Czech neurosurgeons hook up to PACS

Few hospitals in Central and Eastern Europe use electronic image management systems. But neurosurgeons at one of the first Czech Republic institutions to install a PACS are delighted to have access to such a facility.

Plans to introduce a PACS at the St Ann's Faculty Hospital in Brno got off the ground in 2000. After a period of preliminary investigation, the system became integrated into the hospital's routine workflow during spring 2002.

The hospital's neurosurgery department was connected to the PACS from the outset. MRI, CT, and digital angiography data acquired in the radiology department became available for manipulation on a dedicated neurosurgery workstation. A separate PACS workstation, grabber computer for endoscopic streaming, and digital intraoperative equipment were also hooked up to the hospital network.

PACS implementation yielded immense benefits that became clear during the first year of operation, according to Dr. Zdenik Novák, head of neurosurgery at St Ann's, who described the set-up at this year's Computer Assisted Radiology and Surgery meeting.

"When connected to the PACS network, the neurosurgical workstation could be used more frequently and intensively for surgical planning, navigation, and data transfer than it was before," he said.

More than 300 patients have undergone navigated neurosurgical procedures at the Brno hospital since 2000. Patients' imaging data, including 3D reconstructions and virtual endoscopies, are stored in the department's 40-GB local archive in compressed form. MR navigation scans are saved as both axial and sagittal slices, guaranteeing accurate image reconstruction in multiple planes at any point in the future.

"The data sets are used at many different times during a patient's course of treatment," Novák said. "There is presurgical planning, the navigated neurosurgery itself, evaluation and publications, as well as postsurgical investigations, follow-up, and comparison. The importance of storing data from endoscopic surgery should be stressed for the purposes of further decision-making and education."

The neurosurgery department's local archive has storage capacity for up to 2500 MRI or 10,000 CT navigated studies, while the PACS server has 0.8 TB of disk space for storing images in full DICOM format. This capacity will likely be increased in the future, given that two thirds of the disk space is already full.

"Storage of data is a problem for all healthcare facilities," Novák said. "The volumes of data we use are large and are sometimes used again after a certain time period. The computer network we have enables stable communication, and the entire system is continually upgraded in close cooperation with the provider. But no available PACS is absolutely perfect."