British Journal of Radiology (2003) 76, 82
© 2003 British Institute of Radiology
doi:
PACS A Guide to the Digital Revolution. Edited by K J Dreyer, A Metha and J H Thrall, pp. x+435, 2002 (Springer-Verlag, New York NY), £76.50 ISBN 0 387 25291 8
A M K Thomas
It is very appropriate that this useful book has been published. Digital technology is now in many of our departments and is being networked throughout our hospitals. We live in an exciting time. What was once talked about as a possibility is now becoming a reality. This book covers all aspects of PACS including the initial financial aspects, the fundamentals of computing, the technologies required and the future opportunities.
The initial chapters on the fundamentals assume little knowledge and the jargon so much beloved by computer experts is explained clearly. The complexities and difficulties of installing PACS should not be underestimated and in particular the problems associated with networking outside the radiology department. Of major importance is the robustness and reliability of the system. Modern medical imaging is central to the running of the modern hospital and most patients will have contact with radiology. As has been seen in my own hospital, when the PACS or the web viewing technology that allows clinicians to view images in offices and ward areas is not running, clinical activity and patient management is impossible. The introduction of digital imaging and PACs must be done well. There is good coverage of image acquisition, image manipulation and image storage and an interesting account of image compression.
The section on policies, standards and legal issues is more orientated to the North American experience rather than the European, however is still of interest. There are considerable medico-legal implications of PACS and teleradiology and we do not give enough attention to this aspect. Of considerable interest will be the use of electronic data collected on radiological examinations and the referral patterns of individual clinicians. It is interesting to read that since 1992 the number of radiology examinations performed on patients in the United States has remained fairly constant, however the number of radiology relative value units (RVUs) used has dramatically increased. The RVU measures the complexity of the radiology examination. American physicians now order fewer of the lower technology studies and more of the expensive high technology studies. The indication is that some 20% or more of the radiology performed in the United States is redundant and unnecessary. The reasons for this excessive use of radiology are unclear. The management of radiology utilization may well become a reality in the same way that the medicines budget for primary care in increasingly controlled. However medicine is still an art as well as a science, and I do not believe that the science of medicine will evolve to the state that allows complete certainty on how one should care for every patient. There is a very interesting final discussion on the collection of data, the changing of physician behaviour and on the development of guidelines.
I would recommend this book for all departments with PACS or about to install PACS. Clinicians interested in medical imaging would also benefit from reading this book.
