INTRODUCTION: Picture Archiving and Communication Systems (PACS) and Teleradiology are now widely used to manage clinical image data in Radiology and to provide timely access to referring physicians both within the institution and at remote sites. Researchers at the University of Florida have been developing systems used in daily clinical practice and have determined that the supporting infrastructure is at least as important as the hardware and software components of the systems.
METHODS: The PACS/Teleradiology System and the Radiology Information System (RIS) implementations at the University of Florida were done in parallel over approximately the same time period without an interface between the two. At the same time, networks were installed throughout the Health Science Center with connections to the Gainesville Metropolitan Area Network which can be used to support outlying clinics and referring physician offices. As network use expanded, so did the need for controlling and managing bandwidth, security, and connections. Patient information was not always consistent among systems, resulting in inefficiencies and requiring human interaction to resolve conflicts.
DISCUSSION: To make the PACS / Teleradiology system more robust, reliable, and user friendly, a number of changes were made to the infrastructure supporting the effort. First, network analysis demonstrated that with careful placement of bridges and routers, the low cost ethernet could be used efficiently and effectively until bandwidth requirements among machines exceeded ethernet bandwidth. Since the main components of PACS can be easily connected to Fiber, ATM or FDDI rings could replace ethernet as soon as needed. To ensure that patient information on the PACS / Teleradiology system was consistent with the RIS - an RIS / PACS interface was written, allowing a PACS application to query the RIS for a packet of information about a study and allowing the RIS to send information to the PACS about each study ordered. This allows both systems to maintain a key into the other's database so images and reports can be matched, as well as to implement consistency in patient information. The personnel required to maintain a PACS or Teleradiology system are frequently overlooked.
CONCLUSION: Each component of the system must be maintained, with constant checking to be sure hardware and software processes are working correcly. In addition, workstations and image acquisition units require daily quality assurance procedures to be sure that clinical decisions can be based on the information presented.
Medical centers, clinics, and imaging centers should be aware of the pitfalls of purchasing a PACS or teleradiology system without the appropriate infrastructure for support. Neglecting this important aspect of a system can lead to unanticipated expense and possibly failure of the system. With careful planning, a system can be implemented that will meet the needs and expectations of the users.