The PACSman The times are a-changing -- or are they? By Michael Cannavo

At my first RSNA meeting, in 1985, there were at best a dozen PACS and teleradiology players. Pioneers like Raytel, Colorado Video, and Dataspan set the path for PACS which, in one form or another, now occupies more than half of the 600 booths at the last RSNA meeting of the millennium.

So much has changed over the years, and so many players have come and gone. Of the triad, only Dataspan survived, and even then with barely a whimper compared to the market dominance it once commanded. What has also substantially changed is market dynamics. As I walk the floor today I see not just the behemoths, but behemoths teaming up with other behemoths to offer up what can be called mega-PACS. With the exception of Agfa and Kodak, who take a vendor-neutral posture regarding RIS interfaces, many of the major PACS vendors have formed partnerships or alliances with the major radiology information systems (RIS) vendors. These include Cerner and GE's co-marketing and sales agreement, IDX forming an alliance with Siemens, ADAC joining with Cedara software (formerly ISG Technologies), SMS' agreement with ALI Technologies, and of course McKesson/HBOC's outright purchase of Imnet last year. While the relationship between PACS and RIS has been often understated, 1999 is the year they in essence become one.

What's new technologically this year? No much, although there have been advances in several areas. The Web continues to play hot and heavy in everyone's mind, with progressive wavelet compression and image streaming a hot topic. This technology allows physicians and others with a standard Web browser and Java-based plug-in to view images in near real-time from any personal computer.

Dr. Paul Chang from the University of Pittsburgh displayed the technology in the InfoRad last year and it was subsequently spun-off commercially as Stentor. Joining Stentor this year with products of their own are RealTimeImage, which offers a product called iPACS, start-up ImageMedical's PracticeBuilder, LizardTech's Mr. SID, and others. As issues with Web security are overcome using products from companies like OA Systems and others, the Web will play an incredibly vital role in PACS' future.

Other new products of note include the first sub-$10,000 film scanner from Vidar Systems, the wall-mountable SIERRA.

On a lighter note, Vidar is also conducting "The Great Digitizer Shootout," using radiologists at the RSNA meeting to determine if there is any real difference between CCD and laser-scanned images. Look for the results in Wednesday's edition.

The battle of computed radiography (CR) versus digital radiography (DR) heats up some, although DR has remained fairly static. Desktop CR is a hot topic this year, with challenges to Lumisys for market share. New CR products from Kodak, Fuji, and Canon also present challenges to both DR, whose price remains out of reach to all but those building new facilities, and traditional CR buyers.

New companies abound this year as in previous years. How many of them will be back remains in the forefront of many people's minds and will be explored in Tuesday's edition.

Michael Cannavo is president of Image Management Consultants. He can be reached by e-mail at pacsman@ix.netcom.com