PACS for imaging centers

PACS can be a difficult and confusing decision for any radiology provider, but it can be an even more dynamic question for an outpatient imaging center. Every center represents a unique situation and requires a specialized solution. Typically, most of what is said and discussed about PACS concentrates on solutions and requirements for hospital radiology facilities. Administrators of imaging centers have different problems from hospital administrators, and they need different answers. For imaging centers, the financial justification for PACS may be less immediate than for hospitals. The first thing that must be understood is that no PAC system can make a typical imaging center completely filmless, at least not for quite a while. A hospital has the ability to dictate to its internal referring physicians how a radiological study is delivered, whereas in an imaging center environment, the roles are very much reversed. Once the justification are made for the financial viability of PACS in an imaging center, the next question is how to finance the acquisition of PACS. The decision will depend on how you cost justify your PACS, as well as the shape of your business model, and it will come to a decision between capital purchase or contracting with an application service provider, or ASP. Historically, in the hospital-dominated marketplace, PAC systems have been treated as capital acquisitions. However, for most imaging center, owning the system is more of a problem than a benefit. ASPs increasingly represent a successful alternative for imaging centers. One of the biggest things to consider with PACS is how to store all of those images. There are typically two options, on-site and off-site, with a new "hybrid" option surfacing more recently. Each option has benefits for the user, but the benefits of off-site storage are increasing as the technology advances. Some of the benefits are data security and access. Other issues to address are HIPAA compliance, standardized interfaces such as HL-7, Web access and the choice of view stations.     

Meeting inspection requirements for outpatient imaging centers

This article, by a manager of outpatient services, provides an overview of the inspection requirements for outpatient imaging centers. According to the author, while most freestanding centers are not currently inspected by the JCAHO, they must follow the guidelines of several other agencies. The author provides a list of 57 questions asked by JCAHO surveyors during a recent inspection of her facility.     

Structuring freestanding diagnostic imaging centers for profitability

Many hospitals have or are contemplating establishing freestanding diagnostic imaging centers with members of their medical staff. Some earlier joint ventures between hospitals and their physicians have not met expectations or financial projections. This article describes guidelines for evaluating the operating performance of freestanding imaging centers and is based on the author's assessment of several freestanding centers; it is not intended to depict the results of any one study or operational review. The areas addressed during an operations review should include: management and organizational structure, technologist and support staffing, equipment utilization, non-salary costs, and outside contracts.     

Marketing considerations for diagnostic imaging centers.

Diagnostic imaging centers seek every possible advantage to maintain a successful practice in the face of competition from hospitals and other freestanding operators. Several radiologists and business managers involved in existing or planned centers discuss their marketing strategies, modality choices, organizational structure, and other issues pertinent to the start-up and operation of a viable free-standing operation.     

Medical imaging, PACS, and imaging informatics: retrospective

Historical reviews of PACS (picture archiving and communication system) and imaging informatics development from different points of view have been published in the past (Huang in Euro J Radiol 78:163–176, 2011; Lemke in Euro J Radiol 78:177–183, 2011; Inamura and Jong in Euro J Radiol 78:184–189, 2011). This retrospective attempts to look at the topic from a different angle by identifying certain basic medical imaging inventions in the 1960s and 1970s which had conceptually defined basic components of PACS guiding its course of development in the 1980s and 1990s, as well as subsequent imaging informatics research in the 2000s. In medical imaging, the emphasis was on the innovations at Georgetown University in Washington, DC, in the 1960s and 1970s. During the 1980s and 1990s, research and training support from US government agencies and public and private medical imaging manufacturers became available for training of young talents in biomedical physics and for developing the key components required for PACS development. In the 2000s, computer hardware and software as well as communication networks advanced by leaps and bounds, opening the door for medical imaging informatics to flourish. Because many key components required for the PACS operation were developed by the UCLA PACS Team and its collaborative partners in the 1980s, this presentation is centered on that aspect. During this period, substantial collaborative research efforts by many individual teams in the US and in Japan were highlighted. Credits are due particularly to the Pattern Recognition Laboratory at Georgetown University, and the computed radiography (CR) development at the Fuji Electric Corp. in collaboration with Stanford University in the 1970s; the Image Processing Laboratory at UCLA in the 1980s–1990s; as well as the early PACS development at the Hokkaido University, Sapporo, Japan, in the late 1970s, and film scanner and digital radiography developed by Konishiroku Photo Ind. Co. Ltd. (Konica-Minolta), Japan, in the 1980–1990s. Major support from the US National Institutes of Health and other federal agencies and private medical imaging industry are appreciated. The NATO (North Atlantic Treaty Organization) Advanced Study Institute (ASI) sponsored the International PACS Conference at Evian, France, in 1990, the contents and presentations of which convinced a half dozen high-level US military healthcare personnel, including surgeons and radiologists, that PACS was feasible and would greatly streamline the current military healthcare services. The impact of the post-conference summary by these individuals to their superiors opened the doors for long-term support of PACS development by the US Military Healthcare Services. PACS and imaging informatics have thus emerged as a daily clinical necessity.     

影像科PACS的实施

1材料与方法1·1材料影像采集设备:具有支持DICOM3·0接口的岛津SCT-7000TS螺旋CT机,航天中兴DDR数字摄影机。PACS服务器、DELL服务器,运行Windows Server 2000 SP4,安装有SQL2000中文版。工作站:DELL工作站(配双显示器),报告终端(运行Windows XP),登记工作站(运行Win-dows XP)     

PACS and diagnostic imaging service delivery--a UK perspective

This review sets out the current position with regard to the implementation of PACS throughout the United Kingdom and the impact this has had on improving patient care. In December 2007 England had implemented full hospital-wide PACS in all hospitals: a major achievement in the relatively short time period of three years. The different approaches used by each country of the UK to achieve full national PACS are described in addition to the current issues with the sharing of images and reports across different healthcare organisations with regard to technical solutions, clinical safety and governance. The review gives insight into the changing methods of service delivery to address increasing demand pressures on diagnostic imaging services and how the national PACS implementation, specifically in England, has made a significant contribution to measures to improve efficiencies. The role of Teleradiology is discussed in the context of supporting local patient services rather than undermining them and the concept of cross-healthcare reporting ‘Grids’ is described. Finally, in the summary it is recognised that the vast wealth of knowledge accumulated during the national implementations has placed the UK in a strong position to facilitate full national data sharing across all healthcare organisations to improve patient care.     

Concept of a PACS and imaging informatics-based server for radiation therapy.

Radiation Therapy (RT) is an image-based treatment. It requires images from projection X-rays, computed tomography, magnetic resonance, positron emission tomography, Linear Accelerator for tumor localization, treatment planning and verification of treatment plans. During the treatment process, patient's images are transmitted to every necessary station in the RT department. However, images of the same patient are generally scattered and there is no permanent home base for them due to the nature and traditional organization of the RT department. The advance in diagnostic picture archiving and communication system and the establishment of RT DICOM Standard provide an opportunity to define and design an RT server as a means to organize RT images and related data. This paper describes the RT workflow and the concept of the DICOM RT server. An example of RT treatment of nasopharyngeal carcinoma based on the RT server concept is given.     

Current strategy for the imaging of neuroblastoma

Advances in the management of neuroblastoma lead radiologists and nuclear medicine specialists to optimize their procedures in order to propose a rational use of their techniques, adjusted to the various clinical presentations and to therapeutic management. The aim of this paper is to assess the imaging procedures for the diagnosis and follow-up of neuroblastoma in children according to current therapeutic European protocols. An imaging strategy at diagnosis is first proposed: optimal assessment of local extension of the primary tumour is made with MRI, or spiral-CT when MRI is not available, for all locations except for abdominal tumours for which CT remains the best imaging modality. Metastatic extension is assessed with mIBG scan and liver sonography. Indications for bone metastasis evaluation with either radiological or radionuclide techniques are detailed. Imaging follow-up during treatment for metastatic or unresectable tumours is described. A check-list of radiological main points to be evaluated before surgery is proposed for localized neuroblastoma. The imaging strategy for the diagnosis of "occult" neuroblastoma is considered. Finally, we explain the management of neuroblastoma detected during the prenatal or neonatal period.     

Impact of manual and computer-assisted PACS for automated PACS

Considerations of totally electronic picture archiving system (PACS) often neglect the fact that every radiology practice currently has some system for storing and retrieving images and related alphanumeric data. Although these systems are usually manual, many departments now use on-line computers to help manage film flow. In either event, the creation of electronic PACS can be viewed as a classic data processing problem of automating an existing system, and the conversion should proceed through the usual steps of documenting the existing system in detail, and conducting feasibility studies and cost-benefit analyses. Documenting current systems should be facilitated by computer-assisted PACS--particularly documenting transaction volumes which can be provided as a by-product of radiology information management systems. Similarly cost-benefit analysis should be facilitated, although the cost/benefit ratio may be less favorable when comparing automated to computer-assisted PACS. Finally, information management features such as those provided by current on-line radiology systems provide a framework necessary to realize the full benefits of automated PACS.     

Systems integration for PACS

A successful PACS (Picture Archiving and Communications System) implementation requires an eclectic integration of a number of key technologies. Among these are equipment interfaces, communications, storage, and display. Coincident with this, the software architecture must support a distributed system of heterogeneous structures, provide for protocol and format conversions to a unified system standard, be scalable to accommodate expansion, and provide a measure of fault tolerance. In this paper we survey the current state of the UCLA PACS components and architecture.     

Impact of PACS deployment strategy on dictation turnaround time of chest radiographs

RATIONALE AND OBJECTIVES: The aim of the study is to measure the impact of a picture archive and communication system (PACS) on dictation turnaround time of chest radiographs in a multisite hospital and relate variations across sites to local factors and implementation strategy. MATERIALS AND METHODS: The multisite hospital is composed of three sites. Dictation turnaround time was calculated by using data obtained from the radiology information system for examinations performed during three 90-day periods (immediately before PACS implementation, immediately after PACS implementation, and 1 year after implementation). Productivity, expressed as number of examinations dictated per full-time-equivalent radiologist, also was calculated. For each 3-month period, average interval delay was calculated. Values for average interval delay obtained during the different pre- and post-PACS periods were compared by using analysis of variance. This was done for each hospital. RESULTS: In the immediate post-PACS period at site 1, dictation turnaround time decreased 5% (P < .05), whereas productivity decreased 16.5%. The implementation strategy was revised for the next two sites, and dictation turnaround time decreased 21% (P < .001) in both sites in the immediate post-PACS period. Productivity increased 2% and 3% in these sites. One year after implementation, decreases in turnaround ranged from 28% to 55% (P < .001) in the three sites. CONCLUSION: Our experience suggests that PACSs cannot be isolated from their contexts; therefore, implementation strategy matters in the realization of projected benefits. In addition, regardless of differences in film-based environments before PACS, all three sites benefited from conversion to filmless operation, with the greatest benefits seen in the site that was least efficient before implementation.     

Diagnostic image workstations for PACS

Image workstations will be the ‘window’ to the complex infrastructure of a PACS with its intertwined image modalities (image sources, image data bases and image processing devices) and data processing modalities (patient data bases, departmental and hospital information systems). They will serve for user-to-system dialogues, image display and local processing of data as well as images. Their hardware and software structures have to be optimized towards an efficient throughput and processing of image data.