Geoff Myers and Michael Ramer, MD, work with the new PACS solution at Booth Radiology Associates.
Geoff Myers and Michael Ramer, MD, work with the new PACS solution at Booth Radiology Associates.

In this age of instant information?where every step of a patient’s medical journey is cataloged, categorized, and recorded for eternity?one would think that upgrading an “ancient” legacy PACS into instantly accessible data would constitute no more than a few keystrokes.

But when Booth Radiology Associates decided that a key way to stay technically advanced was to overhaul its legacy PACS, it was forced to enlist the services of two companies to complete the migration process. Booth Radiology?which performs a high volume of MRs daily among its Woodbury, NJ, and Washington Township facilities?needed to migrate nearly 100,000 patient files.

After investigating a variety of PACS vendors for more than 3 months, Booth Radiology awarded the contract to AMICAS Inc (Boston). Later in the process, however, DeJarnette Research Systems (Towson, Md) also was recruited to ensure a smooth data transition. Here’s how it all happened.

Old Images, New Challenges

“Booth Radiology is a very progressive group,” explains Geoffrey Myers, network manager at the group. “It is important not only to our radiologists but also to our technical and corporate staffs to stay ahead of the curve with equipment upgrades in the most effective manner available.”

From the outside, migrating Booth Radiology’s legacy PACS into the AMICAS system appeared fairly routine. But according to Barry Gutwillig, executive director of marketing and business development at AMICAS, there’s more to upgrading a legacy PACS than transferring data.

“We’re talking about taking a customer from a legacy PACS to, in this case, an AMICAS PACS,” he notes. “We’re upgrading the customer to a totally different system. We’re taking the archive images from the legacy PACS to our system.”

Seems simple enough?in theory. But in practice? Every PACS migration presents a new set of challenges.

“While there is a standard for movement of data (DICOM), every vendor has its own format as an adjunct to DICOM, many of which are proprietary,” Gutwillig explains. “So when a facility moves from one vendor’s format to another, some data conversion is required, and that takes experience. That’s one of the reasons for our relationship with DeJarnette. While we know our side of the PACS very well, what they understand is how to work with legacy data and manipulate it such that the new format or the new vendor will have access to it.”

Charlie Stockham, executive VP of DeJarnette, admits that old images often present new problems.

“These old images on these old archives are just files,” Stockham explains. “You would think, ?Why not just move them over to the new network?’ But it doesn’t work that way. Because when they get over to the new PACS, they’re still just files. [The new] PACS doesn’t have any knowledge of what’s there or what’s in them. It is important to know the patient, the type of study it is, and when the study was taken. The new PACS requires this information, and it has to be in the database.”

Myers notes that, naturally, Booth wanted the process done right and in a timely matter? say, in 3 to 4 months. “We just wanted the basics,” he says. “We needed things like hanging protocols that made sense, that weren’t based on a series of numbers but rather on actual descriptions. It is vital that our radiologists have the ability to read films 24/7 from any location. Our dictation software allows it, so we wanted a PACS that could handle it as well.”

DeJarnette’s Stockham explains that his company can move about 10,000 studies each week, and those files can run from 100,000 to 1 million study migrations. The speed of the migration is determined by:

  • the type of archive;
  • the type of network being used by the client; and
  • how well the old PACS matches the facility’s requirements.

“Some PACS out there are being kept alive by chewing gum and paper clips,” he says. “But we have a lot of software in place that allows us to tune the migration. We can keep the old PACS up and running and still move the images over.”

No Pain, No Gain

The process wasn’t easy. There was the “cleaning up” of data, DICOM compliance, and finding a patch that allowed AMICAS to integrate with Booth Radiology’s RIS. But it has been rewarding.

“The benefits to the client of moving the data are pretty obvious,” Stockham says. “There’s the benefit to having the data itself?they now have their prior studies ready for the radiologist to use in any new cases. Then, there’s the benefit of having it cleaned. If the medical-record number is cleaned, you’ll have a good match when looking for priors. If the study descriptions are clean, the new PACS will be able to ?hang’ the images correctly on a workstation. That helps the radiologist and the radiologist’s speed.”

Integration is the key element at each stage of the migration process.

“The big thing for the PACS was the integration to the RIS,” Myers insists. “Basically, the patient is scheduled in Medical Manager, which is our RIS. The Medical Manager system then shoots a message to our AMICAS PACS, which says we can expect this study, on this date, at this time, and for this patient.”

In turn, the PACS takes that data and sends it to the modality that will perform the study. Because the technologists don’t have to input specific data, nothing will spoil the purity of the information.

Benefits Abound, Everyone’s Happy

So far, the PACS migration has been a win-win on many levels for Booth Radiology. Myers, who has been with the group for 5 years, says that the new system will be more effective on every front.

“The migration offers both short- and long-term benefits,” he says. “The biggest benefit is in the ease of access to information. Going back a couple of years when everything was on film, if I was at one office and I wanted to look at a patient’s MRI, I would have to call the office where it was stored and then travel 30 minutes to actually see it. When we turned to our initial PACS, we still faced a ten- to fifteen-minute delay for the system to find the image and load it. Now, everything is instantaneous?it takes maybe five seconds to load an old study. In terms of ease of access internally, it’s like night and day.”

Patients also find Booth Radiology’s new PACS migration to their liking. “If a patient wanted a copy of his or her MRI, it used to take us a day or two to pull it up, print it, and give it to him or her,” Myers says. “Now, we can still provide him or her with the film copy, but we also can provide the patient’s exams on CD. I even can provide a patient with every exam that he or she has ever had that’s been stored on PACS.”

Referring physicians are very excited about the ability to further interact with their patients’ procedure views, says Michael Ramer, MD, president of Booth Radiology. “Upgrading the PACS was just one way of using the latest technology to maintain state-of-the-art imaging,” he says. “We always offer the highest quality service to our referring physicians for the benefit of their patients. This new system helps us to do just that.”

Myers concurs, adding, “What we do [at Booth Radiology] is generate data about these patients. But the data is meaningless if we don’t share it with the people who need it. With this new system, we’ve achieved our goal.”

Dave Cater is a contributing writer for Medical Imaging.