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All medical staff members will soon be able to get Internet access to diagnostic images and reports through an electronic archiving system that's been praised by the radiologists who've used it for years.

The technology - known as a picture archiving and communication system, or PACS - essentially does away with film-based prints of diagnostic images, and instead presents the images and radiologist reports as computer files stored on a centralized database. The system, which can be accessed via the Internet using a PC, has numerous advantages over old-fashioned film:

• Images from diagnostic tests are available within minutes and can be viewed on any computer connected to the hospital's network, enabling physicians to more promptly make diagnoses and begin treatment.

• The problem of lost or misplaced films is eliminated because all diagnostic images are stored on the centralized database. This improves patient care and saves time, money and storage space.

• Diagnostic images can be viewed by several users at once, allowing physicians in different locations to confer on a case.

• Digitally acquired images can be viewed in different ways by adjusting contrast, magnification and other aspects. This often allows more accurate diagnoses.

• The need to repeat X-rays because of poor image quality will be largely eliminated now that X-ray images will be acquired digitally through a technology called computed radiography.

Digital technology allows CT and MRI images to be rendered as 3-D images, which enhances the representation of large CT and MRI files that routinely contain several hundred images. This capability makes it easier for physicians to manage large amounts of imaging data.

"Everybody who's used the Web browser technology has given it great reviews," said Richard Barth, professor of radiology. "It enhances clinical operations and patient care, and it makes physicians' lives easier." Barth is one of a handful of physicians overseeing implementation of PACS at Stanford and Packard hospitals in a project known as Destination Digital. The multi-phase project is being rolled out under a contract signed two years ago with GE Medical Systems.

Robert Herfkens, professor of diagnostic radiology and the physician director for Destination Digital, explained how PACS makes doctors' lives easier. "Say a surgeon asks me to consult on a patient who had a CT scan here. Under the old system, I'd have to walk to the film library and sort through the films by hand. Now, I just sit at my desk, go to the PACS system, enter the patient's name, select the date (of the study), and within seconds I've retrieved the image."

PACS systems, which were developed in the early 1990s and have evolved steadily since then, have been implemented at a modest but growing number of hospitals nationally. In 1996, Stanford Hospital implemented a PACS system from a company called CEMAX, while the PACS system now being rolled out - known as Centricity PACS - is from GE. (The electronic archive components of the CEMAX system have been integrated with the Centricity system.) While the implementation of Centricity PACS is nearly complete at Packard Children's Hospital and the Blake Wilbur outpatient clinic, the system is still being rolled out at Stanford Hospital.

Radiologists at Stanford have been using the PACS system for six years, and a small number of physicians in other departments began using it late last year. The goal is to roll out Internet access for all interested medical staff members, which will take up to six months.

Meanwhile, the Destination Digital team is working to expand the diagnostic modalities available on the PACS system. Currently, all CT and MRI scans done at both hospitals are stored on the system, as well as X-rays done at Packard Hospital and Blake Wilbur. The next step - expected to be complete by December - will be to digitally acquire all X-rays done at Stanford Hospital. After that, the Destination Digital team will work on digitally acquiring all mammography and nuclear imaging results for both hospitals. (Stanford and Packard hospitals currently have ultrasound exams stored on CEMAX, which will be incorporated into the GE PACS system).

"The ultimate goal is to digitize the entire hospital from an imaging point of view," Herfkens said. To allow optimal viewing of digital X-ray images, the radiology department has about a dozen workstations with high-resolution monitors dedicated to PACS. More of the workstations are being installed in the emergency department, orthopedics, neurology and radiation oncology.

To use Stanford's PACS system, physicians will need a PC that's connected to the hospital's network and operates within its firewall; high-speed Internet access; version 5.5 (or higher) of Internet Explorer; and a logon and password provided by radiology. Digital X-rays are best viewed on a high-resolution workstation, but all other modalities can be viewed on a standard PC monitor.

Barth noted that Web-based access to PACS will particularly benefit community-based referring physicians. Initially the system will be available only on hospital-based computers, but the IT department is testing remote access that would enable referring physicians to use the system from their home or office computer via a secure dial-up connection.

"A number of doctors in the community have been pushing hard" for remote access to the PACS system, Barth said. As a regular user, he understands why. "Physicians crave technology solutions that streamline the workflow in their hectic lives. Web access provides fast, user-friendly access to radiology images and reports."