Dr. Eliot Siegel

IT Matters – The birth of PACS

July 09, 2015
by Sean Ruck, Contributing Editor
Obviously, there was a time B.P. (before PACS). Unlike some of the other historical ages though, B.P. wasn’t all that far back, and HealthCare Business News had the opportunity to catch up with Dr. Eliot Siegel, the guy who was truly there from the start – not just someone in health care at the time, but the person literally there in the physical presence of the first PACS being installed and used over the last couple of decades in a hospital setting.

To add to the intrigue, we caught up with Dr. Siegel just a couple of weeks after that first system was decommissioned. He was gracious enough to share a brief history of PACS from his truly unique perspective. Siegel was just out of medical school training when he was asked to come in as the chief of the radiology department at the V.A. Coming in with a fresh perspective, he asked if the V.A. would be willing to support a filmless radiology department. Somewhat to his surprise, he was given a green light to figure out a budget and whether it was possible to develop the department. “Since no one had done it before, even the DICOM standards weren’t fully agreed upon or completed,” recalls Siegel.

So Siegel and his team went to work to figure out how going digital would impact everything. “We had to work out the timeline and figure out how long it would take to get the technology into place and the modalities it would affect, and even how we could transfer information into PACS,” Siegel says. “And there was also the challenge with staff. There was no experience among radiologists of reading filmless. Looking back, it was probably a real benefit that I was fresh out of my training since I probably didn’t realize how substantial the challenges were to make this happen.“

Siegel says the V.A. fully committed to the idea, building the new department without the capability to do film. “So we created a situation where we kind of forced ourselves to move away from film,” he says. “We weren’t even sure of the legality of reading without film.”

Information gathering
So all of a sudden there was the potential to go filmless in a hospital. Yet, there was also the potential for a lot of problems. “No one was sure what would happen when radiologists had an unlimited ability to stack images, window level, and so on. We weren’t sure whether or not it was practical from speed and performance or an economic perspective for that matter,” Siegel says.

So the team traveled around the country speaking with experts about their experiences with workstations and interviewing vendors to see what they had. “We had some help from the Army, who also came to the same conclusion with about 60 people on their team, and the Hammersmith hospital that had about 12 people. All were in the process of writing specifications for going filmless,” Siegel says.

The team came up with a wide variety of interesting and creative solutions for how to get images from modalities despite vendors reluctant to participate with a filmless project. Some vendors were particularly reluctant because they weren’t sure they wanted radiologists to have the ability to determine how the image looked. According to Siegel, it turned out to be an incredibly fun and exciting adventure.

A hot potato?
PACS, like many cutting-edge technologies, partially owes its existence to the military. “They used military satellites and spy planes to capture information and then used computers to review that information,” says Siegel.
But translating military use into a civilian world is exceedingly costly. That was the case with PACS too, with workstations costing about a quarter of a million dollars. That all changed when Siegel found out about a workstation being developed with Mac-based technology. The price tag was still high by today’s standards, ringing in at $10,000 per workstation, but it was an accessible price point.

The V.A. bought their PACS in 1991, doing a tremendous amount of work with the OEM and other companies involved in the project. “We worked on network, storage and compression,” Siegel recalls. Other details were also hashed out. “So the window level, zoom… all the things you take for granted nowadays, were developed then,” says Siegel.

The system was up and running by 1993, but was just a ghost of what hospitals use today. “We had no Ethernet, so we had to use a proprietary network,” Siegel says. And the storage used was paltry as well. “We had one terabyte at the cost of $800k and it had to last for five years.”

A teaching hospital
The V.A. going filmless showed the entire health care industry that it could be pulled off. “For quite a few years, we had visitors from around the world coming to learn from us,” says Siegel. “They asked, ‘How often are doctors coming down for a face-to-face? How did it change how we practice radiology?’” The team also conducted a groundbreaking study on the costs and benefits associated with making the transition to filmless, and the results provided vindication.