The Successful Usage of the DICOM Images Exchange System (ePACS) in the Czech Republic
03 September 2019
13 December 2019
05 February 2020 (online)
Background The picture archiving and communication system (PACS) has already replaced classic hard copy film technology. With new functions of PACS under consideration, attention turns to the sharing of medical images between different institutions. The Czech Republic is one of the few countries using a nation-wide medical images exchange system known as ePACS. It is based on dedicated hardware and one central router, although theoretical models tend to prefer cloud-based sharing.
Objective Despite its simple design and lack of advanced features, this system has successively evolved into a widely used tool. The aim of this article is to offer an overview of its use and functions and to show that even a simple system can be widely used.
Methods Using data from the producer of ePACS (the ICZ company) and from other sources, the system was described and data about its performance have been obtained.
Results Every acute-care hospital (140) and about a quarter of outpatient facilities (105) in the Czech Republic are now equipped with ePACS and are therefore able to share medical images. The number of studies transmitted rises every year, from 12,000 in 2008 to more than 640,000 in 2018, which is approximately 4% of all studies produced. The system was primarily designed and is used to share images between acute-care hospitals but a very special usage has also evolved, as it is employed in a teleradiology service with private enterprises too.
Conclusion ePACS is expanding in the Czech Republic despite having only limited functions and despite its principle that simply copies a classic workflow when sending studies on Compact Discs. Although other systems for image sharing might be more advanced, ePACS brings to the Czech health care system the capability to exchange medical images on a national level.
Protection of Human and Animal Subjects
Human and/or animal subjects were not included in the project.
- 1 Huang HK. Short history of PACS. Part I: USA. Eur J Radiol 2011; 78 (02) 163-176
- 2 Lemke HU. Short history of PACS (part II: Europe). Eur J Radiol 2011; 78 (02) 177-183
- 3 Song JW, Mango MC, Museru LM. , et al. Successful Implementation of a PACS in Tanzania. J Am Coll Radiol 2017; 14 (05) 710-713
- 4 Schooley B, Hikmet N, Atilgan E. Health IT Maturity and Hospital Quality: Effects of PACS Automation and Integration Levels on U.S. Hospital Performance. Published at: 2016 International Conference on Computational Science and Computational Intelligence (CSCI). Las Vegas, NV: IEEE; 2016: 45-50
- 5 Siegel E, Reiner B. Work flow redesign: the key to success when using PACS. AJR Am J Roentgenol 2002; 178 (03) 563-566
- 6 Hise JH. And then came the PACS. JAMA 2017; 318 (04) 331
- 7 Faggioni L, Neri E, Castellana C, Caramella D, Bartolozzi C. The future of PACS in healthcare enterprises. Eur J Radiol 2011; 78 (02) 253-258
- 8 Sodickson A, Opraseuth J, Ledbetter S. Outside imaging in emergency department transfer patients: CD import reduces rates of subsequent imaging utilization. Radiology 2011; 260 (02) 408-413
- 9 Lu MT, Tellis WM, Fidelman N, Qayyum A, Avrin DE. Reducing the rate of repeat imaging: import of outside images to PACS. AJR Am J Roentgenol 2012; 198 (03) 628-634
- 10 Flanagan PT, Relyea-Chew A, Gross JA, Gunn ML. Using the internet for image transfer in a regional trauma network: effect on CT repeat rate, cost, and radiation exposure. J Am Coll Radiol 2012; 9 (09) 648-656
- 11 Erickson BJ. Experience with importation of electronic images into the medical record from physical media. J Digit Imaging 2011; 24 (04) 694-699
- 12 Flanders AE. Medical image and data sharing: are we there yet?. Radiographics 2009; 29 (05) 1247-1251
- 13 Al-Hajeri M, Clarke M. Future trends in Picture Archiving and Communication System (PACS). Published at: 2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). Milan: IEEE; 2015: 6844-6847 ; Doi: 10.1109/EMBC.2015.7319965
- 14 The Royal College of Radiologists. IT Guidance: National Strategy for Radiology Image and Report Sharing. London, United Kingdom: The Royal College of Radiologist; 2009
- 15 Public health and promoting interoperability programs (formerly, known as electronic health records meaningful use). Available at: https://www.cdc.gov/ehrmeaningfuluse/introduction.html . Accessed January 16, 2020
- 16 Parikh A, Mehta N. Web-based PACS and EHR system. Published at: Proc. SPIE 9418, Medical Imaging 2015: PACS and Imaging Informatics: Next Generation and Innovations. Orlando, FL: 2015: 94180A ; Doi: https://doi.org/10.1117/12.2081975
- 17 Kharat AT, Safvi A, Thind S, Singh A. Cloud computing for radiologists. Indian J Radiol Imaging 2012; 22 (03) 150-154
- 18 Silva LAB, Costa C, Oliveira JL. A PACS archive architecture supported on cloud services. Int J CARS 2012; 7 (03) 349-358
- 19 Mendelson DS, Bak PRG, Menschik E, Siegel E. Informatics in radiology: image exchange: IHE and the evolution of image sharing. Radiographics 2008; 28 (07) 1817-1833
- 20 Fernandez-Bayó J. IHE profiles applied to regional PACS. Eur J Radiol 2011; 78 (02) 250-252
- 21 Silva LAB, Costa C, Oliveira JL. DICOM relay over the cloud. Int J CARS 2013; 8 (03) 323-333
- 22 Ge Y, Ahn DK, Unde B, Gage HD, Carr JJ. Patient-controlled sharing of medical imaging data across unaffiliated healthcare organizations. J Am Med Inform Assoc 2013; 20 (01) 157-163
- 23 Weisser G, Walz M, Ruggiero S. , et al. Standardization of teleradiology using Dicom e-mail: recommendations of the German Radiology Society. Eur Radiol 2006; 16 (03) 753-758
- 24 Kanagaraj G, Sumathi AC. Proposal of an open-source Cloud computing system for exchanging medical images of a Hospital Information System. Published at: 3rd International Conference on Trendz in Information Sciences & Computing (TISC2011). Chennai, India: IEEE; 2011: 144-149 ; Doi: 10.1109/TISC.2011.6169102
- 25 Mendelson DS, Erickson BJ, Choy G. Image sharing: evolving solutions in the age of interoperability. J Am Coll Radiol 2014; 11 (12, Pt B): 1260-1269
- 26 Ross P, Sepper R, Pohjonen H. Cross-border teleradiology-experience from two international teleradiology projects. Eur J Radiol 2010; 73 (01) 20-25
- 27 Kondoh H, Teramoto K, Kawai T, Mochida M, Nishimura M. Development of the regional EPR and PACS sharing system on the infrastructure of cloud computing technology controlled by patient identifier cross reference manager. Stud Health Technol Inform 2013; 192: 1073-1073
- 28 Ma W, Sartipi K, Sharghi H, Koff D, Bak P. OpenID connect as a security service in Cloud-based diagnostic imaging systems. Published at: Proc. SPIE 9418, Medical Imaging 2015: PACS and Imaging Informatics: Next Generation and Innovations. Orlando, FL: 2015: 94180J ; Doi: https://doi.org/10.1117/12.2082519
- 29 O' Reilly MF, Breathnach OP, Mohamed KM, Sheehan EC. The “National Integrated Medical Imaging System” [NIMIS]—friend, not nimesis!. Ir J Med Sci (1971) 2018; 188 (02) 365-369
- 30 ePACS 2019. Available at: http://www.epacs.cz/epacs/faces/pages/index.xhtml . Accessed February 6, 2019
- 31 ePACS: medical facilities. 2019 . Available at: http://www.epacs.cz/epacs/faces/pages/hcu-list.xhtml;jsessionid=116fm64ah28mz1ncdqklif5ypo . Accessed February 10, 2019
- 32 Vainiomäki S, Aalto A-M, Lääveri T. , et al. Better usability and technical stability could lead to better work-related well-being among physicians. Appl Clin Inform 2017; 8 (04) 1057-1067
- 33 Purkayastha S, Gichoya JW, Addepally SA. Implementation of a single sign-on system between practice, research and learning systems. Appl Clin Inform 2017; 8 (01) 306-312
- 34 Institute of Health Information and Statistics. Health statistics yearbook of the Czech Republic 2017. Available at: http://www.uzis.cz/publikace/zdravotnicka-rocenka-ceske-republiky-2017 . Accessed January 16, 2020
- 35 Radiology and imaging methods. Available at: https://www.uzis.cz/category/tematicke-rady/zdravotnicka-statistika/radiologie-zobrazovaci-metody . Accessed January 16, 2020