The day of a digital radiography installation can be smooth as silk or a rocky road. Nothing is worse than realizing that your digital radiography installer came and left and your digital radiographic unit is not fully functioning. Installation problems are extremely common. Incomplete installs, network issues, firewall issues, and poor training are all problems that we routinely encounter.
Your digital radiography vendor may provide educational tutorials and checklists so that your expectations and implementation steps are well-understood. Take advantage of this information for your staff! If your vendor did not make you aware of any of these tools, visit their websites or just ask! In addition, you can use the following checklist as a guideline to follow.
Before the install:
• Tell your IT person what is going on and make sure that they are available during the day of the installation. Digital radiography installations will require the digital radiography vendor to access your computer network. It is best if you have at 3rd party IT person on your side. Your digital radiography vendor will very much appreciate this. Trust me, it is worth the few bucks it takes to have your IT person standing by during the installation. If you do not have an IT person locally, you can use an IT company that operates remotely .
• If you have any other digital modalities that you would like to hook up to your PACS, be sure to understand if they are DICOM compliant. It is your job to determine if these modalities are DICOM compliant. Call your modality (ultrasound, dental, CT, MRI, etc.) vendor and have information about your modality handy. Be certain that you or someone else is available to troubleshoot modality configuration. It is not the job of your digital radiography vendor to trouble shoot issues with modality configuration if they don't have a representative from the modality available during the installation.
Modality 1: AE TITLE___________, IP address ____________, Port______________.
Modality 2: AE TITLE___________, IP address ____________, Port______________.
Modality 3: AE TITLE___________, IP address ____________, Port______________.
Modality 4: AE TITLE___________, IP address ____________, Port______________.
• Inform your clients and associates that digital radiography will NOT be available until the install is complete. No emergencies. No films. No way. This will generally take 1-2 DAYS. Give your vendor time to do the installation. Don't hover and don't rush them. They will let you know when they are done.
• Expect minor issues during the first day or two of configuration. There are always small problems that arise during the installation. Problems with the x-ray machine or hospital network are common. Expect them. If there are no problems. Consider yourself lucky.
• Organize at least 8-10 test subjects of various size to be available during the day of the install. Pay your technicians. Do whatever it takes to have test animals in the building during the installation.
On the day of the installation:
- Be sure that SEVERAL of your technicians can operate the digital radiography system. Training a single technician is a big mistake. There is a little known morbillovirus that only affects technicians or their kids the day after a digital radiography installation. They always seem to call in sick the day after the vendor leaves. Don't let this happen to you.
- Be sure that each of these technicians can operate the system without allowing the vendor in the radiology suite. “I was able to do it when the installer was here. It seemed so simple when he did it” are common laments among technicians. Don't let this happen to you.
- Radiograph all of your test animals and be sure to radiograph multiple body parts. Radiographing 2 body parts on 10 test animals gives you at least 20 test runs on the day of the install. Practice makes perfect.
- Test your technique chart. If you don't have one, have your vendor make you one. Some digital radiography systems are very forgiving and some require a technique chart. If your vendor supplies you with a technique chart, be sure it works. Don't trust it. Technique charts can be machine dependant.
- If you bought a PACS or image distribution system be sure that the vendor configures as many of your computers as you bought licenses for. Go ahead and view the images on each of these computers. Network configuration issues can derail digital installations. Having your IT person available on the day of the installation will help tremendously.
- Evaluate your images for quality. Be sure that you are happy with the image quality. Be critical. Turn the lights off and really look at them. Many systems require some image tweaking to get things in order. Now is the time to determine if you are happy with the images. Calling the vendor in a few days saying that you are not happy with image quality is inappropriate. If the vendor says “ but you said you were happy with the images the other day” you probably did. Be careful what you say.
- Burn a CD. Better yet, teach all of your front desk staff to burn a CD to give to clients.
- Have your vendor configure your information in your DICOM header. Be sure the vendor includes your institution name in the DICOM header so people receiving your images know where they came from.
- Send a test study to a remote DICOM server. Increasingly, teleradiology is performed on a server to server basis. Sending a study to a remote DICOM server will ensure that you can interface with your radiologist or teleradiology group and will also troubleshoot any firewall issues you may have.
- Review your service contract with your vendor. Know what is included and who you should call for what. Know if there are additional charges for this and that. Many service contracts come with a free “honeymoon period.” Be sure that you understand what charges will be added to your bill in the future. Service contract surprises are common. Be sure that your technicians know who to call if there is a problem. You don't want to have to troubleshoot a digital system issue in the middle of appointments.
- Discuss your backup options with your vendor. Digital images must be backed up. All computers crash and now is the time to think about this. Your system may come with a backup client or a remote archival service. If it does not and you have not thought backing up your images until now, discuss this issue with your vendor immediately and come up with a plan.
- If you have other digital modalities that you will hook up to your PACS system, now that your digital radiography system is in order, you can turn to configuring all of your other modalities. Many vendors will charge extra for configuring your other modalities. Sometimes modality configuration can take some time. Vendors deserve the extra fee for this service if the modality configuration is successful.
Once these items are complete, you can then and only then sign the delivery sheet for the digital system. Be sure not to pay in full for your digital system until all of these items are complete. To hold everyone accountable for what transpired during the day of the installation, you should consider ALL signing the following:
We have collectively confirmed that all of these items were successfully completed
_________________ _________________ ___________________
Veterinarian Vendor Representative Technician Representative