What Everyone NEEDS to What Everyone NEEDS to Know About PACSKnow About PACS

Guy Guindon

NORrad PACS Manager

August 08, 2003

PACS

Picture Archiving and Communication System

Not only a Technology Change, but a Process Change that utilizes Technology to achieve goals of increased efficiencies through the reduction of film.

PACS is much more than a Radiology System or Solution

Ensure you understand the BIG picture

A five (5) year plan is a must even if you know technology will change

Revisit and revise the plan annually to reflect changes in environment, technology, internal/external needs and competition.

The only wrong choice is making no choice at all.

The PACS Project Team

Most PACS decisions take upwards to two years from initial planning through contract negotiations and employs a team of people from:

Radiology- Radiologists, Techs

Information Systems- I/S support, networking, etc.

Administration (CIO, CFO, VP, etc.)

Purchasing

Staff Physicians and Nursing staff

Outside Consultant

MythAll PACS Systems are different

Most PACS system perform the same basic functionality using many of the same hardware components, with the primary difference being the applications software, integration plan, and margins.

There are system designs differences, but most are not significantly different.

Experience is the critical component in the evaluation process.

PACS COMPONENTS

CORE COMPONENTS

VIEWING STATIONS

ACQUISITION STATIONS AND PRINTERS

SUPPLEMENTARY EQUIPMENT

SITE EVALUATION

PACS PROJECT SUPPORT

CORE COMPONENTS

Archive/Database ServersImage ServerImage CacheWeb ServersWeb CacheLong Term Storage SystemsNetworks (Core components and switches)Server RacksHIS/RIS Interfaces

VIEWING STATIONS

Diagnostic Workstations (Dual, Triple or Quad Monitors)Clinical Workstations (Single or Dual Monitors)Orthopedic Workstations (Single or Dual Monitors)System Admin Workstation (Single or Dual Monitor)Web Clients

ACQUISITION STATIONS AND PRINTERS

Computed and Digital Radiographic SystemsMulti Plate CR Reader with cassettesSingle Plate CR Reader with cassettesCR ServerCR Clients3 Foot Image Solution (Full Spine and Leg Length)Modality Interfaces or DICOM UpgradesDocument ScannersFilm DigitizersDry Laser Printers

SUPPLEMENTARY EQUIPMENT

Ergonomics Desk Chair

Carts for PC’sArticulating Arms for PC’sViewboxesRenovation CostsPC’s for Web Clients (New or Upgrades)

CORE COMPONENTSThings to Note

Main Servers Cached or Cacheless System Unix, Linux or Windows based Servers

Web Servers Integration into the PACS Link between the Main Image Server and Web Server Lossy versus Lossless Compression

Lossless (<3:1) and Lossy (>3:1) JPEG 2000 is industry standard for compression

Push vs Pull (Either or Both)

CORE COMPONENTSThings to Note

Network Security on intranet and internet (SecureID tokens) HIPPA/PIPEDA Standards

Secure Socket Layer (SSL) Data Encryption Standards (DES) Public Key Infrastructure (PKI) Secure ID

Never to much bandwidth 1GB Backbone 100MB to Desktop PACS has a huge impact on Bandwidth

Vendor controls from Modality to Switch Hospital controls from Switch forward, including WAN VPN (Virtual Private Network) should be considered

CORE COMPONENTSThings to Note

Network WAN (Wide Area Network)

Must to Homes and Offices High speed required (Cable or DSL) T1 or better between sites

HIS/RIS Interfaces Mitra Broker $70-80k each HL7 Interface $25-50k each Cost for I.S. resources Bi-Directional communication for scheduling, reporting

etc.. Allocate 4-6 months for developing, testing and going live

with the HIS/RIS Interface before going live with PACS.

CORE COMPONENTSThings to Note

Archives Acronym City - RAID,MOD, CD-R, DVD-R, DLT, LTO,SAN Short Term Storage (RAID/Cache) should be 6-12 months Long Term Storage should be around 2-3 years do to

Technology changes SAN can be used for large PACS projects Retrieval time from request to display should be <60

seconds No more than 10% of retrievals should come from deep

archive Prefetching and DICOM Worklist is critical and can be

automated when integrated with RIS System

VIEWING STATIONSThings to Note

Diagnostic Workstations 2, 3 or 4 Monitor Workstations 2, 3 or 5 Megapixel Displays Combination

2 (3 or 5 Mpixel Monitor for Reporting) 1 (1280 X 1024 Monitor for RIS, Mail, Voice Recognition etc.)

Flat vs CRT (Replacement, Heat, Space and Costs)Clinical / Orthopedic Workstations 1 or 2 Monitor Workstations Flat vs CRT

Web Client Workstations 1 or 2 Monitor Workstations Flat vs CRT

ACQUISITION STATIONS AND PRINTERS

Things to NoteCR or DR CR mimics General Radiographic processes by using a

stimulable phosphor plate that is read by a reader to generate a digital image.

DR changes the process by creating a digital signal at the source/receptor so that plates are not required.

DR is more than just a Technology change, it’s a process change which saves upwards to 60% of the time associated with either CR or Plain Film.

DR and CR are complimentary to each other and not competing Technologies.

ACQUISITION STATIONS AND PRINTERS

Things to NoteCR or DR CR - $150-$350k each (50-150 plates/hour) DR - $350-$500k / room CR Payback – Elimination of Film DR Payback – Productivity Gains

CR Servers/Clients Redundancy Workflow

Film Digitizers CCD or Laser Laser has better quality but higher maintenance CCD quality has improved and has become the industry

standard

ACQUISITION STATIONS AND PRINTERS

Things to NoteDry Laser Printers Filmless department PACS Downtime

Modality Interfaces / DICOM Upgrades DICOM Interface Cost - $30k DICOM Upgrade Cost - $10-40k

SUPPLEMENTARY EQUIPMENTThings to Note

Server Room Design Power Requirements Air Conditioning Fire Suppressant System Firewall Dial-up Access Raised Floor Space Requirements

IT Infrastructure Upgrades Network and Network Components, Workstations, Displays,

Software, Interface Engines, Security/Firewalls etc..

SUPPLEMENTARY EQUIPMENTThings to Note

Radiology Department Design Power Lighting Ergonomic Chair and Desk Carts for PC’s

OR’s, Clinics, Rounds etc.. Articulating Arms for PC’s

Ultrasound, Clinics, Diagnostic Imaging etc.. Viewboxes

Mount view boxes near Radiology Reporting Station

Renovation Costs Replace or Modify Work space environment

PC’s required for Web Clients Purchase or Upgrade Systems Locate PC’s everywhere you had viewboxes

SITE EVALUATIONThings to Note

Modalities CT MRI R&F Ultrasound Angiography Nuclear Medicine C-Arms Portables Radiography Room (CR or DR)

SITE EVALUATIONThings to Note

Storage Requirements per Modality Image Size Average # of Images/Exam **Storage Requirements Average # of Exams/Year

DI Equipment Info Vendor Model and Software Versions DICOM Conformance Statement DICOM Upgrade Availability

SITE EVALUATIONThings to Note

Supported Clinical Departments Emergency ICU, ACU, CCA, Step Down Clinic Area’s OR’s Physician Viewing Area’s Physician Rounds Education Area’s Film Library Peripheral Sites Physicians’ OfficeNote: Must understand the volume and type of procedures which are

performed in each Clinical Department and their needs.

PACS PROJECT SUPPORTThings to Note

Vendor Maintenance Contract 10-14% of System List Pricing (M-F from 8-5) After hours contract or T&M System Administrator

.5 FTE for Small PACS System 2-3 FTE for Large PACS System .2-.5 FTE from IT Dept.

Training (CRITICAL) System Administrator, Radiologist, Physicians, D.I. Staff

and Nursing Staff

Helpline / Call Centre