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IT Matters – The birth of PACS

by Sean Ruck, Contributing Editor | July 09, 2015

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.
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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.

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