Stop me if you’ve heard this one about PACS

CHICAGO - One of the most fun and frustrating parts of evaluating PACS each year at the RSNA meeting is understanding what vendors really have vs. what they are promoting. Like George Carlin’s comedy routine on the seven words you can’t say on television, there ought to be a ban on seven words often used in conjunction with PACS.

RSNA 2001 was the year of the 1) first-ever 2) unique 3) seamlessly integrated 4) Web-enabled 5) enterprise-wide PACS, featuring 6) scaleable 7) value-based solutions. Of the 200 or so vendors showing PACS and PACS-related products this year, no vendor got away without using at least one of these descriptions, and many combined several.

This was the year of the seamless PACS/RIS integration, with virtually all the major PACS players showing off "integrated" RIS solutions even though the seamless integration was typically limited to RIS offered by the vendor as part of their integrated RIS/PACS. Integration with other legacy systems still require detailed broker-based interfaces that were about as seamless as Jayne Mansfield’s stockings.

The sharing of a single server and archive solution (and in a few circumstances, even Web-based solutions) for cardiology and radiology imaging systems was advanced by a few vendors this year, although the technological issues surrounding a shared enterprise-wide storage solution are much more easily overcome than the political ones. Still this is a concept that is very appealing to information and technology gurus, especially in multi-site entities.

Three-dimensional (3-D) imaging was shown integrated into several of the major vendors’ PACS as a software option, as were specialized packages for orthopedics, therapy planning, and other related areas. There seemed to be an exceptionally high degree of interest in computer-aided diagnosis (CAD) for both mammography and chest imaging as well, with the integration of these technologies into PACS expected within the next two years.

There were more "unique" approaches to PACS promoted this year than ever before, yet the similarities between systems this year blended like a chameleon in the grass. As with RIS and PACS integration, the functionality and form of these systems blended "seamlessly."

So what was new product-wise? Not much, although technological advances in the past year were prominently displayed. Virtually ever vendor offered liquid crystal diode or thin film transistor displays only two years after they first showed up on the floor, with cathode ray tube displays all but relegated to PACS past. Medical and commercial-grade flat panel displays were both shown, providing end users with a choice based on budgetary and diagnostic requirements.

The low cost of RAID (redundant array of inexpensive disks) has allowed most PACS to migrate from the 14-day online cache typically specified in systems last year to six months or one year’s worth of online storage at the server level. This has allowed facilities to delay the implementation of a deep archive significantly while dramatically improving near term performance, using a single DLT (digital linear tape) or LOT (linear optical tape) as a backup for disaster recovery purposes.

Every system shown at RSNA was Web-enabled, although how each vendor defined that varied dramatically. The use of progressive wavelet data compression was fairly common, although compression ratios used varied as much as the image quality. It was not uncommon to see 40:1 or 60:1 compression used for image distribution via the Web, with a variety of strategies shown for both local and wide-area network distribution.

Archives have been reduced in size and price by half or more, but no real technological advances were shown this year. CD-ROM burners were offered by nearly every vendor, up considerably from last year. PACS vendors promote CD-ROMs to hospitals as way of providing images to patients without the high cost or time associated with copy films, using a DICOM viewer burned into the CD-ROM to display images. Paper printers that integrate radiology reports and images as a reference tool for primary care physicians were also widespread.

There were no great shakes in the networking arena, although the continuing decline in wide-area-network-bandwidth pricing allowed a few vendors to promote more favorable options and package deals for both off-site archives and image distribution networks.

The number of vendors offering digital radiography (DR) this year increased nearly three-fold with several players having received the FDA clearance to market their products weeks before the show opening. Still, there were few advances in DR from a technological perspective.

The players in the computed radiography (CR) market remained ostensibly unchanged, with integrated CR readers in X-ray tables being offered this year as a low cost alternative to dedicated DR products. The desktop CR market that developed a few years ago was also still represented, although it has been hurt by falling prices of moderate-throughput multiplate readers.

Features like voice recognition are becoming standard in product designs, as have color capture and display for ultrasound and nuclear medicine studies.

There was more talk of enterprise this and that than Captain Kirk addressing his crew, with most talking about storage area networks (SAN) and similar large-scale archives. Still, a few "enterprising" companies showed image viewing and electronic medical record (EMR) functionality on wireless PDAs (personal digital assistants).

Application service provider (ASP) finance schemes proliferated at last year’s show, yet all but disappeared shortly thereafter. A few ASP-based solutions were shown again this year, especially from vendors whose businesses are built around a pay-per-click model. However, in general the market seems to have elected to purchase PACS directly and amortize it rather than sign up for the three or five-year commitment dictated by ASPs.

Both interest in and sales of PACS are at record highs. It was not unusual to hear vendors promoting sales as having doubled, tripled and even quadrupled from last year, although some vendors expect a brief slowdown in early 2002. Understanding of PACS capabilities from the customers seems to have also dramatically increased, in large part due to the proliferation of information that allowed customers to know how to evaluate PACS and the needs of their institutions.

While show attendance was down fairly significantly this year (officially only by 11%, although most feel that number is off by at least half), most vendors said the quantity of qualified leads remained consistent with prior years and quality actually increased. Even in a year where nothing could be considered or earth-shattering from a technological standpoint, PACS remained a focal point of the RSNA show.

By Michael J. Cannavo contributing writer
November 29, 2001

For the rest of our coverage of the 2001 RSNA meeting, go to our RADCast@RSNA 2001.

Copyright © 2001

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