How can you best prepare staff for the arrival of PACS?

July 1, 2002

Prof. Dimiter TscholakoffProfessor of radiology Rudolfstiftung Hospital, ViennaPACS users need to be well informed about legal and institutional requirements or regulations for archiving.

Prof. Dimiter Tscholakoff
Professor of radiology Rudolfstiftung Hospital, Vienna
PACS users need to be well informed about legal and institutional requirements or regulations for archiving. In Vienna, medical records have to be kept for at least 30 years, but x-ray films only have to be stored for 10 years. It is not specified whether this applies to digital images. We have a short-term archive or RAID (redundant array of inexpensive disks) with at least six months' storage capacity. For long-term storage, we had to produce "twin DVDs." One set is stored in an array of jukeboxes connected to the RAID. The other set is located on a shelf in a separate room across the street. Consider how the images will be retrieved and/or distributed throughout the hospital. A separate server for image distribution and retrieval of images from other departments may be needed.

Dr. Jan Schillebeeckx
Chief, medical imaging, Imelda Hospital, Bonheiden, Belgium
You must avoid making a bad long-term decision. Try to get as much online availability of images as possible for the short-term. For long-time archiving, an ASP might be a good solution, giving vendors responsibility for keeping up with system developments. The ASP vendor also has to take care of data transfer to anticipated newer storage methods. Customers can expect to have a scalable system according to expanding storage capacity requirements and addition of new services. An ASP offers financial advantages. It reduces the need for significant capital outlay upfront, shifts the costs of storage from the capital budget to the operational budget, assists budgeting by enabling you to revisit archive expenses, transfers responsibility for replenishing equipment to the vendor, and decreases staff hours required for internal support

Dr. Davide Caramella
Associate professor of radiology
University of Pisa, Italy
The main risk is incorrectly planning the growing requirements of the archive in terms of data volume. As the number of digital modalities connected to the PACS increases, so should the overall capacity of the archive. Another relevant issue is the legal framework that varies from state to state and changes quite rapidly, although not rapidly enough to follow technological developments. Consider what happened with the competition between CD-ROM and DVD storage media. Emerging technologies that seem to ideally suit the increasing demands of the radiological archive are the storage area network (SAN) and the application service provider (ASP).

Dr. Frits Barneveld Binkhuysen
Radiologist, Hospital Eemland
Amersfoort, the Netherlands
Consider the price for the short-term and the long-term part of your archive system. How many days do you want your images online, and how fast do you want to have them retrieved? Your answers will determine the price. Do not buy an archive for 10 years but only for a few years with the possibility to expand later. Archives are becoming less expensive each year. Be sure that you can transfer all your data in an easy, inexpensive way if you want to move to another system after a few years.

Dr. Keith Foord
Consultant radiologist
Conquest Hospital, Hastings, U.K.
For short-term and Web-based archiving, hard disks and RAIDs are now so large, relatively cheap, and fast to access that even mirrored, multiterabyte RAIDs should be considered. Mirroring is important because RAIDs have been known to fail. A short-term archive may be large enough to store images spanning several years if lossless compression is used. Longer term archiving options include magneto-optical (MO) disk arrays, digital linear tape (DLT), and DVD jukeboxes. MOs are expensive, and DLT may need regular rewriting to ensure data are not lost. DVD jukeboxes should be considered seriously. They will be here to stay for some time and are cheap.

Dr. Raimund Vogl
Imaging information manager
Innsbruck Hospital, Austria
Check your requirements for data access. Do you have to pull data from a central server? How long do you need data online? How many workstations will require access to the data? You will probably have to distribute data over a number of server systems to cope with the load from simultaneous access.
With cheap RAID systems available, consider an EOL (Everything OnLine) solution. Check there is no licensing policy demanding software royalties proportional to the online disk space. Use of SANs is quite fashionable at the moment, but pricing for substantial online times (or even EOL solutions) is still prohibitive. RAIDs provide the data storage capacity needed for EOL at an affordable price.