PACS administration: The systems administrator

March 3, 2003

Technical competencies are one of the three attributes for a PACS administrator, and they often make this person the most recognizable member of the PACS administration team. The third in a series. This is the third in a series of articles exploring

Technical competencies are one of the three attributes for a PACS administrator, and they often make this person the most recognizable member of the PACS administration team. The third in a series.

This is the third in a series of articles exploring the multiple roles of PACS administration. In the first article, I introduced a competency model used in the information technology industry ( The staffing model breaks competencies into technical, behavioral, and business attributes.

PACS administration tasks can be sorted into each of these categories. While individuals might need to accomplish tasks from all three competencies, they are typically most comfortable with one. This article will explore the technical competency category: who this person is, what he or she does, and where this person usually can be found.

Technical competencies involve understanding the technology around PACS. This role is typically called the systems administrator. The systems administrator has been traditionally the most readily identified member of the PACS team. This is because with previous generations of PACS technology, it was a challenge to get the system running and, more important, keep it running. This was a firefighting position, managing queues and monitoring system resources to keep the system operational.

Today's PACS technology has matured and is more robust and fault-tolerant. The PACS administrator at least has the opportunity to be proactive in capacity planning and systems management. This person might work not for radiology but instead as a systems analyst in a larger IS group. Where this person works is irrelevant to the technical tasks that need to be done to ensure a successful PACS implementation.

So who is this person? The systems administrator should enjoy technology and have a continual thirst for knowledge. PACS is inexorably tied to the computer industry that is conservatively described as disruptive and continually reinventing itself. It's a good bet this candidate would be a self-professed geek and have a penchant for gadgets. The primary trait of this role is the ability to quickly learn and assess technology. A background in science or engineering would be beneficial, but formal education is less important than genuine interest and fluency in computer technology.

Five different types of roles should be the primary responsibility of the systems administrator: technology assessment, systems management, systems administration, systems integration, and policy administration.


PACS covers a gamut of technology that is constantly changing. A basic comprehension of the principles behind networking, storage, server, and display technology is essential. It would be impossible to know everything about the computer industry. Success in technology assessment is knowing which battles to fight and being able to come up to speed quickly. This boils down to understanding Moore's Law (Gordon Moore, cofounder of Intel, stated in 1965 that the density of transistors on a processor will double every 18 months for the same cost).

The key to avoiding obsolescence and enjoying the cost and performance benefits of the computer industry is careful adherence to standards. Standards enable flexibility and go well beyond the standards of our industry such as DICOM and HL7, which in themselves are very important. Examples include file systems standards such as Common Internet File System (CIFS) or Network File System (NFS), networking standards such as TCP/IP, and storage standards such as Redundant Array of Inexpensive Disks (RAID).


Systems management is about the tools you should employ to keep everything under control. Systems management is usually what keeps an administrator sane. Vendors can provide tools to the customer, but sometimes they are reluctant, and it is the ultimate responsibility of the consumer to know what's going on. The goal of good systems management is "lights out." Lights out is a term from the IT industry describing a philosophy that minimizes the use of human intervention to consistently deliver desired results.(1)

Systems management tools are useful in the following areas:(2)
? Change management: The first question a PACS administrator should ask when encountering a problem is, What changed? Having tools that track changes provides the first line of defense in resolving problems quickly.
? Availability management: This is a tool that continuously monitors the availability of all the servers and services on those servers.
? Problem management: Logging issues and the actions taken on those issues. This helps build a knowledge base of the various activities of the support staff.
? Configuration management: All system configuration information such as AE Titles, IP addresses, port numbers, physical location, operating systems, for example.
? Performance and capacity planning: System utilization and indications related to performance such network bandwidth, CPU utilization, and disk usage.


An administrator should have the skills to either troubleshoot or proactively monitor the PACS. A basic understanding of the operating system, whether it be Windows or Unix, is necessary to be able to determine if the applications are running correctly and not consuming too many resources on the servers. All critical configuration and database files must be backed up on a regular time frame.

It is very useful for a PACS administrator to know how to do some basic scripting. Scripting allows administrators to automate many tedious activities to keep the system running. Troubleshooting skills should help the administrator be able to separate the forest from the trees and understand the scope of problems. Basic networking skills like using Ping can help make sure devices can see one another on a network. Your toolkit should have more than a stopwatch when users complain about responsiveness.


A major part of PACS administration is getting the modalities, RIS, dictation system, and PACS to coordinate with each other. This is in large part a facilitating role to get different vendors to make their systems talk to each other. DICOM is the preferred way of communicating, as it will lead to a more robust and flexible interface. Being able to do some basic DICOM gap analysis can help the project stay focused on problem solving instead of devolving into fruitless finger-pointing.

The Integrating the Healthcare Enterprise initiative, cosponsored by the RSNA and the Healthcare Information and Management Systems Society, can be a secret weapon for the systems integrator.(3) IHE is not a standard but rather a blueprint for how to design the workflow of the information systems. IHE has spent countless days coming up with well-thought-out solutions for data integrity issues and workflow problems. IHE also includes the lessons learned from facilities that struggled to go filmless over the past decade.


Policy administration is perceived as the boring part of PACS administration. But it is those same "boring" policies that make the "exciting" times, that is those times when systems fail, survivable. Policies can be subtle and complex, having far-reaching implications about the long-term success and acceptance of a PACS. Several policies that need to be developed are password management, security, disaster recovery, off-hour support, quality assurance, data integrity, archiving regulations, film requests, and CD burning. These are just a few of the policies necessary for successful PACS implementation.

Paul Nagy's previous articles on PACS administration:

The many faces of PACS administration - an overview

PACS administration: Enter the application specialist - working with and understanding the needs of users


1. Lyke H, Cottone D. IT automation: the quest for lights out. Upper Saddle River, NJ: Prentice Hall, 2000.
2. Schiesser R. IT systems management. Upper Saddle River, NJ: Prentice Hall, 2002.
3. IHE: Integrating the Healthcare Enterprise.

Dr. Nagy operates ClubPACS, a Web-based source of PACS information. He can be reached by e-mail at