Introduction to the Paper by Seong K. Mun, Ph.D., et al, 'Experience with Image Management Networks at Three Universities: Is the Cup Half-empty or Half-full?'

OUR RESEARCH APPROACH to the development of a picture archiving and communication system (PACS) has been at the system level. While component technology was developed by various investigators, we felt that our unique role was to look at the PACS from the perspective of network and clinical operations as well as the management of insertion of technology into a complex environment. One of the first questions we tried to address was, “How should one describe PACS?” The paper reprinted here was an early attempt to describe PACS at an operational level without being limited to specific component technology, as we knew the technology would eventually change. This approach as laid the foundation for the performance specifications of the Medical Diagnostic Imaging System that the Department of Defense adopted in the 1990s. During that decade many new efforts were directed toward developing quantitative requirements for the PACS performance, especially to meet the needs of radiologists. Whereas workstation performance and network topologies were topics of intense discussion and development in various quarters, our focus remained on the system level performance and technology deployment. Today PACS is a mature technology. It is difficult to know if any aspects of PACS development influenced the advances in generic computer and information technology. It is reasonable to assume, however, that the PACS initiative has a significant impact on advancing imaging, image processing and image processing technologies. Certainly the PACS efforts in the radiology community have laid the foundation for filmless electronic hospitals and telemedicine. Many major technical issues have been resolved, but as applications expand and the landscape of usage changes, new issues arise. The questions of network topology, workstation performance, image quality on the electronic displays, digital radiography, and clinical acceptance are no longer challenges for PACS today. But the integration of PACS with the radiology information system and other enterprise-wide information and imaging systems continues to pose implementation difficulties. Network security, patient privacy, and health information assurance are a few of the new requirements that the PACS community must address. Through participation in the evolution of PACS, we have experienced firsthand the old lessons associated with the adoption of new technology. This process must begin with proof of the merit of the technology; in addition it requires overcoming entrenched habits and self-interest associated with preserving old technology and old work rules. For PACS, the process of maturation has taken more than 10 years. It was successful because the technology solved difficult problems of managing large amount of complex data for many different stakeholders. The next challenges may be the development of new research programs and patient care capabilities by accessing the vast image databases that are accumulating at PACS hospitals.