Tips When Looking for the Ideal Cath Lab PACS

Systems should offer connectivity, data-mining and increased efficiency.
By Jeffrey A. Breall, M.D., Ph.D.


February 10, 2010
The latest Horizon Cardiology version 12.1 from McKesson integrates barcode inventory management. Supplies used in the cath lab are scanned during the procedure and immediately recorded for inventory and billing purposes.

In today’s market, many vendors have very good cardiovascular picture archiving and communications systems (PACS). One needs to only hit the exhibit floor for a short time at the Radiological Society of North America (RSNA) or the American College of Cardiology (ACC) before it becomes apparent that there is a myriad of systems available right now that are excellent and fairly user friendly. They are capable of storing and retrieving high-quality images in just seconds.

So how does one choose if all of the PACS give crisp clean images that are easily retrievable? Start by asking yourself the following questions: Can the PACS system readily tie into your centralized patient information system? How easy is this connectivity? Can information flow forward and backwards? In other words, at the completion of a study, can all of the information be readily “dumped” into your central patient server? When initializing a study can information be downloaded from your central patient server to the PACS to avoid duplication (such as patient demographics)? These issues are of paramount importance when choosing a CV PACS.

A PACS should allow you to see your images with excellent clarity, allow you to manipulate the image and do quantitative analyses without having to read a 400-page user manual. You may also want to be able to pull up old studies at a moment’s notice with no lag time, and add the ability to store and retrieve and manipulate digital subtraction images for your peripheral vascular studies in an ideal system, However, there are deeper issues to consider, such as connectivity, the ability to mine data and using technology to increase efficiency.

PACS Need to be Interoperable

While many major vendors have image storage and retrieval systems, they have a very closed architecture that makes it difficult, if not impossible, to “talk” to other information units in a hospital. This lack of interoperability may include systems in the cardiac catheterization lab itself. This offers a financial advantage for a given vendor, as it forces hospitals to purchase all of its individual components to insure the best connectivity.

However, it is unusual for a given vendor to have the “best” of everything. Clinicians prefer different vendor systems because the image quality of one cath lab is preferred over another. Some hemodynamic monitoring systems are also more intuitive for technologists and nurses to run. It is important to have a PACS that integrates with the clinicians’ preferred devices.

Auto Report-Generation Saves Time

It is also important the system has automated report-generation. In the current era, there is little reason to not be able to complete a study and have the report 80-90 percent completed and waiting. A physician should only need to spend an extra three to five minutes to finalize things. Dictation is so 1960’s. The ability for information to automatically transfer from the image acquisition system and the hemodynamic monitor to the PACS system is crucial. This also allows for automatic population of a nearly completed report. Remember saving time is a critically important feature to the interventional cardiologist.

The flow of data is not simply one-way into the PACS, there needs to be two-way communication. Data acquired in the cath lab must be sent to a central hospital information system, and IT communication is key for any system under consideration. This transfer of information might come in several forms, such as a finalized cath report.

Data-Mining Is Needed

The ability to easily program the PACS to pluck out data elements of interest that are subsequently collected and sent it to another repository is also quite helpful. It might be useful to know how many cases were successful vs. those that were unsuccessful; how many drug-eluting eluting stents were placed vs. bare-metal stents; or how many complications occurred and what was the precise nature of said complications. This information is requested on a regular basis by national data registries and quality assurance organizations. Furthermore, third-party payers are now demanding to know this information regularly. Reimbursement (both physician and hospital) is often tied to providing this information in a timely fashion. A hospital may have two, three, four or more full-time employees laboriously combing through charts to get this information. Alternatively, pre-specifying what data elements are sent automatically to a report from a PACS is worth its weight in gold.

At the conclusion of any given case, an optimal PACS has the ability to provide the operator with a report that is 90 percent complete and provide the operator with images that are easy to review and can be ultimately kept in storage. The system should also provide data elements that go to a central repository for later distribution to a quality assurance committee, national data bank registry, or any third-party payer as deemed appropriate by the hospital.


Obviously, inherent in this discussion is my belief that any PACS worth investigating is one that offers an open architecture. In other words it must be vendor-neutral. It must be able to easily communicate with whatever systems are either present in the cath lab, or are to be brought into the cath lab at a later date. It must be able to communicate with the overall hospital information system as well. This allows you to have a system as described above. The technology is moving and evolving in a fast and furious manner. My advice is to do your homework on any system and do not to rush into purchasing a system. This will pay off in the end.

Editor’s Note: Dr. Breall serves on the Editorial Advisory Board of Diagnostic and Invasive Cardiology. He is a professor of clinical medicine, director of the cardiac catheterization laboratories and head of interventional cardiology for Indiana University, Krannert Institute of Cardiology. He is also medical director of the cardiac catheterization laboratories for Clarian Health Partners in Indianapolis. He recently researched and purchased a cardio PACS for one of his facilities.


Cardio PACS Not Just for Pictures Anymore

Several vendors explained recent trends in cardiac PACS during the Radiological Society of North America (RSNA) annual meeting Nov. 29 – Dec. 3 in Chicago. Industry experts from Siemens, INFINITT, McKesson, AGFA, Visage, Thinking Systems, BRIT, FUJI/ProSolv, Carestream, and ScImage all agreed on the following points:

More Than Pictures

“People will still say ‘I want a cardio PACS,’ but what they really want is the whole package,” said Robert Baumgartner, RN, product marketing director for McKesson’s medical imaging group.

Vendors say it is no longer good enough to just store and retrieve an image. As cardiac PACS evolve, the lines are increasingly blurred for what were previously self-contained IT systems for imaging, advanced visualization, cardiac image reports, echo image management, ECG management, inventory control, billing, and cath lab and hemodynamic reporting.

Vendors said new integrations in 2010 will include inventory control systems, computerized physician order entry (CPOE) and cardiac department scheduling.

“The trend is definitely moving toward a single solution, consolidated PACS,” said Lisa Braunreuther, global business manager, AGFA cardiology IT. She said the goal is to take isolated islands of information scattered between various software systems and consolidate it into one place.

“I see a lot of confusion in the cardio space,” said Chris Carr, marketing manager for ScImage. “There are separate systems for electrophysiology, cath lab, ECG, imaging, and vascular, and all these specialties are starting to see there is a benefit to consolidating their PACS and reporting systems.”

Cardio PACS are bridging the gap between these specialties and separate imaging and diagnostic modalities. “Cardiology is putting its people under a PACS administrator,” said Karen Boltich, RTR, RDMS, RDCS, RVT, senior cardiovascular product line manager for FUJIFILM Medical Systems USA.

Workflow Efficiency

Improvements to increase efficiency are a key trend, Baumgartner said. Structured reporting can help auto complete final reports. Structured reports also allow data to be mined for clinical information used for registries or comparative effectiveness studies. He said these time-saving features are part of the physician “buy-in” for these systems.

Vendors are also improving efficiency by offering more customized report templates and how images are displayed, sometimes down to individual user preferences.


Vendors say connectivity is rapidly becoming the No. 1 end-user request – they want to be able to network the software and devices they prefer. This is easier said than done, and it is not enough to simply have HL7 or DICOM based systems. Several PACS vendors said they are working closely with industry partners to increase interoperability with “vendor-neutral” and “open-architecture” systems. They are also partnering to take advantage of best-of-breed software for advanced visualization and cath lab analysis modules.

Remote Access

Many cardio PACS are now offered as Web-based solutions that can be accessed anywhere without the use of dedicated workstations. Since many cardiologists work with multiple hospitals or have separate office locations, they want remote access to DICOM images, Braunreuther said. They don’t want reference images, they want full, high-resolution images and the ability to complete and file full reports, she said.

New features being rolled out include DICOM file sharing that can be e-mailed directly to a referring physicians, instead of overnighting hard copies or CDs. New viewers also allow PACS images to be launched directly from a patient’s EMR.

  • Most cath lab PACS/cardiovascular information systems integrate data from the hemodynamic monitoring system to create a more complete patient record.