I have never really considered imaging without interpretation. Sorry! This must be a legal nightmare - I'm imagining a missed pneumothorax, fluid collection (Not always obvious when supine). That said, something is often better than nothing. Were you in the military? I assume this would be more trauma type work, which tends to be a bit easier for identifying badness. However the working conditions would be somewhat worse I imagine (I have been hospital/clinic based). I would have thought that the most useful type of imaging I the fields would be ultrasound for finding a decent vessel to jab or guiding some sort of drainage (chest fluid, ascites etc). What was most your work?
Sorry rdl, I cant seem to reply to your comment below (comment to deep?), thats some great experience. There must be a few hairy stories from that period. What was your company's product name (No problem if you cant post this). Ive used Agfa, IntelliPacs, Kodak (didnt enjoy).
From 2008-2010 I worked for medweb (company and product, it's a small/private business, doesn't make imaging devices, just software and packaged PACS); it's an ActiveX based viewer, really low end but also a cutting edge idea back in 1997 or so when they invented it. They ended up making a super lightweight system with the PACS server on a laptop, too.
AGFA was probably my least unfavorite, although IIRC they were really expensive. (In Kanadahar, the Canadian Forces who ran the medical role 3 until 2010 were using a pirated version of the software; they kept re-installing a trial license and hacking the date to work!) Really none of them were amazing, although I did really like the high-megapixel Barco monitors.
I've talked to some people doing an interesting cloud-hosted PACS (although they're in private beta, I see them listed in various places, so I think they're public -- radiology.io, now clariso.com.)
The sector is ripe for a grand slam by a good, integrated system. Decent CD/DVD printers that don't cost $20k US (for the damn referrers that insist on some kind of physical product), decent Mac and PC compatibility. Software that talks to GE, Siemens, Philips, Toshiba hardware in a reasonable manner. The ability to edit bad data easily and have it update remote workstations properly. Be easily searchable (Let me set up customised searches PLEASE - last 3 days of imaging off the scanner right by me for example). There are so many pieces to the puzzle and all seem to actively break each other. It's a hell of a mess at the moment.
You should talk to the Clariso guys -- I think they're US focused but really smart. Talking DICOM to the various modalities isn't that big a deal (although they all have weird bugs, and DICOM is a disgusting protocol), but good support for those stupid Plasmon archivers would be useful, or just figuring out a good client support option for local-to-workstation DVD burners. As for interop, the big issue is usually HL7/HIS integration at hospitals (for DoD, it was AHLTA, and for the VA, Vista, and for everyone else, usually EPIC but sometimes Practice Fusion). I think even the worst PACS is usually better than most hospital HIS/EHR.
It was really funny when I was supporting an ActiveX-based system and every single one of the doctors had a Mac personally, and I used a Mac running VMware windows as my primary machine. I think the percentage of radiologists (or really, doctors in general) using Macs is >75%, but the hospital deployments are always Windows.
One good way for a new PACS or RIS to get started would be in training environments. Telerad is the other good way (sending CTs, and usually several studies, over a VSAT network with ~16/4M bandwidth for all of theater, was interesting -- especially since the goal was to always beat the patient to the facility to give surgical teams time to study the studies. Easy for the 8h ride to Landstuhl, hard for the <60 minute medevac helecopter from Jalalabad to Bagram.)
What surprised me is a lot of people wanted to at least be able to read reports (and usually look at images) on an iPad. Some rads even wanted to read on an iPhone screen (!!!) so they didn't have to get out of bed, although that was for things like sprained ankles and they'd read for real the next day. A Retina iPad is a pretty adequate device, though, honestly; it would be amazing to see what a Retina MacBook Pro 15 could do. (for everyone else, a radiology monitor is often $10-20k and approximately Retina resolution; there are some special FDA regulations about the screens for uniformity, but fundamentally they're 2-3x overpriced for what they are. A decent IPS LCD is perfectly adequate in many cases, particularly for CT/MR/US which are low resolution; mammography is the main area where really high quality screens matter (often black and white, 3-5MP). And the high quality screen really only matters for a radiologist; for every other doctor reviewing the images, a good quality normal monitor is perfectly adequate, as the rad writes a text report and marks up the images to identify anything important.)
I worked for a small PACS vendor (mainly IT support and network engineering, and satellite network stuff, but also training rads, techs, and other doctors on how to use the image viewer, report writer, etc.) which was used for dod and others in iraq/afghanistan/kuwait/etc, and spent 2 years in Afghanistan (enh), Kuwait (awesome), and Iraq (been there, done that, was kind of boring by 2010). Also by the federal bureau of prisons, and some cruise lines.
Before that I was doing satellite/wireless/etc. networking, and some of my customers were various SOF who had fairly badass medics (regular army SF 18D is probably better than a civilian paramedic, at least for trauma, and the "other" guys had people beyond that, including some actual MDs who were also shooters). I did "combat lifesaver" class and then spent a lot of my spare time hanging out with the SF or SOF medics (because they tended to be more interesting than the shooters). I got some of the rad techs to teach me the basics of how to get decent images from CR/DR/CT/US, since I was trying to figure out which problems were caused by technique, which were caused by emitters or tables, which were caused by plates or scanners, and which were caused by our system. I kind of want to do an EMT course when I have time here, although I'm not sure where I'd volunteer to keep the skills current after that.
Before all of this I actually lived out in Baghdad for most of 2004/2005 with ~zero medical care or really any professional support (2 Americans, 100+ Iraqis), so it was mostly "learn anything you might possibly need well enough to do it yourself", and "don't get shot").
There were also civil affairs/outreach efforts, and some charity efforts (rotary club) to bring medical care to civilian population, which was weird, since Kabul had a private hospital with a 64-slice CT (when DOD had 16 and 32), and there was a private 2 Tesla MR in Jalalabad.
Mostly I was in "role 3" facilities, which were essentially as good a level 2 trauma center and a little bit of additional facility in the US. Also went to "role 2" (which were essentially 5-10 doctors, plus nurses and techs, with a couple of trauma bays, and X-Ray and US but not usually CT, and some of the FSTs (who augmented role 2 with much better surgical capabilities). In general the equipment and staff were top-notch, and the only problems were physical facilities. CTs tended to be in shipping containers, and the Army CSHes were big tent farms (which sucked), while USN and USAF tended to build fairly decent hardstand buildings (not as good as Stanford, but better than most of the rural counties).
On the issue of imaging without interpretation -- it's kind of funny. One of the big DoD pushes was to go back and have a radiologist read and issue an official report for every image shot of a US patient from the start of operations (2001/2002), in ... 2009 or 2010. There is the benefit that US people can't sue the government for malpractice, and Iraqis/Afghans aren't really in a position to sue, either (arguably the only ones with standing would be enemy combatants held in US custody).
