The radiology focus of PACS vendors has kept them from developing products that meet the needs of an integrated healthcare enterprise. Moreover, the "big pipe" approach is keeping the cost of PACS too high for many departments.
These are the observations of Dr. Paul J. Chang of the University of Pittsburgh, who talked about the shortcomings of commercial PACS during an explanation of his award-winning infoRAD exhibit.
"We need an efficient and flexible way to distribute diagnostic images throughout the healthcare enterprise," Chang said. "This means providing the option for rapid scalable delivery of full-fidelity images through cost-effective and usually modest network and client computer resources."
He also noted some problems with Web-based systems. Although they work for about 80% of cases, they are not enough to show full-fidelity images. And with the release of new MRA protocols, where clinicians may be looking at as many as 2,000 images, these systems could quickly be overloaded.
"You know surgeons don't want to wait 10 minutes for the case to show up on the monitor," Chang said. "They complain about waiting a few seconds."
PACS are available to handle this high workload, but they have too many icons and controls that impede their efficient use, he observed. Radiologists reading mammograms, for example, spend a great deal of time doing close-up work. Having to constantly hunt for the zoom icon is irritating.
The system developed by Chang and his colleagues follows what he calls the "90-5 rule."
"That is, about 90% of the time we use about 5% of the functions on PACS," he said. "Our system exploits the limitations in the brain."
Specifically, dynamic transfer syntax (DTS) uses a "just-in-time" data delivery model to provide required image detail on demand whenever the radiologist would naturally need that detail. For studies like mammograms that include extensive close-up reading, simply moving the mouse would allow the radiologist to hone in on an ROI.
