Picture Archiving and Communication Systems
This chapter described the major system components and technologies related to picture archiving and communication systems (PACS) used in medical imaging. First a definition of PACS is provided followed by a brief description of the major components of a PACS. Several definitions have been cited in the chapter. One such definition is that PACS is fundamentally a highly sophisticated storage system that stores data and images from the image acquisition equipment and uses computer networks and application software not only to display images for viewing and interpretation but to transmit the data and images to remote locations, and as a result, PACS has become an enterprise image management system. Major components include image acquisition modalities, computer networks, the PACS main computer, image storage characteristics, image compression, display and analysis workstations, the radiology information system (RIS) and the PACS broker, and finally the web server. PACS is also characterized by the use of two communication standards, Digital Imaging and Communications in Medicine (DICOM®) and Health Level-7 (HL-7). While HL-7 deals with the flow of textual information between the hospital information system (HIS) and the RIS and other information systems in the hospital, DICOM® deals primarily with the exchange of images in the radiology department and facilitates communication among manufacturer-specific imaging equipment.
DICOM® is an international standard to transmit, store, retrieve, print, process, and display medical imaging information. An essential feature of PACS is that in order to facilitate communications between various computer-based healthcare information systems and imaging modalities and PACS vendors through the integrated use of DICOM® and HL-7 requires an initiative referred to as Integrating the Healthcare Enterprise (IHE). IHE provides a process flowchart that illustrates the resources and tools such as standards, technical specifications, integration profiles, and technical frameworks, for example, for the purpose of helping users not only to integrate systems but also to share information in an efficient and effective manner.
Two other significant features gaining widespread attention in the PACS environment is the vendor neutral archive (VNA) and more recently enterprise imaging. A VNA is an archive that “can be easily migrated, ported to interface with another vendor’s viewing, acquisition, and workflow engine to manage medical images and related information”; enterprise imaging is a technology that offers improved efficiencies in data archiving and management and creates a comprehensive program that can combine data from different departments into one system. An enterprise imaging system should consist of elements such as governance, enterprise imaging strategy, enterprise imaging platform (infrastructure), clinical images and multimedia content, electronic health record (EHR) enterprise viewer, image exchange services, and image analytics, in order to be successful. Finally the chapter outlines briefly important characteristics of the PACS administrator and the evolving role of the medical imaging technologist as an informaticist.
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