TABLE OF CONTENTS
•Picture Archiving and Communication System (PACS) is an advanced technology which not only forms a “centralized repository for all imaging data” but also acquires and transmits the radiological images and its report to the physicians digitally, thus replacing the film-based radiological images i.e. hard copy replacement.
PACS enables the image acquisition, storage, display of digital images and reports throughout the facility to many users simultaneously.
HISTORY OF PACS
- The principles of PACS were first discussed at meetings of radiologists in 1982.
- Cardiovascular radiologists DR. Andre Duerinckx reported in 1983.
- Various other people are also credited with the coinage of the term PACS.
- Later in 1990s DR. Harold Glass, a medical physicist secured UK Govt. funding and managed the project over many years which transformed Hammersmith Hospital in London as the first filmless hospital in the UK.
PACS – TYPE OF IMAGES
Most PACSs handle images from various medical imaging modality, including ultrasound (US), magnetic resonance (MR), positron emission tomography (PET), computed tomography (CT), endoscopy (ES), mammograms (MG), Digital radiography (DR), computed radiography (CR)etc.
Additional types of image formats are always being added. Clinical areas beyond radiology; cardiology, oncology, gastroenterology and even the laboratory are creating medical images that can be incorporated into PACS.
•The member of PACS include-
- PACS Manager
- Medical Physicist
- Department Administrator
- RIS/HIS/IT Department Representative
- Senior Management.
ROLE OF PACS
Remote access-PACS usage includes increased communication between the radiologist and the referring physician, decrease in instances of missing images, provide internal and external members easy access to images, and make all the departments more efficient and even it enables practitioners in different physical locations to access the same information simultaneously for teleradiology.
Electronic image integration platform: PACS provides the electronic platform for radiology images interfacing with other medical automation systems such as Hospital Information System(HIS), Electronic Medical Record (EMR), and Radiology Information System (RIS). Digital images viewed on monitors in conjunction with Clinical details.
Radiology workflow management-PACS is a cost-effective technology as it reduces expenditure related to film, chemicals, film processors, physical storage space, and the manpower needed in traditional film based environments.
Main aim : EFFICIENCY OF DATA MANAGEMENT
Providing efficient patient care
IT IS A FAMILY OF PRODUCTS ARE
•Digitizing (computerizing) medical images.
•Displaying and manipulating medical images.
•Transferring medical images within the hospital area or to other locations.
•Permanently archiving medical images.
TYPES OF PACS
•Full-PACS : PACS system where all imaging modalities in radiology are connected to the PACS system, with the advanced software.
•Mini-PACS : PACS system which have limited software for manipulation of the medical image.
WHY DO WE NEED PACS
- Easy comparison of patients current and historical examinations
- Comparison of different examination techniques used for imaging the same body part
- Simultaneous multilocation viewing of the same image
- Image retrieval is infinitely quicker
- Allows numerous post-processing soft-copy manipulation
- Images are automatically chronologically ordered
- No image can be lost / misfiled
- No patient is re-irradiated
- Introduction of teleradiology over a wide area network
- Some direct cost savings
- Time saving for non-radiological clinicians
PACS CONSISTS OF 5 MAJOR SUBSYSTEM
STEP 1 – PATIENT EXAMINATION AND DATA ENTRY
HIS (HOSPITAL INFORMATION SYSTEM )
Hospital information system (most important computer system in the hospital)
•Stores demographic data of all the patients whether or not they have any imaging procedures performed.
•Also records the admission and discharge dates, outpatient appointments etc.
•Other modules : laboratory reports.
RIS (RADIOLOGY INFORMATION SYSTEM)
•A separate system or a part of HIS
•Stores information specific to the radiology department
HIS – RIS – PACS
bidirectional integration is preffered
•1) input of demographic data only once minimizes human error.
•2) any scheduling or status data is distributed to all systems automatically.
•3) PACS propagated to all systems automatically, ensures that all systems contain accurate information.
STEP 2 IMAGE ACQUISITION
STEP 3 –DATABASE MANAGEMENT AND STORAGE
- Brains of this system.
- Point of integration between HIS and PACS.
- Allows access to prefetching , patients demographic and historical information.
- Creates and manages patient folders.
- Manages the flow of images and patient data.
STEP 4 – SERVER
1) SHORT TERM STORAGE 2) LONG TERM STORAGE
SHORT TERM STORAGE
- Provided by RAID devices containing magnetic disks.
- Expensive but have high performance
- Larger the RAID : greater the number of examinations that can be retained online for image retrieval and display.
- Modern PACS allows retrieval of images within 2 sec.
LONG TERM STORAGE
- Used to store digital data for longer periods of time.
- COMPACT DISKS :cheap but storage capacity is too low (650 MB).
- MAGNETO OPTIC DISK: most commonly used (6 GB ).
- DIGITAL VERSATILE DISK: 16 GB , cheaper than MODs but very fragile.
STEP 5 – NETWORKS AND COMMUNICATION
PACS WORK STATION
1) DISPLAY workstation : located within the radiology department for interpretation of films.
2) REVIEW workstations : located everywhere else in the hospital for viewing by physicians and staff.
HIGH RESOLUTION MONITOR
- 1K resolution : are adequate for CT, MRI, USG and digital angiography.
- 2K : are necessary to view whole of a plain radiographic image at full resolution
SOFT COPY TOOLS
- CENTRALIZED PACS 2. DISTRIBUTED PACS
Short term storage is located on a single high performance image server.
•Short term storage is located on a number of separate image servers
CARE OF PACS
- Weekly back up of storage system through tape.
- Merging patient exams and clearing monitor logs.
- Should monitor error logs.
- Dust free atmosphere should be maintained in server room.
- Monitors should be switched off before leaving for the day..
- Should check for incremental back up everyday.
WHAT IS DICOM
- DICOM (Digital Imaging and Communications in Medicine) provides standardized formats for transmitting images and a file format for storing them and to communicate with the application server .
- DICOM is the First version of a standard developed by American College of Radiology (ACR) and National Electrical Manufacturers Association(NEMA).
- A DICOM data object consists of a number of attributes, including items such as name, ID, etc., and also one special attribute containing the image pixel data .
- 3D- 4D data can be encapsulated in a single DICOM object. Pixel data can be compressed using a variety of standards, but this has rarely been implemented.
DICOM consists of many different services, most of which involve transmission of data over a network.
Store •The DICOM Store service is used to send images or other persistent objects (structured reports, etc.) to a PACS or workstation.
Storage commitment •The DICOM storage commitment service is used to confirm that an image has been permanently stored by a device (either on redundant disks or on backup media, e.g. CD), to make sure that it is safe to delete the images locally.
Query/Retrieve •This enables a workstation to find lists of images or other such objects and then retrieve them from a PACS.
Modality work list •This enables a piece of imaging equipment (a modality) to obtain details of patients and scheduled examinations electronically, avoiding the need to type such information multiple times (and the mistakes caused by retyping).
Modality performed procedure step(MPPS ) •A complementary service to Modality Work list, this enables the modality to send a report about a performed examination including data about the images acquired, beginning time, end time, and duration of a study, dose delivered, etc. It helps give the radiology department a more precise handle on resource (acquisition station) use. •This service allows a modality to better coordinate with image storage servers by giving the server a list of objects to send before or while actually sending such objects.
Printing •The DICOM Printing service is used to send images to a DICOM Printer, normally to print an “X-Ray” film.
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