<s>
A	O
picture	B-Application
archiving	I-Application
and	I-Application
communication	I-Application
system	I-Application
(	O
PACS	B-Application
)	O
is	O
a	O
medical	B-Application
imaging	I-Application
technology	O
which	O
provides	O
economical	O
storage	B-General_Concept
and	O
convenient	O
access	O
to	O
images	O
from	O
multiple	O
modalities	O
(	O
source	O
machine	O
types	O
)	O
.	O
</s>
<s>
Electronic	B-Algorithm
images	I-Algorithm
and	O
reports	O
are	O
transmitted	O
digitally	O
via	O
PACS	B-Application
;	O
this	O
eliminates	O
the	O
need	O
to	O
manually	O
file	O
,	O
retrieve	O
,	O
or	O
transport	O
film	O
jackets	O
,	O
the	O
folders	O
used	O
to	O
store	O
and	O
protect	O
X-ray	B-Library
film	O
.	O
</s>
<s>
The	O
universal	O
format	O
for	O
PACS	B-Application
image	O
storage	B-General_Concept
and	O
transfer	O
is	O
DICOM	B-Algorithm
(	O
Digital	B-Algorithm
Imaging	I-Algorithm
and	I-Algorithm
Communications	I-Algorithm
in	I-Algorithm
Medicine	I-Algorithm
)	O
.	O
</s>
<s>
Non-image	O
data	O
,	O
such	O
as	O
scanned	B-Application
documents	O
,	O
may	O
be	O
incorporated	O
using	O
consumer	O
industry	O
standard	O
formats	O
like	O
PDF	B-Application
(	O
Portable	B-Application
Document	I-Application
Format	I-Application
)	O
,	O
once	O
encapsulated	O
in	O
DICOM	B-Algorithm
.	O
</s>
<s>
A	O
PACS	B-Application
consists	O
of	O
four	O
major	O
components	O
:	O
The	O
imaging	O
modalities	O
such	O
as	O
X-ray	B-Library
plain	O
film	O
(	O
PF	O
)	O
,	O
computed	O
tomography	O
(	O
CT	O
)	O
and	O
magnetic	O
resonance	O
imaging	O
(	O
MRI	O
)	O
,	O
a	O
secured	O
network	B-Architecture
for	O
the	O
transmission	O
of	O
patient	O
information	O
,	O
workstations	B-Device
for	O
interpreting	O
and	O
reviewing	O
images	O
,	O
and	O
archives	O
for	O
the	O
storage	B-General_Concept
and	O
retrieval	O
of	O
images	O
and	O
reports	O
.	O
</s>
<s>
Combined	O
with	O
available	O
and	O
emerging	O
web	O
technology	O
,	O
PACS	B-Application
has	O
the	O
ability	O
to	O
deliver	O
timely	O
and	O
efficient	O
access	O
to	O
images	O
,	O
interpretations	O
,	O
and	O
related	O
data	O
.	O
</s>
<s>
PACS	B-Application
reduces	O
the	O
physical	O
and	O
time	O
barriers	O
associated	O
with	O
traditional	O
film-based	O
image	B-General_Concept
retrieval	I-General_Concept
,	O
distribution	O
,	O
and	O
display	O
.	O
</s>
<s>
Most	O
PACS	B-Application
handle	O
images	O
from	O
various	O
medical	B-Application
imaging	I-Application
instruments	O
,	O
including	O
ultrasound	O
(	O
US	O
)	O
,	O
magnetic	O
resonance	O
(	O
MR	O
)	O
,	O
Nuclear	O
Medicine	O
imaging	O
,	O
positron	B-Application
emission	I-Application
tomography	I-Application
(	O
PET	O
)	O
,	O
computed	O
tomography	O
(	O
CT	O
)	O
,	O
endoscopy	B-Application
(	O
ES	O
)	O
,	O
mammograms	O
(	O
MG	O
)	O
,	O
digital	O
radiography	O
(	O
DR	O
)	O
,	O
phosphor	O
plate	O
radiography	O
,	O
Visible	O
Light	O
Photography	O
(	O
VL	O
)	O
,	O
Histopathology	O
,	O
ophthalmology	O
,	O
etc	O
.	O
</s>
<s>
Clinical	O
areas	O
beyond	O
radiology	O
;	O
cardiology	O
,	O
oncology	O
,	O
gastroenterology	O
,	O
and	O
even	O
the	O
laboratory	O
are	O
creating	O
medical	B-Application
images	I-Application
that	O
can	O
be	O
incorporated	O
into	O
PACS	B-Application
.	O
</s>
<s>
(	O
see	O
DICOM	B-Algorithm
Application	O
areas	O
)	O
.	O
</s>
<s>
PACS	B-Application
has	O
four	O
main	O
uses	O
:	O
</s>
<s>
Hard	B-General_Concept
copy	I-General_Concept
replacement	O
:	O
PACS	B-Application
replaces	O
hard-copy	B-General_Concept
based	O
means	O
of	O
managing	O
medical	B-Application
images	I-Application
,	O
such	O
as	O
film	O
archives	O
.	O
</s>
<s>
With	O
the	O
decreasing	O
price	O
of	O
digital	O
storage	B-General_Concept
,	O
PACS	B-Application
provide	O
a	O
growing	O
cost	O
and	O
space	O
advantage	O
over	O
film	O
archives	O
in	O
addition	O
to	O
the	O
instant	O
access	O
to	O
prior	O
images	O
at	O
the	O
same	O
institution	O
.	O
</s>
<s>
It	O
enables	O
practitioners	O
in	O
different	O
physical	O
locations	O
to	O
access	O
the	O
same	O
information	O
simultaneously	O
for	O
teleradiology	B-Application
.	O
</s>
<s>
Electronic	O
image	O
integration	O
platform	O
:	O
PACS	B-Application
provides	O
the	O
electronic	O
platform	O
for	O
radiology	O
images	O
interfacing	O
with	O
other	O
medical	O
automation	O
systems	O
such	O
as	O
Hospital	O
Information	O
System	O
(	O
HIS	O
)	O
,	O
Electronic	B-Application
Medical	I-Application
Record	I-Application
(	O
EMR	O
)	O
,	O
Practice	B-Application
Management	I-Application
Software	I-Application
,	O
and	O
Radiology	O
Information	O
System	O
(	O
RIS	O
)	O
.	O
</s>
<s>
Radiology	O
Workflow	O
Management	O
:	O
PACS	B-Application
is	O
used	O
by	O
radiology	O
personnel	O
to	O
manage	O
the	O
workflow	O
of	O
patient	O
exams	O
.	O
</s>
<s>
PACS	B-Application
is	O
offered	O
by	O
virtually	O
all	O
the	O
major	O
medical	B-Application
imaging	I-Application
equipment	O
manufacturers	O
,	O
medical	O
IT	O
companies	O
and	O
many	O
independent	O
software	O
companies	O
.	O
</s>
<s>
Basic	O
PACS	B-Application
software	O
can	O
be	O
found	O
free	O
on	O
the	O
Internet	O
.	O
</s>
<s>
A	O
radiologist	O
typically	O
sees	O
a	O
viewing	O
station	O
,	O
a	O
technologist	O
a	O
QA	O
workstation	B-Device
,	O
while	O
a	O
PACS	B-Application
administrator	O
might	O
spend	O
most	O
of	O
their	O
time	O
in	O
the	O
climate-controlled	O
computer	O
room	O
.	O
</s>
<s>
Typically	O
a	O
PACS	B-Application
consists	O
of	O
a	O
multitude	O
of	O
devices	O
.	O
</s>
<s>
The	O
first	O
step	O
in	O
typical	O
PACS	B-Application
systems	O
is	O
the	O
modality	O
.	O
</s>
<s>
Modalities	O
are	O
typically	O
computed	O
tomography	O
(	O
CT	O
)	O
,	O
ultrasound	O
,	O
nuclear	O
medicine	O
,	O
positron	B-Application
emission	I-Application
tomography	I-Application
(	O
PET	O
)	O
,	O
and	O
magnetic	O
resonance	O
imaging	O
(	O
MRI	O
)	O
.	O
</s>
<s>
Depending	O
on	O
the	O
facility	O
's	O
workflow	O
most	O
modalities	O
send	O
to	O
a	O
quality	O
assurance	O
(	O
QA	O
)	O
workstation	B-Device
or	O
sometimes	O
called	O
a	O
PACS	B-Application
gateway	O
.	O
</s>
<s>
The	O
QA	O
workstation	B-Device
is	O
a	O
checkpoint	O
to	O
make	O
sure	O
patient	O
demographics	O
are	O
correct	O
as	O
well	O
as	O
other	O
important	O
attributes	O
of	O
a	O
study	O
.	O
</s>
<s>
If	O
the	O
study	O
information	O
is	O
correct	O
the	O
images	O
are	O
passed	O
to	O
the	O
archive	O
for	O
storage	B-General_Concept
.	O
</s>
<s>
The	O
central	O
storage	B-General_Concept
device	O
(	O
archive	O
)	O
stores	O
images	O
and	O
in	O
some	O
cases	O
reports	O
,	O
measurements	O
and	O
other	O
information	O
that	O
resides	O
with	O
the	O
images	O
.	O
</s>
<s>
The	O
next	O
step	O
in	O
the	O
PACS	B-Application
workflow	O
is	O
the	O
reading	O
workstations	B-Device
.	O
</s>
<s>
The	O
reading	O
workstation	B-Device
is	O
where	O
the	O
radiologist	O
reviews	O
the	O
patient	O
's	O
study	O
and	O
formulates	O
their	O
diagnosis	O
.	O
</s>
<s>
Normally	O
tied	O
to	O
the	O
reading	O
workstation	B-Device
is	O
a	O
reporting	O
package	O
that	O
assists	O
the	O
radiologist	O
with	O
dictating	O
the	O
final	O
report	O
.	O
</s>
<s>
Note	O
that	O
this	O
section	O
does	O
not	O
cover	O
integration	O
to	O
a	O
Radiology	O
Information	O
System	O
,	O
Hospital	O
Information	O
System	O
and	O
other	O
such	O
front-end	O
system	O
that	O
relates	O
to	O
the	O
PACS	B-Application
workflow	O
.	O
</s>
<s>
More	O
and	O
more	O
PACS	B-Application
include	O
web-based	O
interfaces	O
to	O
utilize	O
the	O
internet	O
or	O
a	O
wide	O
area	O
network	B-Architecture
(	O
WAN	O
)	O
as	O
their	O
means	O
of	O
communication	O
,	O
usually	O
via	O
VPN	B-Application
(	O
Virtual	B-Application
Private	I-Application
Network	I-Application
)	O
or	O
SSL	B-Protocol
(	O
Secure	B-Protocol
Sockets	I-Protocol
Layer	I-Protocol
)	O
.	O
</s>
<s>
The	O
clients	O
side	O
software	O
may	O
use	O
ActiveX	B-Application
,	O
JavaScript	B-Language
and/or	O
a	O
Java	B-Application
Applet	I-Application
.	O
</s>
<s>
More	O
robust	O
PACS	B-Application
clients	O
are	O
full	O
applications	O
which	O
can	O
utilize	O
the	O
full	O
resources	O
of	O
the	O
computer	O
they	O
are	O
executing	O
on	O
and	O
are	O
unaffected	O
by	O
the	O
frequent	O
unattended	O
Web	B-Application
Browser	I-Application
and	O
Java	O
updates	O
.	O
</s>
<s>
As	O
the	O
need	O
for	O
distribution	O
of	O
images	O
and	O
reports	O
becomes	O
more	O
widespread	O
there	O
is	O
a	O
push	O
for	O
PACS	B-Application
systems	O
to	O
support	O
DICOM	B-Algorithm
part	O
18	O
of	O
the	O
DICOM	B-Algorithm
standard	O
.	O
</s>
<s>
Web	O
Access	O
to	O
DICOM	B-Algorithm
Objects	O
(	O
WADO	O
)	O
creates	O
the	O
necessary	O
standard	O
to	O
expose	O
images	O
and	O
reports	O
over	O
the	O
web	O
through	O
truly	O
portable	O
medium	O
.	O
</s>
<s>
Without	O
stepping	O
outside	O
the	O
focus	O
of	O
the	O
PACS	B-Application
architecture	O
,	O
WADO	O
becomes	O
the	O
solution	O
to	O
cross	O
platform	O
capability	O
and	O
can	O
increase	O
the	O
distribution	O
of	O
images	O
and	O
reports	O
to	O
referring	O
physicians	O
and	O
patients	O
.	O
</s>
<s>
PACS	B-Application
image	I-Application
backup	I-Application
is	O
a	O
critical	O
,	O
but	O
sometimes	O
overlooked	O
,	O
part	O
of	O
the	O
PACS	B-Application
Architecture	O
(	O
see	O
below	O
)	O
.	O
</s>
<s>
Within	O
the	O
United	O
States	O
,	O
HIPAA	O
requires	O
that	O
backup	O
copies	O
of	O
patient	O
images	O
be	O
made	O
in	O
case	O
of	O
image	O
loss	O
from	O
the	O
PACS	B-Application
.	O
</s>
<s>
There	O
are	O
several	O
methods	O
of	O
backing	O
up	O
the	O
images	O
,	O
but	O
they	O
typically	O
involve	O
automatically	O
sending	O
copies	O
of	O
the	O
images	O
to	O
a	O
separate	O
computer	O
for	O
storage	B-General_Concept
,	O
preferably	O
off-site	O
.	O
</s>
<s>
The	O
communication	O
with	O
the	O
PACS	B-Application
server	O
is	O
done	O
through	O
DICOM	B-Algorithm
messages	O
that	O
are	O
similar	O
to	O
DICOM	B-Algorithm
image	O
"	O
headers	O
"	O
,	O
but	O
with	O
different	O
attributes	O
.	O
</s>
<s>
The	O
client	O
establishes	O
the	O
network	B-Architecture
connection	O
to	O
the	O
PACS	B-Application
server	O
.	O
</s>
<s>
The	O
client	O
prepares	O
a	O
C-FIND	O
request	O
message	O
which	O
is	O
a	O
list	O
of	O
DICOM	B-Algorithm
attributes	O
.	O
</s>
<s>
if	O
the	O
client	O
wishes	O
to	O
receive	O
an	O
ID	O
that	O
it	O
can	O
use	O
to	O
receive	O
images	O
(	O
see	O
image	B-General_Concept
retrieval	I-General_Concept
)	O
it	O
should	O
include	O
a	O
zero-length	O
SOPInstanceUID	O
(	O
0008	O
,	O
0018	O
)	O
attribute	O
in	O
the	O
C-FIND	O
request	O
messages	O
.	O
</s>
<s>
The	O
server	O
sends	O
back	O
to	O
the	O
client	O
a	O
list	O
of	O
C-FIND	O
response	O
messages	O
,	O
each	O
of	O
which	O
is	O
also	O
a	O
list	O
of	O
DICOM	B-Algorithm
attributes	O
,	O
populated	O
with	O
values	O
for	O
each	O
match	O
.	O
</s>
<s>
Images	O
(	O
and	O
other	O
composite	O
instances	O
like	O
Presentation	O
States	O
and	O
Structured	O
Reports	O
)	O
are	O
then	O
retrieved	O
from	O
a	O
PACS	B-Application
server	O
through	O
either	O
a	O
C-MOVE	O
or	O
C-GET	O
request	O
,	O
using	O
the	O
DICOM	B-Algorithm
network	B-Architecture
protocol	O
.	O
</s>
<s>
A	O
C-GET	O
,	O
on	O
the	O
other	O
hand	O
,	O
performs	O
the	O
C-STORE	O
operations	O
on	O
the	O
same	O
connection	O
as	O
the	O
request	O
,	O
and	O
hence	O
does	O
not	O
require	O
that	O
the	O
"	O
server	O
"	O
know	O
the	O
"	O
client	O
"	O
TCP/IP	O
address	O
and	O
port	O
,	O
and	O
hence	O
also	O
works	O
more	O
easily	O
through	O
firewalls	O
and	O
with	O
network	B-Architecture
address	O
translation	O
,	O
environments	O
in	O
which	O
the	O
incoming	O
TCP	O
C-STORE	O
connections	O
required	O
for	O
C-MOVE	O
may	O
not	O
get	O
through	O
.	O
</s>
<s>
In	O
addition	O
to	O
the	O
traditional	O
DICOM	B-Algorithm
network	B-Architecture
services	O
,	O
particularly	O
for	O
cross-enterprise	O
use	O
,	O
DICOM	B-Algorithm
(	O
and	O
IHE	O
)	O
define	O
other	O
retrieval	O
mechanisms	O
,	O
including	O
WADO	O
,	O
WADO-WS	O
and	O
most	O
recently	O
WADO-RS	O
.	O
</s>
<s>
Digital	O
medical	B-Application
images	I-Application
are	O
typically	O
stored	O
locally	O
on	O
a	O
PACS	B-Application
for	O
retrieval	O
.	O
</s>
<s>
The	O
hope	O
is	O
that	O
the	O
copies	O
wo	O
n't	O
be	O
needed	O
;	O
however	O
,	O
disaster	B-General_Concept
recovery	I-General_Concept
and	O
business	O
continuity	O
planning	O
dictates	O
that	O
plans	O
should	O
include	O
maintaining	O
copies	O
of	O
data	O
even	O
when	O
an	O
entire	O
site	O
is	O
temporarily	O
or	O
permanently	O
lost	O
.	O
</s>
<s>
Ideally	O
,	O
copies	O
of	O
images	O
should	O
be	O
maintained	O
in	O
several	O
locations	O
,	O
including	O
off-site	O
to	O
provide	O
disaster	B-General_Concept
recovery	I-General_Concept
capabilities	O
.	O
</s>
<s>
In	O
general	O
,	O
PACS	B-Application
data	O
is	O
no	O
different	O
than	O
other	O
business	O
critical	O
data	O
and	O
should	O
be	O
protected	O
with	O
multiple	O
copies	O
at	O
multiple	O
locations	O
.	O
</s>
<s>
As	O
PACS	B-Application
data	O
can	O
be	O
considered	O
protected	O
health	O
information	O
(	O
PHI	O
)	O
,	O
regulations	O
may	O
apply	O
,	O
most	O
notably	O
HIPAA	O
and	O
HIPAA	O
Hi-Tech	O
requirements	O
.	O
</s>
<s>
The	O
use	O
of	O
storage	B-General_Concept
systems	I-General_Concept
,	O
using	O
modern	O
data	O
protection	O
technologies	O
has	O
become	O
increasingly	O
common	O
,	O
particularly	O
for	O
larger	O
organizations	O
with	O
greater	O
capacity	O
and	O
performance	O
requirements	O
.	O
</s>
<s>
Storage	B-General_Concept
systems	I-General_Concept
may	O
be	O
configured	O
and	O
attached	O
to	O
the	O
PACS	B-Application
server	O
in	O
various	O
ways	O
,	O
either	O
as	O
Direct-Attached	B-General_Concept
Storage	I-General_Concept
(	O
DAS	O
)	O
,	O
Network-attached	B-Application
storage	I-Application
(	O
NAS	B-Application
)	O
,	O
or	O
via	O
a	O
Storage	B-General_Concept
Area	O
Network	B-Architecture
(	O
SAN	O
)	O
.	O
</s>
<s>
However	O
the	O
storage	B-General_Concept
is	O
attached	O
,	O
enterprise	O
storage	B-General_Concept
systems	I-General_Concept
commonly	O
utilize	O
RAID	B-Architecture
and	O
other	O
technologies	O
to	O
provide	O
high	O
availability	O
and	O
fault	O
tolerance	O
to	O
protect	O
against	O
failures	O
.	O
</s>
<s>
In	O
the	O
event	O
that	O
it	O
is	O
necessary	O
to	O
reconstruct	O
a	O
PACS	B-Application
partially	O
or	O
completely	O
,	O
some	O
means	O
of	O
rapidly	O
transferring	O
data	O
back	O
to	O
the	O
PACS	B-Application
is	O
required	O
,	O
preferably	O
while	O
the	O
PACS	B-Application
continues	O
to	O
operate	O
.	O
</s>
<s>
Modern	O
data	O
storage	B-General_Concept
replication	O
technologies	O
may	O
be	O
applied	O
to	O
PACS	B-Application
information	O
,	O
including	O
the	O
creation	O
of	O
local	O
copies	O
via	O
point-in-time	O
copy	O
for	O
locally	O
protected	O
copies	O
,	O
along	O
with	O
complete	O
copies	O
of	O
data	O
on	O
separate	O
repositories	O
including	O
disk	O
and	O
tape	O
based	O
systems	O
.	O
</s>
<s>
Remote	O
copies	O
of	O
data	O
should	O
be	O
created	O
,	O
either	O
by	O
physically	O
moving	O
tapes	O
off-site	O
,	O
or	O
copying	O
data	O
to	O
remote	O
storage	B-General_Concept
systems	I-General_Concept
.	O
</s>
<s>
Other	O
options	O
for	O
creating	O
copies	O
of	O
PACS	B-Application
data	O
include	O
removable	O
media	O
(	O
hard	O
drives	O
,	O
DVDs	O
or	O
other	O
media	O
that	O
can	O
hold	O
many	O
patients	O
 '	O
images	O
)	O
that	O
is	O
physically	O
transferred	O
off-site	O
.	O
</s>
<s>
The	O
back-up	O
infrastructure	O
may	O
also	O
be	O
capable	O
of	O
supporting	O
the	O
migration	O
of	O
images	O
to	O
a	O
new	O
PACS	B-Application
.	O
</s>
<s>
Due	O
to	O
the	O
high	O
volume	O
of	O
images	O
that	O
need	O
to	O
be	O
archived	O
many	O
rad	O
centers	O
are	O
migrating	O
their	O
systems	O
to	O
a	O
Cloud-based	O
PACS	B-Application
.	O
</s>
<s>
A	O
full	O
PACS	B-Application
should	O
provide	O
a	O
single	O
point	O
of	O
access	O
for	O
images	O
and	O
their	O
associated	O
data	O
.	O
</s>
<s>
However	O
,	O
until	O
PACS	B-Application
penetration	O
is	O
complete	O
,	O
individual	O
islands	O
of	O
digital	O
imaging	O
not	O
yet	O
connected	O
to	O
a	O
central	O
PACS	B-Application
may	O
exist	O
.	O
</s>
<s>
These	O
may	O
take	O
the	O
form	O
of	O
a	O
localized	O
,	O
modality-specific	O
network	B-Architecture
of	O
modalities	O
,	O
workstations	B-Device
and	O
storage	B-General_Concept
(	O
a	O
so-called	O
"	O
mini-PACS	O
"	O
)	O
,	O
or	O
may	O
consist	O
of	O
a	O
small	O
cluster	O
of	O
modalities	O
directly	O
connected	O
to	O
reading	O
workstations	B-Device
without	O
long	O
term	O
storage	B-General_Concept
or	O
management	O
.	O
</s>
<s>
The	O
rapid	O
deployment	O
of	O
FFDM	O
in	O
the	O
US	O
following	O
the	O
DMIST	O
study	O
has	O
led	O
to	O
the	O
integration	O
of	O
Digital	O
Mammography	O
and	O
PACS	B-Application
becoming	O
more	O
commonplace	O
.	O
</s>
<s>
All	O
PACS	B-Application
,	O
whether	O
they	O
span	O
the	O
entire	O
enterprise	O
or	O
are	O
localized	O
within	O
a	O
department	O
,	O
should	O
also	O
interface	O
with	O
existing	O
hospital	O
information	O
systems	O
:	O
Hospital	O
information	O
system	O
(	O
HIS	O
)	O
and	O
Radiology	O
Information	O
System	O
(	O
RIS	O
)	O
.	O
</s>
<s>
There	O
are	O
several	O
data	O
flowing	O
into	O
PACS	B-Application
as	O
inputs	O
for	O
next	O
procedures	O
and	O
back	O
to	O
HIS	O
as	O
results	O
corresponding	O
inputs	O
:	O
</s>
<s>
Patient	O
ID	O
and	O
Orders	O
will	O
be	O
sent	O
to	O
Modality	O
(	O
CT	O
,	O
MR	O
,	O
etc	O
)	O
via	O
DICOM	B-Algorithm
protocol	O
(	O
Worklist	O
)	O
.	O
</s>
<s>
Images	O
will	O
be	O
created	O
after	O
images	O
scanning	O
and	O
then	O
forwarded	O
to	O
PACS	B-Application
Server	O
.	O
</s>
<s>
Diagnosis	O
Report	O
is	O
created	O
based	O
on	O
the	O
images	O
retrieved	O
for	O
presenting	O
from	O
PACS	B-Application
Server	O
by	O
physician/radiologist	O
and	O
then	O
saved	O
to	O
RIS	O
System	O
.	O
</s>
<s>
Diagnosis	O
Report	O
is	O
sent	O
back	O
to	O
HIS	O
via	O
HL7	O
usually	O
and	O
Images	O
are	O
sent	O
back	O
to	O
HIS	O
via	O
DICOM	B-Algorithm
usually	O
if	O
there	O
is	O
a	O
DICOM	B-Algorithm
Viewer	O
integrated	O
with	O
HIS	O
in	O
hospitals	O
(	O
In	O
most	O
of	O
cases	O
,	O
Clinical	O
Physician	O
gets	O
reminder	O
of	O
Diagnosis	O
Report	O
coming	O
and	O
then	O
queries	O
images	O
from	O
PACS	B-Application
Server	O
)	O
.	O
</s>
<s>
Less	O
risk	O
of	O
entering	O
an	O
incorrect	O
patient	O
ID	O
for	O
a	O
study	O
–	O
modalities	O
that	O
support	O
DICOM	B-Algorithm
worklists	O
can	O
retrieve	O
identifying	O
patient	O
information	O
(	O
patient	O
name	O
,	O
patient	O
number	O
,	O
accession	O
number	O
)	O
for	O
upcoming	O
cases	O
and	O
present	O
that	O
to	O
the	O
technologist	O
,	O
preventing	O
data	O
entry	O
errors	O
during	O
acquisition	O
.	O
</s>
<s>
Once	O
the	O
acquisition	O
is	O
complete	O
,	O
the	O
PACS	B-Application
can	O
compare	O
the	O
embedded	O
image	O
data	O
with	O
a	O
list	O
of	O
scheduled	O
studies	O
from	O
RIS	O
,	O
and	O
can	O
flag	O
a	O
warning	O
if	O
the	O
image	O
data	O
does	O
not	O
match	O
a	O
scheduled	O
study	O
.	O
</s>
<s>
Data	O
saved	O
in	O
the	O
PACS	B-Application
can	O
be	O
tagged	O
with	O
unique	O
patient	O
identifiers	O
(	O
such	O
as	O
a	O
social	O
security	O
number	O
or	O
NHS	O
number	O
)	O
obtained	O
from	O
HIS	O
.	O
</s>
<s>
When	O
a	O
study	O
has	O
been	O
reported	O
by	O
a	O
radiologist	O
the	O
PACS	B-Application
can	O
mark	O
it	O
as	O
read	O
.	O
</s>
<s>
Improved	O
use	O
of	O
online	B-General_Concept
storage	I-General_Concept
and	O
nearline	B-General_Concept
storage	I-General_Concept
in	O
the	O
image	O
archive	O
.	O
</s>
<s>
The	O
PACS	B-Application
can	O
obtain	O
lists	O
of	O
appointments	O
and	O
admissions	O
in	O
advance	O
,	O
allowing	O
images	O
to	O
be	O
pre-fetched	O
from	O
off-line	O
storage	B-General_Concept
or	O
near-line	B-General_Concept
storage	I-General_Concept
onto	O
online	O
disk	O
storage	B-General_Concept
.	O
</s>
<s>
Recognition	O
of	O
the	O
importance	O
of	O
integration	O
has	O
led	O
a	O
number	O
of	O
suppliers	O
to	O
develop	O
fully	O
integrated	O
RIS/PACS	O
.	O
</s>
<s>
That	O
recording	O
may	O
be	O
automatically	O
sent	O
to	O
a	O
transcript	O
writer	O
's	O
workstation	B-Device
for	O
typing	O
,	O
but	O
it	O
can	O
also	O
be	O
made	O
available	O
for	O
access	O
by	O
physicians	O
,	O
avoiding	O
typing	O
delays	O
for	O
urgent	O
results	O
,	O
or	O
retained	O
in	O
case	O
of	O
typing	O
error	O
.	O
</s>
<s>
The	O
PACS	B-Application
installation	O
process	O
is	O
complicated	O
requiring	O
time	O
,	O
resources	O
,	O
planning	O
,	O
and	O
testing	O
.	O
</s>
<s>
The	O
acceptance	O
test	O
determines	O
whether	O
the	O
PACS	B-Application
is	O
ready	O
for	O
clinical	O
use	O
and	O
marks	O
the	O
warranty	O
timeline	O
while	O
serving	O
as	O
a	O
payment	O
milestone	O
.	O
</s>
<s>
Failures	O
ranked	O
from	O
most-to-least	O
common	O
are	O
:	O
Workstation	B-Device
;	O
HIS/RIS/ACS	O
broker	O
interfaces	O
;	O
RIS	O
;	O
Computer	B-Device
Monitors	I-Device
;	O
Web-based	O
image	O
distribution	O
system	O
;	O
Modality	O
interfaces	O
;	O
Archive	O
devices	O
;	O
Maintenance	O
;	O
Training	O
;	O
Network	B-Architecture
;	O
DICOM	B-Algorithm
;	O
Teleradiology	B-Application
;	O
Security	O
;	O
Film	O
digitizer	O
.	O
</s>
<s>
One	O
of	O
the	O
first	O
basic	O
PACS	B-Application
was	O
created	O
in	O
1972	O
by	O
Dr	O
Richard	O
J	O
.	O
Steckel	O
.	O
</s>
<s>
The	O
principles	O
of	O
PACS	B-Application
were	O
first	O
discussed	O
at	O
meetings	O
of	O
radiologists	O
in	O
1982	O
.	O
</s>
<s>
Various	O
people	O
are	O
credited	O
with	O
the	O
coinage	O
of	O
the	O
term	O
PACS	B-Application
.	O
</s>
<s>
Dr	O
Glass	O
died	O
a	O
few	O
months	O
after	O
the	O
project	O
came	O
live	O
but	O
is	O
credited	O
with	O
being	O
one	O
of	O
the	O
pioneers	O
of	O
PACS	B-Application
.	O
</s>
<s>
The	O
first	O
large-scale	O
PACS	B-Application
installation	O
was	O
in	O
1982	O
at	O
the	O
University	O
of	O
Kansas	O
,	O
Kansas	O
City	O
.	O
</s>
<s>
This	O
first	O
installation	O
became	O
more	O
of	O
a	O
teaching	O
experience	O
of	O
what	O
not	O
to	O
do	O
rather	O
than	O
what	O
to	O
do	O
in	O
a	O
PACS	B-Application
installation	O
.	O
</s>
<s>
In	O
the	O
US	O
PACS	B-Application
are	O
classified	O
as	O
Medical	O
Devices	O
,	O
and	O
hence	O
if	O
for	O
sale	O
are	O
regulated	O
by	O
the	O
USFDA	O
.	O
</s>
<s>
In	O
general	O
they	O
are	O
subject	O
to	O
Class	O
2	O
controls	O
and	O
hence	O
require	O
a	O
510(k )	O
,	O
though	O
individual	O
PACS	B-Application
components	O
may	O
be	O
subject	O
to	O
less	O
stringent	O
general	O
controls	O
.	O
</s>
<s>
The	O
Society	O
for	O
Imaging	O
Informatics	O
in	O
Medicine	O
(	O
SIIM	O
)	O
is	O
the	O
worldwide	O
professional	O
and	O
trade	O
organization	O
that	O
provides	O
an	O
annual	O
meeting	O
and	O
a	O
peer-reviewed	O
journal	O
to	O
promote	O
research	O
and	O
education	O
about	O
PACS	B-Application
and	O
related	O
digital	O
topics	O
.	O
</s>
