PACS is the Key to Efficiency in Imaging Centers

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Wilson Wong, MD, of Arcadia Radiology, uses DR Systems’ Dominator diagnostic reading station.Freestanding imaging centers are joining their “big brother” medical center counterparts en masse, realizing the benefits of deploying PACS. To some extent, multi-facility imaging systems have reaped even greater rewards because they can manage images across their several center enterprise, utilize their most precious resource radiologists to greater effectiveness and vastly improve report turnaround times that in turn enhances their relationship with referring physicians.

As the case studies in this article illustrate, imaging systems of all sizes have benefited greatly from PACS. They carefully analyzed their needs and workflow, set goals and studied the marketplace to determine the appropriate solution for their particular circumstance.
This month Health Imaging & IT spoke with experienced PACS users at seven imaging centers across North America who offer advice on how to do PACS right.

Advance Radiology Consultants | Trumbull, Conn.

This group has been providing radiology expertise for 100 years, and installed their first PACS in 1998. Duleep Wikramanayake, director of IT has 24 years of IT experience that he brought to bear in designing this PACS network with 99.99 percent uptime. He explains that of their eight imaging centers, half are full-service and they complete about 130,000 procedures a year with 17 radiologists. In 2002, they installed Intelerad IntelePACS software to serve as the backbone of their PACS, and he says that they are one of the most accountable companies he’s ever encountered.

“In many sites, we have DS3 [lines] and then we have two frame clouds. Our main site has an OC3 [line],” he says. In terms of storage, they have 14 Terabytes online and are upgrading to 20 TB, and those servers are mirrored. In this way, they always have three years of prior exams on spinning disks, so when their radiologists need to pull up something, it’s instantaneous.

“When you’re talking about data in radiology, it is now in terabytes (TB) rather than gigabytes (GB),” Wikramanayake says. If a server goes down (and that is inevitable because it’s hardware), the data recovery time on a 2 TB array could take approximately three to four weeks.
Wikramanayake relates that one time when one of their servers was down for 26 days, although his four member IT team was working like fury, the radiologists never knew there was a problem. Their maintenance window is between midnight and 4:00 a.m. and that is when Intelerad does any updates, which they install remotely. “It’s the only company I’ve ever known that pulls this off in such a nice fashion,” he concludes. They install upgrades, test them, and then they can pull it off if they need to without disrupting operation.

His advice to others considering PACS is to plan decades ahead for storage needs. Because migrating huge amounts of data is very time consuming and costly, IT professionals must plan accordingly and keep up with technology. He recommends planning for at least a 10-year window, and working to upgrade systems along the way.

Arcadia Radiology Medical Group | Arcadia, Calif.

Careful planning is essential to effective design of a PACS deployment, according to Alicia Vasquez, CRA, Arcadia’s practice administrator. In the midst of bringing the three hospitals and two imaging centers onto the same DR Systems PACS, they have found a significant cost savings, and a redistribution of the workload to increase their radiologists’ efficiency to be the primary benefits. They accomplish 40,000 multimodality imaging exams with nine physicians and have seen their film costs drop from $250,000 to about $27,000, with $17,000 due to screening mammography studies, which are performed on film-based systems.

As a California entity, they work within the constraints of managed care, which means they are challenged to provide quality exams and interpretation while working within fiscal constraints. Vasquez notes that adding PACS has allowed them to remain competitive.

Once several of their referring physicians learned about the PACS installation, they asked to have it installed in their homes. These physicians often face emergency situations in the middle of the night, and having a viewing station in their home allows them to make patient management decisions quickly. Additionally, this system has improved the throughput of the emergency departments in the hospitals, as the decision-making process is facilitated.

“Our patient satisfaction has increased dramatically,” Vasquez