How to copy a blank image to an empty examination

I love this site. You see some great signs in hospitals too. I’m not thinking so much of the official ones but more the ones that are just printed off and tacked up. Like the sign above a computer used by radiology registrars which is headed “How to copy a blank image to an empty examination”.

It gives instructions for two ways to do this. An easy way, and a hard way. The easy way doesn’t look that easy, so I’m guessing that the system designers didn’t anticipate that users would routinely want to copy blank images into empty investigations. Well, why would you?

The answer is interesting, since it tells something about what happens when carefully designed systems are released into the wild. The system in question is a Picture Archiving and Communication System. These systems are the essence of a modern radiology department and deal with the acquisition, storage and display of digital images. I guess a lot of radiologists spend a lot of their working day at PACS workstations.

But if you look at radiology as a component of a healthcare organisation, its function isn’t to produce and store images, its function is to generate reports. The report tells the referring physician what the radiologist can conclude about the patient’s condition. It is the report that the referring physician wants, not the image. And actually, you can have a report without an image. I’m guessing that in scans that are reported in real time, such as ultrasound, the radiologist sometimes forgets to save an image. I imagine too that sometimes patients are entered onto the system in advance of their appointment, so that if they don’t turn up, there is an entry that doesn’t have an image.

So you have a tool, PACS, which is so useful that it becomes the primary tool around which a radiologist organises his or her daily work, but which is performing a function (storing and organising images) which isn’t quite the one the radiologist wants (keeping track of patients, creating and transmitting reports). So when you have a patient who doesn’t have any images (and therefore isn’t on PACS) you get a difficulty. And the simplest way for the busy radiologist to work around this is to copy blank images into empty examinations on PACS.

What I don’t understand, however, is why anyone would want to do it the hard way?