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Readers Write: 256 Shades of Grey(scale): The Dirty Little Secrets of Radiology and PACS

May 17, 2013 Readers Write 5 Comments

256 Shades of Grey(scale): The Dirty Little Secrets of Radiology and PACS
By Brad Levin

5-17-2013 7-39-27 PM

There is widespread agreement that radiology has been the epitome of success spreading PACS far and wide over the last two decades. Thousands of organizations transformed from the dark ages of film to digital operations. Early activity started in the mid-1990s and peaked in the mid-2000s. Once the 2000s were in full swing, many groups moved to PACS for the first time, but it was relatively common for PACS early adopters to have implemented their second or in rare cases, their third PACS by then.

Along came the late 2000s, when industry analysts KLAS and Frost & Sullivan called for the next wave of PACS replacements. Many systems had aged well beyond the average 5-7 year lifespan of PACS, and it seemed like a solid market forecast. However, in reality the replacements never came in earnest. 

Fast forward to present day and the institutional use of PACS has stagnated. PACS continue to be used past their useful life, problems persist, and upgrades are delayed. The other contributing factor is a majority of institutions today are using PACS born in the late 1990s or early 2000s. Their vendors purchased PACS largely through acquisition, and while these systems have been upgraded periodically, most of the core architectures remain largely unchanged.

This would be fine if time stood still, but of course it hasn’t. Over the last two decades, modalities have advanced at breakneck speed, producing computed/digital radiography, multislice CT, PET/CT, digital mammography, and the newest modality, digital breast tomosynthesis (or 3D mammography).

Modern technology has also dramatically changed consumer and physician expectations. Everyone expects instant gratification. Pay phones are extinct and we all use smartphones. The world is app-driven and tablet accessible. LPs/CDs have been replaced with MP3s. Medicine is mobile, and we’ve ditched our VCRs/DVDs for streaming media.

Today’s challenging healthcare environment, supported by yesterday’s PACS technology, has led to widespread chronic problems and missed opportunities. When I was told recently that some of the most senior leaders in imaging informatics had convened and were discussing how "Radiology Has Solved The Problems of Going Digital", I was stunned. Based on what I see at community hospitals, academic medical centers, IDNs, imaging centers, radiology groups, and teleradiology vendors, I know that statement couldn’t be farther from the truth.  

The vast majority of practices are digital, but are their problems solved? In my view, absolutely not. Just this week I spoke with a PACS administrator from a 400-bed hospital in the Southwest. I was told that when their network access peaks, performance gets crushed on PACS, taking up to a minute to launch even a small CR study. Radiologists launch the study on PACS, grab a coffee, and hope that when they come back they can start reading the study. While this may or may not be just a PACS issue, it is a persistent, unacceptable problem nonetheless.

If you are unaware of the state of your imaging operations, I encourage you to speak to your radiologists, referring physicians, PACS administrators, and your IT staff. You may also consider meeting with your affiliates, and plan on attending the upcoming SIIM 2013. If you tackle today’s Imaging problems with the same vigor you used to transform from film to digital, your problems will quickly go into the rearview mirror.

Brad Levin is general manager, North America for Visage Imaging.

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Currently there are "5 comments" on this Article:

  1. Well said, Brad. PACS remains immature, which leaves plenty of opportunity for industry to produce much more useful products.

  2. Good summary of PACS issues. PACS remains an immature technology, essentially replacing old film imaging without improving on that workflow like it should. This field is ripe for new PACS systems with features that improve productivity and quality.

  3. I think the largest part of the current PACS “problems” stem from the relationship between IT and Radiology. It seems to me that PACS has brought a world of efficiency to Radiology and a host of obstacles to IT. It will be IT’s challenge to make that system work efficiently as they have for other systems in previous decades. The unique thing about PACS is that it requires a lot of storage and a fair amount of bandwidth.

  4. Being new to PACS it would be easy to sway me towards the belief that digital imaging is a sophisticated operation. As I learn more about the application side of PACS I see that there is much to be improved upon. I look forward to seeing more articles published regarding the direction of digital imagery, especially tomosynthesis and mammography!

  5. In the 90’s I implemented that first generation PACS to replace film. It’s not that long ago and many practicing radiologists are keenly aware of the serious problems PACS addressed, most notably: lost films. Let’s not forget poor visualization, the chemistry and equipment for developing film, misidentified or unidentified films, lost comparison films, the real estate and round-the-clock labor costs of film storage/retrieval/transport, waiting hours for the truck to come from the warehouse with comparison studies, film disposal and silver recovery. Also remember: film is a single user system so ordering MDs walked to the Film Library or waited for requested films to be delivered (if they weren’t already requested by someone else).

    That was the starting point, so yes, many radiologists see tremendous gains from PACS. And when technology is poorly implemented, please don’t reflexively blame the technology. If “performance gets crushed on PACS”, my first inclination is to hire a new network administrator.

    Can PACS be better? Of course, it’s a system built by humans and must evolve to meet new needs. Is it much better than film? Absolutely.

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