Picture Archiving And Communication System Implementation Research Articles

The Impact of Implementing a Picture Archiving and Communication System (PACS) on Minimum Service Standards in the Field of Radiology

The use of Picture Archiving and Communication System (PACS) has become an important step to increase the efficiency of radiology services. With PACS, fast access and flexibility in accessing patient medical images has had a major impact on reducing waiting times for radiology examination results. The aim of this research is to determine the waiting time for radiology services at the UPTD Embung Fatimah Regional Hospital, Batam City after implementing PACS. The research uses a mix-method method, namely research that combines quantitative and qualitative methods. Quantitative method by collecting service time data. Qualitative method by conducting in-depth interviews (in-depth interviews) and focus group discussions (FGD) to obtain information on perceptions from service implementers and users, then researchers will assess the impact of PACS on Minimum Service Standards (SPM) in the field of radiology at UPTD RSUD Embung Fatimah Batam city.The results of this research are that the use of PACS has significantly reduced radiology service time at the UPTD Embung Fatimah Regional Hospital, Batam City. There was a significant decrease in service time for outpatient services previously from 101.09 minutes to 62 minutes or 35.3%, for inpatient services from 108.26 minutes to 65.6 minutes or 41.04% and for CITO patients from 104.27 minutes to 60.5 minutes or 41.06% after application of PACS. The views of radiologists and radiographers regarding the differences in the quality of radiology services before and after using the PACS system show that there are better changes in the efficiency and quality of radiology services in hospitals. Stakeholder perceptions related to the speed of radiology service time after using the PACS system through various factors are considered to have a positive impact. Implementation of PACS clearly shows the potential for improving the efficiency, speed, and overall quality of radiology services. There was a significant reduction in waiting time for radiology examination services at the UPTD Embung Fatimah Hospital, Batam City after the implementation of PACS, which can provide an alternative in changing workflow and efficiency of radiology services.

Designing Digital Diagnostics

Abstract Since the 1990s Western clinical radiology has been confronted with a fundamental media-induced change - the so-called analogue-digital migration. Film-based diagnostics and archiving of radiological images are transformed into digital interfaces and infrastructures. Networked software applications, namely picture archiving and communication systems (PACS), provide a new basis for processing and displaying image data. The design and implementation of PACS and their (user) interfaces challenged, amongst others, the search for data standards for digital diagnostics. The data format DICOM (Digital Imaging and Communication) was developed to provide the technological basis for encoding image data. Simultaneously, DICOM determines how patients’ bodies are rendered machine-readable and how radiologists are able to gain software-based insights. A main function of DICOM metadata is encoding and continuously actualising patient identification for technological and human actors. A misidentification of image data and specific patient could lead to fatal errors in the furthe+r treatment process. Accordingly, metadata themselves meander between being invisible to the human user and being essential and hence necessarily visible information for diagnostics. Shifting between normativity and fluidity, DICOM metadata enables new practices of radiological diagnostics, which literally bear vital consequences for patients and, on another level, for the profession of radiology. The paper analyses inherent politics and tensions of metadata from a media theoretical point of view by employing the case of the DICOM standard. Based on subject-specific discourses, data models as well as an in-depth examination of exemplary DICOM metadata it shows how (meta)data politics redefine diagnostic infrastructures and routines as well as gain impact on epistemic and aesthetic practices at the turn of the analogue-digital migration.

Picture Archiving and Communication Systems (PACS): A Pre-Post Comparative Analysis

Background: A picture archiving and communication systems (PACS) is a computerised means ofacquiring, storing, transmitting and displaying images digitally. PACS is a standard component for radiologyinformation systems.Method: A comprehensive descriptive and observational study was undertaken at two tertiary care hospitalsfrom April 2012 to December 2012, the main hospital and an associated hospital. The main hospital hadthe functional RIS and PACS while PACS was being installed in the associated hospital. So, the mainhospital represented Post-PACS scenario and the associated hospital represented Pre-PACS era. The datawas collected from the Radiology Information Systems and the PACS Servers. The historical data wasobtained from secondary sources. Simple random sampling was used to select cases for the calculation ofaverage waiting time and report TAT for examinations on different modalities.Results: The findings showed improvement in the TAT following PACS implementation at Main Hospital. Anoteworthy improvement had been in the case of X-ray unit which had declined considerably from the peakvalue of 6.8 days in the year 2006 to 2.2 days in the year 2011. In the case of USG, the TAT had reducedand the reports were available on the same day with an average TAT of 0.5 days. In the case of CT, the TATreduced by more than 50% to 1 day on an average. In the case of MRI, the TAT reduced from 3 days in theyear 2004 to 2.4 days in the year 2011. On the other hand, the TAT in case of Associated Hospital was higherin almost all the modalities.Discussion and Conclusion: It may be concluded that the introduction of PACS in Main Hospital had paidthe dividends and the decision to install and implement the PACS in Associated Hospital was pragmatic one

The first picture archiving and communication system in Lao People’s Democratic Republic: Changes in the utilization rate of imaging tests in the first year after implementation

BackgroundImplementation of the Picture Archiving and Communication System (PACS) is more challenging in developing countries than in developed countries. Given that the first PACS in Lao People’s Democratic Republic (PDR) was successfully installed at the Children’s Hospital of Lao PDR, we aimed to investigate whether the utilization rate of imaging tests increased after PACS implementation. MethodsPACS was implemented at the Children’s Hospital of Lao PDR in December 2014. We compared the utilization rates of imaging tests including X-ray and ultrasound examinations between the pre-PACS period (from December 2013 to November 2014) and the post-PACS period (from December 2014 to November 2015). The utilization rate was defined as the number of imaging tests divided by the number of patients per month. ResultsThe average number of total imaging tests was 225.8/month (standard deviation [SD], 37.7) during the 1-year pre-PACS period and was 269.4/month (SD, 38.5) during the 1-year post-PACS period (P=0.0103). The utilization rate of total imaging tests significantly increased after PACS implementation (pre-PACS, 2.47%/month; post-PACS, 4.23%/month; P<0.0001). Increased utilization rates were observed for both X-rays (pre-PACS, 1.65%/month; post-PACS, 2.38%/month; P=0.0004) and ultrasound examinations (pre-PACS, 0.82%/month; post-PACS, 1.85%/month; P=0.0001). ConclusionsThe implementation of PACS at the Children’s Hospital of Lao PDR resulted in a significant increase in the utilization rate of imaging tests, suggesting the indirect benefit of improved quality of care. Our findings showed that the benefits of PACS can be realized even in a resource-limited country such as Lao PDR.

A Socio-technical assessment of the success of picture archiving and communication systems: the radiology technologist’s perspective

BackgroundWith the increasing prevalence of Picture Archiving and Communication Systems (PACS) in healthcare institutions, there is a growing need to measure their success. However, there is a lack of published literature emphasizing the technical and social factors underlying a successful PACS.MethodsAn updated Information Systems Success Model was utilized by radiology technologists (RTs) to evaluate the success of PACS at a large medical center in Taiwan. A survey, consisting of 109 questionnaires, was analyzed by Structural Equation Modeling.ResultsSocio-technical factors (including system quality, information quality, service quality, perceived usefulness, user satisfaction, and PACS dependence) were proven to be effective measures of PACS success. Although the relationship between service quality and perceived usefulness was not significant, other proposed relationships amongst the six measurement parameters of success were all confirmed.ConclusionsManagers have an obligation to improve the attributes of PACS. At the onset of its deployment, RTs will have formed their own subjective opinions with regards to its quality (system quality, information quality, and service quality). As these personal concepts are either refuted or reinforced based on personal experiences, RTs will become either satisfied or dissatisfied with PACS, based on their perception of its usefulness or lack of usefulness. A satisfied RT may play a pivotal role in the implementation of PACS in the future.

User acceptance of a picture archiving and communication system (PACS) in a Saudi Arabian hospital radiology department

BackgroundCompared with the increasingly widespread use of picture archiving and communication systems (PACSs), knowledge concerning users’ acceptance of such systems is limited. Knowledge of acceptance is needed given the large (and growing) financial investment associated with the implementation of PACSs, and because the level of user acceptance influences the degree to which the benefits of the systems for healthcare can be realized.MethodsA Technology Acceptance Model (TAM) was used to assess the level of acceptance of the host PACS by staff in the radiology department at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. A questionnaire survey of 89 PACS users was employed to obtain data regarding user characteristics, perceived usefulness (PU) (6 items), perceived ease of use (PEU) (4 items), a change construct (4 items), and a behavior (acceptance) construct (9 items). Respondents graded each item in each construct using five-point likert scales.ResultsSurveyed users reported high levels of PU (4.33/5), PEU (4.15/5), change (4.26/5), and acceptance (3.86/5). The three constructs of PU, PEU, and change explained 41 % of the variation in PACS user acceptance. PU was the most important predictor, explaining 38 % of the variation on its own. The most important single item in the explanatory constructs was that users found PACS to have improved the quality of their work in providing better patient care. Technologists had lower acceptance ratings than did clinicians/radiologists, but no influence on acceptance level was found due to gender, age, or length of experience using the PACS. Although not directly measured, there appeared to be no cultural influence on either the level of acceptance or its determinants.ConclusionsUser acceptance must be considered when an organization implements a PACS, in order to enhance its successful adoption. Health organizations should adopt a PACS that offers all required functions and which is likely to generate high PU on the part of its users, rather than a system that is easy to use. Training/familiarization programs should aim at establishing high levels of PU in all users, particularly technologists. Health organizations are advised to measure all the factors that influence the acceptance of a PACS by their staff, in order to optimize the productivity of the system and realize the potential benefits to the greatest extent possible.

Informatics in Medical Imaging

Informatics in Medical Imaging presents a comprehensive overview of concepts and principles of medical imaging informatics. The book has 23 chapters divided into six major sections: Introduction to Informatics in Medicine, Standard Protocols in Imaging Informatics, Key Technologies, Information Systems in Healthcare Informatics, Operational Issues, and Medical Informatics beyond the Radiology Department. The book is 367 pages long and is written by 33 contributing authors from around the world, including many well-known experts in their respective fields. Today's technologies of medical imaging and radiation oncology are so complex and computer-driven in the digital era, it is difficult for medical specialists and technologists responsible for their clinical use to know exactly what is happening at the point of patient care. Medical physicists are facing these new challenges too. They are best trained to understand the technologies involved and their applications and are taking more clinical responsibilities than before to ensure that the best patient care is delivered safely and effectively. Medical imaging informatics is about medical image and healthcare information management, integration, storage, transmission, distribution, and security during these processes. In this book, the authors tried to provide an integrated publication dealing with the fundamental and updated issues within the scope of medical imaging informatics. Readers will understand the principal components of modern computing, networks, storage systems, and their extensive applications in medical imaging informatics after reading each focused chapter which give a broad overview. The field of medical imaging informatics is still changing rapidly. Because of the comprehensive nature of this book with many topics in medical imaging informatics, the targeted readers include professionals in medical physics and biomedical imaging, as well as students and researchers. It may also be used as a helpful reference guide for medical physicists, radiologists, and administrative staff seeking additional information on medical imaging informatics. The book discusses basic concepts in medical imaging informatics, data representation and transmission, primary imaging informatics protocols, picture archiving and communication systems (PACS), and the electronic medical record. It also details key instrumentation and data mining technologies used in medical imaging informatics, typical information systems used within imaging departments such as orders and result systems, acquisition systems, reporting systems, archives, and information-display systems, as well as practical operational issues. For HL7, DICOM, and IHE that are fundamental communication protocols used to support various aspects of information in the health care enterprise, not only basic concepts are discussed but also in-depth information is covered, making them useful for readers with different backgrounds in medical imaging informatics. Readers with administrative responsibilities may be interested in special topics discussions about equipment procurement, operational issues, and ethics in the radiology department. In addition to radiology, issues concerning other medical specialties such as pathology, cardiology, dermatology, surgery, and radiation oncology that use digital imaging are also addressed in the book. Although these 23 chapters are written by many authors, unlike an integrated one by only a few authors, most chapters are well written and easy to read even for readers without much prior knowledge in medical imaging informatics. Since this book is one volume of the series “Imaging in Medical Diagnosis and Therapy,” some chapters may have been better included in other volumes of the series. With abundant respective information from various resources, this book is an attempt to cover fundamental principles and state-of-the-art technologies as well as major challenges for future advances with the radiology and radiation oncology community in mind. From background information in medical informatics including a detailed overview of key technologies such as operating systems, networks, standard protocols, digital storage, and image compression in Sections I–III, to principles of PACS, display technologies, hospital information systems, and special topics about operational issues in medical imaging and beyond the radiology department in Sections IV–VI, the book provides a comprehensive survey of the field of medical imaging informatics. Overall, this book is well written by experts in their respective fields and has good coverage. Readers may also obtain a wealth of information in medical imaging informatics from references listed at the end of each chapter which supplement materials discussed in this book. Yu Liu is a Senior Imaging Physicist certified by the American Board of Radiology in the Radiology Department at St. Luke's Medical Center of Aurora Healthcare, Milwaukee, Wisconsin. He has been involved in PACS implementation, operation, and quality control since 1997. His expertise and current interests are in PACS and MRI physics.

Monitoring the PACS Implementation Process in a Large University Hospital—Discrepancies Between Radiologists and Physicians

Successfully introducing a new technology in a health-care setting is not a walk in the park. Many barriers need to be overcome, not only technical and financial but also human barriers. In this study, we focus on the human barriers to health-care information systems' implementation. We monitored the acceptance of a Picture Archiving and Communication System (PACS) by radiologists and hospital physicians in a large Belgian university hospital. Hereto, questionnaires were taken pre-implementation (T1) and 1 year after the radiology department stopped printing film (T2). The framework we used to perform the study was the Unified Theory of Acceptance and Use of Technology. Main findings were that both groups were positive toward PACS prior to the introduction and that each group was even more positive at T2 with extensive PACS experience. In general, the ratings of the radiologists were higher than those of the physicians, as the radiologists experienced more of the benefits of PACS and had to use PACS throughout the day. Two factors were salient for predicting users' intention to use PACS: the usefulness of PACS (performance expectancy) and the availability of support of any kind (facilitating conditions). The results show that our approach was successful. Both radiologists and physicians give evidence of an excellent level of user acceptance. We can conclude that the implementation of PACS into our hospital has succeeded.

Ergonomics evaluation of picture archiving and communication system implementations in two X-ray departments

Two large X-ray departments in the County of Stockholm have changed from traditional analogue technology to digital imaging, including the implementation of Picture Archiving and Communication Systems (PACS). One of the departments was moved to a completely new purpose-built building and equipped with the latest technology, but for the other one the change merely meant rebuilding and adaptation of existing rooms on the premises. The objectives of the present study were to evaluate the ergonomics effects of the new technique in the two X-ray departments and to find out whether the implementation of digital imaging technique came up to expectations of improved ergonomics and work environment. Another purpose was to compare the outcomes for the two departments, in order to learn about the importance of the different implementation approaches. Questionnaires were sent out to the two departments both before the implementation of PACS and after the transition. The questionnaires covered several aspects of work conditions, such as working time, the physical and psychosocial environment, physical work load and musculoskeletal complaints, expectations from the digital technology, etc. The changeover went better than expected and even high expectations were fulfilled and surpassed. However, there were also some unexpected and distressing results; for example, a substantial increase in headaches and musculoskeletal symptoms as well as the use of pain killers among the radiologists of one of the X-ray departments.

A Filmless Radiology Department in a Full Digital Regional Hospital: Quantitative Evaluation of the Increased Quality and Efficiency

Reggio Emilia hospital installed Picture Archiving and Communications Systems (PACS) as the final step towards a completely digital clinical environment completing the HIS/EMR and 1,400 web/terminals for patient information access. Financial benefits throughout the hospital were assessed upfront and measured periodically. Key indicators (radiology exam turnaround time, number of radiology procedures performed, inpatients length of stay before and after the PACS implementation, etc.) were analyzed and values were statistically tested to assess workflow and productivity improvements. The hospital went “filmless” in 28 weeks. Between the half of 2004 and the respective period in 2003, overall Radiology Department productivity increased by 12%, TAT improved by more than 60%. Timelier patient care resulted in decreased lengths of stay. Neurology alone experienced a 12% improvement in average patient stay. To quantify the impact of PACS on the average hospital stays and the expected productivity benefits to inpatient productivity were used a “high level” and a “detailed” business model. Annual financial upsides have exceeded $1.9 millions/year. A well-planned PACS deployment simplifies imaging workflow and improves patient care throughout the hospital while delivering substantial financial benefits. Staff buy-in was the key in this process and on-going training and process monitoring are a must.

Picture Archiving and Communication System and its Impact on Image Viewing in Physical Therapy Practice

Imaging plays an increasing role in physical therapy (PT) practice. We sought to determine if picture archiving and communication system (PACS) deployment would increase the proportion of imaging studies viewed by physical therapists (PTs) at the point of care and to assess PTs' perception of the value of access to imaging information. The study was performed in a 720-bed urban teaching hospital where an average of 2,000 rehabilitation visits per month are performed by 12 PTs. We compared the proportion of imaging studies viewed by PTs before and after PACS implementation. We surveyed PTs to assess their perception on the value of access to imaging studies. Film library records pre-PACS and web server audit trail post-PACS implementation were reviewed to measure access. Chi-square was used to compare proportions and trends. During the 3-month period before PACS usage, PTs viewed 1% (6/505) of imaging studies, citing time as the primary barrier. Post-PACS, the proportion of imaging studies viewed rose from 28% (95/344, second month) to 84% (163/192, fifth month) (p < 0.0001, chi-square). Most PTs believed that access to imaging studies has high value and has a positive impact on clinical practice. Physical therapists rarely viewed imaging studies before PACS due to time barriers. They viewed more imaging studies (84%) post-PACS and felt that access to imaging studies has a positive impact on clinical practice. Further studies are needed to assess whether PACS enhances PTs' clinical decision making and improves patient outcomes.

Financial Assessment of a Picture Archiving and Communication System Implemented all at Once

The objective of this study was to determine the differential cost between film-based radiology and a hospital-wide picture archiving and communication system (PACS) implemented all at once. The cash flow and running costs of PACS and film-based operation were measured over an 8-year time horizon. When the hospital-wide PACS was implemented over a short period, there was instant conversion into digital film and archives. The net present value (NPV) for PACS operation is US $1,598,698, whereas the NPV for film-based operation is US $2,083,856, indicating a net saving of US $485,157. The payback period is 4 years. The costs of computed radiography and image plates account for 40% of the initial capital expenditure in PACS implementation, followed by computer hardware (30%) and software (9%) costs. Our experience shows that implementation of hospital-wide PACS all at once can produce cost savings. For hospitals intending to go filmless, this study offers a model for financial evaluation of PACS to help in decision making.

KIS-RIS-PACS-Integration: Der Marburger Weg

When describing the development of data processing at the Department of Radiology at the Philipps University of Marburg, three phases can be identified covering the areas of patient care, education, and research as well as administrative and organizational aspects. The first phase (1987-1995) was centered on radiology and characterized by the early implementation of the radiology information system (RIS) and installation of a picture archiving and communication system (PACS). The experiences gained during this phase led to intensive discussion on application-oriented information processing. The second phase (1996-2000) describes the changes in the general framework brought by Internet technology and international standards. The course was set for the future of data processing in the hospital setting. The phase ended with implementation of a clinical workplace system (KAS) as the basis for a comprehensive electronic patient record and the switch in radiology to an integrated RIS solution. The third phase (2001-2006) addressed further implementation and development of clinical data management in which both regular documentation of patient data and information processing not related to patients are optimized by making use of Intranet/Internet technology. It includes the hospital wide implementation of PACS and the forthcoming phase of information processing increasingly shaped by workflow and decision support.

Multi-detector computed tomography and 3-dimensional imaging in a multi-vendor picture archiving and communications systems (PACS) environment 1

Rationale and objectives To show the impact of the introduction of multi-detector computed tomography (CT) on radiologic workflow and to demonstrate how this reflects on picture archiving and communications systems (PACS) requirements. Materials and methods Production measurements were obtained from different CT scanners (first two single-slice CT scanners; from December 2001 single and 4-slice CT; from April 2002 single and 16-slice CT) in number of patients from the radiologic information system. Implications on our PACS were recorded in terms of images and studies stored. Furthermore, our PACS design was made so that optimal use of 3-dimensional imaging within the radiologic workflow was possible. Finally, the number of nondiagnosed studies were recorded every day since the start of the transition to a filmless radiology department. Results This PACS design achieved a high level of integration between simple viewing and advanced 3-dimensional imaging and is optimized for handling large amounts of data. Overall increase of patients scanned with CT from January 2002-December 2003 was 54%. The number of series increased by 286% from December 2001-April 2003 and by 130% from April 2002-December 2003. From January 2002-February 2003, the number of images per patient increased from 175 to 450 (157%). Nondiagnosed studies decreased from about 100–120 before to practically zero after PACS implementation. Conclusion PACS significantly increases productivity because of availability of the images and elimination of certain manual tasks. These results show that although the amount of examinations increases significantly with the introduction of MDCT, simultaneous introduction of PACS and filmless operation allows radiologists to handle the growth in workload.

Introduction to Paper by H. K. Huang, D.Sc., et al, ?Digital Radiology at the University of California, Los Angeles: A Feasibility Study?

THE PACS CONCEPT was introduced during the First International Conference and Workshop: Picture Archiving and Communication Systems (PACS) for Medical Applications in 1982.1 A paper titled “Cost of Managing Digital Diagnostic Images for a 614 Bed Hospital” was presented by Dr. Sam Dwyer.2 It established the methodology on how to justify the cost of implementing a PACS system. The present paper: “Digital Radiology at the University of California, Los Angeles (UCLA): A feasibility Study,” published in 1983, used similar methods to estimate the cost of implementing PACS at UCLA. This paper established the guidelines for the PACS implementation at UCLA. Subsequently, the National Institutes of Health funded several large-scale research and development projects at UCLA, including a Program Project Grant (PPG): PACS in Radiology; R01 Grant: Multiple Viewing Stations; and R01 Grant: Image Compression. Later, the Department of Radiological Sciences provided a matching fund for the PPG to launch the PACS for clinical use. The PACS at that time was mainly a standalone system. The author and seven other investigators relocated to the University of California at San Francisco Medical Center (UCSF) in 1992. There they developed a hospital-integrated PACS that was released for clinical use in 1996.3,4 The funds for such development were provided by the National Library of Medicine, the Army Medical Research and Materiel Command, the National Cancer Institute, the California Cancer Research Program, Pacific Bell, and an endowment fund provided by UCSF when the group relocated there.5 Since then, the key change in PACS has been an emphasis on health care information system integration, enterprise PACS, and ePR-based (Electronic Patient Record) image distribution.6

PACS-based functional Magnetic Resonance Imaging

The picture archiving and communication system (PACS) technology reaches its 10th anniversary. Retrospectively no one could foresee the impact the PACS would have to the health care enterprise, but it is common consent today, that PACS is the key technology crucial to daily clinical image operations and especially to image related basic and clinical research. During the past 10 years the PACS has been matured from a research and developmental stage into commercial products which are provided by all major modality and health care equipment vendors. The PACS, originally implemented in the Radiology Department, needs to grow and has already carried well beyond departmental limits conquering all image relevant areas inside the hospital. During the past 10 years a dramatic development in imaging techniques especially within MRI emerged. Advanced 3D- and 4D-MR imaging techniques result in much more images and more complex data objects than ever before which need to be implemented into the existing PACS. These new imaging techniques require intensive post-processing apart from the imaging modality which need to be integrated into the image workflow and the PACS implementation. Along with these new imaging techniques new clinical applications, e.g. stroke detection, and research applications, e.g. study of heart and brain function, in Neurology and Cardiology require changes to the traditional PACS concept. Therefore inter-disciplinary image distribution will become the high-water mark for the next 10 years in the PACS endeavor. This paper focuses on one new advanced imaging technique, functional magnetic resonance imaging (fMRI), and discusses how fMRI data is defined, what fMRI requires in terms of clinical and research applications and how to implement fMRI in the existing PACS.

Picture Archiving and Communication System: Effect on Reporting of Incidental Findings

To determine the effect of a picture archiving and communication system (PACS) on reporting of incidental findings outside the area of interest, with a focus on lumbar spinal magnetic resonance (MR) imaging. Results of 2,500 lumbar spinal 1.5-T MR examinations were reviewed. These included 500 consecutive lumbar spinal MR reports for each of 5 years: 1 year prior to PACS introduction, 1 year during transition to PACS, and 3 consecutive years thereafter. Incidental findings cited in the reports were tabulated, and the frequency, organ system involved, and radiologist recommendations in each case were noted and compared, as were projected expenses based on the Medicare payment scale for recommended follow-up studies. Results of available follow-up studies were also reviewed. The number of incidental findings increased from 19 before PACS to 31 during transition and 53, 49, and 50 after PACS implementation, which resulted in a maximum increase of 179%. The increase was statistically significant during each post-PACS year. The most common incidental findings involved potential renal, pelvic, hepatic, pulmonary, and lymph node abnormalities. The total number of recommended follow-up studies increased from five before PACS to 15 during transition and 32, 22, and 18 after PACS implementation, with a maximum increase of as much as 540%. Recommended ultrasonographic studies increased the most from two in the pre-PACS year to 11 during transition and 27, 17, and 14 in the 3 post-PACS years. Follow-up expense increased by a mean of 146% after PACS implementation from 4,221 dollars per 1,000 studies in the pre-PACS year to 9,307 dollars, 13,426 dollars, 10,558 dollars, and 8,252 dollars thereafter. Of the 202 incidental findings, four represented occult malignancy, which is an expense of 5,721 dollars per diagnosis. The introduction of PACS into radiology practice for lumbar spinal MR imaging appears to be associated with an increased number of reported incidental findings and recommended follow-up studies.

RadiologyEducation.com: A Digital Library of Radiology Education Resources

Goal. The goal of this Web site is to provide a digital library of up-to-date radiology education resources that can be used by radiologists at the point of care to seek answers to questions to improve patient care, outcomes, and lives. Learning Objectives. The objective of the site is to show radiologists how to use a digital library to seek answers to clinical questions at the point of care. Content. A digital library can be defined as an organized collection of information that can be used to answer questions. Radiologists often have questions about imaging studies they are performing and interpreting. Traditionally, seeking answers to questions has been difficult because of barriers to accessing information at the point of care. Today, the transformation of radiology into a digital profession through the implementation of PACS (picture archiving and communication system) and the use of the Internet in reading rooms promises to lower barriers to accessing information at the point of care. Unfortunately, access to the Internet is not enough because the vast amount of information available is disorganized and often of questionable authority. The most common method for seeking information on the Internet—using a search engine—often results in failure and user frustration. Digital libraries hold the promise of bringing order to the chaos of the Internet. RadiologyEducation.com is a digital library of authoritative radiology education resources on the Internet.

Interfacing the PACS and the HIS: results of a 5-year implementation.

An interface was created between the Department of Defense's hospital information system (HIS) and its two picture archiving and communication system (PACS)-based radiology information systems (RISs). The HIS is called the Composite Healthcare Computer System (CHCS), and the RISs are called the Medical Diagnostic Imaging System (MDIS) and the Digital Imaging Network (DIN)-PACS. Extensive mapping between dissimilar data protocols was required to translate data from the HIS into both RISs. The CHCS uses a Health Level 7 (HL7) protocol, whereas the MDIS uses the American College of Radiology-National Electrical Manufacturers Association 2.0 protocol and the DIN-PACS uses the Digital Imaging and Communications in Medicine (DICOM) 3.0 protocol. An interface engine was required to change some data formats, as well as to address some nonstandard HL7 data being output from the CHCS. In addition, there are differences in terminology between fields and segments in all three protocols. This interface is in use at 20 military facilities throughout the world. The interface reduces the amount of manual entry into more than one automated system to the smallest level possible. Data mapping during installation saved time, improved productivity, and increased user acceptance during PACS implementation. It also resulted in more standardized database entries in both the HIS (CHCS) and the RIS (PACS).

Incremental cost of department-wide implementation of a picture archiving and communication system and computed radiography.

To determine the incremental cash flows associated with department-wide implementation of a picture archiving and communication system (PACS) and computed radiography (CR) at a large academic medical center. The authors determined all capital and operational costs associated with PACS implementation during an 8-year time horizon. Economic effects were identified, adjusted for time value, and used to calculate net present values (NPVs) for each section of the department of radiology and for the department as a whole. The chest-bone section used the most resources. Changes in cost assumptions for the chest-bone section had a dominant effect on the department-wide NPV. The base-case NPV (i.e., that determined by using the initial assumptions) was negative, indicating that additional net costs are incurred by the radiology department from PACS implementation. PACS and CR provide cost savings only when a 12-year hardware life span is assumed, when CR equipment is removed from the analysis, or when digitized long-term archives are compressed at a rate of 10:1. Full PACS-CR implementation would not provide cost savings for a large, subspecialized department. However, institutions that are committed to CR implementation (for whom CR implementation would represent a sunk cost) or institutions that are able to archive images by using image compression will experience cost savings from PACS.