Emergency, operating, and intensive care units demand flexible PACS implementation

A successful PACS implementation outside of the radiology department requires planning, organization, and flexibility, according to research presented at the PACS 2005 conference in San Antonio.

Dr. David L. Weiss, clinical head of imaging informatics at Geisinger Medical Center in Danville, PA, highlighted the need for flexibility when implementing PACS in emergency departments, operating rooms, and intensive care units.

To make the conversion process as seamless as possible, Weiss recommends performing a needs assessment through committee to determine what hardware specifications are required and also what physicians prefer.

Physician preference and/or volume and efficiency demands may dictate the number of monitors needed in the ED, for example. PACS software and monitor resolution should be the same as that used in diagnostic radiology.

In the OR, monitor placement and type may be important. Standard or large flat-panel display monitors can be mounted on the wall, whereas an articulating arm monitor could be on the ceiling. Both can be used with a PACS workstation, preferably wireless, on a cart. If cost, not diagnostic quality, is an issue, the workstation on a cart or wall-mounted monitors are cheaper options, according to Weiss.

During surgery, certain specialists may need the capability to review key and reconstructed images or navigate and control images on the monitor, using specialty-specific software and a mouse and keyboard in sterile wrap.

In the ICU, the type of PACS being used - such as an enterprise PACS or a separate Web-based server and software - should be the same as that used in diagnostic radiology. This may determine the necessary hardware. Work list functionality with filtering capabilities by location, physician, and resource are important software features that should be included so that physicians can see what they need to read.

In each of these areas, the appropriate space, lighting, and acoustics are key. Involvement and input from IT and clinical and support staff are also important in the conversion process, along with technical support from the radiology department.

Although many considerations are involved in implementing a PACS, the benefits usually outweigh the initial high costs and trepidation of computer-phobic physicians. Benefits include instant access to images by multiple viewers in multiple locations; cost-savings in film purchasing, processing, and storage; elimination of lost images and retakes; improved physician productivity; decreased support personnel time for retrieval; and improved patient care and overall physician efficiency.