When one PACS isn't enough, academic center develops a second

Radiologists in academic medical centers sometimes find PACS inadequate for teaching purposes because it can be inflexibly configured, inhibiting their ability to modify the original data.

One solution is to construct a duplicate PACS, which can be useful for conference preparation, research, teaching, and backup to the primary system.

"A duplicate system provides teaching and research tools that are not readily available on many commercial PACS," said Dr. Randy Ernst, a radiologist at the University of Texas Medical Branch (UTMB).

PACS administrators prefer to limit access to imaging software and to maintain a single type of hardware, Ernst said. Adding software such as PowerPoint, Photoshop, CD-ROM copying, patient anonymizing tools, and e-mail to support teaching exposes the enterprise PACS to viruses and complicates management issues.

Ernst and UTMB colleagues Drs. Rajeev Shah and Matthew Anderson equipped a PC with a 160-GB hard drive, 3D postprocessing, and image review software, then linked it to the enterprise PACS. Now images from the enterprise PACS, CT, and MR scanners are queried or pushed to the duplicate PACS' archives and/or workstations.

"A duplicate system enables the preparation of all medical student, resident, multidisciplinary, and technologist conferences," he said. "It provides faculty and residents the opportunity to improve their computer skills and to enhance their talks and publications."

Imaging data are readily available for research and publication. The removable hard drives and CD-DVD software allow for portability of large data sets for collaboration and work at home and on weekends.

Only images with significant pathology are saved, Ernst said. In just over nine months, 107 GB of uncompressed DICOM data was stored, including 239,543 images for 1926 patients.

For the duplicate archive, 4 x 200-GB IDE hard drives (Western Digital, Lake Forest, CA, $220 each) are linked using an IDE RAID card (Promisenn Technologies, Milpitas, CA). Windows XP is the operating system on a Pentium 4 PC. The Conquest DICOM Server (University of California, Davis Medical Center and Netherlands Cancer Institute), Microsoft SQL Server, and eFilm (eFilm Medical, Toronto, ON) are used for image management. Software for e-mail, Paint Shop Pro, Microsoft Office, and RIS is added. Additional workstations with removable 120 to 200-GB hard drives are used in the reading rooms.

"This configuration may also be useful for a small imaging center," Ernst said.

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