Running the Numbers
Informatics Report: PACS Administration?In Their Own Words
Upcoming Event: Womens Health and Imaging Conference to Focus on Digital Transition
Faster Than the Speed of Light?

Running the Numbers

47.8% of the respondents to our monthly Web Poll said that their PACS had a less-than-1% average annual downtime, including scheduled maintenance and upgrades. The Poll?s full results can be seen below.

To participate in Medical Imaging?s latest Monthly Web poll, visit the poll location on the left side of the home page.

Informatics Report: PACS Administration?In Their Own Words

By Michael Mack

At the Thomas Group Ltd (Anaheim, Calif), we conducted a client survey of PACS administrators (PAs) to gather their opinions about the PA hiring process. Here, I will share a summary of the responses and my insight about them.

Q1: When in the PACS process were you hired?

The responses showed no real clear answer. Two answers—”prior to vendor selection” and “I was not the original PA for our PACS”—generated a response of 25% each. Two other answers—”at committee formation” and “hired by default”—each generated 17% of responses. The respondents also gave 8% each to the answers of hired “after financial approval” and “during implementation.” These results are very reflective of what I have observed and written about in the past—except for the 25% who were not the original PAs. Without interviewing each of these individuals as to why they may have changed jobs, the only thing we can know for certain is that there are many reasons for making a change. Some may have a better opportunity elsewhere with more money; some PAs may move to jobs with PACS vendors; or sometimes, it may just be the wrong position for a person.

Q2: What is your background?

“Radiology” was the answer for 75% of our respondents. (One response was “biomed,” and I am presuming that he or she supported radiology. I, therefore, included that response in the 75%.) The remaining 25% of the responses were “IT.” None of the respondents came from a vendor. This, too, reflects what I have observed and would expect to see: This job requires a very strong understanding of radiology workflow and terminology.

Q3: What was your PACS experience prior to hiring?

A dominant 58% responded “none.” Of the total responses, 17% had either “worked at another facility that had PACS” or “was a PA elsewhere.” Another 8% stated that they had completed “formal PACS training” before being hired. In my experience, it has been very common to hire someone at your current facility with the proper aptitude and a strong, well-known work ethic. Again, talented people with the proper support and skill set are able to understand and comprehend this technology. One question that I am asked all the time is, “How does someone make themselves attractive as a candidate for one of these positions?” I am fairly certain that the respondents with no experience were all existing employees of the facility with a solid performance track record reflecting the skill set shown in the answer to Q5.

Q4: If a non-health care IT, nonradiology person would like to become a PA, what do you recommend as a precursor?

An overwhelming 75% responded with “formal training.” This included 58% with “formal school for radiology or other health care position” and 17% with “third-party PACS school.” Of the respondents, 17% recommend getting “vendor experience” (although none of the respondents worked for a vendor), and 8% recommended starting with an “entry-level health care IT” position to get your foot in the door.

Q5: What do you believe is the most important asset that a PA can bring to the job?

“Radiology knowledge” was selected by 58% as most important. At 17% each were both “computer, hardware, software, and network knowledge” and “communication skills.” Of the total respondents, 8% stated “all of the above” are most important. However, as clearly seen in the responses to Q3, an innate knowledge of radiology is the top criteria to prepare for this position. A PA is going to spend most of his or her days working with technologists and radiologists. Any conversations outside of radiology will focus around radiology image sets, series, views, and the keys to displaying them to best suit users’ needs. This would easily be more than 95% of the PA’s day-to-day (or night-to-night) activities.

Q6: What are your typical working hours?

As would be expected, the vast majority (83%) responded that they are on-site daily, Monday through Friday. Also, 58% also responded that they provide call support in the evenings and weekend coverage; 50% provide holiday coverage. For those considering PACS administration as a career, these answers are a key insight into the job requirements. PACS is a 24/7 commitment that will always cause problems, issues, or real failures after hours. Therefore, you will be expected to be available and provide support or be a vendor resource to address and manage/fix the inevitable issues. You must have the mentality to deal with these opportunities (issues). In general, when you receive a call, it’s because someone has a problem. Your satisfaction will come from helping them; however, sometimes, it will take more effort or longer than the user understands, and you must deal with that situation as well.

Oddly, one respondent selected “Other” and wrote “part-time.” I have two thoughts about that: One, there must be two or more people sharing the support responsibility; or, two, if not, I know several hundred PAs who would love to know the secret to a site or system that requires only part-time support.

Q7: Who provides backup coverage, if needed?

Not surprisingly, 75% answered that backup support is provided by IT personnel; several respondents specifically noted RIS support, and one noted clinical analyst, which I added into the IT personnel number. This approach is very common and logical. If any two individuals should know, understand, and live radiology workflow and technology, it should be your PA and the RIS support analyst. In many cases, the PA also provides backup coverage (relief) to the RIS person. On a day-to-day basis, the issues they face are so intertwined that their relationship is very important to a successful support effort. Many times, the after-hours support is directed to the IT help desk as a first line, and many times, the issue is not PACS related; it may be passwords, the network, or other clinical systems creating the problem. Radiology administrators were named in 17% of the responses. My guess is that these are smaller sites that have less of an infrastructure to leverage as backup. Other responses were for biomed or clerical personnel. This is a tough position for these folks to assume, but it might be the only or the most cost-efficient option.

Q8: If you had to choose one thing that would make your job as a PA easier, what would that be and why?

This question really opened a can of worms. First, almost everyone said they would like additional training/support and a second PA to help deal with all the day-to-day issues that need to be managed. The list of things that need to be done each day becomes a juggling act with whatever the next phone call brings. There are concerns about living in a “reactive” versus a “proactive” world; in the latter, PAs would be able to perform routine system activities, train referring physicians, and strategically plan. All of these responsibilities quickly can become overwhelming and stressful. Over time, neither of these reactions will be beneficial to the PA or his or her facility.

One respondent mentioned that growing and expanding demands on PAs into other “ologies,” such as cardiology, pathology, and endoscopy, are going to raise the pressure and time demands on these positions. This question will be answered over time, but PAs must be prepared to expand their horizons, especially in smaller facilities that have the bandwidth.

Michael Mack is president and CEO of the Thomas Group Ltd (Anaheim, Calif). With 20-plus years of experience in medical imaging, Mack now specializes in PACS planning and implementation. For more information, contact .

Upcoming Event: Womens Health and Imaging Conference to Focus on Digital Transition

The Department of Imaging Sciences at the University of Rochester School of Medicine and Dentistry recently announced a new conference series, “Women’s Health and Imaging in a Digital Environment.” The 3-day conference will focus on women’s health care management in a format that includes lectures, a breast biopsy workshop, and Q&A sessions with faculty. Ten sessions will cover mammography and CAD, managing pelvic disease, screening for osteoporosis, approaches to breast biopsy, implementing a digital environment, cardiac evaluation in post-menopausal women, and using PET/CT to diagnose and manage cancer in women. The conference will take place January 22?24, 2007, in San Antonio. Efforts are under way to provide accreditation for technologists and mammography credits. For more information, visit

Faster Than the Speed of Light?

Because Radiology Associates of South Florida (RASF of Miami) needed a better plan to manage night readings, says practice manager Dennis Wiseman, the facility hired a radiologist in Israel to read its night studies. But with exams taking up to an average of 53 minutes to traverse the miles, work was bottlenecked, and the practice still had to keep someone on the shift locally—a challenge that, ironically, had originally inspired the international service. So, RASF did some more research and discovered wide area network (WAN) application acceleration and optimization.

“We learned that we did not have to purchase a direct connect from the Baptist Hospital of Miami to Israel at an exorbitant cost but rather could transfer files over the Internet very quickly using this technology,” Wiseman explains. RASF is affiliated with Baptist Health Enterprises, which covers the emergency departments of three regional Miami hospitals, including Baptist Hospital of Miami.

WAN acceleration and optimization technology sped delivery of files between Miami and Israel from 57 minutes to 7 minutes.

The technology works by compressing the image files into smaller, more manageable sizes that are then transferred more quickly over common T1 or T3 lines, according to Chris Williams, chief marketing and channels officer at Expand Networks (Roseland, NJ). The company’s solution, employed by RASF, mitigates the effects of latency (which is physically limited by the speed of light) and can provide an average 100% to 400% more WAN capacity. As a result, the time to transfer RASF’s image files between Miami and Israel fell to less than 7 minutes.

Not only do all of RASF’s radiologists now get a good night’s sleep, but the system has become physician-dependent rather than system-dependent—a benefit to patient care. “Before, physicians had to wait for the system to transfer images. One study would block the others, and our turnaround time was substandard from the norm,” Wiseman says. “Now, multiple studies can be compressed and sent at the same time and read in a timely fashion. The individual physician is now the one who needs to keep up with the work.”

Cheaper Than a Direct Line

The benefits came at a reasonable cost. Wiseman estimates that it took about 3 weeks to configure and test the system. “Expand Networks was generous in allowing us to have a 30-day trial with the product,” he says, adding that RASF test-drove the system for 2 months, negotiating the contract during the last week.

Dennis Wiseman

RASF purchased a server for each end, but did not need one for each of the facilities it covers. “We didn’t need three servers on this side,” Wiseman says. “So, when a technologist performs a study at Baptist Hospital, he or she sends it in two directions—one to the main service for the hospital, which throws it onto PACS, and one to Expand, which sends it to Israel. The other sites do the same thing, but don’t need their own servers.”

The US server compresses the files; the Israeli server expands them. Different systems are employed at each end. “In the United States, we have 20 megabytes to hold more data and transfer the files faster; but in Israel, we have a 10-megabyte system to handle downloads,” Wiseman says. He explains that because the lines transmit at 5 megabytes, the higher volume would not be used and could not be justified. RASF saved money on bandwidth by reducing its two 20-megabyte lines in Israel to two 10-megabyte lines.

Able to Improve Care in a Single Night

The technology enables extremely large files to be transferred much more quickly. Wiseman estimates that one 64-slice CT exam typically produces approximately 1,000 images. RASF performs about 85 studies per evening at three facilities, of which roughly 85% are CT exams. “About 50% of the CT exams are multiple studies,” he says, adding that he has not seen the number of exams increase with speedier transfer, but that the system could handle it if it needed to do so.

Being able to send studies to Israel in 7 minutes meant that the practice no longer needed a local radiologist to handle the backlog. One Israeli physician now handles the shift throughout the week, rather than three or four local doctors, according to Wiseman. Physician scheduling became much less complicated and satisfaction went up, averting a potential problem for the practice.

In sending the studies offshore, the administration wanted to fix the group’s call system before any of the physicians became too unhappy with the arrangements. “One option was to ask the older physicians to once again work nights, which we didn’t expect to be received very well. We wanted a long-term solution that would contribute to our stability and progress,” Wiseman says.

In addition, new radiologists would be easier to recruit. “The younger generation coming out of school is much more inclined to join groups with nighthawk to alleviate them from working nights,” he says.

RASF selected the Israeli service because it already had a relationship with Israeli physicians and the time frame worked. “Israel is 7 hours ahead, so they are interpreting our midnight exams at 7 am,” Wiseman says. “Theoretically, interpretation is easier during daylight hours.”

Faster delivery has meant that the system works as it was intended, with indirect benefits impacting patient care. Williams hypothesizes, “If we start with the premise that patient health care can be improved by reducing the time it takes to diagnose and treat, then faster technology means faster patient treatment and recovery.”

Renee DiIulio is a contributing writer for Medical Imaging. For more information, contact .