PACS—How to Choose One
• PACS – What to Look For and What to
Avoid From an Experienced Perspective
• PACS Communication:RIS, HIS, Internet
and Doctors
• Integrating a PACS: Interfacing Computers,
Doctors and IT Personnel
The Way It Used To Be...
ACQUISITION
FILE FILM
RETRIEVE
OLD STUDIES...
PROCESSING
Camera
Vendor
#1
FILM
CAPTURE
RADIOLOGIST
READ STUDY
Camera
Vendor
#2
REDO
FILM...
Camera
Vendor
#3
ANNOTATE
FILM
TEACHING
FILES...
ACQUISITION
PROCESSING
FILM
CAPTURE
ANNOTATE
FILM
REDO
FILM
FILE FILM
RETRIEVE
OLD STUDIES...
RADIOLOGIST
READ STUDY
TEACHING
FILE...
PACS Way...
Camera
Vendor
#1
Web
Cable
TV
Web
Windows
NT Server
RIS / HIS / RTAS
Camera
Vendor
#2
Camera
Vendor
#3
RTAS
Disk Storage
Backup
Viewing Room
A PACS Replaces...
» Film
» Image formatter and Camera
» Processor
» Viewboxes
» File Room & Personnel
» Film jackets
» Repeat films
» Laser printers
» Lost film = lost billings
Why PACS?
• Lower costs
• Faster access to studies
• Read studies from home or beach
(or SNM meeting...)
• Efficient interpretation
•
•
•
•
•
No repeat studies
Instant access to older studies
Old study & new study dialed to same gray level
W W W access by referring physician
Cheap plain paper copies of studies with reports to
referring physicians
PACS Efficiencies
¤ No wrong patient id, misspelled names, or other header data
¤ Technologist time
• No waiting for on-call MD
• No processor time
• Combine images from different gamma cameras (and different times)
¤ Multiple camera vendors; one set of analysis & display
software to learn
¤ Instant study availability
¤ Dynamic display
¤ Gray scale variation
Distributed MiniPACS
Separate, stand alone, self contained
PACS for each Radiology
Subspecialty, with Communication to
other MiniPACS
MiniPACS
• No Radiology Departmentwide PACS Has
Adequate Nuclear Medicine Module
• Unique Software for Each Subspecialty
• Backup and Redundancy
– Archive
– Workstations
– Network
• Network Overload
Caveat Emptor
• One man’s “dicom compatible” is the next
man’s headache.
• Be sure your PACS can translate native
vendor formats
A PACS Is For The Nuclear Medicine
Physician, Not the Programmer
•
•
•
•
5 Minute Training
Intuitive Operations
PACS for Doctors (i.e. Dummies)
Backup and Redundancy– System NEVER
Goes Down
Photographic vs. Digital Costs
Annual Exam Volume:
Nuclear Medicine
CT
MRI
Ultrasound
13,368
22,050
7,775
22,951
66,144
43.6% of total departmental exam volume
Photographic Costs
Film & File Room:
Film (NM (?), CT, MRI, US)
Maintenance
Processors,Multiloaders,Alternators
Film jackets, Folders, & Supplies
Storage off-site
File Room Personnel / Benefits
File Room space
-Personnel overhead
-Depreciation
$
410,988
42,006
11,964
32,669
286,233
101,227
29,936
$ 915,023
Photographic Costs
Equipment Depreciation:
$ 20,000
50,000
Film processors
Laser Printers
______________
Total:
$ 70,000
Photographic Costs
Technologist time:
Process time
Loading/unloading cassette
Annotation, flashing & preparation
for filing
Total:
90 seconds
60 seconds
120 seconds
4.5minutes/study
Salary/benefits @ $23.52/hr
Cost per study $1.76
Total:
$116,413
Digital costs
12 Workstations, 5 year depreciation
$ 200,000
4 MiniPACs servers,
with backup, 5 year depreciation
60,000
High speed network, 5yr depreciation 30,000
System supplies
10,000
Space depreciation and Maintenance 30,000
System manager and benefits
70,000
Service contracts
130,000
Total:
$530,000/yr
Annual Savings
Photographic costs
Digital costs
$ 1,101,436
530,000
SAVINGS = $571,436
NUCLEAR MEDICINE
Total photographic cost/study = $4.13
NUCLEAR MEDICINE
Digital costs
Equipment
2 Workstations, 5 year depreciation
1 Server, 5 year depreciation
Maintenance
Total:
$14,000/yr
7,800/yr
9,810/yr
$31,610/yr
Cost per study = $3.16
Enormous Gain in Nuclear
Medicine Physician Efficiency
Gains in REFERRING PHYSICIAN Efficiency:
No waiting to retrieve new and old study
No waiting for Nuclear Medicine Physician to
review emergency study
INTERNET
OFFICE
PACS SERVER
Mt. Auburn
Hospital
NT
BIDMC West
Nuclear Medicine
BIDMC East
Nuclear Medicine
BIDMC East
Clinical Center
MT. AUBURN
BIDMC West Nuclear Medicine
Siemens
SH
Ohio
Nuclear
Siemens
SH
SPECT
Strichman
Siemens
Camera
DH SPECT
BIDMC East Nuclear Medicine
GE
StarCam
Technicare
Mobile
Trionix
BIAD
Elscint
HELIX
Elscint
SP6
Nuclear Medicine
Network
ADAC
PEGASYS
BIDMC East Clinical Center
ADAC
Pegasys
ADAC
Pegasys
ADAC
Pegasys
Cameras
Internet
Cell Modem
Cable
Modem
Telephone Modem
Nuclear Medicine
Network
Remote Access
for
Physicians
BIDMC East Nuclear Medicine
Projection Screen
RTAS
WorkStation
Nuclear Medicine
Network
RTAS
Work Station
Optical Backup
1.3GB
Work Station
Image Center
Workstations
Standard off-the-shelf
Software & Hardware
•
•
•
•
•
•
Low cost
Multiple vendors
Upgradeable
Easy maintainability and serviceability
Links to other systems
Creation of new functions
BACKUP
What’s got to be there
when everything is broke...
What could happen...
1) Hospital fire fries all disks
2) Server is down
3) Hospital Ethernet is down
4) ALL workstations are down
1) Data backup
2) Database backup
3) Hardware backup
Data backup
1) Two disks
-not mirrored
2) Daily automatic (night) backup
-WORM disk
-not on Server
3) Weekly download to tape
-taken off-site
Database backup
1) Nightly backup
-to workstation
2) Recovery program
-to reconstruct database by reading
header data on all files
Hardware Backup
• Use standard PC hardware
• All Workstations and Server are PC-based and
interchangeable
• Network backup with floppy disks
• Modem backup for telenuclear medicine access for
W W W-Internet failure
• Floppy transfer if network is down
How does BACKUP work?
Automatically
14 YEAR’S EXPERIENCE
What did happen...
1) Power Supply
2) Disk Controller
3) Disk Errors
4) Disk Crash
5) Work Station Down
6) Gamma Camera Gateway to Server Down
7) Delete *.*
8) Four hours total system downtime.
Citywide power failure.
Publications on the Web
•
The All-Digital Department Moves to the Web
-http://ej.rsna.org/EJ_0_96/0006-96/home.htm
• Cable Modem–assisted Tele–Nuclear Medicine
-http://ej.rsna.org/EJ_0_96/001996.fin/cable_modem.html
• Cost Savings in a Digital Radiology Department
-http://ej.rsna.org/EJ_0_96/005197.fin/Pacs97.html
• Backup and Redundancy:
10-Year Experience with a Division-wide
PACS
-http://ej.rsna.org/ej2/0052-97.fin/pacsfail.html
*Gerald M. Kolodny, M.D.
J. Anthony Parker, M.D., Ph.D.
Kevin J. Donohoe, M.D.
Thomas C. Hill, M.D.
Dace Jansons, M.S., C.N.M.T.
Larry Barbaras, B.S.
Division of Nuclear Medicine
Beth Israel Deaconess Medical Center
Boston, MA
*stockholder, Sudbury Systems, Inc.