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Correspondence |
Digital radiograph imaging has brought obvious benefits to healthcare; for example, images can be viewed just minutes after exposure via computer networks, thus being seen by many people at once in several different locations [1]. However, with the increasing use of digitalization, are patients having access to their digital radiographs? In our hospital, all radiograph images are digitalized. In clinic, there is only one computer terminal in the office, and adjoining examination rooms have no computer access. We conducted a simple prospective audit to assess whether patients attending a fracture clinic were shown their digital radiograph images and what impact this had on their understanding of their condition.
All new patients attending our fracture clinics (Addenbrookes Hospital, Cambridge) over a 4-week period were asked to fill out a simple questionnaire reporting whether or not they had seen their digital radiographs (there are two computer terminals for four examination rooms). If they had seen them, they were asked to report on how useful they had found it using a visual analogue scale (VAS) ranging from 0 (not useful) to 10 (very useful), and whether it had helped them to better understand their injury. Those patients who had not seen their radiographs were asked if they would have liked to view them.
There were 240 new patients with fractures who attended our clinic over the 4-week study period, seeing a total of 12 different doctors (5 consultants, 5 specialist registrars and 2 senior house officers). Of these, 164 patients completed the questionnaire, which gave a 68.3% response rate. 97 patients had seen their radiographs (60%) and the usefulness was rated as 8.2±1.6 (range, 5–10) on the VAS. Of these, almost 90% (87/97) reported that it helped them gain a better understanding of their injury. There were 67 (40%) patients who had not seen their radiographs and 61 (91%) of these stated that they would have liked to have seen them.
Clearly, patients find it very useful to view their radiographs, and approximately 90% reported that it helped them understand their injury better. Furthermore, over 90% of patients who had not seen their radiograph images believed that it would have been helpful to them. The high cost of implementation has clearly impeded the adoption of digital systems, although some cost analyses have shown that the high cost can be justified in a high volume setting [2]. The increase in the overall speed of service, from the request for an examination to reporting, may also justify the high cost. One comparison of the operating and investment costs between conventional and digital systems found that the average total cost of digital technology was 20% lower than that of a conventional system [3].
There are also confidentiality issues associated with the addition of computers to each room, as the terminal screen would need to be cleared in between patients. Nevertheless, in a patient-centred National Health Service [4], patients should have easy access to their radiographs, especially if they express a desire to see them. One of the aims of the modernization programme with regards to technology is to "generate enthusiasm in people about the positive benefits for patient care that technology can bring" [5]. Our audit clearly shows that patients find it extremely useful to view their digital images and it improves understanding of their injuries.
Yours etc.,
Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK. E-mail: nasquraishi{at}hotmail.com
Received for publication November 15, 2007. Revision received December 26, 2007. Accepted for publication January 9, 2008.
References
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