Cardiology PACS: Solutions to Fit Your Needs

Cardiac-related advances in imaging modalities such as CT, MR, PET/CT, SPECT and echocardiography have created a demand for cardiology PACS capabilities that offer individualized solutions to fit evolving image management and patient information management needs.

The cardiology PACS market is maturing toward a data revolution that has allowed for a continued decline in cardiac morbidity and mortality, says James E. Tcheng, MD, professor of medicine at Duke University in Durham, N.C. The American Heart Association says that since 2005, deaths from heart disease have dropped by 25.8 percent and deaths from stroke have fallen 24.4 percent.

Tcheng says that, considering that the major advances in cardiovascular medicine have been in the last 20 years to drive this reduction, he attributes the reduction to four things. “Statin therapy, new stent technology, a reduction in smoking, and imaging—which is one of the biggest reasons cardiovascular deaths have dropped,” he says. “With better imaging, comes better diagnosing—which means better care for patients.”

Tcheng says these advancements in imaging have enabled staff at Duke’s Heart Center to view multiple modalities in an integrated, web-accessible environment in the echocardiography lab through Xcelera cardiology PACS from Philips Healthcare.

They’re also in the process of linking Xcelera to the cardiac catheterization lab. “In the heart cath lab, we are obtaining images with intracardiac echo, intravascular ultrasound, and we want to be able to associate these studies so that if you are looking at the cath and you see an ultrasound probe in the coronary artery, you can simply pull up the ultrasound as well—Xcelera gives that capability,” he says.

Going from one hospital lab to three hospitals demanded a cardiology PACS with scalability, Tcheng says. “We needed an application that was more robust with the horsepower we needed to manage the flow of patient information and images in an efficient fashion,” he says. Moving to an enterprise SAN (storage area network) demanded a mature solution to handle the interfaces that had to be created. Tcheng says Duke is planning to develop into a multimodality, multi-vendor environment to bring up images from all cardiac-specific modalities.

Centralized image management

When the Cardiology Unit at the University of Rochester Medical Center decided to upgrade its echocardiography lab, including ultrasound and a server to a cardiology PACS, administrators went with a solution that would connect physicians from multiple departments and sites.

With PicomEnterprise from ScImage, which was already installed in the center’s cardiac catheterization lab, Cardiology IT Manager Martin E. Smith says he consolidated services under one global “cardiology umbrella. I needed one centralized image archive that could allow the physicians to work as a team.”

Smith says he has a back-end system with PicomEnterprise that can accept data from all cardiac modalities and send those images back to the user the same way they come in. “We now have a centralized image archive that nuclear, echo and cath can use,” he adds “and pediatric echo, OB/GYN and cardiac anesthesia are in the works.” Smith says a key benefit to the ScImage PACS is the ability to consolidate fragmented mini-cardiology PACS into one that is usable by everyone. “Our current cardiology PACS archive allows multiple modalities to choose an analysis/viewing package that best fits their needs, yet combining it in a centralized PACS archive that is easier to manage.”

Banner Health in Phoenix, Ariz., a nonprofit healthcare system serving seven states from Alaska to Arizona, also needed a centralized database for its echo and cath labs and found a solution with HeartLab, a cardiology PACS from Agfa HealthCare. (The system is now known as Impax Cardiology.) “We wanted to send both echo and cath imaging to the same regional database,” says Jon Pavlicek, biomedical engineering senior consultant at Banner. He says that the radiology PACS in use did not run cine loops cleanly and measurement tools were very poor, which he says did not allow for a refined report for cardiology.

Banner uses HeartLab as the main viewing software for staff and physicians to create reports for patient records. The system “talks” with a radiology PACS from Fujifilm Medical Systems through Bycast, a data management company that focuses on storage grids and management of the data that passes between the two PACS, says Pavlicek.

“We are planning to set up a DICOM query and retrieve so HeartLab can query the Fuji system to pull those radiology systems over for viewing,” he adds.

Scalability and flexibility

The Care Group, a statewide, Indiana network of approximately 130 cardiologists and primary-care physicians across more than 30 sites, was in the process of expanding its network to gain more market share and quickly realized that the existing cardiology PACS could not handle the expansion. “It was a very single facility system and we needed a system to work across multiple facilities, combined with a good reporting feature,” according to Don Crail, clinical application analyst. Crail says they found what they needed with ProSolv Cardiovascular.

“We can put it on whatever hardware we want—even our own custom-built server,” says Crail. The software-based PACS offered the flexibility to choose what servers and back-ups to use.

Since implementation, they have improved report turn-around times to same-day or one-day from four to five days. “Because we control the hardware, the networking, the total configuration—we have a stability that enables us to have almost no downtime,” he adds. “We can really choose what best fits us as an IT shop.”

The Washington Hospital found a patient information management solution that best fit its cardiology PACS needs with McKesson Horizon Cardiology for its cardiac cath lab, which performs approximately 3,800 procedures annually. “We started with a small product, not really knowing that we would need it for cath,” says Kelly Neal, RN, MSN, director of cardiovascular services. “We were interested in it at first for echo, which set us down the path to get the whole package with reporting capabilities—we wanted one system that had everything in place.”

According to Neal, physicians in the cath lab had been doing a quick operative note with the procedure and dictating later. “Now all the procedural information is included—inventory used, lesions intervened upon—which is verified and signed off on when the cath is complete,” she says. “That information goes with the patient, sent out to referring doctors and made available to the hospital information system as well. We wanted it to be our complete information system for cardiology and have invested a lot of time and effort to get it the way we have it.”

Neal says one of the biggest benefits to using McKesson is the ability to roll out different features at different times. “We actually implemented the PACS first, then added McKesson’s hemo[dynamic monitoring] product and have now added physician reporting to the mix to gain real-time access to cath and echo,” she adds. 


What you need to know…BEFORE YOU BUY
What should you consider when shopping for and deploying a cardiology PACS? Martin E. Smith, of the University of Rochester Medical Center Cardiology Unit in New York offers this key advice. 
  • Identify all the various associated costs and recognize areas where cost might prohibit certain PACS features.
  • Plan for needs such as interconnectivity, DICOM requirements and worklists.
  • Recognize the true amount of data space required, being sure to include different modalities.
  • Recognize the limitations of the software with regard to the network and select appropriate speeds to guarantee smooth streaming.
  • Understand software limitations to viewing and storing each modality.
  • Choose the appropriate method of long-term storage to meet state/location/patient requirements as well as meet the physicians’ needs.
  • Retrieval of studies should be quick and smooth for comparative studies. Tape systems just won’t cut it despite the reasonable costs—you get what you pay for.
  • Find a system that allows for individuality among various modalities such as nuclear cardiology, echocardiography and catheterization lab.
  • Choose hardware that will provide the maximum uptime at a reasonable cost.
  • Build an appropriate disaster recovery plan to include a full alternative location for the main server with duplicated data.
  • Choose an application that provides a method to maximize your bandwidth and allow physicians to work as a cohesive team to provide timely, reliable patient results.