Whether you have PACS or are planning to implement it, you will need someone to coordinate every aspect of your initiative. From capital budget planning to drafting future systems configurations, an administrator with an array of talents is a critical component of any PACS effort. If such a leader is required, who should fill the role? What types of skills should that person have? What is in involved in managing a PACS? What do PACS administrators do?

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General Responsibilities

Responsibilities of a PACS administrator vary depending on the organizational structure of the department of radiology. In most departments, the PACS manager assumes responsibility for daily systems operations, capital budget preparation, data integrity, modality interfacing, and system maintenance and improvement.

Strategic PACS planning is a key role that is often overlooked or omitted when the scope of this position is defined. The most important factor in a PACS manager's success or failure is the ability to construct a plan, communicate milestones, and achieve implementation deadlines.

The strategic plan becomes the cornerstone of PACS administration, but the development of such a plan is not a one-time event. An annual strategic plan will be required to continue to evaluate system performance and optimize emerging technologies once PACS is fully implemented. At Massachusetts General Hospital, we started our PACS implementation in April 1997, and every year since, we have prepared and continue to prepare a strategic plan that clearly articulates our objectives in the next fiscal year.

Traditionally, our strategic plan has been organized around the following core conceptual areas:

1. System architecture;
2. Financial management;
3. Resources strategy;
4. Implementation schedules; and
5. Quality control programs.

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System Architecture

For most PACS, the individual image acquisition devices or modalities are connected to network gateways. Gateways perform three primary functions:

• Perform radiology information system (RIS) validation;
• Compress images; and
• Distribute images throughout the system to radiologist workstations, the archive, and the Web server.

The gateway queries the broker or RIS and validates that the new study information that the technologist is sending to PACS is correct by determining that the medical record number, accession number, and patient name all match the demographic data in the RIS. This is a critical component that also constitutes part of the quality control mechanism for PACS. RIS validation ensures that the information you store in PACS matches the data in the RIS and prevents data entry errors from being stored on the system.

The second function of a gateway is compression. This is allows the images to transfer throughout the system with greater speed, thus enhancing performance. Most PACS are compressing either 2:1 or 3:1 at the gateway level. Advances have been made toward 4:1 for certain mini-PACS.

The last core function of a gateway is distribution. The network gateway sends the image to an archive of some kind, with most archives using tape -- digital linear tape (DLT) or advanced intelligent tape (AIT) -- or spinning media. Larger archives typically employ tape for storage because the cost per megabyte stored is less than spinning technology. Because it needs to be available to the referring clinician and/or become part of the electronic medical record, the gateway also routes the study to the radiologist workstation for interpretation. Finally, the images need to be available to the referring clinician, so a copy is also sent to the Web server or attached RAID (redundant array of inexpensive disks) system.

Today, the MGH system architecture consists of 46 networked workstations with plans to expand to over 65 stations in five locations. All workstations have two monitors each, and only three of them are 2K stations. The modalities connected to PACS are CT, MRI, fluoroscopy, ultrasound, angiography, nuclear medicine, and computed radiography (CR). There are 44 terabytes of data storage on the system, with a 40-terabyte tape archive, two 1-terabyte disk archives, and a 1-terabyte Web server.

As part of our downtime contingency plan, we also have a laser printer network. Systems do go down, and the hospital should include a PACS downtime contingency plan in its strategic plan. The contingency plan should include emergency resource contacts, an overview of the goals of the plan, and instructions for four types of downtime: power, RIS, PACS, and network.

By including those elements in a written document, we found that each operational area was able to implement the appropriate next actions depending on the type of interruption. The contingency plan is not a set of guidelines written by the PACS manager. To help structure this document at MGH, a template was created by the PACS manager and circulated among operations managers, who were responsible for completing the plan. All operations managers share the applicable documents with their staff, who also form a communication tree in the event of unexpected problems. The key to successful contingency planning is to have the operations managers themselves determine their course of action in the event of downtime. If guidelines are created by the area that has to use them, they are more likely to be followed.

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