The Quest for the Ideal PACS Administrator

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Herman OosterwijkThe PACS System Administrator (SA) profession is still relatively young. There are many questions about the skill set, experience, and background that are required for the ideal candidate for this job. To determine what the particular background, environment, and experiences are, as well as the need for training and certification, one can simply poll current PACS SAs, which is what we did.

There will be requirements for a PACS SA in the future that are driven by new technologies as well as by the additional domains and specialties that PACS may be responsible for such as mammography, endoscopy, eye care, and so on that are not obvious today. That being said, data derived from current PACS SAs should provide a good starting point for what the core competencies should be. Therefore, we polled PACS professionals during our quarterly e-conferences and solicited feedback via our bi-weekly newsletter.

Institutional background

From my experience with PACS SA professionals, it appears that there are some differences between the competencies required when a SA supports a PACS at a major institution vs. someone who is the “PACS-guy” at a free-standing imaging clinic, orthopedic office, or small rural-based hospital. In many larger institutions, there is strong IT and network support for hardware and technical support, a biomedical department that might take care of monitor calibrations and new modality acceptance and installation, and possibly even a physicist who can assist when there are tricky image quality issues. In smaller institutions and free-standing clinics, the SA has to be much more of an all-round person and take care of these issues. Key for these professionals is the ability to acquire the skills to be able to support a broader area and, more importantly, to be able to develop broad networking skills with other professionals.

The institutional background of the population we polled is as follows:

  • 37 percent of the institutions reported more than 125,000 exams per year
  • 28 percent reported 75,000 to 125,000 exams annually
  • The remaining 35 percent of the institutions log 10,000 to 25,000 exams or  25,000 to 75,000 exams each year
  • 42 percent do not use a formal PACS planning process
  • 33 percent utilize some or complete outsourcing of their radiology reads (nighthawk services or contract radiologists)

PACS SA background

There have been animated and sometimes heated discussions about the ideal background of the PACS SA. Interestingly enough, the arguments heard are often self-serving, for example, an IT person would argue that one needs to have a strong IT background, and an RT would argue that a clinical background is more important. One should not forget that background is often less important than skills: An RT with sharp analytical skills can, with proper training, learn the IT skill set to become a very effective PACS SA. On the other hand, an IT person who takes great interest in the clinical workflow and is willing to learn the “lingo” also can be very effective. Obviously, one needs both IT and clinical skills to perform this job.

Another hot issue is the reporting structure, that is, should a PACS SA report to radiology or IT, and in either case have a dotted line to the other? In my experience, there seems to be a shift by which many SAs are being moved over to IT, something that seems to make sense as PACS is becoming more of an IT strategic tool and an enterprise-wide system. The number of professionals supporting the PACS also is often debated. It seems obvious that a single person is not sufficient, unless that person is some type of a superhero, i.e. never sick, does not need any vacation, always available 24/7, and is not in need of any training off-site. Two full-time persons are required; or as a minimum, one primary person with a second person trained as a back-up.

In our polls, we found that 46 percent of the audience had an IT background, and 38 percent had a clinical background. When asked what they thought would be most important, our audience's opinion was almost equally divided: 40 percent thought a clinical background is more important, while 37 percent found an IT background more desirable (23 percent had no preference). With regard to the reporting structure, 60 percent reported to radiology and 26 percent to IT, and the remainder reported to other departments. One person supports PACS in the majority of the cases (53 percent), which defies common sense. For 25 percent of the institutions,