Assessment planning improves PACS performance

ANAHEIM - It’s been said that ignorance is bliss, but try telling that to a radiology administrator tasked with a PACS project. Consultants and administrators who have presided over PACS installations know that the greater the detail in the planning stage, the fewer surprises will arise during implementation and integration.

Jay Mazurowski, a radiology administrator and director of radiology at Concord Hospital in Concord, NH, has first-hand knowledge of the perils of launching a PACS. An experience with bringing a system online at a previous employer provided him with a hard-won understanding of what it takes to shepherd a successful PACS venture.

Mazurowski is in the process of bringing a PACS to his current institution and shared the lessons he’s learned with attendees at the American Healthcare Radiology Administrators annual meeting on Sunday.

"A PACS project will not keep you young," he observed wryly.


The first step that Mazurowski undertook at Concord Hospital was to create a PACS team. The members of this team may vary slightly from facility to facility, depending on the scope of the PACS project.

His group consisted of the radiology administrator, the radiology practice chair, the operations manager, a radiologist, the chief technologist, a radiology systems specialist, the IT director, a representative from the biomedical group, the director of cardiology, the orthopedics business manager, and the purchasing manager.

Ad hoc members of the group included a compliance officer, a cardiologist, an orthopedist, a representative from medical records, an emergency room physician, and a nursing representative. Although they did not attend every meeting of the PACS team, they were informed of meeting dates and agendas and were provided with meeting minutes.

Because it impacts a wide variety of clinical personnel at an institution, Mazurowski believes it prudent to take the time to gather input and establish the needs of these groups in order to properly scope a PACS project.


Once the stakeholders in a PACS installation have been identified and brought together as a team, an assessment will need to be undertaken in four critical areas. These are:

  • Assessment of reading areas.
  • Assessment of imaging equipment.
  • Assessment of HIS/RIS.
  • Assessment of potential expenses.

A reading-area assessment should consider factors such as indirect lighting, network access, ergonomic considerations, and fundamental issues such as the amount of available space for requested equipment.

"If you think you’ll need two data drops in an area, go ahead and pull four cables so that you’ll have the capability for future expansion," he advised.

Imaging equipment assessment is crucial in terms of future PACS uptime and administrative support. All modalities must be evaluated for DICOM compliance.

"All implementations of DICOM are not created equal," Mazurowski said.

Assessing current information systems such as a HIS or RIS is another critical component of the PACS planning process. If the PACS will integrate with a RIS, the capability of each modality to support the DICOM modality worklist standard must be established.

Also, if bi-directional communication is desired from the modality to the RIS, the DICOM performed procedure step standard must be supported. Equally important is to keep in mind that each upgrade on either side of the RIS/PACS equation will need to function seamlessly with one another, and, if applicable, a HIS as well.

"The integrity of the electronic database is critical for a successful PACS implementation," he said.

An assessment of potential expenses can be calculated on the basis of data gathered in the previously mentioned evaluations. Capital equipment costs will include diagnostic-quality workstations, clinical review-quality workstations, and quality-control workstations. Interface expenses can be forecast based on the level of DICOM interoperability of the modalities and gateways to the HIS/RIS, such as a broker. Service agreements for PACS upgrades and maintenance will need to be added onto the expense column as well.

Electronic storage needs, both near-term and long-term, can be calculated based on annual procedure volume. Data drops and cable runs can be assessed by the desired number of review stations in areas outside the radiology department. Reading areas may also need to be modified for privacy and ambient light, requiring structural costs to be determined in advance.

"Keep in mind that the initial reading environment may well require the ability to read both soft copy and film in the same space," advised Mazurowski.

The network backbone itself will have to be evaluated to see if it can withstand the increase in load that will come with the adoption of a PACS.

"A PACS will not function well on a substandard infrastructure," he said.


"There’s an old joke that PACS actually stands for Promise Anything to Complete the Sale," said Mazurowski. "By documenting initial assessments of your PACS needs and liabilities you’ll have a good start on the necessary tools to begin crafting a request for proposal from PACS vendors."

According to Mazurowski, performing initial assessments provides a facility with the following benefits:

  • A detailed assessment of current physical and network infrastructure for future planning.
  • The ability to anticipate future trouble spots and expenses by assessing interface and networking issues.
  • The ability to anticipate and prevent or reduce potential database and image retrieval errors.
  • Stakeholder education.
  • Financial planning.
  • The development of a track on which a PACS project can run.

By Jonathan S. Batchelor staff writer
August 11, 2003

Copyright © 2003

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