Dr. Schilling is president of RBS Consulting Group in Los Altos Hills, CA; he is also a member of the editorial advisory board of Applied Radiology .

The group of articles contained herein address the most significant challenge associated with picture archiving and communications systems (PACS)--realizing productivity gains. Since PACS does not provide a source of additional income (excluding computed radiography [CR]/digital radiography [DR]), the bottom line of the institution considering PACS can be improved only by increasing productivity. The history of PACS installations with regard to productivity gains is mixed. The material presented in this special insert, when followed closely, will allow the user to have an excellent chance of achieving the intended productivity requirements.

A partnership between vendor and customer is required to ensure implementation of workflow improvements that will lead to productivity gains. This is necessary to effectively attain the customization that fits the needs of the customer. A good demonstration of this is presented in the first article in this insert, using workstation design as the example. All the ingredients (eg, excellence and flexibility in monitor design) of a beneficial workstation are set forth to help readers understand how to replicate these workstations and thus enhance their own radiology reading rooms.

The process of PACS implementation is a very complex one. To achieve a smooth transition, a detailed and well thought-out checklist is a must. The second article provides the direction required by providing suggestions on system integration (eg, between PACS and RIS), archive strategies, system architecture, etc.

Productivity is achieved via a combination of technology and behavior modification. If both are not achieved, the results will be far from optimum. Using CR/DR as an example, the third article demonstrates that a combination of technology (in the form of integration of the electronic radiology practice [ERP] to achieve communication among all system components) and behavior modification (in the form of a workflow management layer) is the necessary equation to be successful.

Perhaps the most critical part of any system is the interface with the user. For PACS, it is the reading room. As noted in the fourth article, the pressure to diagnose ever-increasing numbers of cases has made the reading room productivity the key to success. In the past, reading room considerations have not been addressed adequately. With attention given to room layout, lighting, temperature, ventilation, sound, etc., this subject is finally dealt with in the manner it deserves.

There is much to digest in this excellent set of articles. The effort is worthwhile to ensure realizing productivity gains with PACS.