Wednesday, 15 November 2006

PACS - The Bad and Ugly

PACS is like anything in the world, it has Pros and it has Cons. I will be focusing on some of the negatives in PACS in this post. I will focus specifically on some of the hidden costs that one may not be aware of in the beginning.

The Network Problems
PACS systems are essentially a communication and distribution system. Networking is the base of a good PACS system. The system requires a good network to get the images around in a timely fashion to both Radiologists and external doctors. With this in mind you need to consider the following before implementing a PACS system.
  • The Local Area Network (LAN)
  • The Wide Area Network (WAN)
  • The Hospital Network
  • And Finally Internet Connectivity
The Local Area Network
A local area network (LAN) is defined as "a computer network covering a local area, like a home, office or small group of buildings such as a college." [from]. This is basically the computer network within the Radiology department responsible for distributing images between various modalities, the PACS archive, the radiologist workstation, etc. It is critical that you have a network with quality hardware to handle the volumes of information that will be generated by the digital system. I suggest having a Gigabit network when ever possible and at the very least a 100Mbps network.

The Wide Area Network
A WAN is a network used to connect local area networks (LANs) together, so that users and computers in one location can communicate with users and computers in other locations. [from]. If you have multiple sites and you wish to connect them all to a central PACS Archive you will need to re-evaluate your WAN to accommodate the increased traffic. WAN's are typically considered to be very costly and this could considerably alter your budget. You will need to consult with your PACS vendor on their requirements for a WAN based on the modalities and volumes of studies you will be performing at remote sites.

The Hospital Network
The hospital network can also be a blind spot when it comes to PACS. One needs to consider how images are going to be distributed within the hospital to the various doctors, wards, etc. Negotiations with the hospital on these items is essential as their network will be responsible for delivering images to your clients and if their network is not up to certain standards your services will be viewed in a bad light.

Internet Connectivity
Internet connectivity for distribution of images via a web server is also something else to consider. Exposing your network to the internet without proper security measures such as a decent firewall or other security measures could open you up to security vulnerabilities that could result confidential information being compromised. Internet connectivity bandwidth also needs to be capable of coping with the information exchange between external doctors and your web server.

The DICOM Problem
The other problem I have picked up on is that the DICOM compliance of modalities needs to be addressed. Modalities may need to be upgraded to be capable of DICOM worklist, DICOM send, DICOM receive, etc. This also has relatively big cost implications on a PACS implementation.

All of the above mentioned items are best addressed ahead of time so that key decision makers in the organisations are aware of the cost implications and so that they can budget for them accordingly.