Massachusetts General Hospital spends half the amount of money it used to spend for copies of X-rays and magnetic resonance scans.
The Boston academic medical center also trimmed from its payroll two dozen employees who formerly moved diagnostic film studies throughout the hospital.
Using World Wide Web browsers, the 848-bed hospital, part of Boston-based Partners HealthCare System, achieved $2 million in cost savings in the third year of testing a system for distributing radiology images that's based on the same technology employed in Internet communications.
The breakthrough also enables Massachusetts General to route electronic images to browser-based computers instead of more expensive high-resolution workstations deployed in computerized image management systems until now.
But the switch to Web-powered image distribution has its drawbacks for some, who contend that it affects the quality of the images by reducing the full resolution caregivers require to make an accurate diagnosis.
When it started installing the Web-based system in 1997, Massachusetts General was also implementing a traditional "picture archival communication system," or PACS, which manages and distributes images within a radiology department.
Installing only the PACS, however, was not what the doctor ordered.
"We realized that none of the commercial PACS systems would help us with teleradiology or enterprise image distribution," says James Thrall, M.D., chairman of the radiology department at Massachusetts General and professor of radiology at Harvard Medical School.
Using Web-based diagnostic imaging software provided by Amicas, of Newton, Mass., Massachusetts General now is capable of consulting with radiologists from around the world who can send their images over the Internet for another opinion.
On a daily basis, the hospital uses the system to move images through the medical center itself.
Thrall says the Amicas system enables Massachusetts General to distribute images on Web workstations, which top out at $15,000, compared with the roughly $50,000 needed to buy a traditional PACS workstation.
In addition to offering faster and broader access to diagnostic images, Web-based distribution enables radiologists to see more and do more with those images -- such as zooming in on sections and adjusting the contrast -- than they can with a traditional PACS system, says Hamid Tabatabaie, chief executive officer of Amicas.
But sending images over the World Wide Web requires compression, a process that makes the size of an image file small enough to travel over telephone lines and computer networks, says Paul Chang, M.D., a radiologist at the University of Pittsburgh Medical Center.
Shrinking the size of the image to make it portable on the Internet compromises the quality of that image, says Chang, who explored an alternative technology to provide fast and accurate access to image studies without sacrificing diagnostic quality.
The technology he developed, which is now the basis of a commercial product sold by San Francisco-based Stentor, sends only pieces of the image at a time so that any given section can be viewed in full resolution with no loss of clarity.
For instance, if a physician wants to more closely examine a particular section of an X-ray to see a tumor, he or she can do so without worrying that the electronic format has compromised quality.
Amicas' Tabatabaie grants that compression does discard some of the bits that make up a complete image. Even so, he says, the federal Food and Drug Administration has blessed Amicas' product because the compression it uses does not degrade the image enough to be an impediment to diagnosis.
In addition, products that don't use compression can stress out computer servers when dozens of physicians at once request detailed image slices, according to Tabatabaie.
Thrall emphasizes that Massachusetts General uses less film but is not filmless. Still, the hospital spent about $4 million to print hard-copy images before implementing the Web-based system. Now it spends about half that, he says.
Using digital images instead of film or paper also saves hospital space once occupied by throngs of archived film studies. But storing digital images takes space too -- cyberspace. And the bulky computer files can fill hard drives quickly.
Working to solve that problem is InSite One, a Wallingford, Conn.-based company that maintains a "digital warehouse" for images once the immediate need for them has been met.
The company charges $3.60 per image study per year for the first two years the studies are stored. Thereafter, as the need to frequently access the images decreases, the cost goes down to 24 cents per year.
By comparison, storing hard-copy images can cost as much as $12 per study per year and digital images about $7 if the hospital maintains its own computer archive.