By Erik L. Ridley, AuntMinnie staff writer

September 25, 2018 -- PACS has come a long way since it was first adopted in the early 1980s. But PACS software developers still need to address important technological limitations that can have a negative impact user experience, according to research published online on 17 September in the Journal of Digital Imaging (JDI).

After analyzing four online PACS discussion groups over a two-year period, Mona Alhajeri, PhD, of the Jaber Al Ahmad Center for Molecular Imaging in Kuwait and Brunel University London of Uxbridge, U.K., and Dr. Syed Ghulam Sarwar Shah, PhD, of St. Thomas' Hospital in London, found the current generation of PACS technology has a number of important limitations, including limited storage, limited windows on PACS workstations, and standalone PACS units from different vendors that don't integrate with each other. These issues need to be addressed in the next generation of PACS, according to the researchers.

Dr. Syed Ghulam Sarwar Shah, PhD
Dr. Syed Ghulam Sarwar Shah, PhD, of St. Thomas' Hospital in London.

"Despite ongoing technological developments, the current generation of PACS has limitations that affect PACS functionality leading to unmet needs and requirements of PACS users, which could impact workflow and efficiency in healthcare," the authors wrote.

Not much research has been performed to analyze the limitations in the current generation of PACS software and the solutions for addressing these limitations. As a result, Alhajeri and Shah sought to obtain the perspectives of PACS professionals by collecting and analyzing discussion threads on four online discussion groups on PACS on the LinkedIn professional social networking website. The four discussion groups were viewed once every three months from January 2014 to December 2015. All comments or posts that were deemed relevant to the study were exported directly using a screen capture function to a local database on a PC (JDI, 17 September 2018).

Group 1 had 1,739 members, while group 2 had 5,261 members, and group 3 had 1,833 members. Group 4 had 502 members. Of the discussion group participants, 71% were from North America, 13% were from Europe, and 5% were from Asia. Analysis of the textual data of 250 posts showed two major themes: the limitations of current PACS and solutions for improving PACS functionality.

Current limitations

From their analysis of the online discussions, the researchers concluded that the current generation of PACS has the following six main limitations:

  • Problems in viewing, copying, and importing images and data
  • Issues in data backup, archiving, and recovery
  • Difficulties in transmitting images
  • Problems in changing Internet Protocol (IP), hostname, application entry title (AET), and hard-coded DICOM attributes
  • Standalone PACS units and lack of proper tools
  • Limits of open-source PACS

The discussions also revealed the following 14 major opportunities for increasing PACS functionality:

  • Integrating multisite and intrasite PACS
  • Enabling image transmission
  • Allowing changes in IP, hostname, AET, and DICOM attributes
  • Ensuring data backup, archiving, and recovery
  • Interfacing PACS with RIS and EMR
  • Using multidimensional visualization methods
  • Applying open standards for data interoperability and system integration
  • Adopting multimedia solutions for PACS
  • Utilizing web-based solutions
  • Utilizing medical image viewer applications
  • Exploiting open-source PACS
  • Accessing PACS on mobile devices
  • Using vendor-neutral archives
  • Integrating speech recognition in PACS

Implications for users

The researchers found that users often report challenges in using and accessing PACS, including issues with integrating PACS software developed by different vendors, integration of PACS between hospitals, and integration of PACS with other hospital systems, according to the researchers. What's more, some users encounter difficulties in accessing the PACS software remotely.

Mona Alhajeri, PhD
Mona Alhajeri, PhD, of the Jaber Al Ahmad Center for Molecular Imaging in Kuwait and Brunel University London of Uxbridge, U.K.

"Hospital managers and PACS managers therefore need to adopt the latest solutions that can help in improving the functionality, integration, and access to PACS," the authors wrote.

The research also revealed issues with training various types of users. As a result, hospital managers in charge of education and training need to develop programs for training on PACS applications, according to the researchers. They also noted it's important to consult with potential users prior to implementing PACS.

Adopting the latest PACS technology such as web-based PACS software can also have data security implications. Consequently, users, implementers, and hospital managers must adopt appropriate PACS security and backup methods, according to the researchers.

Further evaluation

While a number of different factors limit the functionality of the current generation of PACS software, there are various technological approaches to address these limitations, according to the investigators.

"These solutions need to be evaluated on several aspects such as the cost, implementation, management, effectiveness, and security, which are imperative from the perspectives of PACS users," the authors wrote. "Thus, both the limitations in the current generations of PACS and the solutions for enhancing the PACS functionality identified in our study have implications for PACS developers, users, and implementers as discussed in this paper."

They noted, however, that online conversations -- while offering many insights -- are random and lack depth and supporting evidence. As a result, online conversations in discussion groups are more useful for only for exploratory studies.

"Findings of research studies based on online data need to be confirmed through scientific enquiry using other means of data collection from the population of interest," the authors wrote.


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