PACS: the silent revolution

More than 15 years ago the idea of a Picture Archiving and Communication System (PACS) and a filmless hospital was created. In a PACS environment images are acquired, read, communicated and stored digitally. After many years of unsuccessful attempts and prototype installations, the necessary hardware components for a successful PACS installation are now readily available. However, software development is still lagging behind. Only very recently, software developers have realized that it is not sufficient for PACS software to store, communicate and display images, but that PACS software should effectively support the radiologist in the task of interpreting and communicating imaging findings through context-dependent default display arrangements, work-flow management, radiological and hospital information systems integration, and computer-assisted diagnosis. This review examines hard- and software requirements for efficient PACS operation, analyses costs and benefits, and discusses future developments. Received: 26 October 1998; Revision received: 11 January 1999; Accepted: 4 February 1999     

Soviet space flight: the human element

Building on past experience and knowledge, the Soviet manned space flight effort has become broad, comprehensive, and forward-looking. Their long-running space station program has provided the capabilities to investigate long-term effects of microgravity on human physiology and behavior, and test various countermeasures against microgravity-induced physiological deconditioning. Since the beginning of Soviet manned space flight, the biomedical training and preparation of cosmonauts has evolved from a process that increased human tolerance to space flight factors, to a system of interrelated measures to prepare cosmonauts physically and psychologically to live and work in space. Currently, the Soviet Union is constructing a multimodular space station, the Mir. With the emergence of dedicated laboratory modules, the Soviets have begun the transition from small-scale experimental research to large-scale production activities and specialized scientific work in space. In the future, additional laboratory modules will be added, including one dedicated to biomedical research, called the "Medilab." The longest manned space flight to date (326 d) has been completed by the Soviets. The biomedical effects of previous long-duration flights, and perhaps those of still greater length, may contribute important insight into the possibility of extended missions beyond Earth, such as a voyage to Mars.     

PACS: the second time around

Conquest Hospital was a Picture Archiving and Communication Systems development site, designed to inform the specification of low cost systems and to provide information on benefits and drawbacks. The American College of Radiologists/National Electrical Manufacturers Association 2.0 protocol was used for image management. The Regional Health Authority sponsored the system, initially installed in mid 1992. It used a high-speed dedicated optical fibre distributed data interface network and for teleradiology an Integrated Services Digital Network solution. Image and other data were captured and archived satisfactorily. Image reporting folders were manually constructed and sent to reporting viewstations. Radiologists were able to directly request 'ad hoc' images from archive. The reporting function of the associated but unlinked radiology information system was satisfactory. Identification was made of data transfer, ergonomic, single point of failure and many other issues. These informed re-specification and the commercial approach for a Digital Images Communication in Medicine/Hyper Text Mark-up Language Picture Archiving and Communication System, the first stages of which have been whole hospital re-networking, Intranet introduction, installation of new Computed Radiography/Fluorography and Computed Tomography/Magnetic Resonance Imaging segments and a new Radiology Information System. The Picture Archiving and Communication System is now seen as part of a full Electronic Patient Record system. Networking and provision of high quality Personal Computer hardware for data review are seen as a corporate responsibility and a hospital overhead, no longer borne by individual projects. Our present work is synergistic with the procurement of a new Clinical Information System and the further development of the hospital Intranet.     

PACS系统中常见的问题及解决方法

我院较早就使用了ＰＡＣＳ系统 ,给放射科医生带来了巨大便利 ,也给医院带来了实惠。ＰＡＣＳ是一个涉及多种技术领域的综合性高技术应用项目 ,日常的维护工作量很大[1 ] 。我们在日常的维护工作中积累了不少成功的经验。本文是笔者对本院ＰＡＣＳ系统并结合国内一些知名ＰＡＣ     

Mastering the PACS RFP

The level of a realized picture archiving and communications system (PACS) benefit is dependent upon a careful approach to choosing a vendor that will satisfy the specific requirements of an organization, including architecture, storage, networking, hardware specifications, user interfaces, and workflow. The request for proposal (RFP) process serves to provide a systematic approach to requesting, receiving, scoring, and awarding competitive bids for contracts. Typically, administrators (and vendors) must endure a very arduous process before a vendor is ultimately selected. This can take as much as 9, 12, or even 18 months. A significant problem with the legacy RFP is the length of time the process can take. If the decision point is determined to be 12 to 18 months in the future, much of the data in a fast-changing industry will be irrelevant right now. A dynamic RFP is conducted in 3 to 5 months, depending on the product or service being reviewed. This shortened timeline will provide a better chance of having the right people on the steering committee. A shorter timeline also increases the accuracy of the steering RFP decision. The dynamic RFP creates a level playing field that will enable the committee to select the right vendor. This level playing field can be created through weighting, on-site demonstrations, and vendor presentations.     

医院PACS系统的应用和管理

PACS系统是近年来计算机技术、网络技术和数字化成像技术协同发展的结果，本文旨在论述我院PACS的应用和管理情况。我们热切希望本文将对国内正在兴起的PACS建设有一定的借鉴意义。     

PACS: effect on incidental findings

Previous studies have addressed the increased volume of incidental findings when interpreting MRI lumbar spine studies after the implementation of a picture archiving and communication system (PACS). The purpose of this study is to confirm prior findings and contribute additional knowledge that supports the use of technology in complimenting the quality of patient care. Lumbar spine interpretations were reprinted from 900 studies and individually reviewed. These lumbar spine studies were performed on a 1.5-tesla magnet. Included were 300 consecutive lumbar spine reports over a two year period: four months prior to PACS introduction, four months during the transition to PACS, and four months post PACS implementation. Reports stating incidental findings were tabulated, along with the frequency patient gender, age, location (outpatient, inpatient or emergency room), reporting radiologist, specific finding and radiologist recommendations in each case were documented. The number of incidental findings increased from five pre-PACS to nine during the transition phase to PACS, followed by 11 post-PACS. This results in a maximum increase of 120 percent from pre- to post-PACS. The most common incidental findings include renal mass, cyst or lesions, aortic aneurysms and lymph node abnormalities. Statistical data confirms that the implementation of PACS into a radiology practice for MRI lumbar spine imaging appears to have a beneficial impact on the number of reported incidental findings and recommended follow-up studies.     

PACS: current status and cost-effectiveness

European Radiology -     

PACS: use in routine operations

In the Department of Radiology at the University of Graz, parts of a picture archiving and communication system (PACS) are routinely used. The PACS includes 4 CT scanner, an evaluation console, an MR scanner, a diagnostic console with three monitors and an archive with two drives for optical disks. All the CT examinations are archived on optical disk. It is possible to store up to 26,000 images on one optical disk. The management of the archived images and the retrieval is done by a radiological information system (RIS). There are no problems with the transfer rates and network capacity. Failures that occur during the routine work may spread out and hamper the routine. Reporting on the diagnostic console is still not routinely accepted.     

PACS磁盘阵列故障修复2例

磁盘阵列RAID(redundant arrays of inexpensive disks)是目前PACS常用的数据存储介质,本院影像科PACS从建立投入使用到现在磁盘阵列出现了2例比较大的故障,现将该故障及处理过程整理列出供同行参考.     

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)