PACS History - HUSM

PACS stands for Picture Archiving and Communications System. This system electronically stores images and reports, instead of using the old method of manually filing, retrieving and transporting here and there for storing X-ray films. 

The first PACS was introduced to the world in November 1984 at the annual Chicago meeting of the Radiological Society of North America (RSNA). PACS have become one of the most popular health care systems between 2003 and 2008. During this period, archiving media and interpretation media changed from film based to digital imaging. PACS was then considered a major breakthrough, in that digital image acquisition devices were an extension of conventional radiology.

PACS works with x-ray and scanning technology such as CT, MRI and ultrasound to make x-rays and scanned images available to view on screens not just within radiology, but also other departments such as wards or clinics.

PACS also acts as a digital filing system to store patients’ images in an organized way which enables records to be retrieved with ease. PACS saves time and money and reduces the liability caused by filing errors and lost film.

June 1995
With 1 PC Win 3.1, began the era of the use of computer systems. 10 members of X-ray Film Developer with no basic knowledge about computer, get training in the workplace... finally they were able to control the movement of the x-ray films smoothly (tracing and filing).

July 1998

1. Digital Radiography with local area network created for connecting between modality MRI, DSA and fluoroscopy LCA Lagacy Advantage workstation with two 3.1 and two wet Kodak laser printer.
2. Kenite Kenites system to be used to connect both the printer.
3. Image on both workstation is copied into a CD for storage and reference when needed.

October 1999
1. HDI3500 digital ultrasound equipment available, but its image is stored in magnetic optical disk (MOD).

A Magneto-optical disk (MOD) 

December 2000.
1. Central archiving was introduced with the use of software Pathspeed 7.12:

• Storage capacity obtained at that time was 144 gigabytes.
• 3 units of G4 - used as a Modality interphase unit.
• Networking system using 2 Cajun switches and 1 3COM switch.

2. Digital modality acquired next is 4 slices Lightspeed CT plus.
3. Images from CT, MRI, Angio, ultrasound and fluoroscopy was sent to the central archiving, also known as the mini PACS.
4. Local area network has been improved considerably with additional switches and also connected to the online intranet and internet.
5. Some equipment and workstation also obtained in this upgrade process:

• 2 units Diagnostic workstation that uses Barco CRT type monitor was used for reporting.
• 2 units of reconstruction workstation type ADW4.0
• 1 unit - Digitizer (radwork software)
• 15 apple computer used for patient registration and reporting (using PARIS).
• 1 unit - Dryview 8100 Laser Imager. 

July 2001.

1. Elegra Sonoline Ultrasound equipment available and continue to be sent to the central image archiving.

August 2001.

1. Multipurpose digital fluoroscopy modalities to increase the number of successful digital images sent to PACS workstation using the easy vision.
2. Images from X-Ray bone absorptionometry at that time was not successfully sent to PACS, image is stored in CD.

March 2002.

1. The effect of the additional modalities and increasing the number of examinations, storage capacity has reached a critical stage.
2. To solve the above problem,long term storage (Plasmon) using MOD (magneto optical disc) was installed.
3. A total of 104 MOD, 5.2 and 9.1 gigabyte of space per MOD was put into Plasmon. When MOD filled up, then you had to physically go into the system and remove the old MOD and put in a new one.
4. Arc Controller software was used to integrate the long term to short term storage storage.
5. With the addition of more than 1 terabyte of storage capacity, a portion of the MRI examination of long stored in CD also sent to PACS.
6. Medical technicians was assigned to retrieve images. 

An optical library 

April 2002.

1. Pathspeed 7.12 was upgraded to the new version 8.1 Pathspeed.
2. This upgrade process took about a week.
3. Some software and hardware has been changed in this upgrade process:

• Registration and reporting using the PARIS software on the iMac computer has been converted to a web base RIS running Windows operating system.
• Virtual PC software has been used to enable the iMac used.

4. Web server for users outside the Department of Radiology has been installed:

• This system allows users outside the Department of Radiology to view true resolution radiology images.
• User ID and Password for the PACS system has been expanding to all preachers.
• The software is also fully utilized during the radiology conference.

5. Three units with barco monitor diagnostic workstation for reporting and 3 units radiographers workstation for viewing also available.
6. DICOM box was used to send a non-DICOM ultrasound image of Toshbee equipment.
7. This month also filmless ultrasound was introduced with the image of three ultrasound units were sent to PACS.

DICOM (Digital Imaging and Communications in Medicine)

DICOM enables the integration of scanners, servers, workstations, printers, and network hardware from multiple manufacturers into a picture archiving and communication system(PACS).

June 2004

1. MYRIS was introduced and well received by users ranging from lecturers,specialist, medical officers, nurses, radiographers and hospital attendants.
2. In June 2010, the number of users exceeds 750 people covering 48 locations. 
3. Our department became filmless, with all images viewed on monitors and stored electronically. This technology enables rapid retrieval of old images. The handling and storage of volumes of x-ray films, which are bulky, heavy, and flammable, are things of the past.

The transition from use of film-based to 
filmless technologies in Radiology Dept.

There are companies specialize in proper disposal.

They will pick up x-ray films for no charge.

5 Advantages of Digital Radiography:

1. Digital x-rays eliminate the need for a dark room to develop films. Equipment is generally smaller and takes up less space. 
2. The chemicals used to develop traditional x-rays were bad for the environment. 
3. Digital x-ray imaging does not require any chemicals, 
4. Images can be immediately retrieved, deleted, modified, and subsequently sent to a network of computers.
5. The images are better stored and there is less chance of losing or misplacing them.

 If the radiologist says selected x-rays are worth keeping.
Keep them in a filing cabinet or somewhere safe.

Special thanks to IT committee headed by PM Dr Ezanee and assisted by Mr. Nik Fauriza, they contribute a lot to the realization of IT in the Department of Radiology. IT skills and experience they have greatly helped the success of the radiology department as there is today.