PACS administrators' and radiologists' perspective on the importance of features for PACS selection.

Picture archiving and communication systems (PACS) play a critical role in radiology. This paper presents the criteria important to PACS administrators for selecting a PACS. A set of criteria are identified and organized into an integrative hierarchical framework. Survey responses from 48 administrators are used to identify the relative weights of these criteria through an analytical hierarchy process. The five main dimensions for PACS selection in order of importance are system continuity and functionality, system performance and architecture, user interface for workflow management, user interface for image manipulation, and display quality. Among the subdimensions, the highest weights were assessed for security, backup, and continuity; tools for continuous performance monitoring; support for multispecialty images; and voice recognition/transcription. PACS administrators' preferences were generally in line with that of previously reported results for radiologists. Both groups assigned the highest priority to ensuring business continuity and preventing loss of data through features such as security, backup, downtime prevention, and tools for continuous PACS performance monitoring. PACS administrators' next high priorities were support for multispecialty images, image retrieval speeds from short-term and long-term storage, real-time monitoring, and architectural issues of compatibility and integration with other products. Thus, next to ensuring business continuity, administrators' focus was on issues that impact their ability to deliver services and support. On the other hand, radiologists gave high priorities to voice recognition, transcription, and reporting; structured reporting; and convenience and responsiveness in manipulation of images. Thus, radiologists' focus appears to be on issues that may impact their productivity, effort, and accuracy.

Empirical investigation of radiologists' priorities for PACS selection: an analytical hierarchy process approach.

Picture archiving and communication systems (PACS) are being widely adopted in radiology practice. The objective of this study was to find radiologists' perspective on the relative importance of the required features when selecting or developing a PACS. Important features for PACS were identified based on the literature and consultation/interviews with radiologists. These features were categorized and organized into a logical hierarchy consisting of the main dimensions and sub-dimensions. An online survey was conducted to obtain data from 58 radiologists about their relative preferences. Analytical hierarchy process methodology was used to determine the relative priority weights for different dimensions along with the consistency of responses. System continuity and functionality was found to be the most important dimension, followed by system performance and architecture, user interface for workflow management, user interface for image manipulation, and display quality. Among the sub-dimensions, the top two features were: security, backup, and downtime prevention; and voice recognition, transcription, and reporting. Structured reporting was also given very high priority. The results point to the dimensions that can be critical discriminators between different PACS and highlight the importance of faster integration of the emerging developments in radiology into PACS.

Tools for managing image flow in the modality to clinical-image-review chain.

Web-based clinical-image viewing is commonplace in large medical centers. As demands for product and performance escalate, physicians, sold on the concept of "any image, anytime, anywhere," fret when image studies cannot be viewed in a time frame to which they are accustomed. Image delivery pathways in large medical centers are oftentimes complicated by multiple networks, multiple picture archiving and communication systems (PACS), and multiple groups responsible for image acquisition and delivery to multiple destinations. When studies are delayed, it may be difficult to rapidly pinpoint bottlenecks. Described here are the tools used to monitor likely failure points in our modality to clinical-image-viewing chain and tools for reporting volume and throughput trends. Though perhaps unique to our environment, we believe that tools of this type are essential for understanding and monitoring image-study flow, re-configuring resources to achieve better throughput, and planning for anticipated growth. Without such tools, quality clinical-image delivery may not be what it should.

Effects of 17alpha-ethinylestradiol on immune parameters in the lizard Sceloporus occidentalis.

We examined the effect of 17alpha-ethinylestradiol on immunity of the Western fence lizard, Sceloporus occidentalis. Injection of 17alpha-ethinylestradiol resulted in dose-dependent suppression of peripheral blood leukocyte levels as determined by cell counts, whereas total spleen cell levels were decreased only at higher doses of 17alpha-ethinylestradiol. In contrast, spleen cell proliferation was enhanced by 17alpha-ethinylestradiol as measured by reduction of MTT to formazan following a two-way mixed lymphocyte reaction. Antibody responses were unaffected. Effects on peripheral blood leukocyte levels and spleen cell proliferation similar to those observed in response to injection of 17alpha-ethinylestradiol were observed following injection of a single dose of hydrocortisone. However, injection of lizards with 17alpha-ethinylestradiol did not result in a significant increase in serum cortisol. Results of this study suggest that exposure of Western fence lizards to 17alpha-ethinylestradiol leads to decreased numbers of circulating leukocytes and total spleen cell numbers and the enhancement of spleen cell proliferation in a two-way mixed lymphocyte reaction. These effects probably involve mechanisms other than or in addition to the induction of cortisol release.

Challenges in image acquisition and distribution for clinical image service.

We have developed a centralized application for acquiring images from multiple picture archiving and communication systems (PACS) and distributing images to a clinical image web server and other repositories. Our flexible strategy addresses a number of administrative challenges associated with delivering images into clinical, research, and test environments. DICOM images flow from PACSs and modalities to a UNIX-based "distributor" application, which relays them to one or more destinations. Image volume and transmission times were collected and analyzed. Three distributors receive an average of 34 gigabytes of image data per day. Images are sent concurrently to two web-based image servers, one used clinically by physicians and one used for testing. Transmission of certain classes of studies is prioritized for key physician groups. Delivery to research systems is also supported. Acquiring images from multi-vendor PACS for distribution to a web server for clinical image viewing is a challenging task. Centralizing the acquisition and distribution process reduces both the administrative effort and the impact on clinical operations associated with maintaining dynamic clinical, testing, and research environments.