SCAR preview: Focus broadens as PACS matures

The maturing of the PACS marketplace and its broadening scope - from large hospitals and academic institutions to midsized and smaller facilities - is expected to be reflected in the 21st annual meeting of the Society for Computer Applications in Radiology. The event will take place in Vancouver, BC, from May 20 to 23.

Longtime participants in SCAR say they've observed a shift in typical questions raised at the meeting, from "Does it work?" to "We know it works, now how do we do it?" or, in some instances, "How do we refine what we already have?"

Dr. Byrn Williamson, chair of the SCAR program committee, recalls a panel discussion at SCAR's 1997 meeting in which three academic institutions described their experience with filmless imaging.

"That was perhaps 50% of the institutions that were filmless then," he said. "Although we still have a long way to go, there are maybe hundreds of institutions that are filmless now."

At that time, according to Williamson, radiology departments were asking whether they should or shouldn't purchase a PACS. Now, participants are more likely to encounter information at the conference that tells them how to get the most from their existing systems or how to deal with upgrading or changing a system. As the use of PACS has matured, the subject matter of the meeting has matured along with it.

At the same time, the program continues to draw participants new to PACS and digital imaging, who seek information about where to start. SCAR attempts to bridge varying levels of PACS and digital imaging expertise with its "SCAR University" program, a series of didactic courses at introductory, intermediate, and advanced levels.

"The number of new members has increased significantly, and the higher turnover of membership reflects the fact that many people join to help them get started with PACS and other digital information systems," said Dr. Eliot Siegel, chief of radiology and nuclear medicine at the VA Maryland Health Care System, and a member of the SCAR education committee.

The SCAR U lectures cover some of the hottest topics in digital imaging, such as structured reporting, system security, and decision support, Siegel said. Introductory courses include overviews of computed and digital radiography, speech recognition, and digital mammography. Among the topics in the advanced courses are image database mining, decision support, outcomes analysis, and auditing radiologist workflow.

SCAR also offers poster and scientific session presentations, and the tone is changing there as well, Williamson said.

"We're seeing more presentations by community hospitals. Originally, PACS was adopted by large academic institutions with big budgets. Now we're seeing private practices and community practices describe their experiences," he said. "We are pleased to dispel the myth that PACS is only for large or academic institutions. It eventually will be universal."

Along with the growing presence of smaller institutions, the sophistication of the presentations has increased, said Dr. Samuel J. Dwyer III, a professor of radiology at the University of Virginia.

"Five or 10 years ago, we had speakers say how great PACS was, with no data to back it up," Dwyer said. "Now there are evaluations along the lines of 'This is what we've done, here are the metrics we used, and here is what we found out.'"

Besides providing a range of learning opportunities for both new and experienced PACS users, SCAR offers a collegial setting in which attendees can ask questions and exchange information, said John Strauss, director of marketing, imaging systems, at Fuji Medical Systems.

"You can stop people in the hall, ask questions, or sit down with them over a box lunch," Strauss said.

PACS still accounts for most of the program, but the SCAR umbrella extends to other computer applications as well. CR and DR are covered extensively, both in scientific presentations and at the SCAR University course. Other topics include computer-aided diagnosis, the use of PDAs, monitors, and wireless technologies. The variety of topics and courses available at the conference allows individual participants, whatever their experience level, to find information that is not only the most useful, but also the most entertaining.

"I personally am very interested in room design and ergonomic issues related to PACS implementations, CAD, digital communication challenges associated with radiology reporting, and auditing tools that help understand how radiologists perform image interpretation and use that information to build truly intelligent workstations," Siegel said.

SCAR's closing session traditionally addresses a big-picture topic in radiology. The subject of last year's closer, data overload in medical imaging, remains high on SCAR's agenda. An update session this year will cover the status of TRIP (Transforming the Radiology Intepretation Process), the society's initiative to deal with imaging data overload.

Among new elements of TRIP is the partners program, which will invite industry and other professional and scientific societies to join the initiative. Donations they provide will fund research into strategies for dealing with data overload, said Richard L. Morin, Ph.D., Brooks-Hollerin professor of radiology at the Mayo Clinic in Jacksonville, FL, and chair of SCAR's TRIP subcommittee. Members of the subcommittee also hope participating vendors will develop sabbatical programs in which SCAR-selected researchers can work for a period of time at the vendor's facility.

This year's closing session will turn to the use of open-source software in medicine. Advocates of Linux, the free operating system, have been making headway in getting it adopted in medicine as an alternative to the dominant Microsoft operating system. Linux now has the backing of IBM and has been specified in some large-scale contracts issued by foreign governments.

"SCAR has changed fundamentally from a society that puts on an excellent annual meeting to one that is having a major influence on the practice of diagnostic imaging," Siegel said.