The current outlook for picture archiving and communications systems (PACS) in day-to-day clinical use is examined. After reviewing the components of a PACS, a set of requirements for a clinically acceptable system is outlined. The PACS concept employed by the US military is presented as an example of an integrated approach to a filmless hospital. Clinical evaluation, future applications, and current limitations of PACS technology are also reviewed. >

Requirements for picture archiving and communications

Picture archiving and communications systems (PACS).

Many information technologies have been or could be applied to efforts to measure and improve health care quality. This article reviews the recent literature in medical informatics, quality assurance, and quality improvement to identify these and current, emerging, and potential technologies.

Information Technology Applications in Quality Assurance and Quality Improvement, Part II

Previous studies focusing on the value of laboratory testing have sometimes been flawed because they had not always determined whether the data generated had been appropriately used by clinicians. It has been well documented that neither clinicians nor administrators always use objective data effectively. When data are not used appropriately by clinicians, not only are morbidity and mortality increased, but also care costs are higher. Failures by administrators result in lost opportunities to identify and correct system deficiencies. To provide information support to assure good data utilization, a prototype desktop workstation has been developed and partially implemented. Experience with such a system suggests that not only may it help provide better care more economically, but it can also aid in implementation of Practice Guidelines (Agency for Health Care Policy and Research) and Clinical Indicator (Joint Commission on Accreditation of Healthcare Organizations) programs. Laboratorians can be influential in this effort and promote the use of new knowledge in patient care in a timely and responsible manner.

Data utilization, not data acquisition, is the main problem.

The difference between an invention and a discovery is discussed, before turning to the sources of medical images. Next, the ongoing integration of image modalities in clinical routine is reviewed, as well as improvements in diagnosis and therapy planning with the help of better images in inter-connected distributed systems. Current shortcomings of image processing, and the attempts to overcome these shortcomings are presented. Examples of image processing are given, together with a vision on future systems and procedures.

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Medical Images in Integrated Health Care Workstations.

We report the use of an interactive graphics-oriented workstation to explore quantitative information extracted from medical images. At the University of California at Los Angeles, a Macintosh II personal computer operates as a stand-alone system and images are imported from a central PACS (picture archiving and communication system) server through an Ethernet network. The image-analysis program contains a complete set of general-purpose tools for image manipulation and processing, as well as specific tools for clinical analysis of cardiac and vascular images obtained by various techniques. Most of these features were designed to communicate information through color-coded graphic displays. Ten novice users were given a brief introduction to the program and asked to perform eight analytic tasks. The overall success rate was 95%, and the subjects considered the program easy to use without a manual or formal training. We conclude that with a well-designed graphic interface, physicians without training in the use of computers can easily learn to manipulate and analyze medical images.

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Papers

Desktop image analysis: workstations of the future.