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Just like with anything in life, advantages and disadvantages will always exist.  When it comes to Information Technology (IT) there is certainly no exception to this rule.  Whatever decisions have been made, or not, comparing pros and cons, it just seems that deliberating to invest in a Picture Archiving and Communications System (PACS) takes center stage. PACS are computers or networks that present, distribute, store, and retrieve images from one or more medical imaging instruments, i.e. mammogram, ultrasound, endoscopy, magnetic resonance, etc., and are viewed on monitors along with a patient’s clinical details and radiological reports.  The medical images are commonly stored in an independent format called DICOM (Digital Imaging and Communications in Medicine) and aims to replace conventional film and paper with a completely computerized, electronic, digital, and paperless form.

“Any image, anytime, anywhere—that's the mantra," says Reuben Mezrich, MD, PhD, describing the capability of PACS in an Imaging Economics article, "but none of this could have happened without DICOM.”

Understanding why a nay decision is usually due to a cost limitation, and in the case of PACS, perhaps, the sheer complexity of implementing such a system, the advantages far, far outweigh the disadvantages and non-implementation borderline jeopardizes the interests of an errorless and most advantageous clinical practice.  Some would argue that PACS represents an advance in health care management and that a determination should not be made solely on cost-benefit.  Recognizing the aforementioned, PACS installations are increasing at an exponential rate worldwide, and it would now be illogical not to install PACS in a new imaging department, or a new hospital.

The brains behind PACS and why clinical practice even considers their upgrade in the first place - the efficiency of data management, is due to DICOM and its ability to allow systems to interface.  An MRI scanner made by one manufacturer, a thermal imaging scanner made by another, and an ultrasound machine made yet by another, all interface with the same PACS.  All three modalities, including others, can be interpreted at the same PACS workstation.

Other advantages of PACS are quite striking and compelling:

•    No image can ever be lost or misfiled
•    Image always available when needed
•    No patient is re-irradiated simply because a previous key study has been lost
•    Easy comparison of a patient's current and historical examinations
•    None of the relevant comparative images is missing
•    Comparison of examinations performed on the same body part using different imaging techniques
•    Images remain accessible from the PACS archives day and night, every day of the year
•    Simultaneous multilocation viewing
•    Image retrieval is infinitely quicker from PACS than it is using conventional film
•    Images correctly and permanently reside under the appropriate imaging study
•    Images remain in their correct orientation
•    Images automatically chronologically ordered
•    Computerized data can easily be duplicated
•    Time saving incurred never having to search for or retrieve films
•    Direct and indirect cost savings:
o    No film budget, film packet cost, or chemical processing needed
o    Filing clerks and darkroom technicians not needed
o    No need for maintenance of a film store, with its associated lighting, heating and cleaning, and the value of the physical space itself

The most compelling advantage is that a PACS infrastructure, which utilizes a local area network (LAN), provides the base for a wide area network (WAN) leap, if desired, which allows not only the ability to view and report off-site for things like distance education and telediagnosis, but also enables practitioners all over the world to access the same information simultaneously. Teleradiology, among other advantages, offers the potential for efficiency augmentation by referring studies to various additional institutions or perhaps allowing geographically remote areas access via a centralized reporting service.

The disadvantages of implementing PACS are not many.  For any organization, the investment layout does not come without trepidation, but even the financial demands today are tested.

Providers are coming up with innovative ways to get these PACS systems into the hands that need them most, such as leasing arrangements, and the advantages they provide allow organizations without the capital resources to purchase a hospital-wide PACS and make an otherwise impossible quantum leap in technology to move to a PACS solution.

Alleviating the burden, at least up front, allows the ‘PACSee’ (PACS purchaser) to focus on the launch date and to ease the disadvantage called complexity.  The coordinated input of a multidisciplinary team, from all different departments must stress a “buy in” mentality, a commitment embraced organization-wide.   'Radiological toy' is not an option.

A list of PACS manufacturers, PACS company profiles, and other resources relating to PACS also can be found highlighted elsewhere on the Medicexchange website.

Sources

Reiner BI, Siegel EL, Hooper F, Protopapas Z: Impact of filmless imaging on the frequency of clinician review of radiology images.  J Digit Imaging  1998; 11(suppl 1):149-150.

Redfern RO, Kundel HL, Polansky M, Langlotz CP, Horii SC, Lanken PN: A picture archival and communication system shortens delays in obtaining radiographic information in a medical intensive care unit.  Crit Care Med  2000; 28:1006-1013.

Reiner BI, Siegel EL, Hooper FJ, Glasser D: Effect of film-based versus filmless operation on the productivity of CT technologists.  Radiology  1998; 207:481-485.

Reiner BI, Siegel EL, Hooper FJ, Pomerantz S, Dahike A, Rallis D: Radiologists' productivity in the interpretation of CT scans: a comparison of PACS with conventional film.  Am J Roentgenol  2001; 176:861-864.
Strickland N H 1998 Role of a project leader implementing a hospital-wide PACS. In: Horrii S C, Blaine J G (eds) Proceedings of SPIE Medical Imaging 3339: PACS design and evaluation: engineering and clinical issues, pp 476–478.

http://www.imagingeconomics.com/issues/articles/2005-05_01.asp

http://www.medicexchange.com/Rotator-News/pacs-companies.html