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More and more digital imaging equipment is used in the daily routine of radiology departments. Computerized diagnostic equipment provides new capabilities for radiologists. It provides improvement of the work flow within the department, of the exchange of information between radiologists and referring physicians, and the exchange of information between radiologists specialized in specific diagnostic procedures. This exchange of information has to be performed locally within the department, between different buildings belonging to one department or between widely separated buildings in different hospital. The penetration of 'computer-assisted radiology' makes the organization of an imaging department and the information to be handled within it more and more complex. Specific requirements result from this increasing complexity. To meet these requirements, Siemens has developed technical solutions for integrated digital diagnostic imaging. These solutions allow the functional integration of physically separated systems such as multiple computed tomography (CT) units or CT plus magnetic resonance (MR) units belonging to one department, centralized archiving, hard-copy generation and image display, rapid access to images from multiple locations and effective image communication for intensive care units, child care units and trauma patients. Some of these requirements are discussed and the corresponding products are described. It is shown how these solutions will migrate to future comprehensive picture archiving and communication systems (PACS) configurations.

The challenge for Europe in the field of information and communications technologies applied to health care is that of addressing positively the problem of the widening gap between the expectations of the citizens of the type of care that can be made available and the limited resources to provide that care. If the expectations of the population are to be fulfilled, it will be necessary to find innovative ways of delivering health services and to do it more efficiently than has yet been the case. Advanced information and communications technologies will be important tools for Member States to achieve the levels of efficiency required. Based on the results of the Community AIM Exploratory Action, further collaborative work is required at EEC level to create an Integrated Health Information Environment (lHE) allowing essentially for integration, modularity and security.

Siemens Medical Engineering Group has been committed to Diagnostic Imaging from the very beginnings of x-ray imaging. The forerunner of the today's factory in Erlangen co-operated with Professor Conrad Rontgen and manufactured x-ray tubes for his research work and for the very first patient examinations in 1896. Encouraged by the positive results for the hospitals from the use of our equipment and the possibility of additional benefits expected by networking modern digital modalities, Siemens committed itself to digital image management systems (PACS) in the early 1980s [1]. Siemens now has more than ten years of experience with different application scenarios. Many of these scenarios are now running with SIENET which is the Siemens networked digital image management system. These SIENET systems are in multiple hospital or clinical settings in countries around the world. This past history has allowed us to accumulate experience from multiple configurations installed and used in these differing clinical routine environments

In many countries today, politicians are faced with the difficulty of having to reduce the overproportional increase in the costs of Healthcare. In this context the contribution of medical technology to costs in the total spend are nearly always overestimated and its potential for savings underestimated.

Experience gained from Siemens PACS installations since 1986 has been of great value and has lead to a continuous upgrading culminating in our today's products. Valuable information not only on technical aspects but also experience in PACS project engineering and operating a PACS has been acquired from a manufacturer's point of view. It might supplement what the PACS users are reporting on their individual results.

PACS is a topic which has not yet been granted a Seal of Approval by Radiology. One must only count the negative reports published to see that. A change of name from PACS to Image Management, Archival and Communication Systems (IMACS) will also not help the matter at the current stage of development. What is needed are clinical demonstrations of the philosophy behind PACS and of the fact that it works today and is not just an ugly duckling.© (1990) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

The challenge for Europe in the field of information and communications technologies applied to health care is that of addressing positively the problem of the widening gap between the expectations of the citizens of the type of care that can be made available and the limited resources to provide that care. If the expectations of the population are to be fulfilled, it will be necessary to find innovative ways of delivering health services and to do it more efficiently than has yet been the case. Advanced information and communications technologies will be important tools for Member States to achieve the levels of efficiency required. Based on the results of the Community AIM Exploratory Action, further collaborative work is required at EEC level to create an Integrated Health Information Environment (IHE) allowing essentially for integration, modularity and security.

The PACS-project of Graz was started two years ago in cooperation with Siemens Erlangen. The system environment consists of three CT-devices (DR2, DR3, DRH) connected to an Ethernet-based LAN (CTnet), which is linked to a second Ethernet via a MicroVAX II. This computer works as a gateway, as an image-converter and as an archive. All CT-images of one device (DRH) are transmitted to the PACS system. The images are organized in patient-oriented folders. The physician is able to make reports about those examinations for which he is responsible. The availability of tools for secondary image processing during the reporting session (windowing, zooming, displaying statistic information, etc.) and further image-functions should make the PACS system more convenient for the physician than film-based images. After reporting, all scans which are relevant for the diagnosis (according to the physician's opinion) are selected, automatically reorganized in folders and transmitted to the archive. This needs about one to two minutes per examination. Some internal data-structures and further future aspects concerning the improvement of reliability and user acceptance are mentioned.

The first part of this chapter describes the result of applying the Marburg Methodology to the radiological environment. The model so constructed is used to derive an interface specification between a radiological information system (RIS) and a picture archiving and communication system (PACS). The results of the derivation process are documented in the second part of the chapter.

When the first international conference on Picture Archiving and Communication Systems (PACS) took place in 1982, a considerable number of Radiology (Management) Information Systems (RIS) [2] was already in operation in hospitals throughout the world [4,5,6,7,13,18,21].

Die Entwicklung digitaler bildgebender Verfahren ebenso wie die Entwicklung im Computerbereich fuhren tendenziell zur Moglichkeit eines Krankenhauses, in dem die Entstehung, Ubertragung, Auswertung und Archivierung von Bildern auf digitalem Weg erfolgt.

Since 1983 the computerized record and verify system Mevamatic 3 was tested in connection with the linear accelerator Mevatron 77 (Siemens Company). In consequence of the software development the handling of the system was improved for the clinical routine with the result of a fully utilizable system. The topics of this report are the description of the hardware, the functions of the system, the software development and some possibilities for improvements in the future.