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.