Just pretend for a moment that you’ve been charged with implementing a brand new picture archiving and communications system at your facility. If you’re among those few in radiology who have already conquered this task, pretend anyway — especially since your new slate is blank and you have the advantage of hindsight. (And you’re probably in need of a serious upgrade or overhaul.)

And pretend again that before embarking on this challenge you may contemplate, for however long you need, the task before you. You can take the time to look at the forest through the trees and “see” what your department, center or facility really needs to enter the digital realm — as well as the benefits of boosting patient throughput, bettering patient care, improving workflow, tightening cost controls, competing more effectively and integrating images toward a robust electronic patient record.

Now back to reality. Even this jest at a mental exercise rears thoughts of many things that must get done but aren’t, right? But how seldom do we allow ourselves the time to look around to get a better grasp on our needs.

Having recently spent some time at the (terrific) Society for Computer Applications in Radiology’s 20th annual meeting, PACS is high on my mind — and from the vibes and conversations of the 2,500 or so attendees who made the journey to Boston too, it is clearly a priority. Maybe it isn’t tomorrow’s task, but it is on the strategic plan.

If you’re on the move toward PACS, start educating yourself with everything you can find — articles, conversations with peers, symposia, the Internet, friendly and knowledgeable consultants. With PACS, everything is connected. You need to be sure that current and planned modalities and technology will integrate and interface well, even the 16-slice CT (100 MB per study), digital mammography systems (72 MB per study) and peripheral vascular angio (450 MB per study!) that will flood your already taxed network and storage option with many more images. Departmental operations and enterprise IT environments are crucial as are HIS/RIS interfacing, data archival, DICOM compatibility, and integrated image storage, retrieval and distribution and workstations. Think about how each area of the department and facility — such as the ER, ICU and referring physicians — will be affected. How will you handle QA/QC? Do you need new lighting for workstations as opposed to lightboxes? Can you assure reading everywhere it is currently conducted? (You’ll be amazed at the number of locations.) How much film will you still use? How much training will your staff require? How will your radiologists and techs interact in this new environment, as well as physicians from other specialties? How will this new technology change your “culture”?

The road to PACS starts by mapping workflow — clinical, technical, operational and financial. Experts say 30 people “touch” an image in the clinical workflow alone.

So take time to stop, and think. And build in some time to plan with your department and facility.

Mary C. Tierney, Editor