PACS (2-8-10)

This is not an essay about packing but something possibly more boring. People familiar with medical lingo must know an acronym, PACS, standing for Picture Archiving and Communication Systems, and the installation of this system in the X-ray and other sections is apparently gaining steam across medical facilities, according to the drawing-near revision of the rewards for medical procedures. Speculatively, the Japanese government has such an intent to create an online network connecting medical facilities.

Having been a responsible radiographer in a private hospital with 94 beds in Tokyo, I sensed a ruffle of the phenomenon and was urged to take action.

The X-ray division of my hospital already has a Computed Radiography system. With it, every X-ray image--except for those obtained under fluoroscopy and those for analyzing bone strength/density, as the machines for them are still analogue--is composed of digital data to enable the user to modify density, contrast and/or other settings by simply pressing the screen before printing out a film to help doctors diagnose more easily.

Thanks to the CR system, my work has been efficient ever since the installation in 2004. For instance, an X-ray overexposure won’t lead to a re-examination. (Meanwhile, an underdose could noticeably affect the quality of an image, therefore examiners usually tend to preset the strength of the X-ray beam higher than one with the analogue system.) And, as the digital screen allows the user to judge whether the captured image qualifies for diagnosis before printing, failed films are fewer.

However, interestingly or not, uniquely or not, in the case of my hospital the chief motivation for the introduction of the CR system was not these advantages. We were aware of additional revenue after X-rays were taken with a CR system. Indeed, we already receive 60 points, which translate into 600 yen or about 6.70 US dollars, per body part.

The system was not so cheap, costing about 5 million yen with a warranty, but expected to be lucrative even counting in expenditures on regular maintenance.

In Japan’s medical society, the more procedures are taken, the more rewards are paid as per the table of remunerations/reimbursement. This fact doesn’t mean that doctors are given free rein to order unnecessary procedures just for the sake of income. Yet they should be judicious with the knowledge about what procedure will bring in how much--and how much a patient will pay--when writing treatments. In the process of deciding to buy CR machines, we believed that clearer images and the special remunerations would have comprehensively surpassed a bundle of downsides. (Surely, the CR system has been prevailing.)

The list of medical remunerations is revised every two years and its aggregate amount has been phased down. So has the additional reward for X-ray exams with a CR system. The returning points per body part had lasted as 60 until the end of March 2008, and fell to 15 which lasted until the same time in 2010. The return will be zero at the nearing revision.

In the transition to the digital system, the film-less one is also specified for remuneration. The government set rewards for X-ray-used exams with a PACS in the 2008 revision: standard X-rays, like those for chests and bones, would bring in another 60 points per body part while CT and MRI exams--although technically MRI machines don’t use X-rays--would do 120 points.

PACS usually don’t need films, as digital data from modalities like a CR system or a CT system is stored at a server and distributed to workstations across sections.

The installation of a PACS will bring about certain advantages: a medical facility can reduce its manpower, not needing people who carry X-rays; a facility can have additional space, eliminating a repository for films; a facility can transfer images in a second within itself or to a separate facility; and as data is stored in the server, images which have been sent from different modalities can be observed on a screen.

Meanwhile, the drawbacks of PACS are these: a server trouble could paralyze the functions of an X-ray section and a facility; and as far as the system handles digital data online, there always is the risk of information leakage.

What a PACS refers to is the data-exchanging network around a server. If the network expands to the whole X-ray section, it can also be called a RIS--Radiology Information System--on DICOM--Digital Imaging and Communications in Medicine--which is a code used for transferring digital data between different machines. Further, if the network expands to the whole facility, it can as well be called an HIS--Hospital Information System--on HL 7--Healthcare Level 7--which is a code used for transferring digital data of not only radiation-related exams but also laboratory exams and paperwork such as receipts. The ultimate goal was set at building a nationwide network linking medical facilities on IHE--Integrating the Healthcare Enterprise--which is a guideline for exchanging digital information.

Having learned all these merits, on a recent day I suggested the introduction of a PAC system to the head of my hospital’s office after several companies had quoted their products between about eight million yen (or around 89 thousand dollars) and about 10 million yen. The idea is now discussed by the board including the boss doctor.

Kodak (or Carestream Health) is one of those companies. What the rep of Kodak touted were the location of the image servers in Yaesu--right on the north side of the Tokyo rail station--and their total capacity much larger than that of a server in a hospital.

If my proposal is accepted, the digital images of patients will be efficiently delivered. (※ Later the place was found right with Toyosu, not Yaesu.)