Workstation, RIS deficiencies lead DOD DIN-PACS citation list

More than half of the deficiency citations dealt out by PACS acceptance testing performed by the Department of Defense on its huge Digital Imaging Network-PACS (DIN-PACS) involve problems with the radiologist's workstation, system interfaces, and the radiology information system.

The DIN-PACS acceptance testing results were detailed in a scientific session at the May meeting of the Society for Computer Applications in Radiology by Dr. Scott Allison, a radiologist at the University of Oklahoma Health Sciences Center.

The larger the PACS deployment, the higher number of system deficiencies, according to Allison. The systems most commonly cited for deficiencies - the RIS and diagnostic workstation - were also among the most expensive PACS components.

Allison said a total of 14 sites were tested between 1998 and 2000, using a protocol consisting of 12 segments. More than 400 separate testing elements were divided into 16 primary categories ranked in order of clinical and technical importance. Each specific type of system deficiency was recorded and its relative frequency established. The various problems were then ranked in order of importance.

The components most frequently cited for deficiencies were workstations (25.3% of all citations), RIS/PACS broker interfaces (16.2%), and the RIS itself (14.0%).

"The component needing replacement most often prior to turning the system over to clinical operations was the diagnostic-quality monitor," Allison said.

Other common anomalies were seen with Web-based image distribution systems (6.4%), modality interfaces (4.5%), archive devices (4.5%), maintenance (3.9%), failover capability (3.2%), and training (2.6%).

"The overall percentage of component failure varied from 0% to 42%, with the larger PACS having proportionately more deficiencies than smaller systems," Allison said.

The DOD has extensive experience at successful PACS implementations as well as in developing, organizing, and applying PACS acceptance testing protocol.

"The DOD had five years' experience performing acceptance testing with the Medical Diagnostic Imaging Support (MDIS) systems and has now refined its process according to new testing methods developed in conjunction with DIN-PACS," Allison said.

He said that since the initial DIN-PACS contract was written, improvements in software, development of brokerless interfaces, and widespread use of flat-panel displays could potentially alleviate some of the more common deficiencies.