1. What Everyone NEEDS to Know About PACS Guy Guindon NORrad PACS Manager August 08, 2003

2. PACS Picture Archiving and Communication System Not only a Technology Change, but a Process Change that utilizes Technology to achieve goals of increased efficiencies through the reduction of film.

3. PACS is much more than a Radiology System or Solution Ensure you understand the BIG picture A five (5) year plan is a must even if you know technology will change Revisit and revise the plan annually to reflect changes in environment, technology, internal/external needs and competition. The only wrong choice is making no choice at all.

4. The PACS Project Team Most PACS decisions take upwards to two years from initial planning through contract negotiations and employs a team of people from:  Radiology- Radiologists, Techs  Information Systems- I/S support, networking, etc.  Administration (CIO, CFO, VP, etc.)  Purchasing  Staff Physicians and Nursing staff  Outside Consultant

5. Myth All PACS Systems are different Most PACS system perform the same basic functionality using many of the same hardware components, with the primary difference being the applications software, integration plan, and margins. There are system designs differences, but most are not significantly different. Experience is the critical component in the evaluation process.

6. PACS COMPONENTS CORE COMPONENTS VIEWING STATIONS ACQUISITION STATIONS AND PRINTERS SUPPLEMENTARY EQUIPMENT SITE EVALUATION PACS PROJECT SUPPORT

7. CORE COMPONENTS Archive/Database Servers Image Server Image Cache Web Servers Web Cache Long Term Storage Systems Networks (Core components and switches) Server Racks HIS/RIS Interfaces

8. VIEWING STATIONS Diagnostic Workstations (Dual, Triple or Quad Monitors) Clinical Workstations (Single or Dual Monitors) Orthopedic Workstations (Single or Dual Monitors) System Admin Workstation (Single or Dual Monitor) Web Clients

9. ACQUISITION STATIONS AND PRINTERS Computed and Digital Radiographic Systems Multi Plate CR Reader with cassettes Single Plate CR Reader with cassettes CR Server CR Clients 3 Foot Image Solution (Full Spine and Leg Length) Modality Interfaces or DICOM Upgrades Document Scanners Film Digitizers Dry Laser Printers

10. SUPPLEMENTARY EQUIPMENT Ergonomics Desk Chair Carts for PC’s Articulating Arms for PC’s Viewboxes Renovation Costs PC’s for Web Clients (New or Upgrades)

11. CORE COMPONENTS Things to Note Main Servers Cached or Cacheless System Unix, Linux or Windows based Servers Web Servers Integration into the PACS Link between the Main Image Server and Web Server Lossy versus Lossless Compression Lossless ( 3:1) JPEG 2000 is industry standard for compression Push vs Pull (Either or Both)

12. CORE COMPONENTS Things to Note Network Security on intranet and internet (SecureID tokens) HIPPA/PIPEDA Standards Secure Socket Layer (SSL) Data Encryption Standards (DES) Public Key Infrastructure (PKI) Secure ID Never to much bandwidth 1GB Backbone 100MB to Desktop PACS has a huge impact on Bandwidth Vendor controls from Modality to Switch Hospital controls from Switch forward, including WAN VPN (Virtual Private Network) should be considered

13. CORE COMPONENTS Things to Note Network WAN (Wide Area Network) Must to Homes and Offices High speed required (Cable or DSL) T1 or better between sites HIS/RIS Interfaces Mitra Broker $70-80k each HL7 Interface $25-50k each Cost for I.S. resources Bi-Directional communication for scheduling, reporting etc.. Allocate 4-6 months for developing, testing and going live with the HIS/RIS Interface before going live with PACS.

14. CORE COMPONENTS Things to Note Archives Acronym City - RAID,MOD, CD-R, DVD-R, DLT, LTO,SAN Short Term Storage (RAID/Cache) should be 6-12 months Long Term Storage should be around 2-3 years do to Technology changes SAN can be used for large PACS projects Retrieval time from request to display should be <60 seconds No more than 10% of retrievals should come from deep archive Prefetching and DICOM Worklist is critical and can be automated when integrated with RIS System

15. VIEWING STATIONS Things to Note Diagnostic Workstations 2, 3 or 4 Monitor Workstations 2, 3 or 5 Megapixel Displays Combination 2 (3 or 5 Mpixel Monitor for Reporting) 1 (1280 X 1024 Monitor for RIS, Mail, Voice Recognition etc.) Flat vs CRT (Replacement, Heat, Space and Costs) Clinical / Orthopedic Workstations 1 or 2 Monitor Workstations Flat vs CRT Web Client Workstations 1 or 2 Monitor Workstations Flat vs CRT

16. ACQUISITION STATIONS AND PRINTERS Things to Note CR or DR CR mimics General Radiographic processes by using a stimulable phosphor plate that is read by a reader to generate a digital image. DR changes the process by creating a digital signal at the source/receptor so that plates are not required. DR is more than just a Technology change, it’s a process change which saves upwards to 60% of the time associated with either CR or Plain Film. DR and CR are complimentary to each other and not competing Technologies.

17. ACQUISITION STATIONS AND PRINTERS Things to Note CR or DR CR - $150-$350k each (50-150 plates/hour) DR - $350-$500k / room CR Payback – Elimination of Film DR Payback – Productivity Gains CR Servers/Clients Redundancy Workflow Film Digitizers CCD or Laser Laser has better quality but higher maintenance CCD quality has improved and has become the industry standard

18. ACQUISITION STATIONS AND PRINTERS Things to Note Dry Laser Printers Filmless department PACS Downtime Modality Interfaces / DICOM Upgrades DICOM Interface Cost - $30k DICOM Upgrade Cost - $10-40k

19. SUPPLEMENTARY EQUIPMENT Things to Note Server Room Design Power Requirements Air Conditioning Fire Suppressant System Firewall Dial-up Access Raised Floor Space Requirements IT Infrastructure Upgrades Network and Network Components, Workstations, Displays, Software, Interface Engines, Security/Firewalls etc..

20. SUPPLEMENTARY EQUIPMENT Things to Note Radiology Department Design Power Lighting Ergonomic Chair and Desk Carts for PC’s OR’s, Clinics, Rounds etc.. Articulating Arms for PC’s Ultrasound, Clinics, Diagnostic Imaging etc.. Viewboxes Mount view boxes near Radiology Reporting Station Renovation Costs Replace or Modify Work space environment PC’s required for Web Clients Purchase or Upgrade Systems Locate PC’s everywhere you had viewboxes

21. SITE EVALUATION Things to Note Modalities CT MRI R&F Ultrasound Angiography Nuclear Medicine C-Arms Portables Radiography Room (CR or DR)

22. SITE EVALUATION Things to Note Storage Requirements per Modality Image Size Average # of Images/Exam**Storage Requirements Average # of Exams/Year DI Equipment Info Vendor Model and Software Versions DICOM Conformance Statement DICOM Upgrade Availability

23. SITE EVALUATION Things to Note Supported Clinical Departments Emergency ICU, ACU, CCA, Step Down Clinic Area’s OR’s Physician Viewing Area’s Physician Rounds Education Area’s Film Library Peripheral Sites Physicians’ Office Note: Must understand the volume and type of procedures which are performed in each Clinical Department and their needs.

24. PACS PROJECT SUPPORT Things to Note Vendor Maintenance Contract 10-14% of System List Pricing (M-F from 8-5) After hours contract or T&M System Administrator.5 FTE for Small PACS System 2-3 FTE for Large PACS System.2-.5 FTE from IT Dept. Training (CRITICAL) System Administrator, Radiologist, Physicians, D.I. Staff and Nursing Staff Helpline / Call Centre