No radiologists? No problem

Besides facilitating filmless hospitals, PACS can also be an asset for hospitals with no radiologists. A teleradiology system in eastern North Carolina, for example, connects the PACS at Pitt County Memorial Hospital (PCMH) to six area hospitals who do not staff radiologists 24/7.

PCMH is part of the University Health Systems of Eastern Carolina (UHS), a regional healthcare network serving 1.2 million people in 29 counties.

"Having the PACS capability provides faster access to the best subspecialists, providing a more rapid diagnosis for our patients," said Ed McFall, UHS chief information officer. "The system also avails patients in our rural areas better diagnostic care."

Data transfer is efficient and generally reliable, he said.

Modalities including CT, MRI, ultrasound, computed radiography, and nuclear medicine send images to PACS servers directly or via DICOM gateway. Images are transmitted on a regional hospital local area network, then onto high-speed phone circuits to reach PCMH. They then go onto the UHS network core and PACS servers.

"Typical image transfer speeds on CR images are approximately 90 seconds," McFall said. "Once the images arrive, they can be read by radiologists anywhere on the UHS network."

Major challenges to the system include interruptions in connectivity provided by the regional phone service provider, major vendor changes on the modalities, and the unanticipated arrival of new diagnostic equipment.

"Upgrades to modalities that are currently connected provide a challenge to our staff," he said. "We constantly have to plan to meet the storage needs of the new equipment."

UHS has chosen to develop an enterprise plan to migrate all facilities to all digital modalities. This plan includes the back-end PACS upgrades and improvements that will be required to house the huge volumes of data that will result.

UHS is also involved in a regional project that will place fiber connectivity to all but one of its entities. McFall sees an encouraging future, provided costs drop.

"Physician and patient demands will bring more robust Web clients for PACS solutions," he said. "Exponential improvements in storage technologies will offer multiple options for creating an imaging warehouse. A reduction in costs for DICOM software is going to be required."

Modality vendors are making only digital equipment today, forcing providers to purchase some type of PACS solution.

"But it has to be more affordable," McFall said.