Emergency room physician Hank DiMuzio, MD, reviews chest x-rays on a PACS display at the central nurses station in the ER at Rutland Regional Medical Center in Rutland, Vt.

More than three-fourths of physicians said that PACS has positively benefited their work, despite barely half of physicians having received formal training for PACS and 20 percent complaining that PACS was totally unusable for at least seven days of the year, according to a survey of U.K. hospitals published in the September issue of the European Journal of Radiology.

The study was the first to interview physicians and other specialties separately, from various hospitals and regions of the U.K., and the first to ask about specific problems associated with PACS, according to authors See Ling Tan, MD, of Heartlands Hospital in Birmingham, England, and Richard A. Lewis, MD, of Worcestershire Royal Hospital in Worcester, England.

The authors sent a 12-question survey to 1,518 clinicians, asking whether participants strongly agreed to strongly disagreed with a variety of questions about their use of PACS, as well as asking clinicians to share additional comments about PACS. Two hundred eighty-six clinicians responded, including 111 from medical specialties, 96 surgeons, 32 radiologists and 47 consultants from other healthcare specialties.

Half of the 286 respondents claimed to use PACS alone to view radiological images, while 79 percent said that PACS was better than hard copies and 83 percent said they would recommend it to other hospitals and physicians.

Clinicians expressed differences about the quality of PACS images depending on imaging modality. Digital CT and MR images received the highest marks, with majorities of respondents indicating that viewing CT and MR with PACS provided better quality than reading hard copies. Nuclear images received the worst quality ratings, with only about one-quarter of respondents saying nuclear images viewed with PACS were of higher quality than hard copies. Overall, 91 percent of radiologists responded affirmatively that “PACS is better than hard copies.”

Large majorities of all respondents answered that PACS had benefited their work, with no radiologists or general physician specialists disagreeing. Fifteen percent of surgeons said that PACS had not benefited their work, and 25 percent of surgeons complained that PACS was not better than using hard copies to view films.

The authors did not report any statistically significant differences in perceptions of PACS based on specialty, while acknowledging their survey’s low-response rate of 19 percent.

Despite most physicians’ positive perceptions of PACS, Tan and Lewis reported several key areas for improvement, especially for the planned PACS implementation in all UK Trust hospitals.

The first concern was training: “It is surprising that nearly half of respondents state that they had received no training and, of those, half of them mentioned that no training had been offered.” Physicians’ responses to this question apparently contradicted PACS managers’ claims that training is offered to all physicians when PACS is first introduced in hospitals, as well as on continual and ad-hoc bases. Nevertheless, the authors conjectured that the lack of training may have contributed to common complaints of PACS’ slowness, unreliability and total unavailability for more than one week of the year.

The most common concern raised by physicians, particularly those in specialties other than radiology, was that images viewed on normal computer screens using PACS were often of poor quality. The authors wrote, “concerns that diagnoses could be missed due to poor quality of screens were raised,” while “many surgeons found the images were of insufficient quality for theatre use.”

While Tan and Lewis pointed out specific areas for improvement, they concluded that their data showed that “PACS are generally very well accepted by clinicians.”