Chapter 5

PACS (PICTURE
ARCHIVING
& COMMUNICATIONS
SYSTEM)
 D EF INIT
ION

 A picture archiving and

communications
system (PACS) is a medical
imaging technology which provides
economical storage of, and convenient access
to, images from multiple modalities.
 HIS TO R ICAL D EVELO P MENT

 Concept began with Alber t Jutras in Canada in

the 1950s.
 Early PACS systems were developed by
the
militar y to send images between Veterans
Administration hospitals in the 1980s.
 Development was encouraged and suppor
ted
by the U.S. government.
  Early process involved scanning
radiographs
into the computer and sending them from
computer to computer.
 Images were then stored in PACS.
 Computed and digital radiography followed.
 PAC S

 A network of computer s used by radiology

depar
tments that replaces film with electronically
stored & displayed digital images.
 It provides archives for storage of multimodality
images, in tegrates images with patient database
in formation, facilitates laser prin tin g of images &
displays both images & patient information at
work stations throughout the network .
 It also allows viewing of images in
remote
 PAC S

 Can accept any image that is in DICOM format

 Custom designed for each facility
 Components/features can var y based on the
following:
• Volume
of
patients
• Number
of
interpret
ation
 D IC O
M
 DICOM (Digital Imaging and
Communications
in Medicine) is the universal format for PACS
image storage and transfer.
 Non-image data, such as scanned
documents,
may be incorporated using consumer industr y
standard formats like PDF (Por table
Document Format), once encapsulated in
DICOM.
 IN IT IAL P RO BL EM S

 Early systems did not have standardized

image formats.
 Matching up systems was dif ficult.
 Vendors kept systems proprietar y and did not
share information.
 DICOM standards helped change this by
allowing communication between vendors’
products.
 C O M P ONENT
S
 Made up of 4 major components:
1. Imaging modalities - such as X-ray plain film
(PF), CT and MRI.
2. A secured network for the transmission of
patient information.
3. Workstations for interpreting and reviewing
images.
4. Archives for the storage and retrieval of
images and repor ts.
 IM AGE AC Q UISIT ION C O M P ONENT

 Images of a PACS are produced by several

radiologic imaging modalities.
 Images of CT, U/S, MRI & nuclear medicine
imaging (PET/SPECT) are digitally captured.
 Images of X-ray scanner s
have to be
digitalized first.
 The images can be transmitted from
the
modalities using a specified inter
face.
 A RC H ITECT URE

 The architecture is the physical

implementation of required functionality, or
what one sees from the outside .
 A radiologist typically sees a viewing
station.
A technologist present at a QA workstation.
While a PACS administrator spend most of
their time in computer room .
 A RC HITECT URE C O N T INUED …

 QA workstation is a checkpoint to make sure

patient demographics are correct.
 If study information is correct, images are
passed
to arc hive for storage.
 The central storage device (archive) stores
images & may also store repor ts, measurements
& other information present with images.
 Next step is the reading workstations.
 Reading workstation is where radiologist
reviews
patient's study and formulates their diagnosis.
 A RC HITECT URE C O N T INUED …

 Normally attached to a reading workstation is

a repor ting package assisting with final
repor t.
 Repor ting sof tware is optional .
 CD/DVD authoring sof tware may also be
annexed, used to burn patient studies for
distribution to patients or referring physicians
 US
ES
 PACS has four main uses:
 Hard copy replacement: PACS replaces
hard-
copy storage.
 Remote access: Provides capabilities of of f -
site
viewing and repor ting ( distance
education , telediagnosis
 Radiology Workflow Management:Used by
radiology personnel to manage workflow of
patient exams.
 U S ES C O N T INUED ..

 Electronic image integration platform:

Provides electronic platform for radiology
images inter facing with other medical
automation systems such as Hospital
Information System (HIS), Radiology
Information System (RIS).
 A D D IT IONAL U S ES

 Early PACS seen only in radiology & some

cardiology depar tments.
 Now can be used in multiple depar tments.
 Archive space can be shared among
depar tments.
PACS breaks down the physical & time
barrier s associated with traditional
film- based image retrieval, distribution,
and display.
 PACS allows radiologists to reconstruct &
stitch images in their of fices.
 US
ES
 PACS reading stations may also have image
processing capabilities .
 Or thopedic workstations are available for the
following:
• Surgeons can plan joint replacement surgery.
• Specialized software allows matching of best
replacement for patient with patient anatomy.
• System saves time and provides better fit .
 D ISA DVANTAGES

Firstly, implementing a PACS is an expens

ive
project.
The change in workflow could be frighten
ing for
conservative radiologists & physicians.
Most of staff will need introduction & add
itional
trainings to work with PACS software.
No archive can guarantee a total fault-to
lerance
as a result images can be lost or deleted.
Computer engineer availability required,
 CON
CLUSION
 To p u t thi ng s i n a nu ts he l l , the b e ne fi ts o f PAC S
are
c l e a rl y v i s i bl e, b u t the re a re s o m e re a s o na b l
e d o u b ts
l e f t.
 To i m p rove the nu m b e r o f PAC S i ns ta l l a tio ns,
the
ve nd o r s a nd d eve lo per s o f PAC S s ys te m s s ho u
ld,
b e s i de s the te c hni c a l a d va nc em e nt, fo c u s i n
he l p i ng
the e nd u s e r s to re m ove the l a s t d o u b ts.
 T hi s c o u l d b e re a c he d wi th e a s i e r i ntro d u c
ti ons i nto
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