What's PACS?

Picture Archiving and Communication Systems (PACS) is a concept perceived in the early 1980s by the radiology community as a future method of practicing radiology.
PACS consists of image acquisition devices, storage archiving units, display stations, computer processors, and database management systems. These components are integrated by a communications network system. During the past 10 years, technologies related to these components became mature, and their applications have gone beyond radiology to the entire health care delivery system. As a result, PACS for special clinical apllications as well as large- scale, hospital-wide PACS are being installed throughout the United States and the world.
    A literature search related to PACS reveals that there are about two thousand publications, several edited books, several special issues in journals, and three chapters in H.K. Huang's book,
Elements in Digital Radiology. Although these publications provide, chronologically, documentation on research and development advancement of PACS during the past decade or so, they lack coherence in the subject matter. Although originating in the radiology community, the PACS concept can be applied to any scientific field that requires the handling of voluminous pictures and textual data. We anticipate that this field will continue to grow in the next 5 years.

History of Picture Archiving and Communication Systems (PACS)

The term "digital radiology" was introduced by Dr. Paul Capp in the early 1970s. Lack of technological development to support the requirements of digital radiologists, however, prevented the concept from becoming popular until the early 1980s.
    The First International Conference and Workshop on Picture Archiving and Communication Systems (PACS) was held in Newport Beach, California, in January 1982, sponsored by
SPIE (the International Society for Optical Engineering). Therafter, the PACS conference has been combined with the Medical Imaging Conference. The joint meeting has become an annual event, always held February  in southern California.
    In Japan, the First international Symposium on PACS and PHD (personal health data) was held in July 1982, sposored by the Japan Association of Medical Imaging Technology (JAMIT). This conference, combined with the Medical Imaging Technology meeting, also became an annual event, EuroPACS (Picture Archiving and Communication Systems in  Europe) has held annual meetings since 1984 and is a driving force for European PACS information exchange.
    One of the earliest research projects related to PACS in the United States was the teleradiology  project sposored by the U.S Army in 1983. A follow-up project was the Installation Site for Digital Imaging Network and Picture Archiving and Communication  System (DIN/PACS)
funded by the U.S. Army and administered by the MITRE Corporation in 1985. Two university sites were selected for implementation, the University of Washington at Seattle, with paticipation of Philips Medical Systems, and Georgetown University/George Washington University Consortium in Washington, D.C. with AT&T collaboration. The National Cancer Institute in the United States funded one of its first PACS-related research projects in 1985, under the title Multiple Viewing Stations for Diagnostic Radiology.
    A meeting concentrating on dedicated PACS sponsored by NATO ASI (Advanced Study Institute) was PACS in Medicine, held in Evian, from October 12-24, 1990. Approximately 100 scientists from over seventeen countries participated. The ASI proceedings summarized international efforts in PACS research and development at that time. This meeting stimulated the medical diagnostic imaging support (MDIS) systems ptoject sponsored by the U.S. Army Medical Command, which has been responsible for large-scale military PACS installations in the United States.

PACS and Related Research in Various Countries

In this section, we summarize the PACS and related research and development in 15 countries.
The countries are Austria, Belgium, Denmark, France, Germany, Greece, Japan, Italy, South Korea, the Netherlands, Spain, Sweden, Switzerland, Turkey, and the United Kingdom.
    Austria has installed a large-scale PACS project at the Social and Medical Center East, known by its German acronym: SMZO.
    In Belgium, three institutes are active in PACS research: the University of Leuven (KUL), the University Hospital of Brussels (ULB), and the Pluridisciplanary Research Institute for Medical Imaging Science (PRIMIS) at the University of Brussels. At the KUL the PACS project's main application is to support  reseach activities in acquisition techniques and image processing methods. The ULB, together with the PRIMIS group, started a multivendor installation PACS project. In addition, the ULB is working on an evaluation project in teleradiology. In Denmark, the Viborg Sygehus, a general hospital of 400 beds, installed a PACS (SIENET, Siemens) in 1989. And in 1992, the department was almost filmless except for mammography. In France, there are seven PACS projects, in Grenoble, Lille, Montpelier, Nanates, Rennes, and Villejuif. In Grenoble and in Rennes, PAC systems are in the university hospital with  a special connection to neurosurgery. The University Hospital of Rennes recently assumed the major responsability for the EuroPACS  MIMOSA project,  which aims at providing a generic framework for an information system dealing with the management of medical images within a medical institute. In Lille and Villejuif, PAC systems are designed into the university hospital infrastructure under the framework of a hospital information system project. In Montpellier, the PACS is designed for the university hospital instead of the radiology department. In Nantes, the PACS is confined to the nuclear medicine area. A recent project in the Hospital of Paris is the MIRIAM, a long-term integrated RIS-PACS project.
    In Germany, there are three PACS-related projects, one from the University of Hamburg, the University of Berlin, and the Rudolf Virchow University Hospital. The Hamburg project is related to the use of computed radiography (CR). The Berlin Communication Project (BERKOM), initiated in 1986, served as a test bed for future developments of broadband communication services, terminal devices, and applications.
    In Greece, a new project, TelePACS 2.0, is being launched in Crete to support the health care network on the island.
    In Italy, nine hospitals installed the turnkey CommView PACS system from AT&T and Philips. These hospitals are Mater Dei Clinic, Bari: Maggiore Hospital, Bologna; Castelfranco Hospital, Castelfranco; Sant'Anna Hospital, Ferrara; Messina Hospital, Messina; S. Gerardo Hospital, Monza; and many others. Research activities in Italy include economic evaluation, metropolitan PACS, operational analysis, RIS-PACS integration, and teleradiology.
    In Seoul, South Korea, a large- scale PACS has been installed in the Samsung Medical Center. ASAN Medical Center is in the process of installing a large-scale system, designed and implemented by Hyundai Electronic, Ltd.
    With more than 2000 CR systems in clinical use, Japan is very active in computed radiography. As for PACS, about 100 hospitals have already installed systems of various complexity.
    In Switzerland, a hospital-wide PACS project integrated within a hospital information system is in progress at the University Hospital of Geneva.
    In Turkey, the PACS project is being implemented in our Ragaris laboratory (see our corresponding topics in this homepage), and then it will deployed in the East Mediterranean University Hospital in Antalya.
    In the United Kingdom, there are two PACS projects, one in Hammmersmith Hospital and the the other in Conquest Hospital, Hastings, East Sussex.
    Other countries also have PACS research and development efforts at various stages of design and implementation; thus the preceding list, by no means exhaustive, will increase as time progresses.