The Picture Archival and Communication System (PACS) is a system that permits several types of imaging including CT, MRI, plain X-rays, etc, to be captured, stored and transmitted electronically (using a computer). This would enable convenience for the doctors and other healthcare professionals in accessing and evaluating the images. Films have been used in medicine for more than 100 years. By using PACS, there is a great chance that the entire process of imaging would go from film to film-free, encouraging greater convenience and flexibility in accessing, storage, transmission and retrieval of the X-ray images (NHS, 2009).
When PACS was initially developed (early 1980’s), all images including X-rays, CT scans and MRI scans were shot on films and then converted to images by taking frame-grabbed snapshots. Although technology was able to obtain snapshots of the CT and MRI scans on the computer, they were still converted to film and photographed, as plain X-rays had to be film-processed and then photographed. Once photographed, the images could be stored in the forms of files and folders on the computer system and shared over the LAN network.
During the early 1990’s, there was also a chance of sharing radiographic images over an external network or with a dedicated gateway. During the 1990’s, the network connections were very slow and the images needed a greater bandwidth for effective transmission of images. Hence many of the PACS systems had failed to prevent digital transmission of information over a network of hospitals. The Hammersmith Hospital in London and the Sozialmedizinisches Zentrum Ost in Vienna were the first hospitals in the Europe to employ the PACS system in the early 1990’s (Inchingol, 2001).
Today, automatic capturing methods can be used with PACS (first captured images) and this has replaced conventional imaging techniques with digital ones. Certain protocols have been developed by several organizations including the DICOM standards (Digital Imaging and Communication in Medicine and the TCP/IP (Transmission Control Protocol/Internet Protocol). Effectively, these two standards are utilized in managing the storage, input, retrieval and transmission of images. These protocols have been extended to use for laboratory and other healthcare settings which transmission of medical reports has been essential.
Hospitals would play a major role in the management of the clinical data associated with the PACS system. DICOM is also ensuring that the end-users have greater conveniences in using the PACS system rather than creating greater problems and making issues more difficult. Another system known as Data and Picture Archiving and Communication System (DPACS) which was initiated by a university in Italy helps in several aspects including retrieval of images and remote consultation with specialists, transmission of information, etc.
This system is superior and is capable of being used with other EMR tools. Several imaging machinery, hardware and software systems are based on DICOM. Newer management systems are effectively trying to integrate several components of the EMR with the PACS and develop a very strong integrated system. There are rapid changes in technology and the PACS systems have to stay abreast of the use of such technology. In the year 2000, only 5% of the hospitals in the US had a PACS system, which increased to 20 to 40 % in 2003 and 2004.
PACS helps in the management of sensitive radiological data, and hence is very critical in handling the patients in various clinical setups (Inchingol, 2001). The use of a PACS system in a hospital may be initially very costly for the hospital, but in the long-run, there is set to be an advantage has PACS can help lower costs and provide several benefits in terms of quality standards, flexibility and the ease in transferring information to other hospitals. Some of the advantages of the PACS system include:-
• Images can be transferred anywhere over the network (or internet) and hence consultation with specialists can be organized across the world • In the future, there would be several benefits as costs would come down, support would improve, standards would be more easily followed, technical innovations would be developed, etc • PACS can be utilized across various setting including cardiology, oncology, surgery, nuclear medicine, obstetrics and gynecology, dentistry, oral and maxillofacial surgery, community medicine, etc.
These specialists may require individual specialized images to be taken and used over the PACS. • PACS promises to be a reliable and safe system • Greater integration of the PACS with other systems such as the EMR, LIS, etc, to form what is known as the virtually integrated electronic patient record (VIEPR). In the early 1990’s, the implementation of a PACS system was very costly for the hospital. Some of the elements of the purchase of such a system included hardware, software, development of a network, infrastructure, support systems, etc.
Initially, as PACS was newer technology, a hospital had to spend several millions on purchasing such a system. There was an even higher expenditure on running and maintaining such a system and the usage of electricity, and support staff. However, with time, technology of PACS became even cheaper, and there were several benefits noted including decrease in the number of lost images, reduced exposure to X-rays, higher quality of images, reduction in errors whilst observing the X-ray, etc (Bryan S, 1998).
There is also a reduced need to use films, which helps reduce the costs of X-rays for the patient. However, it is important to note than although PCAS would ensure a film-free setup, there may be several situations in which films would also be required (Inchingol, 2001). The PCAS can be integrated with several systems including the radiology information system, HIS, VIEPR, etc. The vendors of all these systems should ensure greater amount of integration so that the functional efficiency would be able to be improved (Inchingol, 2001).
Overall the PCAS has been implemented in several hospitals over the world and huge benefits are obtained in terms of reduction in costs, effectiveness, quality and access of healthcare, etc. Initially an organization may find it costly to implement such a system. However, in the long-run, there would be immense benefits and organizations would be able to recover the costs. Vendors also need to improve the integration of PCAS with other systems.
Bibliography Bryan S, W. G. (1998). Costs and benefits of hospital-wide picture archive and communications systems (PACS): results from the evaluation of Hammersmith Hospital.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet , 14: 84. http://gateway. nlm. nih. gov/MeetingAbstracts/ma? f=102237049. html Inchingol, P. (2001). Picture Archiving and Communications Systems in Today’s Healthcare. B u s i n e s s b r i e f i n g : n e x t – g e n e r a t i o n h e a l t h c a r e. http://www. wma. net/e/publications/pdf/2000/inchingolo. pdf NHS. (2009). Learn more about PACS. Retrieved February 24, 2009, from Connecting for Health NHS: http://www. connectingforhealth. nhs. uk/systemsandservices/pacs/learn