Cardiology Picture Archiving and Communication Systems (PACS) Defined
By definition, a cardiology PACS solution refers to the electronic storage of images in a networked digital archive that stores, manages, transmits and displays cardiology images. Basically, the digital images generated during an echocardiograph or catheterization procedure are sent to a server, designed specifically to store DICOM compliant digital images. A database management server manages the retrieval and storage of the images.
As shown in Figure 1 the cardiologist views the digital images on a cardiology workstation, which is composed of a display monitor and a central processing unit that is networked into PACS. Networked digital archives refer to image servers that store the digital images. Short-term storage, typically stored up to 6 months, uses high end, higher cost, high-speed magnetic disks, set up as redundant arrays of independent discs (referred at as a RAID). Mid-term storage, typically stored up to 18 months, can use lower cost linear tape drives, magneto-optical and/or digital video disc drives, which are often used in conjunction with jukeboxes to increase storage capacity.
Significant Trends Driving Growth in the Market
A number of significant changes in image capture and archiving, data retrieval, departmental information systems integration and networking have dramatically helped reshape the cardiology picture archiving communication systems (PACS) landscape. Where independent, siloed cardiology PACS solutions once reigned, networked multi-lab solutions and radiology-linked, enterprise PACS solutions are now the norm.
The great majority of cardiology PACS solutions continue to be installed into catheterization labs. However, single-lab solutions are on the decline as networked departmental solutions expand. The number of cath labs being networked to echocardiology labs is on the rise and starting from a small base, multi-lab solutions have also linked cath labs to vascular labs, electrophysiology labs and nuclear medicine labs as well.
The addition of reporting capabilities and functions has become the leading software feature in new or upgraded cardiology PACS installations. While this has become an integral component of both the multi-lab and enterprise PACS installations, a large number of single lab installs have now incorporated this function as well. If linked to a lab’s billing software, completed reports can eliminate administrative requirements by immediately triggering electronic bill preparation and faxing or sending the bill, with attached report, over the network to the insurance provider.
With the advent of network efficiencies, falling storage costs and growing demands to store patient records for extended periods of time, the architecture of cardiology PACS solutions is increasingly moving to a radiology-type archiving architecture. On-line storage, once dedicated to storing images for 0 to 6 months, is in some cases extending out to 18 months of image storage through the addition of scalable servers. Images sent to near-line storage are increasingly being sent simultaneously to the enterprise storage area network (SAN), with the enterprise SAN becoming the fail-over solution.
The coming adoption of ultra-fast, 64 slice computed tomography (CT) scans, 2D and 3D, is expected to bring the biggest change to cardiology PACS archiving requirements over the next couple of years. With requests for CT angiography (CTA) procedure codes already in the works, industry sources expect cardiologists to adopt CTAs as a less costly, non-invasive form of cardiology diagnostics; possibly using CTA procedures as a pre-certification for an invasive catheterization study. CTA scans use considerably more megabyte storage than a traditional cath or echo procedure and, if 3D volumetric images are created, has the potential to significantly increase the cardiology PACS storage requirements in the near future.
Going forward, the key trends in cardiology PACS will continue to be digitization of the workflow, significantly improved workflow efficiencies, centralization and consolidation of cardiology PACS through out the cardiology department and network integration with radiology modalities. Cardiology PACS architecture is now scalable allowing customers to start with a single-lab or multi-lab solutions and move to multi-center and multi-modality solutions over time. Cardiology PACS installations in the hospital are gradually incorporating other cardiology procedural labs, such as electrophysiology and vascular labs, and will be adding CT image storage to the systems as the use of ultra-fast, 64 slice CTs become adopted as a pre-certification procedure to the invasive cath procedure. Outpatient nuclear and echocardiology diagnostic procedures are also adding PACS capabilities, as the equipment becomes DICOM compliant.
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