Room for improvement: 6 key issues with today’s PACS

Are you happy with your radiology department’s PACS? What is its biggest weakness?

The adoption of PACS technology has been incredibly important for radiology, according to a new study published in the Journal of Digital Imaging, helping the specialty become largely filmless while improving workflow, efficiency and productivity. However, the authors noted, this current generation of PACS has numerous limitations. 

“PACS implementation is marred with many issues such as difficulties in integrating multiple PACS units both within and between hospitals and integrating PACS with other hospital systems, limited storage capacity, accesses issues—e.g., synchronous, multiple and remote access—and solutions for backup and recovery, and problems in data migration,” wrote author Syed Ghulam Sarwar Shah, MBBS, St. Thomas’ Hospital in London, and colleagues. “In addition, there are challenges in enhancing radiology workflow, productivity, and efficiency to keep the pace with rising calls for improvement in health care quality and delivery. PACS users are thus calling for improvements in the PACS functionality and developing new PACS functionalities.”

The authors analyzed 250 comments made in four online discussion groups (ODGs) to see what users were experiencing with their own PACS. More than 26 percent of the ODG participants were engineers and manufacturing managers, more than 24 percent were IT or informatics consultants and more than 23 percent were PACS administrators and implementers. The ODGs also included consultants, CEOs, radiologists, technologists and clinicians.

These are six key issues with current PACS identified by the groups:

1. Problems in Viewing, Copying and Importing Images and Data

Interoperability strikes again! Participants noted that PACS from different vendors can have issues communicating with one another. “A lot of the CDs from various vendors do not have the DICOM directory in the root directory of the CD/DVD,” one online participant wrote. “This causes a lot of issues.”

There were also complaints about sharing data with CDs and DVDs, which can take a long time and get quite expensive. As one online participant asked, “Why are facilities still using CDs / DVDs when study/report/views can be made available to patients and ref physicians via the internet?”

2. Issues in Data Backup, Archiving and Recovery

Disasters such a tropical storms, hurricanes, tornadoes and fires have the potential to hit healthcare providers hard—are PACS units being designed with this in mind?

“The findings revealed that backup, archiving, and recovery were critical issues in PACS,” the study’s authors wrote. “The participants argued that the recovery system in PACS was not well developed and the PACS data could be lost in an accident. They suggested that due to accidents such as fire or water in the server room, there was a possibility of losing data if it was not backed up, and the recovery would not be a true recovery despite paying huge costs.”

3. Difficulties in Transmitting Images

Some participants reported that it takes numerous attempts before they can successfully send an image, wasting precious time. These complaints, the study’s authors noted, were more common with older PACS.

Poor internet connections were also listed as a potential reason for such issues. Are IT specialists so focused on the bigger picture that they don’t provide specialists with a strong Internet connection?

4. Problems in Changing IP, Hostname, AET and DICOM Attributes

It happens to all of us—you are trying to get something done and you experience a random IT-related issue you can’t solve. It can take time and break your focus.

“The findings revealed that while using PACS, some participants encountered problems in changing some parameters such as the IP (internet protocol), hostname, AET (application entity title) and hardcoded DICOM attributes, e.g., data element,” the study’s authors wrote.

5. Standalone PACS Units and Lack of Proper Tools

To do one’s job, of course, there are certain things you need.

“I do not feel that the PACS vendors are providing us the proper tools,” one online participant said, adding that it seems as if systems are still being siloed.

6. Limits of Open Source PACS

Open source PACS users noted “a number of critical issues,” the authors noted. This includes problems with workflow, data security, data storage and more.

“Some of these limitations such as difficulties encountered in image transmission issues and changing specific settings such as IP, hostname, AET, and hardcoded DICOM attributes could be important issues for some users such as novice users because these are minor issues for the expert users,” the study’s authors concluded. “Thus, these issues do not warn much discussion from the perspectives of the wider community of PACS users and implementers. Nevertheless, issues such as difficulties encountered in implementing an open source PACS can be an important issue from the perspectives of PACS users; hence, this issue is discussed below.”