PICTURE ARCHIVING AND COMMUNICATION SYSTEM

PACS (picture archiving and communication system) is a healthcare technology for the short- and long-

term storage, retrieval, management, distribution and presentation of medical images.

A PACS allows a healthcare organization (such as a hospital) to capture, store, view and share all types of

images internally and externally. When deploying a PACS, the organization needs to consider the

environment in which it will be used (inpatient, ambulatory, emergency, specialties) and the other electronic

systems with which it will integrate.

The universal format for PACS image storage and transfer is DICOM (Digital Imaging and

Communications in Medicine). Non-image data, such as scanned documents, may be incorporated using

consumer industry standard formats like PDF (Portable Document Format), once encapsulated in DICOM.

A PACS consists of four major components: The imaging modalities such as X-ray plain film

(PF), computed tomography (CT) and magnetic resonance imaging (MRI), a secured network for the

transmission of patient information, workstations for interpreting and reviewing images, and archives for

the storage and retrieval of images and reports. Combined with available and emerging web technology,

PACS has the ability to deliver timely and efficient access to images, interpretations, and related data.

PACS breaks down the physical and time barriers associated with traditional film-based image retrieval,

distribution, and display.

 An image as stored on a PACS

PACS has four main uses:

Hard copy replacement: PACS replaces hard-copy based means of managing medical images, such as film

archives. With the decreasing price of digital storage, PACSs provide a growing cost and space advantage

over film archives in addition to the instant access to prior images at the same institution. Digital copies are

referred to as Soft-copy.

Remote access: It expands on the possibilities of conventional systems by providing capabilities of off-site

viewing and reporting (distance education, telediagnosis). It enables practitioners in different physical

locations to access the same information simultaneously for teleradiology.

Electronic image integration platform: PACS provides the electronic platform for radiology images

interfacing with other medical automation systems such as Hospital Information System (HIS), Electronic

Medical Record (EMR), Practice Management Software, and Radiology Information System (RIS).

Radiology Workflow Management: PACS is used by radiology personnel to manage the workflow of patient

exams.
 PACS is offered by virtually all the major medical imaging equipment manufacturers, medical IT companies

and many independent software companies. Basic PACS software can be found free on the Internet.

Typically a PACS consists of a multitude of devices. The first step in typical PACS systems is the modality.

Modalities are typically computed tomography (CT), ultrasound, nuclear medicine, positron emission tomography

(PET), and magnetic resonance imaging (MRI). Depending on the facility's workflow most modalities send to a

quality assurance (QA) workstation or sometimes called a PACS gateway. The QA workstation is a checkpoint to

make sure patient demographics are correct as well as other important attributes of a study. If the study information

is correct the images are passed to the archive for storage. The central storage device (archive) stores images and

in some cases reports, measurements and other information that resides with the images. The next step in the PACS

workflow is the reading workstations. The reading workstation is where the radiologist reviews the patient's study

and formulates their diagnosis. Normally tied to the reading workstation is a reporting package that assists the

radiologist with dictating the final report. Reporting software is optional and there are various ways in which

doctors prefer to dictate their report. Ancillary to the workflow mentioned, there is normally CD/DVD authoring

software used to burn patient studies for distribution to patients or referring physicians. The diagram above shows

a typical workflow in most imaging centers and hospitals. Note that this section does not cover integration to a

Radiology Information System, Hospital Information System and other such front-end system that relates to the

PACS workflow.

An essential component in a PACS environment

Hospital Information Systems (HIS), Radiology Information Systems (RIS) and EMR/EHR solutions provide

a master index of patient demographics and exam scheduling information.

Without DICOM MWL, modalities must take patient healthcare information (PHI) and manually enter the

PHI into the modality, introducing human error and increasing unnecessary manual labor.
 DCMSYS Enerprise MWL automates the transfer of information from any HIS/RIS/EMR to unlimited

modalities and also aggregates obsolete, non-scalable MWLs across the enterprise, turning any exam-

scheduling database into an enterprise-grade DICOM MWL server.

Features

Modality DICOM Proxy to aggregate multiple disparate MWLs.

Receives HL7 messages and adapts to other protocols and formats

Automatically transfers patient identifiers, created by the existing information systems to your network as

DICOM worklists
 TLS encryption for remote location MWL support. Does not require a VPN

Secure multiple remote access, web-based user interface

CFIND-WORKLIST DICOM tag manipulation for outdated modalities (optional).

Incoming and Outgoing Modality worklist DICOM tag modification ability (optional)

Advanced logging capability and MWL debug tools

Returns study statuses (converted from DICOM to HL7) to information systems and enables patient identifier in

accordance with IHE (optional)

High availability with automated failover feature (optional)

Includes a powerful Web-based administration and remote technical support built-in functionality

PACS-Server with 35 Terabyte RAID Archive and high speed fiber optic switch
Modality worklist (MWL) is one of DICOM's workflow services that really make a difference. It's the

difference between grocery store workflow with notes on little pieces of paper and a true modern

accountable workflow.

List of PACS Systems

Cerner ProVision

Fujifilm Synapse

GE Healthcare

McKesson Enterprise Image Repository Review

Medicor Imaging

Novarad NovaPACS

OnePacs

OsiriX

RamSoft

Sectra

ICT For Health

Agfa HealthCare

Carestream Health

RADinfo Systems