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 Link to this message Ann Marie Hayes  posted on Wednesday, June 23, 2010 - 08:46 pm Edit Post Delete Post Print Post
We are currently looking for a PACS system. I would be interested in knowing what Consultants other than Radiologists want from a PACS. For example viewing priors, 3D/MPR functionality, resolution of screen, reports embedded into the images etc
 Link to this message Nick Hollings  posted on Thursday, June 24, 2010 - 10:32 am Edit Post Delete Post Print Post
Dear Anne They need to tell you rather than you try and second guess it. A physician = wants something different from a colorectal surgeon from an orthopaedic = surgeon. They all want reports (except the orthopods who look at their = images and send us letters complaining that we've got it wrong, often = copied to the patient and GP!) They also want MPRs, preferably do-able on = the web solution (usually not possible unless you go down a server-client = model like they have in Poole). To my mind the important must haves are IHE spec./conformance such as it = exists, for which a wealth of information abounds on this site. A sensible = view on which monitors are required where. Clinicians, on the whole, do = NOT need expensive monitors, whatever they say. Quick response times, = plenty of local storage, teaching files (!), and very importantly, the = ability to communicate with other PACS systems, from different vendors in = neighbouring hospitals AND to see their reports are all important. There are dozens of other things to think about. I would recommend your = surgeons go to a Trust with a good PACS set up and see what it offers (and = what it doesn't). Finally, you MUST have good engagement with your clincal = colleagues during procurement, and installation, with several clinical = champions, from different disciplines.
 Link to this message Grant Shaw  posted on Thursday, June 24, 2010 - 09:44 pm Edit Post Delete Post Print Post
As an Orthopaedic surgeon I can only say what I would like. I think other surgical specialties such as Neuro, plastics and ENT will have different requirements.

In Orthopaedics I would like:

Easy quick patient selection:

Clinic/ward lists (requires links to PAS)or an integrated patient record unifying all data on a patient including PACS images.

Folders for meetings such as our daily trauma meetings. (Academic Folders)

Accurate Image selection:

Comparison images. If I start looking at a R knee It is much easier if a list of similar comparisons of other knees, femur and tibia are easily available without having to go back to a screen full of other images.

Image Manipulation:

The majority of the time I simply use Windowing, zoom and rotate. But some subspecialties such as spinal work require all the full cross sectional tools and image links.

Image display:

For routine work I spend the majority of my time comparing 2 images. This works well on a twin monitor setup. 2 x Standard 21"colour LCD panels work well enough.

For higher risk fracture clinic work where we are expected to report the images I still maintain the high res monochrome monitors are required.


We do need direct access to the reports for cross sectional imaging, U/S and a few other images.


Orthopaedic preoperative planning if being used far more than a few years ago. The specialist templating software should be linked with the PACS so that the current patient's images are automatically transferred into the templating application. Scaling markers need to be included on the preop images for templating to be useful.


Images for our patients sent from other hospitals should be imported into our archive from the source be it CD or electronic transfer. We also need the ability to send images without all the current encryption difficulties.

Teaching library:

A facility for tagging and indexing good examples of pathology.

Remote access:

Very useful to be able to access PACS images at home.

I have most but not all of the above and our PACS works for us. I am sure I will think of some more issues in the middle of the night (such as long log off times in theatre) but that's my list for now.

Grant Shaw

Orthopaedics Portsmouth
 Link to this message Neelam Dugar  posted on Friday, June 25, 2010 - 10:42 am Edit Post Delete Post Print Post
Thanks Anne, for raising such an important issue. I think the SOFTWARE requirements for all clinical users is the same really. Now-adays most PACS vendors supply a single application--for all clinical users---Radiologists & surgeons alike. The hardware requirements may differ (3 monitor &gray scale for radiologists vs. colour single/double for clinical areas-dependent on use & space). Most PACS vendors no longer force you to buy hardware anyway (unless you go through LSPS!!! where hardware is forced on you for commercial reasons).

Nick is correct
1. Quick response times (<3secs to load an image)
2.Good display of reports-which is linked to images via a single mouse click

Grant is right
1. Quick & easy search for a patient
2. Ability to link to other information systems--RIS, Ordercomms/Results Acknowledgement System, Clincal Letter system, Endoscopy system, PAS etc. Context Link display is key to improving searching. PACS systems in future should not require you to seach for a patient again you should be able to display that patient via a single mouse click from another system. This will allow for Clinic lists/Ward lists that are present on other systems---PAS/HIS/"EPR" etc to be relevant to patients on PACS.
3. Image display & Comparisn of similar prior images--- as Grant describes is important yto radiologists/surgeons etc. Some PACS vendors do this better than other. On our Agfa PACS this is a global setting which is set by our system admin. The McKesson PACS which I saw at UKRC has this as a user definable setting and is more intuitive. However, all PACS systems will do something better than others & hence having a objective assessment of various PACS systems is a good idea.
4. Image Manipulation Tools--Pan, Zoom, scroll etc is standard these days. Single mouse click functionality.
5. MPR--Many PACS vendors provide MPR throughout the enterprise.
6. Remote Access--This is not a function of PACS per se. VPN & encrypted laptops is what we use. It is available to all consultants including surgeons if they want it. However, caching ability over slow networks is important for on-call CTs. I have noticed the boon with moving to Impax 5.2 to 6.2 which now allows me to scroll through 500 images of CT as though I am sat in the hospital over a 100Mbps connection (when actually on a 2 Mbps connection)

Some other things that Grant has mentioned
1. Teaching Library--Jon Benham gave a very interesting talk on this at UKRC. Yes this is important. Adoption of IHE standard for this is key by the supplier.
2. Import & Export--This is a local issue. PACS supplier are able to do this through DICON.
3. Templating--PACS suppliers must be willing to connect with other supplier templating systems with provision of a single mouse click workflow.

Clinical Meetings/Conference--Trauma Meeting/MDT etc---What is required here is a scheduling system (like a RIS) with ability to create a document--report/letter/template etc. It needs to be available Trust wide and needs to link to PACS via a context link, and should also context link to other systems like clinical letters system, Pathology results, Ordercomms etc. Most NHS Trusts do this badly--use PAS, RIS, PACS etc. to create conference/meeting lists. It needs a Digital dic attached to it with secretarial workflow support. But if any suppliers are listening, there is a huge need for this kind of Clinical Meeting/conference information system in the NHS. This needs to be a standa-alone system which links to PAS for demographics but context links to all other clinical system for display of radiology/pathology/ECGs etc

A good assessment would be to ask each PACS vendor--
1. " how many mouse clicks will it take for me to do this common task---say change to pan, zoom, measure etc"
2. Are you willing to context link to other clincal systems. Do you have a standard API interface that you would be able to provide which can been sent to any vendor?

At the next meeting in November 8th we are hoping to have a debate--"Next Generation PACS--what does a clinical user need? We are hoping to invite an intelligent user from most of the major PACS systems. I think this will be useful to the whole PACS community. I would encourage Radiologists, other clinical users etc to contribute to this debate.
 Link to this message Dr Tom Bowles  posted on Friday, June 25, 2010 - 10:51 am Edit Post Delete Post Print Post
Commercial interest declared:


Ambivu's ( MDT Workstation does this now:

It provides full viewing capabilities for any DICOM modality.

You can send it worklists for MDT meetings, or input them manually.

It automatically queries DICOM/RIS for images, priors, notes, reports,path images, ECGs.

It can do this automatically in the days leading up to your MDT meeting and then email the coordinator if it cannot find some data.

We designed this to be the ultimate MDT tool, something to save time and bridge the gap between the different specialities.

If you are interested in trying it out just contact me or have a look at our website for the brochure.

Tom Bowles
07785 715228
 Link to this message Neelam Dugar  posted on Sunday, June 27, 2010 - 10:23 pm Edit Post Delete Post Print Post
Thanks Tom.
Ambivu seems to have a good quality DICOM viewing application.

However, what I am trying to describe here is a MDTM(Clinical Meeting) Management System.
1. Schedule patients for MDTM (whether trauma/ cancer/other clinical meeting)
2. patient demographics sync with PAS
3. Allocate responsible consultant
4. Support workflow for creating a mdtm "report". Some MDTM do dictated reports others use a templates document. Flexible enough to support both types of workflow.
5. Episode status--scheduled, report dictated, transcribed, verified
6. MDTM outcome--discharged, for follow-up (after op/next week etc)
7. The system should be flexible enough to allow for capturing meeting specific data fields like TNM
staging for certain cancers, type of treatment, etc
8. Ability for admin staff to input URL type hyperlinks for documents/images for discussion at the meeting
A. Radiology images & reports
B. Pathology images & reports
C. MDTM Referal letter
Obviously for URL type links to be possible there needs to be adherence to standards --with indexing---? XDS. Problem with use of DICOM is the need to duplicate data to view. XDS allows viewing without duplication.

NHS is seriously in need for such a system. I would be interested if any supplier provides such a system. I know some RIS, PASes are trying to fill the gap but are unable to this effectively. On the same note we need adoption of global standards like XDS which will allow a patient centric view without data duplication.
 Link to this message Neelam Dugar  posted on Monday, June 28, 2010 - 09:28 pm Edit Post Delete Post Print Post
What surgeons really need is a patient centric view with radiology images & reports as part of a electronic patient record/EPR.

Currently with NHS secondary care we have 2 elements for a patient record
1. PACS for radiology images & doc (reports)
2. PPR--Paper patient record which holds documents and other clinical images

In the future these need to come together

To realise the dream of a true EPR with radiology within it, PACS vendors & user community need to move from DICOM to XDS. If this does not happen we are in a danger of creating a electronic data silo of radiology--which is not in the benefit of our patients. This is a global direction of travel and not something that only applies to England/NHS.

XDS based EPR is no longer just blue sky thinking. Vendors have already got products in the marketplace which are labelled as XDS. Last UKRC Forcare had a XDS based EPR viewer on display. This UKRC GE had a XDS based RIS on display. Through the XDS registry query on RIS--one would be able to display lab results, ECGs, any form of documents or images.
 Link to this message Neelam Dugar  posted on Monday, June 28, 2010 - 09:52 pm Edit Post Delete Post Print Post
At UKRC 2010, I was speaking about our Group and what we do.

I thought it was a good idea to talk about
"PACS--Past, Present & Future".
This talk provides a pictoral vision of how we could could move from

We have some very exciting talks lined up for the 8th Nov Autumn Meeting with further discussions on this same theme ---"Next Generation PACS".
 Link to this message Ian Judd  posted on Tuesday, June 29, 2010 - 03:59 pm Edit Post Delete Post Print Post
Hi Neelam,
I just looked through the payroll here and I can't see your name on it at all, but thanks for the excellent sales job for the HSS CRIS MDT and Sessions Management module. I think you'll find it hits the requirement quite nicely.

Use CRIS (with MDT module) to manage worklists and record activity (it's what a RIS does best) and use the DTI to drive your favourite PACS viewer.


Love n Hugs
Juddy (Commercial thingies)
 Link to this message Neelam Dugar  posted on Tuesday, June 29, 2010 - 10:15 pm Edit Post Delete Post Print Post

What I am talking about is a stand-alone MDTM/Clinical Meeting Management System. There are many Trusts that are using their PAS or so called EPRs/HIS to fulfil the requirement in the same way as your HSS RIS is trying to fulfil a gap that exists in the market-place. However, many Trusts may already have a good RIS & therefore may only require a Clinical Meeting Management System that can be bought as a standalone system rather than part of a PAS/HIS/EPR/RIS.

XDS adoption with url type links are key for MDTM/Clinical Meeting discussions (multiple DTIs are not the way of the future). GE's XDS adoption within their RIS shows the direction where RISes need to be heading. GE too have a clinical conference module within their RIS. However, I do think Clinical Meeting Management Systems needs to be thought of as a stand-alone product rather that attached at the hip to RIS (whether from HSS or GE)/PAS/HIS/EPR etc.

I am not on anybody's payroll except NHS. These are my unbiased opinions which are clinically based.
 Link to this message Neelam Dugar  posted on Tuesday, June 29, 2010 - 10:23 pm Edit Post Delete Post Print Post
UKRC 2010,
"PACS--Past, Present & Future".
This talk provides a pictoral vision of how we could could move from

Trying to attach the presentation this time.
application/pdfPACS-Past, Present & Future
PACS--a glance into the future copy.pdf (12851.6 k)
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