PACS vendors offer ways to start small and scale up

Toshiba, Kodak configurations cut upfront costs

PACS sales are running well below expected estimates. One reason may be that few institutions can afford the large-scale, big-ticket systems that PACS developers have traditionally created. Now some vendors are coming up with ways for hospitals to get into PACS without breaking the bank. Among the options displayed at the 2001 RSNA meeting were scalable products focused on meeting the needs of specific hospitals.

Toshiba is promoting an "inside out" configuration, which transforms individual scanners—CTs and MRs, for example—into data transmitters. The idea is to allow radiologists to communicate with referring physicians for a relatively small investment by taking advantage of the Internet.

"Many people, when they think of PACS, think of filmless radiology and archiving, which come at considerable expense. But the most important thing about PACS is communication, getting information from inside the radiology department to referring physicians outside," said Frederick Wagner, Ph.D., Toshiba's PACS manager. "All that requires is the communications component."

Toshiba's PACS Inside Out adds a Web server to an imaging modality. Consequently, even if a department relies on film for archiving and permanent storage, it can still use the Web to distribute images across the enterprise.

"You can get the throughput benefits of soft-copy display and still be film-based because you are going directly from the modality," Wagner said.

Kodak's DirectView PACS family provides more options but avoids exorbitant cost. Three PACS "anchor" setups are preconfigured to handle different volumes of images. The hardware and software in each configuration are built into a single rack.

"The system arrives at the hospital in a crate. You haul it in, connect the modalities and workstations to the hospital network, and you're ready to go," said Arturo Gamboa-Aldeco, Ph.D., director of Kodak's health imaging product line management. "It removes the mystery and keeps PACS simple for everyone concerned."

Kodak's PACS ES is designed for small hospitals, imaging centers, and clinics that process up to 14,000 exams a year. It includes the archives, storage jukebox with a capacity of about 2 terabytes, an image server for the workstation, and an integrated console for network management.

The PACS EX is a slightly larger configuration, intended to hold in a single set of racks a StorageTek library and high-performance EMC RAID (redundant array of inexpensive disks) and SAN (storage area network) that can handle 100,000 exams a year. The small-footprint EX fits where space is at a premium. Integrated switches feed the hospital network without overloading it. A sophisticated set of archiving rules permits prefetching, sorting, and delivering images to workstations, as needed.

The PACS EXL can be expanded to 10 terabytes of image storage or a total capacity of 17 terabytes. The system can accommodate SAN technology and RAID for image distribution of as many as 200,000 imaging studies a year. The EXL, therefore, could manage a high volume of images from several multislice CT scanners, for example, or process and deliver images quickly across a healthcare enterprise.

The products offered by Kodak and Toshiba fulfill long-time assertions by vendors that PACS should be scalable. Vendors have, in fact, insisted that their products were scalable, almost since their inception. The core technologies, however, depended on building blocks whose expense often could not be justified unless a large-scale PACS was deployed. By coming up with configurations that solve specific problems, vendors contain costs while flexibility is preserved for future expansion, according to Kodak and Toshiba executives.