Go east, young PACS, go east

PACS is flourishing in some parts of Asia, nourished as much by economic necessity and local medical custom as by desire for filmless imaging.

South Korea leads the curve. Annual spurts of PACS growth there reached 183% or more in 2000, 2001, and 2002, according to a recent paper (Comput Med Imaging Graph 2003;27:121-128).

This startling rush to PACS in Korea is mostly a reaction to local economic conditions. Korea does not have domestic x-ray film manufacturing, and when a serious economic crisis hit in 1997 that prevented the country from importing x-ray film, it became necessary to turn to PACS, said Kiyonari Inamura, Ph.D., emeritus professor in allied health science at Osaka University. As a result, the Korean government in 1999 approved a policy of reimbursement for PACS examinations.

"Because of this policy, hospitals and medical centers in Korea have incentive to implement PACS, and private industry has incentive to invest in PACS research and development," Inamura said.

PACS prospers also in Japan. By 2002, the total number of PACS installations in Japan was 1468, including 1174 small facilities with fewer than four information display terminals, 203 medium sites with five to 14 terminals, and 91 large hospitals with 15 to 1300 monitors, Inamura said.

PACS found favor in Japan as the backbone of an extensive local teleradiology network, established to address a chronic radiologist shortage that resulted from local medical law, which allows any physician to practice radiology. Thus most Japanese hospitals are equipped with digital imaging modalities but are not staffed with radiologists to interpret the studies. As a result, teleradiology and PACS have enjoyed a surge in popularity during the last decade.

"Teleradiology offers the possibility to run imaging centers in local communities without radiologists," said Dr. Mutsumasa Takahashi, chair of radiology at Kumamoto University School of Medicine.

Japanese PACS and teleradiology have expanded for other reasons as well. Information technology has enabled the transmission of high-quality images within an acceptably short time period. The introduction of PACS has promoted an acceptance of filmless radiology.

Filmless radiology is also taking root in Hong Kong, where the information technology department of the local Hong Kong Hospital Authority supports the US$3.6 billion Hong Kong Wide Area Image Distribution/PACS Project. Since 2002, this project has connected all 44 public hospitals in the area.