The Disadvantages of PACS With the Use of Training Programs and Proper Planning - Essay Example

 Abstract This essay focuses on the creation and development of Picture Archiving and Communication Systems (PACS). PACS has been a major player in the development of medical science. PACS is a computerized method of replacing the conventional form of radiological films and images. The creation of PACS has impacted the workflow of medical practitioners and reduced the time used to provide treatment. It has also made accessing medical images easier and faster. It has been discovered that the use of Picture Archiving and Communication Systems (PACS) has had a positive impact on medical staff and patients. However, for the future it is said that PACS needs to work on its IT compatibility. PACS has made the life of many healthcare professionals easy as they can provide faster treatment even at the convenience of their homes. This essay evaluates the functions, uses, advantages and disadvantages of PACS. It also covers the future of the PACS software. Picture Archiving and Communication Systems (PACS) "For more than 100 years, the efficiency of radiology practices has been limited by film and film-handling activities. Pictures archiving and communication systems (PACS) completely reengineer radiology practices by enabling images to be electronically viewed virtually anywhere on a clinical workstation or an ordinary PC” (Dreyer et all, 2006, p. 27) The media used in capturing, displaying and storage of radio graphic images has been restricted to film since the past century but now as we have moved into the 21st century and with the rapid development in technology and science, we have found more effective, efficient and faster ways of processing and maintenance of data, the wide use of computers and technology has helped in the development of various softwares which have helped in many fields like photography, data processing, art and architecture, broadcast media, astronomy, defense systems, security systems, information technology, communication systems and also in the field of medical science. Medical science has seen many innovative creations like sonography and ultrasound scanning systems, MRI, laser surgeries and the like. One such revolutionary change in the process of storage, distribution and presentation of medical images has been the design and development of Picture Archiving and Communication Systems (PACS). The ideology of PACS was first discussed in 1982 at different meeting of radiologists. Dr Andre Duerinckx claimed that he coined the term in 1981, however, Dr Samuel Dwyer, gives credit to Dr Judith M. Prewitt for coming up with the term. Therefore, it is concluded that many people got credit for the coinage of the term Picture Archiving and Communication Systems or PACS. In the early 1990s Dr Harold Glass, a medical physicist who was working in London was granted funding from the government of United Kingdom and managed the PACS project for many years. This made the Hammersmith Hospital in London the first hospital to go filmless in the United Kingdom. Dr Glass is credited with being one of the pioneers of PACS, though he died a few months after the project went on board. Picture Archiving and Communication Systems (PACS) are networks or computers that are used to store, distribute, retrieve images and also are used for the presentation of images. Independent formats are used to store medical images. Simply put the PACS technology helps in storing images such as scans and x-rays electronically, these images can also be viewed on screens. This helps health professionals and doctors access information and also compare it with previous images, all this at the touch of a button. One of the most common formats used to store medical images is Digital Imaging and Communications in Medicine (DICOM). As PACS delivers more efficient imaging processes it can contribute to delivering a patent’s journey up to a maximum of 18 weeks. PACS technology has reduced the usage of films. This is due to the flexible usage of digital systems with PACS. It is more cost effective as it eliminates the cost related with hard films. It also frees up space that is used in storage of hard films. One of the most important uses of PACS is that it has ability to transfer the experience of the patient’s care to the NHS. PACS helps clinicians in their performance and contributes in making them efficient and supports the advancement of 21st century health services. The PACS technology is built on an architecture where a PACS network has a central server. This central server stores images if the form of a database which contains images, these images are connected to one or more clients via a Wide Area Network (WAN) or a Local Area Network (LAN) which utilize or provide the images. Today more and more PACS use the Internet as a means of communication to include web-based interfaces. This is usually done via Virtual Private Network (VPN) or Secure Sockets Layer (SSL). The client side software often used by PACS is Javascript and/or Java, and ActiveX. Local peripherals are used at client workstations where film images can be scanned into the system, provide an interactive display of digital images, and also in printing image films from the systems. PACS workstations also have facilities where images can be manipulated, for example, images can be cropped, zoomed, rotated, leveled, and the like. Today modern radiology modalities and equipment directly feed patient images into the PACS in a digital form. Many imaging departments in hospitals and radiology practices make use of a film digitizer, to help in backward compatibility. One important but often overlooked part of the PACS architecture is the PACS image backup. It is a requirement of Health Insurance Portability and Accounting Act (HIPAA) that the backup copies of patient images be maintained in case of the loss of any images from PACS. The goal of maintaining backup copies of images is to make it easy to administer and automatic. It is hoped that the copies will never be needed, however, as part of disaster planning backup copies need to be available if required. There a quite a few methods of backing up image, however, this process typically involves automatically sending image copies for storage to a separate computer, preferably off-site. Unix is the software used to for some of the largest sites, as it is very secure to viruses and also very stable. At the same time, wintel platforms with the help of modern powerful processors are gaining space. It is required by PACS from hospital information system and radiology information system, images from devices used for imaging and associated patient data to be sent to PACS archive server and controller. The most important chore of PACS is to obtain reliable, accurate and quick images from every radiological imaging modality and also to achieve the relevant data inclusive of the text information that supports the study of the patient, additionally it should include point to point report of the study and the factors applicable to image acquirement and processing. There are two types of interfaces when connecting a general purpose PACS acquisition computer with a radiological imaging modality. Image transfers can be initiated either by the destination PACS acquisition gateway computer that is a “pull” operation or by the radiological gateway computer that is a “push” operation. The pull mode is better than the push mode, because when transferring the images from the radiological imaging modality to the gateway computer and if the gateway computer undergoes a problem or does not function properly, the images can be queued and then pulled by the computer later when it is operational or if the time lag is not acceptable then the examination images can be rerouted to another operational networked acquisition gateway computer or a workstation. The alternative interface is a mater-slave device-level connection as de facto old industry standard, DR-11W. This is a point to point board level interface which is a parallel transfer direct memory access connection. The recovery mechanisms again depend on the kind of machine can start a study transfer that is either the imaging modality or acquisition gateway computer. The PACS controller receives the imaging examination with the relevant patient data from the gateway computer. Also the information from HIS and RIS are sent to the PACS controller. The PACS controller acts as the engine of the system. It consists of servers or high end computers, the main components of the controller are an archive system and a database server, the archive system consists of permanent, long term and short term storage. “The first important rule in building a PACS infrastructure is to incorporate as many industry de facto standards as possible that are consistent with the overall PACS design scheme. The philosophy is to minimize the development of customized software. Furthermore, using industry standard hardware and software increases the profitability of the system to other computer platforms.”(Huang, 2004, p. 159) The following industry standards are used to in PACS infrastructure design WINDOWS XP/ NT operating system, UNIX operating system, Structured Query Language (SQL) as database query language, TCP/IP and DICOM communication protocols, C and C++ programming language, DICOM standard for image data format and communication, ASCII text representation for message passing, X WINDOWS user interface, HL7 for health care database information exchange, Extensible Markup Language XML for data representation and exchange on the world wide web. The major functions of archive server and PACS controller consists of receiving examination images through acquisition gateway computer, receiving the text report of the examination, updating the database of a management that is accessible through a network, automatically retrieving necessary comparison images from long term library archive system or distributed cache storage, determination of the destination workstations which has to receive the exam reports and images, interfacing with PACS application servers, automatically deleting images that have been stored from acquisition gateway computers, performing data reliability checks, storing new reports or exam data onto the long term storage library, compressing image data if required, correcting the direction of computed radiography images, and determining the brightness and optimal contrast. The functions of a PACS workstation are reconstruction of images for appropriate display through the use of various tools for different types of image reconstruction, documentation of the examination including voice and text reports and image annotation, proper diagnosis and interpretation of the exam, arrangement of images for easy review, selection of cases to be examined for a give subpopulation and gathering information and related images of a patients examination. Picture Archiving and Communication Systems (PACS) has many advantages and disadvantages. Benefits of the PACS technology are vast. PACS has brought an innovatory change to the process of medical imaging and data maintenance. At the same time like many other softwares that have been built in different fields the PACS software also has its own disadvantages. If the only use of the PACS software was to replace the conventional film images, then the PACS software would be a complex and expensive system. The primary advantage of PACS is that it improves efficiency which is the result of electronic data handling. The PACS software also has many other advantages under its belt. It provides rapid access to a patient’s examinations, records and reports which helps in faster treatment. One major advantage of the PACS software is that cases can be accessed and viewed in many places at the same time. The images provided using PACS are of consistent high quality. With the PACS software a patient’s examinations records are stored in an orderly manner according to the dates. Since PACS is not like the traditional film imaging it does not require the use of chemicals for processing. PACS also eliminates the film artifacts. Since PACS is a computerized technology, the chance of images being lost is negligible. Using PACS also provides a better and improve workplace. Once a case is closed all that is required with the PACS software is to delete the images in order to get rid of the case information, which is far better than handling films. The use of PACS also helps in massive decrease of storage space. It also reduces the cost that was required to file films. Another advantage of the PACS software is that there is no cost of films. “PACS can be used for the early diagnoses and monitoring of myocardial ischemia” (Murray et all, 2002, p. 131) Though the Picture Archiving and Communication Systems (PACS) has many advantages it also has its own disadvantages. One of the biggest disadvantages of PACS is that it is expensive when it comes to maintaining the technology used in PACS. Though the cost of computer softwares and hardwares has reduces in the past years, the installation of PACS in an average sized hospital is also expensive. To use the PACS software it is important to have trained personnel to use, access and maintain the software. This is considered a disadvantage as major part of the staff needs to be computer literate to use PACS. Though the PACS software is used to archive images digitally, retrieving these archives can be quite slow, when the demand is high. Another disadvantage of the PACS software is in transferring images from portable capture units. Once a hospital becomes filmless with the use of PACS, there is no fall back position because the means to store, generate, view and distribute film does not exist in the hospital. If there is a PACS failure the consequences clinical care are so shocking that even a minimum delay in a resolution of the problem is unacceptable. The disadvantages of PACS are very few when compared to the advantages. It is possible to overcome many of these disadvantages with the use of training programs and proper planning and good backup systems. PACS has been an innovative creation which has helped many hospitals when it comes to storing and retrieving images. Therefore, it can be concluded that PACS with its vast advantages is very useful and its disadvantages can be ignored as they are negligible. PACS is used in almost all healthcare organization, nowadays, for example the pediatrics branch, the fracture unit and many more. In the Hammersmith Hospital, the first hospital to use PACS in the United Kingdom, the PACS software was first implemented in the pediatrics department and neonatal unit. The advantages of PACS are mainly visible in the pediatrics branch of medical science. With premature babies who are usually very unwell, the key factor to determining treatment and management are the hanging radiographic findings. With PACS as soon as a digital image is acquired it is accessible to the clinician on the neonatal unit. This saves plenty of time as there is no need to go to the Imaging department or to wait for the image to be returned to the ward. This results in faster decisions and saves a lot of treatment time. If a radiologist’s opinion is required for the treatment it can be attained by telephone as both the pediatrician and radiologist can view the image at the same time on different monitors with the help of PACS. In the neonatal unit and the pediatrics department, for patients with chronic diseases it is important to be able to view and compare chronological series of scans and radiographs to assess the progress of a patient. Another area where PACS is very useful the neurosurgical branch of medical science. It is believed that one of the main improvements to previous technologies is that PACS is much faster to access. Images can now be accessed immediately and there is no need to wait for hard copies of films to be produced before treatment. When it comes to neurosurgery there are many out-of-hours emergency scans which need to be accessed, with PACS it is easy to access these images remotely, either from outreach clinics in or from trust sites, or even from home. PACS are also used in the mobile form in theatres. This is a huge advantage as patient scans can be viewed in front of the doctor instead of the doctor turning around all the time to the wall behind them. Fracture clinics also benefit a lot from the PACS software. In fracture clinics it is important to compare the current stage of healing of the fracture with earlier images of the same fracture in order to access progress of the treatment. All this helps in speeding up the treatment process and makes the life of the patient as well as the healthcare professional easy. Although the PACS software is very useful, it does have a few areas of improvement. With PACS filmless radiology has been achieved in many hospitals, the next step would be to create complete paperless technology, in order to maintain a complete electronic patient record. Another area for the improvement of PACS is that it should be implemented in many more hospitals around the globe; this would help in faster development of medical science. In conclusion it is not wrong to say that the PACS software has benefited many hospitals, patients, and doctors tremendously worldwide. Picture Archiving and Communication Systems (PACS) not only helps in faster treatment but also helps in easy maintenance of a patients records. Though PACS is expensive to install, its long term use makes it cost effective. PACS not only improves the efficiency of medical science but also makes it very effective. “PACS will allow the entire database of images and reports to be accessed over Internet, over telephone, via satellite communication, or from cable modems.”(Peart, 2005, p. 189) Reference List Dreyer, Keith J., Hirschorn, David S., Thrall, James H., and Mehta, Amit. 2006. PACS: A Guide to the Digital Revolution, Edn 2. Birkhäuser. Huang, H.K., 2004. PACS and Imaging Informatics: Basic Principles and Applications. Edn 2. Wiley-IEEE. Murray, Michael James, COursin, Douglas B., and Prough, Donald S., 2002. Critical Care Medicine: Perioperative Management. Lippincott Williams & Wilkins. Peart, Olive. 2005. Mammography and Breast,Imaging: Just the Facts. McGraw- HillProfessional Read More