What Everyone NEEDS to Know About PACS

1. What Everyone NEEDS to Know About PACS Guy Guindon NORrad PACS Manager August 08, 2003

2. 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.

3. 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.

4. 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

5. 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.

6. PACS COMPONENTS • CORE COMPONENTS • VIEWING STATIONS • ACQUISITION STATIONS AND PRINTERS • SUPPLEMENTARY EQUIPMENT • SITE EVALUATION • PACS PROJECT SUPPORT

7. CORE COMPONENTS • Archive/Database Servers • Image Server • Image Cache • Web Servers • Web Cache • Long Term Storage Systems • Networks (Core components and switches) • Server Racks • HIS/RIS Interfaces

8. 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

9. ACQUISITION STATIONS AND PRINTERS • Computed and Digital Radiographic Systems • Multi Plate CR Reader with cassettes • Single Plate CR Reader with cassettes • CR Server • CR Clients • 3 Foot Image Solution (Full Spine and Leg Length) • Modality Interfaces or DICOM Upgrades • Document Scanners • Film Digitizers • Dry Laser Printers

10. SUPPLEMENTARY EQUIPMENT • Ergonomics • Desk • Chair • Carts for PC’s • Articulating Arms for PC’s • Viewboxes • Renovation Costs • PC’s for Web Clients (New or Upgrades)

11. 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)

12. 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

13. 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.

14. 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

15. 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

16. ACQUISITION STATIONS AND PRINTERSThings to Note • CR 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.

17. ACQUISITION STATIONS AND PRINTERSThings to Note • CR 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

18. ACQUISITION STATIONS AND PRINTERSThings to Note • Dry Laser Printers • Filmless department • PACS Downtime • Modality Interfaces / DICOM Upgrades • DICOM Interface Cost - $30k • DICOM Upgrade Cost - $10-40k

19. 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..

20. 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

21. SITE EVALUATIONThings to Note • Modalities • CT • MRI • R&F • Ultrasound • Angiography • Nuclear Medicine • C-Arms • Portables • Radiography Room (CR or DR)

22. 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

23. 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’ Office Note: Must understand the volume and type of procedures which are performed in each Clinical Department and their needs.

24. 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