Expanding PACS to other specialties presents unique challenges

While digital imaging management through PACS is an accepted technology in radiology, it remains a foreign concept in other areas of medicine, and vendors may have struggles ahead as they try to expand into new fields.

Those struggles were outlined Saturday during a SCAR special session devoted to PACS outside radiology. Barry R. Wiggs, Ph.D., a product manager for McKesson Information Systems, described the issues that have emerged as PACS are expanded to the other "ologies."

Gastroenterology, with copious images produced by endoscopes in colon scans, might be a natural candidate for a digital transformation. The current standard for archiving is VHS tape, and in some advanced situations, CDs or DVDs, Wiggs said.

Wiggs' team devised a system to capture endoscopic cine clips. When they hooked it up to the PACS at the University of Wisconsin, other systems linked to the PACS began running slowly or crashing. Because of insufficient bandwidth, the system didn't have the capacity to handle four gastroenterologists simultaneously hitting the PACS to collect and save their cine exams.

The team also looked at the possibility of adding anatomic pathology, but they found that the legendary multidetector CT scanner with 1000 or more images, a driving force in the expansion of PACS technology, was an archive piker compared with the pathology data that were being generated.

Pathology produces some 300 million slides per year at better than 0.1-micron resolution, Wiggs said. Small images may be 30,000 x 40,000 pixels. Larger ones may hit 1.4 million x 1.7 million pixels. Image sizes range from 3 to 37.5 GB per frame with compression of 70 to 1.

Other issues were identified: As in gastroenterology, VHS is the standard in ENT. But ENT physicians require the capture of 200 frames per second as well as audio data, which must be carefully synched to the visual data.

Interfaces will be critical and must be designed to meet the specialty's unique needs, Wiggs said. He and other presenters noted that standards for image and other data capture are rare outside of radiology, but they will have to be enforced if electronic archiving is to take place.

With mostly gray-scale images, radiology has not had to worry about true color fidelity, which can be very important to other specialists. Even the way exams are organized may need to change, he said. Radiology is most concerned with scheduling specific scans, which is accommodated by a modality work list. Other specialists often schedule patients and order the tests later, an entirely different approach.

"We think there are some technical issues we have to overcome," Wiggs deadpanned.