What Everyone NEEDS to Know About PACS Guy Guindon NORrad PACS Manager August 08, 2003.
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What Everyone NEEDS to What Everyone NEEDS to Know About PACSKnow About PACS
Guy Guindon
NORrad PACS Manager
August 08, 2003
PACS
Picture Archiving and Communication System
Not only a Technology Change, but a Process Change that utilizes Technology to achieve goals of increased efficiencies through the reduction of film.
PACS is much more than a Radiology System or Solution
Ensure you understand the BIG picture
A five (5) year plan is a must even if you know technology will change
Revisit and revise the plan annually to reflect changes in environment, technology, internal/external needs and competition.
The only wrong choice is making no choice at all.
The PACS Project Team
Most PACS decisions take upwards to two years from initial planning through contract negotiations and employs a team of people from:
Radiology- Radiologists, Techs
Information Systems- I/S support, networking, etc.
Administration (CIO, CFO, VP, etc.)
Purchasing
Staff Physicians and Nursing staff
Outside Consultant
MythAll PACS Systems are different
Most PACS system perform the same basic functionality using many of the same hardware components, with the primary difference being the applications software, integration plan, and margins.
There are system designs differences, but most are not significantly different.
Experience is the critical component in the evaluation process.
PACS COMPONENTS
CORE COMPONENTS
VIEWING STATIONS
ACQUISITION STATIONS AND PRINTERS
SUPPLEMENTARY EQUIPMENT
SITE EVALUATION
PACS PROJECT SUPPORT
CORE COMPONENTS
Archive/Database ServersImage ServerImage CacheWeb ServersWeb CacheLong Term Storage SystemsNetworks (Core components and switches)Server RacksHIS/RIS Interfaces
VIEWING STATIONS
Diagnostic Workstations (Dual, Triple or Quad Monitors)Clinical Workstations (Single or Dual Monitors)Orthopedic Workstations (Single or Dual Monitors)System Admin Workstation (Single or Dual Monitor)Web Clients
ACQUISITION STATIONS AND PRINTERS
Computed and Digital Radiographic SystemsMulti Plate CR Reader with cassettesSingle Plate CR Reader with cassettesCR ServerCR Clients3 Foot Image Solution (Full Spine and Leg Length)Modality Interfaces or DICOM UpgradesDocument ScannersFilm DigitizersDry Laser Printers
SUPPLEMENTARY EQUIPMENT
Ergonomics Desk Chair
Carts for PC’sArticulating Arms for PC’sViewboxesRenovation CostsPC’s for Web Clients (New or Upgrades)
CORE COMPONENTSThings to Note
Main Servers Cached or Cacheless System Unix, Linux or Windows based Servers
Web Servers Integration into the PACS Link between the Main Image Server and Web Server Lossy versus Lossless Compression
Lossless (<3:1) and Lossy (>3:1) JPEG 2000 is industry standard for compression
Push vs Pull (Either or Both)
CORE COMPONENTSThings to Note
Network Security on intranet and internet (SecureID tokens) HIPPA/PIPEDA Standards
Secure Socket Layer (SSL) Data Encryption Standards (DES) Public Key Infrastructure (PKI) Secure ID
Never to much bandwidth 1GB Backbone 100MB to Desktop PACS has a huge impact on Bandwidth
Vendor controls from Modality to Switch Hospital controls from Switch forward, including WAN VPN (Virtual Private Network) should be considered
CORE COMPONENTSThings to Note
Network WAN (Wide Area Network)
Must to Homes and Offices High speed required (Cable or DSL) T1 or better between sites
HIS/RIS Interfaces Mitra Broker $70-80k each HL7 Interface $25-50k each Cost for I.S. resources Bi-Directional communication for scheduling, reporting
etc.. Allocate 4-6 months for developing, testing and going live
with the HIS/RIS Interface before going live with PACS.
CORE COMPONENTSThings to Note
Archives Acronym City - RAID,MOD, CD-R, DVD-R, DLT, LTO,SAN Short Term Storage (RAID/Cache) should be 6-12 months Long Term Storage should be around 2-3 years do to
Technology changes SAN can be used for large PACS projects Retrieval time from request to display should be <60
seconds No more than 10% of retrievals should come from deep
archive Prefetching and DICOM Worklist is critical and can be
automated when integrated with RIS System
VIEWING STATIONSThings to Note
Diagnostic Workstations 2, 3 or 4 Monitor Workstations 2, 3 or 5 Megapixel Displays Combination
2 (3 or 5 Mpixel Monitor for Reporting) 1 (1280 X 1024 Monitor for RIS, Mail, Voice Recognition etc.)
Flat vs CRT (Replacement, Heat, Space and Costs)Clinical / Orthopedic Workstations 1 or 2 Monitor Workstations Flat vs CRT
Web Client Workstations 1 or 2 Monitor Workstations Flat vs CRT
ACQUISITION STATIONS AND PRINTERS
Things to NoteCR or DR CR mimics General Radiographic processes by using a
stimulable phosphor plate that is read by a reader to generate a digital image.
DR changes the process by creating a digital signal at the source/receptor so that plates are not required.
DR is more than just a Technology change, it’s a process change which saves upwards to 60% of the time associated with either CR or Plain Film.
DR and CR are complimentary to each other and not competing Technologies.
ACQUISITION STATIONS AND PRINTERS
Things to NoteCR or DR CR - $150-$350k each (50-150 plates/hour) DR - $350-$500k / room CR Payback – Elimination of Film DR Payback – Productivity Gains
CR Servers/Clients Redundancy Workflow
Film Digitizers CCD or Laser Laser has better quality but higher maintenance CCD quality has improved and has become the industry
standard
ACQUISITION STATIONS AND PRINTERS
Things to NoteDry Laser Printers Filmless department PACS Downtime
Modality Interfaces / DICOM Upgrades DICOM Interface Cost - $30k DICOM Upgrade Cost - $10-40k
SUPPLEMENTARY EQUIPMENTThings to Note
Server Room Design Power Requirements Air Conditioning Fire Suppressant System Firewall Dial-up Access Raised Floor Space Requirements
IT Infrastructure Upgrades Network and Network Components, Workstations, Displays,
Software, Interface Engines, Security/Firewalls etc..
SUPPLEMENTARY EQUIPMENTThings to Note
Radiology Department Design Power Lighting Ergonomic Chair and Desk Carts for PC’s
OR’s, Clinics, Rounds etc.. Articulating Arms for PC’s
Ultrasound, Clinics, Diagnostic Imaging etc.. Viewboxes
Mount view boxes near Radiology Reporting Station
Renovation Costs Replace or Modify Work space environment
PC’s required for Web Clients Purchase or Upgrade Systems Locate PC’s everywhere you had viewboxes
SITE EVALUATIONThings to Note
Modalities CT MRI R&F Ultrasound Angiography Nuclear Medicine C-Arms Portables Radiography Room (CR or DR)
SITE EVALUATIONThings to Note
Storage Requirements per Modality Image Size Average # of Images/Exam **Storage Requirements Average # of Exams/Year
DI Equipment Info Vendor Model and Software Versions DICOM Conformance Statement DICOM Upgrade Availability
SITE EVALUATIONThings to Note
Supported Clinical Departments Emergency ICU, ACU, CCA, Step Down Clinic Area’s OR’s Physician Viewing Area’s Physician Rounds Education Area’s Film Library Peripheral Sites Physicians’ OfficeNote: Must understand the volume and type of procedures which are
performed in each Clinical Department and their needs.
PACS PROJECT SUPPORTThings to Note
Vendor Maintenance Contract 10-14% of System List Pricing (M-F from 8-5) After hours contract or T&M System Administrator
.5 FTE for Small PACS System 2-3 FTE for Large PACS System .2-.5 FTE from IT Dept.
Training (CRITICAL) System Administrator, Radiologist, Physicians, D.I. Staff
and Nursing Staff
Helpline / Call Centre
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