PACS: A Guide to the Digital Revolution

This multi-authored book covers the major topics in picture archiving and communication systems (PACS) and provides valuable information in understanding the technologic advancements that have resulted in the digital revolution in the practice of radiology. The thorough and comprehensive analysis of the various PACS concepts and their relationships in forming the digital radiology department in an integrated health care enterprise makes this book a valuable tool for radiologists, computer scientists, administrators, and technologists in the field. One of the main features of this book that greatly enhances its teaching value is the abundance of examples explaining and simplifying technical issues that would otherwise seem complicated, such as determining compatibility between two PACS devices on the basis of Digital Imaging and Communications in Medicine (DICOM) standard. The ability to learn through logically designed examples increases the confidence and participation of the reader, who comes to the realization that a degree in computer science is not a prerequisite to relate to some of the most technical aspects of PACS. The large number of relevant figures and diagrams that illustrate the issues discussed in the text is very effective and enables easier reading and understanding of the material. Ironically, errors found in the legends of some of the figures, particularly in Chapter four, make them awkward and confusing to follow. The strength of the organizational presentation of the material is augmented by the use of tables that organize knowledge and information in a manner that makes it easier to comprehend or reference. The book is divided into four main categories: 1) Introductory Concepts, 2) Computing Fundamentals, 3) Advanced Imaging Technologies, and 4) Future Opportunities. There are 16 chapters in total, with 18 contributors. For those radiology departments that are developing a request for proposal for PACS, this book can be very helpful, because it analyzes all aspects involved in the process: PACS components and technology, departmental workflow changes, enterprise-wide imaging, financial modeling, legal issues and policies, and research and education. The chapter on financial modeling describes various methods of financial analysis for all the major cost elements involved in PACS. It highlights a case of financial analysis by using net present value, which is a widely accepted and respected method. This chapter not only explains cost-savings opportunities but also emphasizes that in a health care environment, nonfinancial benefits should be taken into consideration to fully evaluate the investment. The risks of project implementation are considered from the standpoint of technology (integration, network, etc.) and organization (acceptance, realization of savings in personnel and film). The section on computing fundamentals provides the not-so-computer-skilled reader with some basic computer knowledge by describing the main components and the operation of the personal computer. The usefulness of this chapter is questionable considering that the material is very basic and does not attempt to relate any concepts to PACS. Contrary to what is mentioned in the preface of the book, this chapter does not describe any terminology for digital imaging. I think the value of this chapter, as an introduction to basic computing fundamentals relevant to PACS, could be enhanced by incorporating additional information extracted from other chapters, such as bits, bytes, and pixels (from Chapter 9: Storage and Archives). Two critical chapters in understanding PACS are networking fundamentals and DICOM. They both do an excellent job in providing the background and knowledge necessary to appreciate the importance of good network design and implementation and the fundamental role of the DICOM standard in providing the necessary interoperability among the various devices (scanners, workstations, printers, etc.). A plethora of examples (including real-world scenarios) and relevant illustrations in both of these chapters help to demystify the technical complexities and preserve the continuous interest of the reader in some of the most intricate aspects of PACS. The chapter on image acquisition discusses the process of data entry into the PACS through integration of the various modalities. It is critical that this implementation is successful, because errors generated during image acquisition can propagate throughout the system and adversely affect the PACS-based operation. Furthermore, it is explained that integration of PACS with Radiology Information SystemHospital Information System (RIS-HIS) is essential at image acquisition and that DICOM conformance should be required from both modality and PACS vendors. A detailed description is provided regarding how image acquisition is obtained from computed radiography versus digital radiography. The introduction of PACS should not be thought of as mere computerization of existing processes in radiology but rather as the enabling infrastructure for redesigning and optimizing the entire workflow process (movement of patients, images, and other relevant information).