Digital image archiving and communications will soon become a
medical imperative for radiography in the 21st century. For many
imaging centers and small- to medium-sized hospitals, a transition
to the digital world and the costs associated with it can be
perceived as challenging. This article will demonstrate how a
properly implemented system can save money and improve patient care
by addressing the commonly asked questions that can arise when
beginning this transition:
1. How much will an effective PACS cost? What type of return on
investment can be expected?
2. Can the transition be made in steps, adding enhancements
along the way?
3. How will a PACS make radiologists more efficient?
4. How much training time and investment is involved with
setting up a new system?
5. Is the fidelity of a digital image comparable to that of
6. In a digital environment, can a radiologist readily view
7. How much downtime can be expected?
8. How can a PACS affect patient outcomes?
9. Can remote locations be set up to serve referring physicians
10. Will images and files be transmitted over the Internet? If
so, how will security be implemented?
11. How can I select a vendor that meets my individual
The economics of a PACS
Conventional wisdom has been that a PACS would cost somewhere
between $500,000 and $3,000,000. As such, many prospective PACS
users have been deterred from making the transition. Prices,
however, have dropped in the past 3 years, and today the economics
are much more appealing.
system, developed by American Medical Sales (Hawthorne, CA), is an
excellent example of the value that can now be achieved. Our
innovative design provides exceptional capabilities, yet a typical
package costs less than $250,000. Such a package includes two
diagnostic workstations, each with four medical high-quality
monitors; an archive that can store the equivalent of approximately
250,000 sheets of film; Internet access for referring doctors, and
the Catella Scribe, which provides complete report editing and
access to the integrated dictation module in each Catella
Workstation. Installation and training are also included. Because
of the Catella system's innovative design, the training time
required is usually no longer than 1 week for this type of
This basic configuration can provide a high-quality PACS for
most organizations, and is the cornerstone for future expansion.
With Catella's open architecture, enhancements can be added as
volume grows. The Catella installation can also be expanded to
include a film digitizer and additional archiving and
Meaningful savings can be achieved with the use of a PACS and it
is a reasonable objective to pay off this investment in less than 2
years. Some of these savings can be achieved through:
1. Savings on film and chemistry costs;
2. Elimination of lost films;
3. Reduction of labor costs; and
4. Eliminating maintenance on a film processor.
The labor savings with any digital system can be achieved in a
variety of ways. For the radiologist, the savings is reflected in
the ability to read images more quickly and efficiently and in the
streamlining of report dictation and transcription using Catella
Scribe, which is integrated into the workstation. The Scribe's
"voice-command" microphone records and edits report comments and
accesses the DICOM header files from the patient's images. This
feature eliminates redundant work and the potential for error, for
both physicians and staff.
Yet another saving component relates to reducing the labor it
takes to create and administer film jackets and manually move them
in response to medical requests.
The key to turning a PACS investment into a highly profitable
decision becomes a function of work-flow optimization. According to
Bruce Reiner, MD and Elliot Siegel, MD, "Work-flow redesign must be
customized to the unique and idiosyncratic nature of each
Customizing that work flow and taking advantage of all that a PACS
can provide requires a shift in conceptual approach. On that basis,
a partnership must be forged with a vendor who actively listens to
the organization and is effective in developing a customized PACS
Paramount in making the switch to a digital system is the
prospect of providing improved patient outcomes. Information can be
delivered more quickly and, if appropriate, emergency treatment can
be implemented immediately. Further, confusion associated with
mislabeled film or lost film is eliminated.
The image quality that a PACS can provide is excellent. The
basic Catella package includes medical-grade, high-resolution flat
LCD monitors (pixel rated at 1200 *1600). Since MR, CT and current
ultrasound units begin in a digital format, the display of
information is homogeneous with the source.
Viewing should replicate and enhance the radiologist's reading
room. With four monitors, it is possible to evaluate a study from
several aspects simultaneously. The Catella system also makes it
possible to increase the number of monitors to four-over-four,
providing eight simultaneous displays. With the voice-command
system of the Catella workstation, radiologists can work more
quickly and effectively, and they do not have to take their eyes
off the images during diagnosis. More than 40 voice-activated
commands instantly manipulate images and respond to virtually every
dialect. The ergonomic design of the Catella workstation provides
increased comfort over long periods of time and the "view-box" feel
minimizes transition objections.
Since computers and advanced technology are involved with a
PACS, organizations are often concerned about the potential
downtime they may encounter. As noted earlier, the key to an
effective PACS is a function of the equipment, the software, and
the customized components and work-flow configuration. With the
Catella system, we found that effective planning makes it possible
to virtually eliminate downtime. Establishing a goal of 99% uptime
is realistic. In this regard, it will have less downtime than a
conventional film-based installation.
In addition to the opportunity to provide faster response for
patient care, another key benefit of a PACS is its enhanced
archiving capability. Images can be electronically retrieved
immediately, without manually fishing through files. Also, the PACS
provides the organization with the capability to effectively
archive advanced new studies, such as the MDCT, which has more than
1,000 slices per study.
The digital environment made possible by a PACS also enables
radiologists to efficiently serve hospitals and imaging centers in
distant locations. Using secure Internet-based communications over
DSL or T-1 lines, the images created by these facilities are
transmitted immediately to the Catella workstation. This allows the
radiologist an opportunity to provide a report to remote locations
in a time frame that more quickly provides for treatment and
improves patient outcomes.
This basic system can also be used to serve referring
physicians. In those cases, the imaging center can transmit the
digital images and the report to these physicians via the Internet.
Images no longer need to be sent by courier, and the referring
physician can decide on appropriate treatment more quickly.
Selecting a PACS vendor
Developing a successful PACS becomes a team effort between the
organization and the vendor. New opportunities exist, and the days
of relying on "giant brand-name" companies with their major costs
and multi-layered management are over.
As noted earlier, active listening and response to individual
needs becomes a critical factor in optimizing work-flow decisions,
selecting equipment and training.
The Catella system was created by American Medical Systems more
than 5 years ago, and we pride ourselves in our level of customer
satisfaction. Our company has 50 years of experience servicing the
medical imaging field. Over the years we have earned a reputation
for design, reliability, and craftsmanship in the products we
provide to the medical community. In addition to the Catella family
of digital products, we offer motorized film viewers, film
illuminators, and processor quality control systems.
For institutions and organizations considering transition to a
PACS, the potential rewards for the institution and for the patient