PACS springs leaks during fall disaster

Just months after Hurricane Katrina devastated its city, the radiology department of the Louisiana State University Health Sciences Center at New Orleans passed along valuable lessons about PACS disaster recovery.

A classic PACS setup is very vulnerable, said Dr. Oleg Pianykh, an assistant professor of radiology at LSU. It doesn't take a hurricane to wreak havoc on a facility's PACS, he said, at the 2005 RSNA meeting.

Despite the high costs that come with implementing a PACS, the systems can be vulnerable to configuration updates, computer viruses, and even something as simple as a supporter taking the day off.

The local area nature of the systems, even with remote backup, introduces vulnerability. These systems are dependent on local infrastructures such as power, network, and Internet service providers. At the New Orleans facility, the ISP was located on the first floor of its building and was flooded in the hurricane aftermath, Pianykh said. The PACS there was the central hub for seven nearby cities: Lafayette, Kenner, Shreveport, Baton Rouge, Lallie Kemp, Houma, and Bogalusa.

After flooding deluged New Orleans, the facility faced not only technical challenges such as lost networks, workstations, and PACS servers. It also suffered from nontechnical challenges resulting from the ensuing chaos and personal stress experienced by the radiologists.

Pianykh outlined several PACS myths debunked by the disaster:

- Redundancy. Redundancy can't fix system deficiencies, can't improve performance, increases system and maintenance costs, and decreases system flexibility.

"Redundancy is the worst way to deal with PACS problems," he said. "Tenacity should replace redundancy."

- Backups. Backups can recover data but not functionality. The backups themselves may become damaged. Remote backups can be very expensive, and backups without a PACS are meaningless, according to Pianykh.

"You must have a complete backup PACS solution, not just a data backup," he said.

- Compromise. Low-cost compromise PACS solutions can suffer from DICOM incompatibility, low image quality, and lack of full PACS functionality. Patchwork and temporary fixes may end up staying around longer than intended.

"What you have to do is accept the current situation and brainstorm for the best possible long-term solution," he said.

Pianykh went on to describe a disaster-proof PACS. This would be a distributed PACS that could be installed and configured in minutes by anyone using any off-the-shelf PC.

"You have to look at your PACS architecture and make sure it's not centralized, that it's not localized. It is much better to build smaller, more flexible PACS units," he said.

The lessons learned from Hurricane Katrina were put to good use in Indiana when a devastating tornado that killed 22 and injured hundreds more hit on Sunday, Nov. 6, 2005.

At St. Mary's Medical Center in Evansville, the imaging department was put through its paces when disaster struck. On a typical Sunday, the entire imaging department may read over 200 exams. On the day of the tornado, that number jumped to 439 studies, according to Julie Wolowitz, director of imaging services.

The department had just implemented a wireless communication system six weeks prior to the disaster. Wolowitz credits the system, which involves wearable communication devices that can be used to call and page individuals and entire departments via a wireless communication network, with helping to deal with the overload and chaos of the situation.

About a month prior to the storm, the facility had undergone a mass casualty disaster scenario in order to prepare for disaster.

"We went through a lot of preparation and practicing," Wolowitz said. "We had just seen what had happened with Katrina, and we felt that we needed to be prepared and to think through all possible scenarios."

The PACS, in place at the facility for three years, worked through the storm beautifully, Wolowitz said.

"We have our Web product deployed and have diagnostic-quality monitors throughout the campus. We had no issues for accessing the PACS, and the PACS didn't go down," she said. "We have backups and emergency power prepared, so you will experience only a flicker and a flash, and then the PACS will come back up with no interruption."