It’s difficult to pinpoint when the idea of a PACS was first introduced to the medical world. Some place its inception in 1979, as the brainchild of Professor Heinz Lemke from the Technical University of Berlin; while others credit the first large-scale implementation of PACS in 1982 at the University of Kansas. Regardless of which we decide upon, one thing is certain, the modern PACS is the product of many inputs, innovations, trials, and errors. With that said, here’s a brief history of the PACS and how it has evolved into the powerful radiology solution it is today.
Initially, the early adopters of PACS weren’t able to communicate or share data with one another. Proprietary protocols and data-sets made it difficult if not impossible for an image generated on one vendor’s device to be archived or displayed on the another vendor’s hardware. By the mid-1980s, with the threat of government oversight looming, work had begun on the creation of a standard for both transmitting and storing medical imaging data from and between disparate hardware manufacturers.
This effort was spearheaded by the American College of Radiology (ACR) and National Electrical Manufacturers Association (NEMA). They joined forces in the early 1980s to devise a standard in consultation with some of the industry’s largest players. With some tweaking over the intervening years, a full-fledged standard had been developed by 1993 with the third release of the specification. This specification was then rebranded as DICOM, or Digital Imaging and Communications in Medicine.
Over the last three decades, PACS have subsumed additional responsibilities along the way. To stay competitive many vendors began offering additional services and features typically found elsewhere in the realm of informatics, such as workflow management, reporting, 3D reconstruction, and peer review among others. Through tight integrations with a hospital information system (HIS) and radiology information system (RIS), PACS is able to communicate patient demographics and report findings electronically, further expediting and improving patient care.
As the needs of healthcare providers expand outside of traditional imaging and workflows like those found in radiology and cardiology, IT personnel are looking for more inclusive systems. There’s a need for PACS to be able to manage imaging for disciplines, such as dermatology, endoscopy, and pathology, among others. One such technology that could assist PACS is a vendor neutral archive (VNA).
VNA’s provide a place to store images, documents and other files in a standard format. PACS and other devices could then access that data using a standard communication interface (i.e. DICOM). This move by some vendors towards vendor neutral archives is unlikely to completely supplant PACS, as there’s still a need for a universal viewer, workflow engine, reporting tools, and other services; but it does look as though we may be moving away from a PACS-centric solution.