Cardiology PACS basics: With large studies and growing volume, cardiology can benefit from PACS

PACS are electronic medical image management systems. They consist of image display systems, archiving systems, networks, and interfaces, presenting one unified system to the user. They have been in development since 1982 and have predominantly been used in radiology, transforming manual film operations to a filmless environment. Radiology PACS has evolved from an emerging technology to a mature, billion dollar North American market.Key to the 15% to 18% annual market growth of radiology PACS has been the DICOM (Digital Imaging and Communications in Medicine) standard. This standard has enabled the digital management of images generated from a wide range of radiology imaging modalities and manufacturers. With the success and acceptance of the DICOM standard in radiology, other healthcare specialties have adopted the standard and can now move into a shared electronic world.Cardiology imaging vendors have adopted the DICOM standard to develop commercial PACS specifically designed for cardiology. Since cardiology studies are dynamic (in motion), huge numbers of images and a vast amount of data are generated per study (a single study can range from 200 MB to 1 GB). Also, the number of cardiology studies performed is increasing by 20% per year. With these large data sets, cardiology can expect to benefit substantially from the electronic management of images. Cardiologists have been looking for solutions to manage large data sets and increases in workload. The move to cardiology PACS is also driven by the need to reduce costs, improve access to images, and improve service to patients and referring physicians.Though cardiology imaging differs from radiology imaging, the support requirements for a cardiology electronic imaging service overlap significantly with those for radiology. Both require core technologies such as networks, archives, storage media, workstations, modality interfaces, HIS interfaces, database management software, Web technology, and the DICOM standard. The key differences between a radiology and a cardiology PACS are workflow, cine acquisition and display software (dynamic display), and the use of tracings in cardiology. Today there are many commercial cardiology PACS offerings, and departments are purchasing systems at an increasing rate. The cardiology PACS market was a $160 million market in 2004, and it is expected to grow to $430 million by 2009. Commercial radiology PACS development and the shift to digital cardiac imaging modalities have contributed to this market growth and the acceptance of managing images electronically. Many cardiology PACS are using the same network and archive as the radiology PACS. This combined infrastructure eliminates the need to support two separate archives and shares the cost between departments. A centralized archive for all DICOM images is simpler to manage and provides economies of scale for the IT department.This setup has enabled physicians to electronically view both radiology and cardiology studies from the same patient from any access device located anywhere. The results are faster patient management decisions by the physicians and the ability to view nuclear medicine and echo studies as well.As the lines between radiology and cardiology imaging blur with angiography, interventional radiology, and echocardiography, PACS will complicate these issues even further. Real-time access to medical images is moving diagnostic services toward a commodity market where study interpretation can be conducted from any location. This phenomenon may intensify turf battles for professional fees.Cardiology has been operating in a pseudo-PACS environment for many years. With digital angiography and digital echo cardiology equipment, studies are viewed on workstations or technologist consoles and then transferred to a CD or MOD for storage. This has proven to be an effective method of working in a digital environment. In a full PACS environment, however, studies would be saved to an electronic archive where they can be accessed from any location with the proper device and security clearance. The archive could be a shared DICOM archive holding radiology and cardiology studies and tracings. The radiology and cardiology PACS could share a backup archive for disaster recovery or continuation of business capabilities.When planning for a cardiology PACS implementation, it is wise to follow the procedures established for radiology PACS during the various steps: vendor selection, workflow redesign, cost justification, negotiations and contracting, site planning, installation, training, and acceptance testing.The diagram shows a cardiology and radiology PACS with a shared infrastructure. Other than the graphic user interface (GUI) and diagnostic tools, the design, topology, and technology deployed are the same with similar functional requirements.Mr. Reed is president of Integration Resources in Lebanon, NJ. He can be reached at 908-236-9360 or gary@irpacs.com.