Skip to main content

Advertisement

Log in

Limitations in and Solutions for Improving the Functionality of Picture Archiving and Communication System: an Exploratory Study of PACS Professionals’ Perspectives

  • Published:
Journal of Digital Imaging Aims and scope Submit manuscript

Abstract

Picture Archiving and Communication System (PACS) technology is evolving leading to improvements in the PACS functionality. However, the needs and expectations of PACS users are increasing to cope with the rising demands for improving the workflow and enhancing efficiency in healthcare. The aim was to study the limitations in the current generation of PACS and solutions for improving PACS functionality. This was a longitudinal online observational study of the perspectives of PACS professionals accessed through four online discussion groups on PACS using the LinkedIn network. In this exploratory study, the methodology involved a thematic analysis of qualitative data comprising 250 online posts/comments made by 124 unique PACS professionals collected between January 2014 and December 2015. Participants were mostly male (n = 119, 96%) from the North America (n = 88, 71%). Key themes on limitations in the current generation of PACS were image transmission problems, network and hardware issues, difficulties in changing specific settings, issues in hardcoded Digital Imaging and Communication in Medicine attributes, and problems in implementing open source PACS. Main themes on solutions for improving PACS functionality were the integration of multisite PACS, multimedia for PACS, web-based PACS, medical image viewer, open source PACS, PACS on mobile phones, vendor neutral archives for PACS, speech recognition and integration in PACS, PACS backup and recovery, and connecting PACS with other hospital systems. Despite ongoing technological developments, the current generation of PACS has limitations that affect PACS functionality leading to unmet needs and requirements of PACS users, which could impact workflow and efficiency in healthcare.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Law MY, Zhou Z: New direction in PACS education and training. Comput Med Imaging Graph 27:147–156, 2003

    Article  PubMed  Google Scholar 

  2. Arora D, Mehta Y: Use of picture archiving and communication system for imaging of radiological films in cardiac surgical intensive care unit. J Anaesthesiol Clin Pharmacol 30:447–448, 2014

    Article  PubMed  PubMed Central  Google Scholar 

  3. Liu BJ, Huang HK: PACS and Medical Imaging Informatics for Filmless Hospitals. Amsterdam: Academic Press, 2008

    Book  Google Scholar 

  4. Top M: Physicians’ views and assessments on Picture Archiving and Communication Systems (PACS) in two Turkish public hospitals. J Med Syst 36:3555–3562, 2012

    Article  PubMed  Google Scholar 

  5. van de Wetering R, Batenburg R: Towards a theory of PACS deployment: an integrative PACS maturity framework. J Digit Imaging 27:337–350, 2014

    PubMed  PubMed Central  Google Scholar 

  6. Huang HK: PACS and Imaging Informatics: Basic Principles and Applications. Hoboken: Wiley-Blackwell, 2010

    Google Scholar 

  7. Duerinckx AJ: Introduction to two PACS’ 82 Panel Discussions edited by André J. Duerinckx “Equipment Manufacturers’ View on PACS” and “The Medical Community’s View on PACS”. J Digit Imaging 16:29–31, 2003

  8. Inamura K, Kousaka S, Yamamoto Y, Sukenobu Y, Okura Y, Matsumura Y, Takeda H: PACS development in Asia. Comput Med Imaging Graph 27:121–128, 2003

    Article  PubMed  Google Scholar 

  9. Huang HK: Short history of PACS. Part I: USA. Eur J Radiol 78:163–176, 2011

    Article  PubMed  CAS  Google Scholar 

  10. Mendel JB, Schweitzer AL: PACS for the developing world. J Glob Radiol 1:5, 2015

    Google Scholar 

  11. Strickland NH: PACS (picture archiving and communication systems): filmless radiology. Arch Dis Child 83:82–86, 2000

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  12. Xue Y, Liang H: Understanding PACS development in context: the case of China. IEEE Trans Inf Technol Biomed 11:14–16, 2007

    Article  PubMed  Google Scholar 

  13. Mackinnon A, Billington R, Adam E, Dundas D, Patel U: Picture archiving and communication systems lead to sustained improvements in reporting times and productivity: results of a 5-year audit. Clin Radiol 63:796–804, 2008

    Article  PubMed  CAS  Google Scholar 

  14. Schooley B, Hikmet N, Atilgan E: Health IT Maturity and Hospital Quality: Effects of PACS Automation and Integration Levels on US Hospital Performance. Proc. The 2016 International Conference on Computational Science and Computational Intelligence (CSCI 2016) Las Vegas, Nevada, USA, Dec 15–17, 2016 Year

  15. Sevenster M, Travis AR, Ganesh RK, Liu P, Kose U, Peters J, Chang PJ: Improved Efficiency in Clinical Workflow of Reporting Measured Oncology Lesions Via PACS-Integrated Lesion Tracking Tool. Am J Roentgenol 204:576–583, 2015

    Article  Google Scholar 

  16. Matta EJ, Nunez-Atahualpa L, West OC: Use of a PACS-Based Tool for Improving Communications With Referring Physicians. J Am Coll Radiol 14:1455–1458, 2017

    Article  PubMed  Google Scholar 

  17. Mendoza J, Mallari-Ramos P, Thoren K, Kitley C: Interventional Radiology in the Combat Environment. Curr Trauma Rep 3:249–256, 2017

    Article  Google Scholar 

  18. Godinho TM, Almeida E, Silva LAB, Costa C: Integrating multiple data sources in a cardiology imaging laboratory. Proc. e-Health Networking, Applications and Services (Healthcom), 2016 IEEE 18th International Conference on: Munich, Germany

  19. Sarkar AK, Khan R, Pandey C: Challenges in Data Migration in Super Speciality Tertiary Care Hospital: A case study. Int J Adv Res Comp Sci 8, 2017

  20. Reiner BI: The challenges, opportunities, and imperative of structured reporting in medical imaging. J Digit Imaging 22:562–568, 2009

    Article  PubMed  PubMed Central  Google Scholar 

  21. Graban M: Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement. Boca Raton: CRC Press, 2016

    Book  Google Scholar 

  22. Zheng K, Padman R, Johnson MP, Diamond HS: An interface-driven analysis of user interactions with an electronic health records system. J Am Med Inform Assoc 16:228–237, 2009

    Article  PubMed  PubMed Central  Google Scholar 

  23. Da Cunha JV, Orlikowski WJ: Performing catharsis: the use of online discussion forums in organizational change. Info Organ 18:132–156, 2008

    Article  Google Scholar 

  24. LinkedIn Corporation About LinkedIn. Available at https://press.linkedin.com/about-linkedin. Accessed 2nd August 2018.

  25. Grajales, III FJ, Sheps S, Ho K, Novak-Lauscher H, Eysenbach G: Social media: a review and tutorial of applications in medicine and health care. J Med Internet Res 16:e13, 2014

    Article  PubMed  Google Scholar 

  26. Barley SR: Images of imaging: notes on doing longitudinal field work. Organ Sci 1:220–247, 1990

    Article  Google Scholar 

  27. QSR International Pty Ltd: NVivo qualitative data analysis Software, 2012

  28. Seale C, Charteris-Black J, MacFarlane A, McPherson A: Interviews and internet forums: a comparison of two sources of qualitative data. Qual Health Res 20:595–606, 2010

    Article  PubMed  Google Scholar 

  29. Adair CE, Marcoux G, Williams A, Reimer M: The Internet as a source of data to support the development of a quality-of-life measure for eating disorders. Qual Health Res 16:538–546, 2006

    Article  PubMed  Google Scholar 

  30. Sixsmith J, Murray CD: Ethical issues in the documentary data analysis of internet posts and archives. Qual Health Res 11:423–432, 2001

    Article  PubMed  CAS  Google Scholar 

  31. Eysenbach G, Till JE: Ethical issues in qualitative research on internet communities. BMJ 323:1103–1105, 2001

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  32. Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psychol 3:77–101, 2006

    Article  Google Scholar 

  33. Braun V, Clarke V: Successful Qualitative Research: A Practical Guide for Beginners. London: Sage, 2013

    Google Scholar 

  34. Matar R, Renapurkar R, Obuchowski N, Menon V, Piraino D, Schoenhagen P: Utility of hand-held devices in diagnosis and triage of cardiovascular emergencies. Observations during implementation of a PACS-based system in an acute aortic syndrome (AAS) network. J Cardiovasc Comput Tomogr 9:524–533, 2015

    Article  PubMed  Google Scholar 

  35. Choudhri AF, Norton PT, Carr TM, Stone JR, Hagspiel KD, Dake MD: Diagnosis and treatment planning of acute aortic emergencies using a handheld DICOM viewer. Emerg Radiol 20:267–272, 2013

    Article  PubMed  Google Scholar 

  36. Nagy P: Open Source in Imaging Informatics. J Digit Imaging 20:1–10, 2007

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ratib O, Rosset A, Heuberger J: Open Source software and social networks: disruptive alternatives for medical imaging. Eur J Radiol 78:259–265, 2011

    Article  PubMed  Google Scholar 

  38. Ratib O, Roduit N, Nidup D, De Geer G, Rosset A, Geissbuhler A: PACS for Bhutan: a cost effective open source architecture for emerging countries. Insights Imaging 7:747–753, 2016

    Article  PubMed  PubMed Central  Google Scholar 

  39. Valente F, Silva LAB, Godinho TM, Costa C: Anatomy of an Extensible Open Source PACS. J Digit Imaging 29:284–296, 2016

    Article  PubMed  Google Scholar 

  40. Valeri G, Zuccaccia M, Badaloni A, Ciriaci D, la Riccia L, Mazzoni G, Maggi S, Giovagnoni A: Implementation, reliability, and feasibility test of an Open-Source PACS. La Radiologia Medica 120:1138–1145, 2015

    Article  PubMed  Google Scholar 

  41. Costa C, Ferreira C, Bastiao L, Ribeiro L, Silva A, Oliveira JL: Dicoogle - an open source peer-to-peer PACS. J Digit Imaging 24:848–856, 2011

    Article  PubMed  Google Scholar 

  42. Kagadis GC, Alexakos C, Langer SG, French T: Using an open-source PACS virtual machine for a digital angiography unit: methods and initial impressions. J Digit Imaging 25:81–90, 2012

    Article  PubMed  Google Scholar 

  43. Gray M: ACS Paradigm Shift: Moving control of the data from display applications to an enterprise access infrastructure. Context Magazine:1–16, 2014

  44. Dennison D: PACS in 2018: an autopsy. J Digit Imaging 27:7–11, 2014

    Article  PubMed  Google Scholar 

  45. Cook R: Is VNA the future of image delivery? A platform independent archival system has strong appeal. Healthcare IT News, 2014

  46. Digital Health Intelligence Limited Special Report: VNA and Data Storage. Available at https://www.digitalhealth.net/2016/11/special-report-vendor-neutral-archiving/. Accessed 2nd August 2018.

  47. Kagadis GC et al.: Cloud computing in medical imaging. Med Phys 070901:40, 2013

    Google Scholar 

  48. Sun Y, Zhang J, Xiong Y, Zhu G: Data Security and Privacy in Cloud Computing. Int J Distrib Sens Netw 10:190903, 2014

    Article  Google Scholar 

  49. Hamrioui S et al.: A Systematic Review of Security Mechanisms for Big Data in Health and New Alternatives for Hospitals. Wirel Commun Mob Comput 2017:6, 2017

    Article  Google Scholar 

  50. NHS Digital NHS Digital publishes guidance on data off-shoring and cloud computing for health and social care. Available at https://digital.nhs.uk/news-and-events/latest-news/nhs-digital-publishes-guidance-on-data-off-shoring-and-cloud-computing-for-health-and-social-care. Accessed 2nd August 2018.

  51. Joshi V, Lee K, Melson D, Narra VR: Empirical investigation of radiologists' priorities for PACS selection: an analytical hierarchy process approach. J Digit Imaging 24:700–708, 2011

    Article  PubMed  Google Scholar 

  52. Joshi V, Narra VR, Joshi K, Lee K, Melson D: PACS administrators’ and radiologists’ perspective on the importance of features for PACS selection. J Digit Imaging 27:486–495, 2014

    Article  PubMed  PubMed Central  Google Scholar 

  53. Torrieri M: Talk vs. Type: Taking Another Look at Voice Recognition. Physicians Practice 21, 2011

  54. Fox MA, Aschkenasi CJ, Kalyanpur A: Voice recognition is here comma like it or not period. Indian J Radiol Imaging 23:191, 2013

    Article  PubMed  PubMed Central  Google Scholar 

  55. Hayt DB, Alexander S: The pros and cons of implementing PACS and speech recognition systems. J Digit Imaging 14:149–157, 2001

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  56. Hwang I-C, Lee KW, Park SS, Chanthanoulay S, Sisavanh M, Rajpho V, Kim M, Billamay S, Phangmanixay S, Oudavong B: The first picture archiving and communication system in Lao People’s Democratic Republic: Changes in the utilization rate of imaging tests in the first year after implementation. Int J Med Inform 94:31–38, 2016

    Article  PubMed  Google Scholar 

  57. Shah SGS, Farrow A: Trends in the availability and usage of electrophysical agents in physiotherapy practices from 1990 to 2010: a review. Phys Ther Rev 17:207–226, 2012

    Article  Google Scholar 

  58. Shah SGS, Farrow A, Esnouf A: Availability and use of electrotherapy devices: a survey. Int J Ther Rehabil 14:260–264, 2007

    Article  Google Scholar 

  59. Faggioni L, Neri E, Castellana C, Caramella D, Bartolozzi C: The future of PACS in healthcare enterprises. Eur J Radiol 78:253–258, 2011

    Article  PubMed  Google Scholar 

  60. Chunn T, Honeyman J: Chapter 9. Storage and Database. Bellingham: Spie Press, 2000

    Google Scholar 

  61. Gutiérrez-Martínez J, Núñez-Gaona MA, Aguirre-Meneses H: Business Model for the Security of a Large-Scale PACS, Compliance with ISO/27002:2013 Standard. J Digit Imaging 28:481–491, 2015

    Article  PubMed  PubMed Central  Google Scholar 

  62. Mansoori B, Rosipko B, Erhard KK, Sunshine JL: Design and Implementation of Disaster Recovery and Business Continuity Solution for Radiology PACS. J Digit Imaging 27:19–25, 2014

    Article  PubMed  Google Scholar 

  63. Thurston S: ASP Configuration Handbook. A Guide for ISPs. Syngress: Rockland, 2001

    Google Scholar 

  64. Martin G, Ghafur S, Kinross J, Hankin C, Darzi A: WannaCry—a year on. BMJ 361, 2018

  65. Kun W, Rui-dan S, Zeng-Xin L, Zhen C, Li-Hua Z: Robust disaster recovery system model. Wuhan Uni J Nat Sci 11:170–174, 2006

    Article  Google Scholar 

  66. Anonymous: Lack of confidentiality with the Picture Archiving and Communication System (PACS). J R Soc Med 97:455–455, 2004

    Article  Google Scholar 

  67. Mahlaola TB, van Dyk B: Reasons for Picture Archiving and Communication System (PACS) data security breaches: intentional versus non-intentional breaches. Health SA Gesondheid 21:271–279, 2016

  68. Alhajeri M, Aldosari H, Aldosari B: Evaluating latest developments in PACS and their impact on radiology practices: a systematic literature review. Informatics Medicine Unlocked 9:181–190, 2017

    Article  Google Scholar 

Download references

Acknowledgements

The authors wish to thank to the moderators of LinkedIn based four online discussion groups on PACS for allowing access to their discussions and posts and harnessing their conversations for this study.

Funding

Ministry of Health, State of Kuwait awarded a scholarship to MA for doctoral studies.

Author information

Authors and Affiliations

Authors

Contributions

MA collected and analysed data and drafted the manuscript. SGSS revisited the data and data analysis and extensively revised and finalised the manuscript. Both authors approved the final version of the manuscript.

Corresponding author

Correspondence to Syed Ghulam Sarwar Shah.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was a part of doctoral research by MA and ethics approval was provided by the Research Ethics Committee of School of Information Systems, Computing and Mathematics at Brunel University London in July 2014.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alhajeri, M., Shah, S.G.S. Limitations in and Solutions for Improving the Functionality of Picture Archiving and Communication System: an Exploratory Study of PACS Professionals’ Perspectives. J Digit Imaging 32, 54–67 (2019). https://doi.org/10.1007/s10278-018-0127-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10278-018-0127-2

Keywords

Navigation