." To help them deal with this fast growing facility, Dolan has joined forces with Tom Stride to enhance the treatment of patients by combining radiology with technology.

Tom Stride runs the systems for radiology at FHCS including Cerner RIS, ALI UltraPACS, Dictaphone Voice dictation system, and EMED Teleradiology. Each department has its own segment of these systems and Stride is working with Dolan on a CR implementation and investigation. The implementation of such a system would enhance the present day system to a large degree. Frankford envisioned a complete radiology PACs (Picture Archive Communication System) at the time of the original ALI UltraPACS ultrasound implementation. The first phase of the digital image management network, installed in 1996, connected ultrasound scanners at the three main sites to ALI UltraPACS. Universal access to exams supported workload balancing between sites while digital review enabled the hospital to save the cost of purchasing, processing, and administering film. Expanding the network system would enable Frankford to extend the benefits of filmless image management to all modalities. The hospital could also take full advantage of its three new light speed CT scanners. Electronic display is a necessity for viewing the large number of images - typically 800 or more - generated by these devices.

Phase two of the digital image management network system connects 25 imaging devices (CT, MRI, NM, US) and three film digitizers spread over six facilities to ALI UltraPACS diagnostic and case viewing workstations. The system can be used to capture approximately 240,000 exams per year. The network hub and archive are located at the Torresdale Campus. Here, two 100GB database and image cluster servers coordinate high-volume network traffic between the sites. Image cluster servers at all three hospitals provide immediate access to recent exams. A Data Exchange Server connects UltraPACS to a TDS HIS/RIS via an STC Datagate Openhub interface engine. DICOM compliance and system scalability will enable Frankford to incorporate CR and image management in the future.

Stride says "instead of having a film copy, all of the images can be digitally transmitted throughout the hospital and viewed on the computer monitor. The real advantage of this system is that we can get information to referring doctors, ER, OR the ICU and radiologist in an efficient manner."

"Medical application of computers has been entered into radiology before," explains Dolan, "but we needed increasing input from the technical area."

"What we are trying to accomplish here is to provide medical imaging to all of our physicians and to all of our facilities including radiation, oncology and the MRI center," Dolan says. "Currently we are looking for a CR system, which will be the final piece of the puzzle. We don't really have that much room to grow, so CR is going to solve the problem we are going to face with workflow."

Stride further explains the result of the CR implementation by adding; "The main advantage with the PAC system is that you are going to get all of this vital information to the doctors and others areas in record time, with better patient care, allowing them to leave the ER sooner, complete the procedure quicker, and be able to diagnose quicker. It is actually going to reduce costs because we do not have the overhead of film costs and developing chemicals. Instead of waiting for the film to be processed and read, and then be sent out, these results will now be available in minutes. Right now, we are working on the internal hospitals within our own Internet, and we can send images to the OR and actually do teleconferencing for all of the facilities."

The next step is to put a web-based client out to the physicians and tap into the hospital network to view images. "This technology is the only one of its kind in the Philadelphia area, and no facility is close to integrating the whole package as close as FHCS. Once the CR system is installed, it will be the most outstanding imaging center in the area. The concept has been out there," explains Dolan, "but it wasn't until Tom Stride joined us that we have been able to tie in all of the technology, where others haven't been able to. Other facilities have bits and pieces, but we will be able to say that our diagnostic radiology, ultrasound, nuclear medicine, CAT scan and MRI will all be available to physicians on a PAC system."

As Dolan focuses on the issue of consults and conferencing," he explains. "What Tom Stride has accomplished for us is that we could have a surgeon at Frankford Torresdale, a specialist at the at Frankford's main facility and a radiologist at the Bucks' campus all view the same image at the same time," pointing out the time saved because they don't have set up meetings or in-person consults.

This project has been in the works for about a year and a half, and the last piece of the puzzle is to get CR integrated. Once that happens, then they will move over to voice recognition, and Dolan says, "this completion could possibly take up to three years. Our administration is supportive of this technology and helpful in allowing us to go forward with it."

Although Dolan enjoys his administrative position, he agrees that there is a bit of stress involved, but, he says, "If you truly learn to work with your people and enable your support staff, it can be done. I am fortunate to have Diane Rooney, RT, and Marianne Bair, RT, my lead techs, and people like Tom Stride and the other radiology supervisors in our administration that help keep the stress level down, as long as everyone is on the same page. The mission is to do what is best for the patient. Put all egos and everything else aside, what is best for the patient comes first."

Michael Dolan R.T. (R), native of Pennsylvania, graduated from the Community College of Philadelphia in 1984, and earned his Associates Degree as a Radiology Tech. Dolan is a member of the ARRT, ASRT, and the Philadelphia Society of Radiologic Technologists He has held the past positions of secretary and vice president within the Philadelphia Society of RT.

Julia Elliott is a freelance writer from New York. She is on the editorial staff of NEWS-Line for Radiology Professionals.
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