Well-integrated PACS support workflows can make radiologists more efficient, accurate, and cost-effective. We know that a good salesperson always says "yes" -- and PACS salespeople are no different -- but what can be delivered at the end of the PACS project may be something quite different than what was initially promised. There will, of course, be a justifiable reason: PACS/HIS does not integrate, RIS is not able to send this information, the local network is the problem, etc. Hence, it is important that radiologists involved in the decision-making about their PACS understand the importance of the specifications.
Dr. Neelam Dugar is a consultant radiologist at Doncaster Royal Infirmary, U.K., and chair of the Royal College of Radiologists' Imaging Informatics Group.Adoption of interoperability standards will reduce the blame culture and increase vendor cooperation. We must not allow PACS suppliers to blame other suppliers for lack of integration. Radiologists do not need to understand technology and standards such as DICOM or HL7 to be able to specify for a PACS. They should specify in simple terms that reflect their workflows.
Integrating the Healthcare Enterprise (IHE) deals with workflows in the real world. It is easy to understand by nontechnical people. Specifying using IHE can ensure that vendors conform to interoperability standards.
Here are examples of using IHE in your specification process:
The Basic Image Review Profile of IHE will ensure that your PACS meets a minimum display standard:
"Compliant software must provide a predictable user interface and functionality sufficient to review images for the purpose of clinical decision-making by ordering physicians: display of grayscale and color images from any modality; visual navigation of the available series of images through the use of thumbnails; side-by-side comparison of at least two sets of images (with synchronized scroll, pan, and zoom for cross-sectional modalities); annotation of laterality, orientation, and spatial localization; annotation of demographics, management, and basic technique information for safe identification and usage; simple measurements of linear distance; and angle cine capability for images that involve cardiac motion (e.g., cardiac US, XA, 500 CT or MR)."
PACS (as image manager and image display actors) must support the Basic Image Review Profile of IHE.
The Mammography Image Profile of IHE will ensure that mammography image display meets minimum standards. Ensuring PACS supports this profile will allow a customer to add a computer-assisted diagnosis (CAD) system from a different vendor, and CAD images will automatically get stored and displayed along with original images in PACS:
"Efficient mammography reading requires specific display quality, behavior, layout, and annotation of images, as well as convenient comparison of prior with current images. The IHE Mammography Image Profile was developed specifically to define the necessary mammography requirements."
PACS (as image manager and image display actors) must conform to the Mammography Image Profile of IHE.
PACS must conform to XDS-I source and XDS/XDS-I consumer actors of the Cross-Enterprise Document Sharing Profile of IHE. This will ensure that PACS contributes to and is also able to access an electronic patient record.
Cross-Enterprise Document Sharing for Imaging -- XDS-I: "Sharing imaging documents between radiology departments, private physicians, clinics, long-term care, acute care with different clinical IT systems -- thus contributing to the development of an electronic patient record concept."
The Imaging Informatics Group of the U.K. Royal College of Radiologists (RCR) has been developing a clinical functional specification of a PACS -- from a clinical user perspective. We have defined a small subset of IHE profiles that are important for radiologists and frontline clinical users. This document is available on the public domain for use by radiologists and PACS managers across the globe. We recognize that despite geographical boundaries, the functionality required from PACS is the same, which is why standards such as DICOM, HL7, and IHE work and are successful internationally.
Currently, IHE does not have a profile for PACS plug-ins (CT colon display, CT vessel analysis plug-ins, etc.). This is defined in DICOM standard supplement 118. This concept of standardized integration for best-of-breed plug-ins is fundamental to the future of PACS displays. We have asked IHE to look at this for a profile development in 2011-2012.
The RCR Imaging Informatics Group PACS specification document is on our public website and available by clicking here.
I would recommend that radiologists read this document and use parts of it to support their specification process, because it is written for the clinical user community. These specifications have been endorsed by the RCR and are included in its guidance document.
Dr. Neelam Dugar is a consultant radiologist at Doncaster Royal Infirmary, U.K., and chair of the Royal College of Radiologists' Imaging Informatics Group.
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