We are often asked about PACS; what is it and what is the point or benefit?
PACS is sometimes referred to as Image Management, which is actually a more accurate phrase as it tells you more about what the system can do!
The great thing about digital images (X-Rays, ultrasound CT and MRI) is they are much easier to share with fellow professionals and you no longer have to store boxes of x-ray film. The downside of digital images is that if your computer crashes and dies you lose everything.
The purpose of a PACS (Picture Archive and Communication System) is that you create a safe place to store digital images, which allows easy image manipulation and file sharing.
If you only store images on the system that took them, this works until that system encounters a problem. Sadly, any computer can fail, hard drives are not infallible and physical damage is not uncommon when this type of equipment is used in a veterinary environment.
You can manually back-up images onto CD or DVD, but that takes time, and if you lose the disc your images are lost. It is also worth bearing in mind that the recordable CDs/DVDs we use are not as stable as the discs we buy music on and a percentage of them will fail.
You can back up onto an external hard drive but searching for specific images becomes difficult unless you have the appropriate software; this is where PACS fits in.
PACS software makes it easy to search within the catalogue of stored images, share your images if required and manipulate them for diagnostic purposes or surgical planning.
PACS can be either practice based or cloud based. The cloud works very well if you are a multi-site practice. It means you can share images between sites quickly and easily. You could even ask the boss to look at them when he is on holiday (yup, it happens!)
Practice based PACS should ideally include RAID storage that is at a different location to your acquisition device and can be used for backing up images and sharing them.
RAID is a computing term, it means Redundant Array of Independent Discs, or in layman’s terms, a system that uses multiple hard drives to store multiple copies of data. This ensures that if one drive fails, you still have another copy of the data. Obviously if one drive fails you need to immediately contact your IT Company to get it fixed before more drives fail!
Cloud based PACS can be used instead of practice based PACS or in combination because it provides off-site storage. A cloud system works well but due to the volume of data to upload it is reliant on internet speed.
So, why do I needs PACS? I can just save the images to the patient record as a JPEG, why pay extra for another computer? The simple fact is that most JPEGS that are linked to a patient’s record are of too poor quality to be relied upon for diagnosis. Whilst they would be fine to show to an owner, you could not send them to the BVA to be read for hip scoring or use them when referring a patient; for these purposes you need DICOMS.
DICOM (Digital Imaging Communication of Medicine) is essentially a set of rules that at the most basic level ensures the images is as tamperproof as a sheet of film. A DICOM image includes tags which tell you when and where the image was taken, which equipment was used to produce the image and much more. If the images are altered, this change in data is also documented. In comparison anyone can alter a JPEG, just think of all the photo shopped images you see on social media.
PACS systems store the original DICOM images which means that if your CR system is broken or your equine DR is out with an ambulatory colleague, you can still view, manipulate and send the original images from the PACS system. It also provides the opportunity to view patient data from more than one imaging modality simultaneously, e.g. x-rays and ultrasound images.
If your imaging case load is high, it provides an alternative system and potentially location for a member of staff to view and interpret images whilst a second team continue with acquiring images, thus improving work flow.
Advanced measurement tools are often incorporated into PACS software making surgical planning much easier.
Don’t forget to think about the quality of monitor in use with your PACS system; poor quality monitors can make even the best x-ray appear of sub-optimal diagnostic quality when viewing.
A good PACS or Image Management System should improve workflow by automating tasks that otherwise take up valuable staff time, make your acquisition equipment more readily available and assist with recalling, viewing and sharing patient images around your practice, even if you have multiple sites.
In other words, PACS makes life easier!