PACS has become one of the most important digital advancements in radiology, according to a Sept. 17 Journal of Digital Imaging study—but it is not without flaws.
“PACS implementation is marred with many issues such as difficulties in integrating multiple PACS units both within and between hospitals and integrating PACS with other hospital systems, limited storage capacity, accesses issues—e.g., synchronous, multiple and remote access—and solutions for backup and recovery, and problems in data migration,” wrote first author Mona Alhajeri, with Jaber Al Ahmad Center for Molecular Imaging in Kuwait City, Kuwait, and colleague. “PACS users are thus calling for improvements in the PACS functionality and developing new PACS functionalities.”
With this in mind, Alhajeri and Syed Ghulam Sarwar Shah with St Thomas’ Hospital in London explored 250 comments from PACS users across four LinkedIn discussion groups. Of the 124 unique profiles, a majority (26.6 percent) were engineers and manufacturing managers, 24 percent were IT and informatics consultants and 23 percent were PACS administrators; 96 percent were male.
Researchers found six key limitations:
1. Viewing, copying and importing images and data
Commenters complained PACS units from different vendors often led to interoperability issues between systems. “A lot of the CDs from various vendors do not have the DICOM directory in the root directory of the CD/DVD,” one online user complained. “This causes a lot of issues.”
They also questioned the use of CDs and DVDs, citing their cost and increased time burden. “Why are facilities still using CDs/DVDs when study/report/views can be made available to patients and ref physicians via the internet?” another participant wrote.
2. Data backup, archiving and recovery
Users expressed concern that an accident could easily wipe out all data contained in a PACS, and that retrieving it, if not backed up, would be costly.
“Disaster recovery [DR], not many people see this important until you are hit with data-loss,” one participant posted. “I have seen hospitals [not invest in] this, but spend thousands [of dollars] when they get hit.”
3. Transmitting images
Sending images to a particular department, such as a cardiology stress room, as one user noted, proved difficult. Some participants pointed to network and hardware issues—PACS devices more than 10 years old were a specific concern.
4. Changing IP, hostname, AET, DICOM attributes
Some users cited problems in editing certain parameters such as internet protocol (IP), application entity title (AET) and hardcoded DICOM attributes.
5. Standalone PACS units and lack of proper tools
Many systems are still stuck in silos and vendors are not providing an adequate supply of tools, commenters complained. “Most of our PACS vendors are still offering siloed systems—radiology, cardiology and some have meager ‘other ologies’ incorporated into their products,” one community member wrote.
6. Limits of open source PACS
Users of an open source PACS reported various issues specific to this system, including workflow problems, data storage and migration issues.
“Workflow, not all open sources provide the necessary workflow that fits your radiology department, especially when it comes to routing and reporting,” according to an online comment.
Commenters across the discussion groups also proposed 16 solutions for increasing PACS functionality. A few of those listed included: integrating multisite and intrasite PACS, enabling image transmissio, and interfacing PACS with electronic medical records.
“These solutions need to be evaluated on several aspects such as the cost, implementation, management, effectiveness, and security, which are imperative from the perspectives of PACS users,” the study authors concluded.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.