Digital Tools for the Imaging Professional: EHR, PACS Concepts, and Workplace Technology

Why Digital Tools Matter in Radiologic Technology

Modern imaging departments run on digital systems. Film and paper logs have been replaced by electronic health records (EHRs) and Picture Archiving and Communication Systems (PACS). As a limited X-ray operator or radiologic technologist, you will use these tools every shift. Errors made inside these systems — wrong patient selected, wrong image filed — carry the same real-world consequences as positioning errors. Accuracy and verification habits must be just as sharp at the keyboard as at the tube head.

The Electronic Health Record (EHR)

An EHR is a digital record of a patient's health information maintained across a healthcare organization. For the imaging professional, the EHR is where you will:

• Receive and verify the imaging order — a provider must place a valid order before you expose a patient to radiation. Never perform an examination without a verified order.
• Confirm patient identity — before touching the keyboard to open a record, you must confirm at least two patient identifiers. Standard identifiers include the patient's full name and date of birth, or name and medical record number. The room number or bed number alone is never an acceptable identifier.
• Update examination status — you log when the exam begins, when it is complete, and any relevant notes. This creates the legal and billing record of what occurred.

When you open a patient record in an EHR training environment, follow this sequence every time:

1. Search by name and a second identifier — never assume the first result is correct.

2. Confirm the order matches what the patient tells you and what the requesting provider documented.

3. Make your status update, then log out or close the encounter when finished.

These habits are not suggestions. The ARRT Standards of Ethics require truthful and accurate documentation. Falsifying or incorrectly entering EHR data is a violation that can result in loss of credentials.

PACS: Moving Images from Detector to Display

PACS stands for Picture Archiving and Communication System. It is the digital infrastructure that captures, stores, and distributes radiographic images throughout a facility and to remote readers.

Here is the basic workflow for a digital radiograph:

1. Acquisition — the X-ray detector captures the image and sends it to the acquisition workstation.

2. Quality check — the technologist reviews the image for positioning, exposure, and patient identification tags (called DICOM headers).

3. Commit / send — the technologist commits the image to the PACS server. At this point the image is associated with a specific patient folder and accession number.

4. Radiologist retrieval — the interpreting physician opens the study in a diagnostic viewing workstation and reads the images.

The accession number is the unique identifier assigned to a single imaging study. Think of it as the study's social security number. When you retrieve a patient folder in a PACS simulation, recording the correct accession number confirms you are working with the right study for the right patient.

Before committing any image, verify:

• The patient name and date of birth in the DICOM header match the patient you just imaged.
• The correct body part and projection are labeled.
• No prior patient's images remain open on the workstation.

Mistakenly attaching images to the wrong patient folder is a serious patient-safety event. A radiologist reading the wrong patient's chest film could miss a disease or falsely report one. Develop the habit of closing and clearing every prior study before beginning a new one.

DICOM: The Language of Medical Imaging

All medical images in PACS use a standard format called DICOM (Digital Imaging and Communications in Medicine). DICOM is not just a file format — it is a set of standards that ensures images and patient data can be shared between equipment from different manufacturers. Every DICOM image carries a header containing patient name, date of birth, study date, modality, and other metadata. When that header is wrong, the image is wrong — regardless of how good the picture quality is.

Spreadsheets as a Quality-Control Tool

Technique charts — tables listing recommended exposure factors (kVp, mAs, SID, grid use) for each body part and projection — are a quality-control document. Maintaining them accurately reduces repeat exposures, which directly reduces patient dose. Many facilities store technique charts in spreadsheet format. You are responsible for understanding how to:

• Create and label columns clearly.
• Enter numeric data without rounding errors.
• Save files to a designated, backed-up location.
• Use consistent formatting so any staff member can read the chart without confusion.

A technique chart that contains errors will produce repeated retakes and unnecessary patient dose. Keeping it accurate is a professional and ethical responsibility.

Connecting These Skills to Your Credentials

The ARRT exams — both the Limited Scope examination and the full Radiography (RT-R) examination — test content areas that include quality assurance, patient care, and radiation safety. Accurate documentation and correct patient identification are embedded throughout those content areas. State licensing boards also expect that licensed practitioners follow proper documentation standards. Poor habits formed now become costly errors after licensure.