Design and operation of a nuclear medicine picture archiving and communication system

Construction of a new Veterans Administration Medical Center provided a unique opportunity to design and implement a state-of-the-art nuclear medicine department in a large teaching and research hospital. The new medical center allowed the acquisition of all new gamma cameras and computer systems without any historical need to patch together a system of old and new equipment. The picture archiving and communication system (PACS) was designed to link five gamma cameras to four image viewing areas, followed by digital archive on an optical disc. The gamma cameras' computers and viewing areas' computers are linked to a central networking computer in a manner that provides nine independent but digitally communicating image computers. Each nuclear medicine computer is capable of acquiring gamma camera data while possibly also performing up to three other simultaneous tasks: analysis of image data, transfer of image data from node to node, and patient database manipulation. The nine image computers each appear to the user as a digital file cabinet, containing various folders, which in turn contain patient studies. To transfer a patient study from one location to another, the user simply queues a transfer request by selecting a file drawer-folder combination for the source and destination locations. It takes only a few seconds to queue a transfer request, and the transfer is complete about a minute later without any further user intervention. A computer genie awakens during the early morning off-hours and performs housekeeping tasks, including movement of patient studies (based on date of acquisition) from active viewing folders to inactive archive folders. All scheduling, workload data, patient image reports, etc, are handled by a patient textual information database system. Patient reports and scheduling information are transmitted to the medical center's central computer where they are made readily available throughout the medical center. The PACS, in clinical use since the spring of 1988, is practical and well-received by technologists, nuclear medicine physicians, and more importantly, our consumer, the referring physicians.