Keywords:  PACS, archive, filmless, workstation, database, workflow management software, workflow
A PACS (Picture Archive and Communication System) is a computer-based system used to transfer, store, display, and manage medical images and associated text data.  A PACS presumes the use of softcopy/digital medical images, typically (but not always) in DICOM format.

At a minimum, a PACS consists of an archive device for image storage, database and workflow management software, and diagnostic display stations for interpreting physicians.

A PACS can also incorporate brokers (also called gateways) that are used to communicate with other systems (such as modalities or a HIS/RIS), display stations for non-diagnostic image review, and dictation/report management software. Some image-producing modalities such as CR and DR devices are considered to be PACS components as well. Film digitizers may be used to convert film-based images into digital images for storage in a PACS, and printers can be used to produce hardcopy for situations where softcopy access is not convenient.

The development of PACS technology has revolutionized medical imaging.  One study shows that “the change in work flow associated with the use of the PACS has resulted in increased efficiencies of our technologists by 20-60%, of our clerical staff by more than 50%, and of our radiologists by more than 40%”*. PACS technology has also supported the expansion of new diagnostic methods such as teleradiology (offsite interpretation of medical images) and CAD (computer-assisted diagnosis).

While PACS systems are becoming the norm at larger institutions, many community hospitals have yet to implement a PACS. Implementation and maintenance of a PACS requires staff with both IT and clinical skills. Depending on the scale of the PACS, one or more PACS administrators are needed to maintain efficiency and data integrity, resolve issues, and manage upgrades.

The first large-scale PACS installation was in 1982 at the University of Kansas. As an early PACS, the primary goal was to replace the film-based workflow as softcopy reading environment. In the late 1980s, the vision of a single “virtual” radiology department was further developed in a joint project between the US Department of Defense (DOD) and the US department of Veterans Affairs (VA) at Georgetown and the University of Washington.

A key factor in realizing the benefits of a PACS is integration with other systems and workflows already present in the hospital. The recent Integrating Healthcare Environment (IHE) initiatives emphasize the integration aspect of PACS implementation.

* American Journal of Roentgenology, Workflow Redesign: The Key to Success when using PACS, Eliot Siegel and Bruce Reiner, 2001 (
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