PACS

PACS - Redefining Radiology

A PACS implementation makes available imagery instantly anywhere within the hospital premises

"Proper consulting and a planned implementation will ensure that recovery of the PACS investment happens" - Deepak Sharma CEO Moksha Digital

In this given age hospitals everyday are increasingly looking at quality and efficiency within their organisations. Here, the term 'quality' means to drive patient satisfaction higher with minimal errors and efficiency to ensure quick turn-around times, minimum hospital stays and also ensuring that cost is kept in control. This article talks about modern healthcare enterprises specifically with respect to their imaging departments and how to better manage radiology and workflow solutions.

As medicine goes digital, with patients preferring high resolution digital data for their medical diagnosis, hospitals are going in for the latest imaging devices, which help them acquire digital imagery. After the acquisition of digital images, there is a need for storage, viewing and transportation (communication) of this imagery. The system that allows hospitals to view, store and ship imagery is called a Picture Archival and Communication System (PACS).

The medical images are stored from various medical imaging instruments, such as Magnetic Resonance (MRI), Computed Tomography (CT), Digital X-Ray (DR), Endoscopy, Mammography etc. in a DICOM format. DICOM stands for Digital Imaging and Communications in Medicine. The DICOM standard allows communication between different modalities and also ensures interoperability.

PACS replaces the hard-copy (film) based means of managing medical images, such as film archives. A PACS implementation makes available imagery instantly anywhere within the hospital premises without having to wait for conventional processing to develop film and have someone physically carry them around. It also expands on the possibilities of such conventional systems by providing capabilities of tele-diagnosis, thus allowing physicians to report on a case from a remote location.

Viewer

Images acquired by different modalities such as (CT, MR, US) etc need to be viewed. When a hospital decides to go filmless, it will need to install viewing software on the LAN at convenient locations through-out the hospital. Most wards in the hospital such as chest medicine, orthopaedics etc will need viewing software for the practicing clinician. The clinician views the digital images with post-processing options at the convenience of sitting in their office without having to wait for the film to arrive. In today's era, where hospitals are looking at streamlining their work-flow solutions to serve the patient in an efficient and raise the quality of treatment given, this is a boon. The patient no longer has to wait for the films to be made available. After the patient's trip to the radiology department the patient's images are available with the consulting physician even before the patient returns from the imaging centre. This definitely pushes the throughput of hospitals higher. Also, as clinicians get access to digital data, they get instantaneous and complete access to the imagery without having to order reprints or request for more information from the radiology department.

In many cases, in the traditional work-flow collaboration between clinicians and radiologists is difficult , but in an online environment they can be looking at the same set of images at the same time, being a few hundred metres away or be across the ocean and still collaborate efficiently and in real time.

Storage

Modality manufacturers do not give adequate storage. Hospitals without PACS systems have a difficult time to store and manage their film archives. Dedicated storage areas store their film archives and it is difficult to retrieve previous cases. In many a case films lose their ability to be used for diagnostic purposes and critical data could be lost. In a lot of cases when the patient has misplaced their imaging files, then the patient has to go through unnecessary radiation again while repeating the exam. Again, if the case coming into the hospital was an emergency and if the patient had prior imaging data available in the hospital archives, coupled with EMR records would be a life-saver.

Most PACS vendors will offer you storage based on the hospital's requirements and this could mean savings in space and ensure that the hospital complies with most of the regulations relating to MRD. Also, as storage is getting cheaper by the day, that day is not far when you may never need to delete data. In any case, it is extremely cost-effective to store data electronically as it guarantees immediate access, convenience and safety. Hospitals have the option to create a secondary backup in a remote location for dealing with unforeseen events.

Tele-radiology

Hospitals might have access to the latest modalities but may need the services of a remote radiologist either to provide second opinion or night coverage. Also, resident radiologists may prefer to pull images into their own office over a fast broadband connection than being at site. Most PACS systems will allow connections to be established to its central server over the internet with sufficient security mechanisms in place. Imagine, an emergency case where a patient is rushed in the middle of the night to the emergency wing of the hospital, as soon as the imaging is done, even before the radiologist can drive to the hospital, the images are made available on the home computer of the radiologist and the physician, where they can respond to the situation presented and possibly suggest life saving measures to the hospital staff during the golden hour.

Preparing for PACS

Most hospitals already would have a computer network in place for their HIS systems, with most of the departments being connected to the central server room. PACS can co-exist on the same network provided that the bandwidth requirements are met for the install. As imaging applications are bandwidth intensive, the PACS vendor usually informs you about the network preparedness after ascertaining the state of the hospital network through a network audit. For a successful PACS implementation it is necessary that the hospital plans for the network, segregates and optimises network traffic and provides adequate hardware for hosting the central server which in turn serves multiple clinicians requesting the imagery on the network.

While most clinicians would prefer high quality imagery with post-processing options, it is imperative for the hospital to ensure that enough training happens with the system that is selected to be installed on the hospital premises. User acceptance is the key to eliminate film within the facility and ensure that clinicians use electronic methods only to access the imagery.

The hospital IT staff needs to present their IT requirements in terms of the operating systems being used and database requirements. The IT staff needs to ensure that the incoming PACS is compatible to the existing HIS system for better integration.

Investment

Most hospitals and healthcare settings would have invested significantly on procuring the imaging equipment. But investing on PACS is a decision that many hospitals need help with. With proper planning, much of the operational expenditure can be reduced in terms of film savings and reduced cost of handling film and an increase in throughput driving the utilisation factor higher. Proper consulting and a planned implementation will ensure that recovery of the PACS investment happens. Thus, an investment in PACS is an investment towards the growth and future of any medical institution as it provides a competitive edge in the quality of services. n

deepak@mokshadigital.com