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:

Economic considerations

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?

Medical considerations

5. Is the fidelity of a digital image comparable to that of film?

6. In a digital environment, can a radiologist readily view multiple studies?

7. How much downtime can be expected?

8. How can a PACS affect patient outcomes?

Other considerations

9. Can remote locations be set up to serve referring physicians and/or institutions?

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 requirements?

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.

The Catella ^™ 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 system.

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 reporting.

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 individual organization." ¹ 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 program.

Improved outcomes

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.

Offsite locations

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 are abundant.

Reference