1. Voice Recognition & PACS Integration Dr Richard Harries, FRCR, MD Northern Lincolnshire and Goole NHS Trust

2. Speech recognition? …met a tart so fell on Gill… (metatarsophalangeal)

3. Why Introduce VR?  Because its fun  To save time  Shortage of Secretaries  To reduce typing errors

4. What time savings? Dictate Audio transcription & correction Authorisation Print & distribute

5. What time savings?  +.5 secretary per radiologist?  -.1 radiologist initially?

6. VR - The disadvantages?  Can’t change report once ‘committed’  Can’t leave messages for secretary  Radiologist has to ‘correct’ for full benefit  Learning curve  Adjustment of dictation technique  Large sound files for remote working  Software ‘crashes’  Integration with imaging system

7. VR - The advantages  Faster and more reliable work throughput  Immediate printed reports (if necessary)  Reports out-of-hours  Complete work before absences  Secretaries have a learning curve  Secretaries occasionally ‘crash’

8. VR - How accurate?  The words VR finds difficult –numbers –the –s–s–s–s –mesenteric –Scoliosis  Accuracy - >99% after training

9. This report includes all attendances from 9/5/03227/5/03. Chests (attendance numbers 1255679 and 1 to 3 for right 67) On examination 2, there is patchy increased density in both lower zones but I suspect that this is old. There is no obvious recent abnormality. On examination 3, there is an endotracheal tube in situ (its tip is 3 cm above the carina). There is also a right jugular line. There is calcification overlying both hemidiaphragms and in the right The [right paravertebral] region (this was also present on the previous film). On examination 5, the endotracheal tube and jugular line has been removed. The lung fields remain unchanged. The pelvis and hips There is an intertrochanteric fracture of the right femur, subsequently internally fixed with a DHS in satisfactory position.

10. VR - the two methods  On-line transcription –Distracting? –Quicker overall? –Corrections?  Off-line transcription

11. VR - the Process DictateVR Transcription Correction Sound Database Sound files Acoustic adaptation Context adaptation

12. VR - The hardware Office PC RIS Server VR Server

13. VR - Model 1 Dictate VR transcription Correction & authorisation Print & distribute

14. VR - Model 2 Dictate VR transcription Authorisation Print & distribute Correction

15. Should secretaries check reports?  Reduces potential time savings  Reduces short-term work for radiologist  Slows ‘learning’ process for VR

16. Maintenance tasks?  Acoustical Adaptation  Context Adaptation  Installation of new users

17. Acoustical Adaptation  Matches waveforms to known words  ~15mins/day/radiologist

18. Context Adaptation  Database of probabilities of word juxtapositions Rapid filling Rapid – filling – 80% Rabbit – filling – 0% Rapid – feeling – 5% Rabbit – feeling – 0%

19. Context Adaptation ?1287883 √ 2399540 √ 2547762 ? 1299048 ? 3288473 √ 1129489

20. Context Adaptation. ? 1289344,2390045 Integratian Watermark Rabbit Ischemia

21. Who does the maintenance?  Secretary – won’t know individual radiologists’ speech nuances  Office manager - ditto  Radiologist – takes more time initially but improves accuracy more rapidly

22. Integrating VR with PACS  VR-RIS integration  PACS-RIS ‘Desktop integration’  Minimises processes  Ensures correct patient & report

23. VR-RIS-PACS Integration PACS RIS VR

24. VR - Integration with RIS  Initial experiences –Slow and tedious –Word crashes  And then… –Full Integration - Slick

25.  In context……..

26. What VR packages are available?  Philips SpeechMagic  Dictaphone  Dragon

27. How popular is VR?  8 SpeechMagic installations

28. How much does it cost?  VR Server - ~2k  License - ~3k  Speech Mike - ~£300

29. Who should use VR?  Nobody.  Departments ‘short’ of secretaries  Enthusiasts  At least one technophile per department

30. Speech Recognition - Summary  Can improve reporting efficiency significantly  Can save significant amounts of secretarial time  Can be cost effective  Requires enthusiasm and committment