[Economic and organizational evaluation of an imaging network (PACS)]

Over the last twenty years, imaging modalities featuring new image production methods (ultrasound, nuclear magnetic resonance, etc.) have appeared on the market. Nevertheless, conventional radiology still accounts for 70% of the image examinations carried out in most western countries, including France. The conventional radiological image is in the process of evolving from analog to digital form. Digitalization of radiology means that image acquisition, archiving and distribution functions that were previously carried out by hand can now be automated using a Picture Archiving and Communication System. Decision-makers are having to decide whether or not to promote the development of PACS which, while they considerably modernize the way in which images are managed, also require heavy capital outlays.

A critical appraisal of the literature allowed us to evaluate the relative cost and the efficiency of these image networks in comparison with film-based archiving and communication systems.

It is clear from the economic evaluation that a PACS strategy involves greater costs than a film system. While PACS systems do generate savings on film and on storage space and obviate the need for certain staff, these savings do not offset the extra equipment and maintenance costs. This situation is likely to persist for some years yet, even when future price reductions are taken into account. The objective of this new radiological information management method is to improve organizational efficiency and hospital productivity. However, the economic evaluations that have been published to date are cost studies which do not take the efficiency criterion into account. A number of potential organizational benefits such as the fact that medical decisions can be made more quickly or that the average length of hospital stays can be reduced, are often claimed for PACS. However, for methodological reasons, these results cannot be generalised to cover all PACS. It is difficult to compare PACS and film systems because the PACS technology is continuously evolving and because each PACS is specific to a site.

After having weighted these different points, the ANAES has made the following recommendations concerning the development of PACS. A strategic analysis should be carried out before any decision is made to install a PACS. Moreover, hospitals will have to define the precise functions of their PACS in relation to the objectives of their medical project and each network must be configurated coherently.