1. PACS, FILMLESS RADIOLOGY AND TELERADIOLOGY -A FUTURE PERSPECTIVE KMA annual scientific conference at Noble hotel Eldoret April 22 nd -2th 2015 OUR EXPERIENCE AT CDIC Dr NGOSEYWE KENNEDY RADIOLOGIST CDIC-NRB

2. BACKGROUND  Radiology has traditionally been considered inseparable from ‘films’, classically in the form of X-ray plates but gradually also including films incorporating images from US, CT and MRI.

3. BACKGROUND  Talk of ‘film-less radiology’ may therefore appear anachronistic.  But the future beckons a world in which the practice of radiology may completely do away with the traditional use of films

4. BACKGROUND  The seeds of film-less radiology were laid with the advent of modalities such as MRI and CT, which were inherently computer-intensive for both acquiring and presenting clinically relevant images.  Since images from these newer modalities were basically in a digital format, they could be treated in the same manner as any other digital data.

5. INTRODUCTION  However, the traditional habit of viewing all images on films, require that these images be also printed on films whether for reporting by the Radiologist, for review by the clinician or for long term archival.

6. BACKGROUND  With the ever-increasing inclusion of computer usage in the medical field and specifically in radiology, this traditional concept was beginning to be questioned.

7. BACKGROUND  The advent of computerized radiography (CR) and digital radiography (DR) which can directly acquire radiographs in the digital format, gave the final push for the introduction of filmless radiology as a viable proposition.  Thus was born the concept of PACS

8. PACS  PACS is a computerized means of replacing the roles of conventional radiological film: images are acquired, stored, transmitted, and displayed digitally.  When such a system is installed throughout the hospital, a filmless clinical environment results.

9.  It is an integrated system of digital products and technology that makes the acquisition,storage,retrieval and display of radiological images possible.  The PACS archive is expected to replace radiology film libraries WHAT IS PACS?

10. Components of the pacs system  The acronym PACS stands for picture archiving and communication system. WHAT IS PACS?

11. So the 4 major components are:  1. Pictures:radiology,cardio,other modalities.  2. Archiving :deparment,specialty,enterprise.  3. Communication:LAN,WAN,VLAN’s.  4.Systems:Hardware,software,people,environment Components of the pacs system

12. PACS Architecture at CDIC Referring MD Core(Gateway) Web server communication LAN Internet Diagnostic workstations Radiologist Web based report And study viewer Imaging centre or Hospital Data Centre Remote location (Off site users) Remote location (Off site users) Local study download Local users Diagnostic workstations modalities

13. TELERADIOLOGY  Teleradiology is the transmission of images and associated data between locations for the purpose of primary interpretation or consultation and/or clinical review.

14.  It allows for remote access to images by radiologists and clinicians.  Generally speaking, teleradiology can be considered as a subset of telemedicine. TELERADIOLOGY

15. ADVANTAGES OF PACS: Radiologist/physician perspective  The main advantage a PACS offers is the improvement in efficiency resulting from electronic data handling  Source of new images and priors  Image manipulation and processing tools.  Tool for cooperation, consultation and demonstration  Allow for flexibility in location.  Faster turn-around times.

16. ADVANTAGES OF PACS patient perspective  Fast availability of results  Share images between patients and physicians.  Exchange media(CD’s) allow for information exchange between providers.  Access to any specialist anywhere in the world.

17. PACS AT CDIC  The PACS at CDIC was developed in order to address the need for a robust, reliable, intuitive, efficient, and seamless platform for transmitting, unifying and integrating diagnostic imaging data.  It is a web based PACs and teleradiology system thus it can be accessed from any location where there is availability of a computer and Internet.  It has been operating since August 2013.

18. PACS AT CDIC Goals:  Provide expert interpretation of images, not only in major urban, but in rural and medically underserved areas as well where radiologist are not available.  Promoting efficiency and quality improvement.

19. CHALLANGES  High dependence on availability of networks,IT infrastructure,hardwares.  Software can have bugs  Image quality needs same amount of checking as in film world.  Vast retraining effort.  Users need to become computer savvy  Pacs require a dedicated support staff.

20. CONCLUSION  PACS is an image and information management system.  It has a major impact on workflow and the way business is conducted.  It requires a dedicated, well trained support staff.  Constant monitoring, QA and QC are critical components.

21. CONCLUSION  Technology is providing us with newer ways of performing conventional jobs in a more efficient manner and it is for us to decide whether we would like to be a part of this change that is sweeping the world of Medicine gradually.

22. CONCLUSION PACS is the future. Thank you all