Monday, August 19, 2013

Tornadoes tested imaging information technology at Children’s

By: Stuart A. Royal, M.S., M.D., is Radiologist in Chief at Children’s of Alabama. He holds the Harry M. Burns Endowed Chair in Pediatric Radiology, and is past president of the Society for Pediatric Radiology.
Most of us remember April 27, 2011, the day 62 tornadoes ripped through Alabama. Those violent storms killed 248 people and injured 2,219, many of them children. We at Children’s of Alabama still have vivid memories of that terrible tragedy, and we remember what helped us deal with the flood of trauma victims that day.

There were many medical professionals and working parts of the Children’s system that allowed us to bring top medical care quickly and efficiently to scores of injured patients, and new imaging information technology was one of the keys to coping with the crisis. This technology represents a huge advance for radiology, which translates into better, faster and less expensive care for patients. But we never thought we’d have to use it to that scale.

Typically, radiologists at Children’s perform 10 to 15 CT scans in an overnight period; after the tornadoes, we did 152 CT scans, 10 times the normal flow. Despite the flood of patients, these scans were done accurately, analyzed immediately and sent quickly to the specialists who needed to see them. Our system, which is made by Siemens, functioned perfectly.

Scanning the patients was one thing, but distributing the images was something else entirely. Information technology for CT scans comes in two parts—the RIS (Radiology Information System) and the PACS (Picture Archiving and Communications System).  RIS essentially handles the textual content of scans, and PACS distributes the images to places where they are critically needed, like the ICU, operating room or emergency department.

A single CT scan can produce 1,000 or more images for a single patient. Each image contains about 250,000 pixels. All those pixels have to be moved around in the computer network, and it’s essential that the information stays connected to individual patients. We had the potential for massive information overload since we were handling 10 times our normal load of data. The system handled it without crashing.

Our job during the tornado was further complicated by the fact that we didn’t know the names of some injured children who were rushed to us by people who found them alongside the road. We had to assign temporary identification. There were no mix-ups.

All this shows that you can blend cutting-edge technology into a critical medical situation and make it work.

Of course, an information system like ours is not static; it evolves. We started 10 years ago with our RIS-PACS system, and we have constantly updated it since then. Most recently, we have been connecting to clinics and hospitals within our referral network. This allows us to share CT scans between doctors, medical institutions and even other types of imaging systems that typically are unable to exchange
information because of different, proprietary software. Children’s has contracted with a cloud-based company called SeeMyRadiology. It is basically a website that allows institutions and doctors to upload CT scans into a system where they can be shared, even on iPhone and iPad apps.

For example pediatricians in Birmingham can view CT scans for patients who have been referred from hospitals in Huntsville where the scans were made. In the past, those scans were sometimes transferred with the patient by CD or not at all. Thus, CT scans often had to be repeated, and patients were exposed to more radiation, something of particular concern for children who are much more sensitive to radiation exposure than adults. The system gives physicians at Children’s immediate access to a patient’s CT scan history.

Our cooperation with healthcare professionals and facilities around the state has been cooperative in getting studies uploaded and downloaded properly. It’s extremely efficient and low cost. We use it many times a day because of the acuity of our patients and the large number of referrals we get. In addition, we use the system within our network of pediatricians for a peer review of CT scans, documents and diagnoses. It’s just another way that this new technology allows us to be more accurate and efficient—and most importantly, help patients.


  1. When natural calamities happens, everyone is affected especially, kids. And I'm happy that we have high tech equipments today especially, in medical field that can really help us in our health conditions. :)

  2. an excellent post; thank you for your cogent analysis Steve.
    Check this out too:

  3. With Meaningful Use affecting all aspects of patient care, various Healthcare IT solutions can now integrate with Radiology information system to allow radiologist with better access to radiology records of patients.