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| ORIGINAL ARTICLE |
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| Year : 2021 | Volume
: 2
| Issue : 1 | Page : 31-35 |
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Evaluation of knowledge, effectiveness, and challenges of picture archiving and communications system in national orthopaedic hospital Dala-Kano, Nigeria
Adamu Muhammad Saidu1, Nasiru Musa Tahir1, Nuhu Muhammad Salihu1, Mohammed Sidi2, Dahiru Mohammed Yunusa3
1 Department of Radiology, National Orthopaedic Hospital, Kano, Nigeria
2 Department of Medical Radiography, Bayero University Kano, Kano, Nigeria
3 Department of Radiology and Imaging, Federal Medical Centre, Yola, Nigeria
| Date of Submission | 02-Feb-2021 |
| Date of Decision | 26-Mar-2021 |
| Date of Acceptance | 10-May-2021 |
| Date of Web Publication | 22-Jun-2021 |
Correspondence Address:
Dahiru Mohammed Yunusa
Department of Radiology and Imaging, Federal Medical Centre, Yola
Nigeria
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jrmt.jrmt_3_21
Background: Picture Archiving and Communications System (PACS) is a networked group of computers, servers, and archives that can be used to manage digital images, specifically designed for the radiology department. Aims: The study aims at evaluating the knowledge, effectiveness, and challenges of picture archiving and communications system (PACS) in National Orthopaedic Hospital Dala-Kano, Nigeria. Materials and Methods: The study design was cross-sectional, and it was prospectively carried out from July 2020 to December 2020. A total number of 120 semi-structured questionnaires were distributed to consented respondents for the purpose of data collection. The validity and reliability of the questionnaire were tested. The collected data were analyzed using SPSS version 21.0. Results: The results showed that 78 (85%) of the respondents had a better knowledge on how to use PACS, 80 (87%) admitted that PACS saves a lot of their time, and 91 (99%) admitted that PACS improves the quality of their work in providing better patient care. Eighty-five (92%) admitted that images on PACS have diagnostic information and 73 (79%) were satisfied with the quality of images on PACS. Challenges faced by the PACS user include epileptic power supply, unavailability of PACS computers at all service points, slow network, improper patient identification, and sometime poor image quality. Conclusion: This study shows that majority of the respondents had good knowledge of PACS and it was highly effective.
Keywords: Challenges, effectiveness, knowledge, picture archival and communication system
How to cite this article:
Saidu AM, Tahir NM, Salihu NM, Sidi M, Yunusa DM. Evaluation of knowledge, effectiveness, and challenges of picture archiving and communications system in national orthopaedic hospital Dala-Kano, Nigeria. J Radiat Med Trop 2021;2:31-5 |
How to cite this URL:
Saidu AM, Tahir NM, Salihu NM, Sidi M, Yunusa DM. Evaluation of knowledge, effectiveness, and challenges of picture archiving and communications system in national orthopaedic hospital Dala-Kano, Nigeria. J Radiat Med Trop [serial online] 2021 [cited 2023 Jun 5];2:31-5. Available from: http://www.jrmt.org/text.asp?2021/2/1/31/319110 |
| Introduction | |  |
Picture archival and communication system (PACS) is a networked group of computers, servers, and archives that can be used to manage digital images. A PACS can accept any image that is in Digital Imaging and Communications in Medicine (DICOM) format, for which it is set up to receive, whether it is from cardiology, radiology, or pathology. A PACS serves as the file room, reading room, duplicator, and courier.[1] It can provide image access to multiple users at the same time, on-demand images, electronic annotation of images, and specialty image processing.[1] In the 1970s, a joint committee was formed between the American College of Radiology and the National Electronic Manufacturers' Association to develop the standard called DICOM. The DICOM standard does not specify the architecture or even the terminology used between different types of imaging equipment, but it does standardize the transmission behavior of all the devices within a PAC system.[2]
Using PACS in hospitals has innumerable benefits at various levels.[3] At the management level, this technology has direct implications for cost reduction, rendering the film production process redundant. At the departmental level, the technology enhances productivity, as all tasks are performed digitally and swiftly; at the clinical level, image interpretation and diagnosis become more precise and accurate.[4] Despite the abundant benefits of employing PACS, there are some challenges in implementing and using this technology, like necessity to make changes in the workflow, cost, and users' resistance to accept the technology.[5] Another potential problem of a PACS is the fear that medical staff will not have sufficient computer literacy to be able to use the new technology, although this is not expected to be an issue for the majority of the current generation of junior doctors.[6]
The study conducted by Ali et al.,[7] titled “Users” Perspectives on a Picture Archiving and Communication System (PACS): An In-Depth Study in a Teaching Hospital in Kuwait,” reported that the PACS had a positive and productive impact on the radiologists' and technologists' work performance. They were endeavoring to resolve current problems while keeping abreast of advances in PACS technology. In another related study conducted by Maryam et al.,[8] titled “A study of picture archiving and communication system adoption in one hospital: Applying the unified theory of acceptance and use of technology model in Iran,” it was demonstrated that performance expectancy (PE) alone can predict behavioral intention, which leads to the application of PACS. Moreover, the role of effort expectancy, social influence, and facilitating condition was found to be less important than that of PE. However, in a study conducted by Alhajeri and Shah[9] titled “Limitations in and solutions for improving the functionality of PACS: An exploratory study of PACS professional's perspective,” it was reported that, despite ongoing technological developments, the current generation of PACS has limitations that affect PACS functionality leading to unmet needs and requirements of PACS users, which could impact workflow and efficiency in health care. In PACS research and practice, once the system has been adopted and implemented, it becomes imperative to evaluate the technology's effectiveness within an organization.[10] For all practical purposes, evaluation could be defined as “the process of describing the implementation of an information resource and judging its merits and worth.”[11] To the best of our knowledge, no research was conducted on PACS in the study locality since its implementation. Failure to carry out such research will lead to missing some vital information regarding its effectiveness and possible challenges. This study will help the managers and the users of PACS to know the effectiveness and the possible solutions to some of the challenges faced while dealing with PACS. Thus, this research aims at evaluation of knowledge, effectiveness, and challenges of picture archiving and communications system (PACS) in National Orthopaedic Hospital Dala-Kano, Nigeria.
| Materials and Methods | | |
The study design was cross-sectional, and it was prospectively carried out from July 2020 to December 2020. An ethical clearance to conduct the study was sought and obtained from the Research Ethical Committee of National Orthopaedic Hospital Dala-Kano. A total number of 120 semi-structured questionnaires were distributed to consented respondents for the purpose of data collection. The questionnaire was designed to evaluate the knowledge, effectiveness, and challenges of PACS among the users of PACS in National Orthopaedic Hospital Dala-Kano. The questionnaire consists of four sections (A, B, C, and D). Section A of the questionnaire contains the demographic data of the respondents, Section B fielded questions to evaluate the knowledge, Section C fielded questions to evaluate the effectiveness, and Section D fielded questions to evaluate challenges among the users of PACS in National Orthopaedic Hospital Dala-Kano, Nigeria. The questionnaire was validated by the most senior of the authors for this study. A pilot study was conducted and the Cronbach alpha reliability coefficient was found to be 0.824. A consent form was attached to every questionnaire in order to obtain the consent of the respondents. The collected data were analyzed using SPSS version 21.0 (SPSS, IBM, USA) to perform descriptive analysis of the responses obtained from the questionnaires. Pie and bar charts were equally plotted.
| Results | | |
Out of 120 distributed questionnaires, 101 (84.2%) were returned and out of the 101 returned questionnaires, 92 (91.1%) were properly filled. Eighty (87%) respondents were males, while 12 (13%) were females.
[Figure 1] shows that the majority of the respondents (40, 43%) were within 31–40 years of age, 25 (27%) within 21–30 years of age, 18 (20%) within 41–50 years of age, and only a few 9 (10%) were within 51–60 years of age.
[Figure 2] shows that the resident doctors were the majority representing (48, 52%), followed by the radiographers (12, 13%) and then consultants and physiotherapists 11 (12%) each. Radiologists have the least number 3 (3%), followed by staff clinic doctors (7, 8%).
[Figure 3] shows that the majority of the respondents (71, 77%) possessed a first degree, 11 (12%) respondents had fellowship, about 7 (8%) respondents have a master's degree, and 3 (3%) respondents are PhD holders.
[Table 1] shows that 32 (35%) respondents were within 1–5 years of working experience, followed by 23 (25%) respondents within 6–10 years and 17 (18%) were >15 years of working experience. A few (4, 4%) of the respondents had <1 year of working experience, followed by 16 (17%) respondents within 11–15 years.
[Figure 4] shows that 86 (93%) respondents can magnify or minify an image on PACS, 80 (87%) respondents had knowledge on how to retrieve an image on PACS, and 78 (85%) respondents can increase or decrease the contrast of an image on PACS. However, 46 (50%) respondents do not know all the component of PACS.
[Table 2] shows that 80 (87%) respondents admit that PACS saves a lot of their time, 91 (99%) respondents admit that PACS improves the quality of their work in providing better patient care, and the same percentage admit that PACS makes their job to easier to perform.
[Figure 5] shows that 58 (63%) respondents admit that PACS makes their job less stressful and 34 (37%) respondents admit that PACS makes their job extremely less stressful.
[Figure 6] shows that 91 (99%) respondents admit that they enjoyed working with PACS and the same respondents recommended the use of PACS in some other hospitals. Eighty-five (92%) respondents admit that images on PACS have diagnostic information and 73 (79%) respondents were satisfied with the quality of images on PACS. However, 6 (7%) respondents admit that the use of PACS is often boring and a few (5, 5%) of the respondents express that it is difficult to learn how to use PACS.
Other challenges mentioned by the respondents are:
- The quality of images is poor sometimes
- Uploading images onto PACS is difficult some times
- PACS computers were not readily available in all the wards and other points of services
- PACS network is slow sometimes, which causes a delay in making a clinical decision
- An epileptic power supply
- Incorrect patient identifications some time, which make it difficult in the retrieval of images
- It is difficult to copy images from PACS computers to other devices.
The respondents suggested some ways to overcome the challenges highlighted above, thus:
- The quality of images should be improved by radiographers before they are uploaded onto PACS
- PACS main server should always be on to allow the prompt uploading of images
- More computers should be available in all the wards and other points of services to ease image accessibility
- PACS network should be upgraded and the server should always be on
- There should be a constant power supply to the entire hospital
- Radiographer should always ensure proper patient identification before uploading images onto the PACS
- There should be a means of copying/transfer of images from PACS computers to other devices
- There should also need for training and retraining of PACS end users
- Routine maintenance of all the computers used for PACS should be employed.
| Discussions | | |
The results of the current study show that the majority of the respondents (40, 43%) were within 31–40 years of age, as shown in [Figure 1]. This is contrary to the study conducted by Maryam et al.,[8] where they reported that the highest frequency of participants (44.18%) ranged between the age group of 20 and 29 years. This might be due to the availability of a well-structured learning system that allows the graduation of professionals at an earlier age as against what is obtainable in our study population. They also reported that the lowest frequency of respondents was over 50 years of age (2.32%) which is similar to the findings of the current study. The findings of this study, as shown in [Figure 2], are almost similar to the findings reported by Maryam et al.,[8] where they reported that the highest frequency of expertise among the participants was orthopedic (20%, n = 9).
The findings of the current study, as shown in [Figure 3], could be related to the fact that in a clinical setting, higher academic degrees are not much needed, rather a practically oriented knowledge. These findings are similar to the study conducted by Hassan et al.,[5] where they reported that most of the participants (54%) had a bachelor educational degree. The results of this study also show that majority 32 (35%) of the respondents were within 1–5 years of working experience, while a few (4, 4%) of the respondents had <1 year of working experience.
The knowledge of Picture Archiving and Communications Systems (PACS) was assessed, as shown in [Figure 4]. This could be attributed to the fact that we are in the digital era and majority of the respondents had at least a first degree. The findings are almost similar to the study conducted by Ali et al.,[7] where they reported that the respondents' average self-rated level of familiarity with computers was 4.8 ± 1.34 (mean ± standard deviation) on a scale of 1–7 and 41% (24 of 59) of the respondents had earlier experience with PACS before working at the current radiology department.
The effectiveness of PACS was also assessed and PACS was found to be highly effective in the study locality, as shown in [Table 2]. The findings are almost similar to the review conducted by Strickland,[6] where he reported that PACS offers an improved efficiency resulting from electronic data handling, once the image has been uploaded onto PACS, it cannot be lost, stolen, or misfiled and images are always available after a PACS has been installed. The findings are also similar to the research conducted by Ali et al.,[7] where they reported that the PACS had a positive and productive impact on the radiologists' and technologists' work performance.
However, despite PACS was highly effective in the study locality, most of the respondents highlighted some challenges such as difficult in uploading images onto PACS some times, PACS computers were not readily available in all the wards and other points of services, and PACS network is slow sometimes which causes a delay in making a clinical decision. An epileptic power supply was also part of the challenges encountered by the respondents, incorrect patient identifications some time which make it difficult in retrieval of images and difficult to copy images from PACS computers to other devices. The results of this study are almost similar to the research conducted by Alhajeri and Shah,[9] where they reported that the key themes on limitations in the PACS were image transmission problems, network and hardware issues, difficulties in changing settings, issues in hardcoded Digital Imaging and Communication in Medicine attributes, and problems in implementing open-source PACS. However, in spite of these challenges, the results of the current study show that a good number of the respondents accepted the use of PACS, as shown in [Figure 6]. These findings are similar to the research conducted by Hassan et al.,[5] where they reported that PACS was highly accepted in all three emergency departments, especially among specialists.
| Conclusion | | |
This study shows that majority of the respondents had good knowledge of PACS and it was highly effective. Challenges faced by the PACS user include as epileptic power supply, unavailability of PACS computers at all service points, slow network, improper patient identification, and sometime poor image quality.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 2. | Carroll QB. Radiography in the Digital Age: Physics, Exposure, Radiation Biology. Charles C. Thomas, Illinois, USA. 2011. |
| 3. | Vest J, Jung H, Ostrovsky A, Das L, McGinty G. Image sharing technologies and reduction of imaging utilization: A systematic review and meta-analysis. J Am Coll Radiol 2015;12:1371-9. |
| 4. | Duyck P, Pynoo B, Devolder P, Voet T, Adang L, Ovaere D, et al. Monitoring the PACS implementation process in a large university hospital--discrepancies between radiologists and physicians. J Digit Imaging 2010;23:73-80. |
| 5. | Hassan G, Seyed MK, Hammidreza J, Sadrollah M, Hojjatollah K, Soleiman H, et al. User acceptance of picture archiving and communication system in the emergency department. Iran J Radiol 2016;13:1-9. |
| 6. | Strickland NH. PACS (picture archiving and communication systems): Filmless radiology. Arch Dis Child 2000;83:82-6. |
| 7. | Ali JB, Dawood AA, Prem S, Salwa H, Hamza A. Users' perspectives on a picture archiving and communication system (PACS): An in-depth study in a teaching hospital in Kuwait. JMIR Med Inform 2016;4:1-14. |
| 8. | Maryam J, Zahra N, Farakhlaghah M, Akbar H. A study of picture archiving and communication system adoption in one hospital: Applying the unified theory of acceptance and use of technology model, Iran. J Educ Health Promot 2018;7:103. |
| 9. | Alhajeri M, Shah SG. Limitations in and solutions for improving the functionality of picture archiving and communication system: An exploratory study of PACS professionals' perspectives. J Digit Imaging 2018;10:1-27. |
| 10. | Van de Wetering R, Batenburg R. Towards a theory of PACS deployment: An integrative PACS maturity framework. J Digit Imaging 2014;27:337-50. |
| 11. | Friedman C, Ash J. Evaluation Methods in Biomedical Informatics. New York: Springer; 2006. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2]
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