(Langlois, Le, Vytialingam & Aziz 1999) This usually results in more efficient patient management and better patient outcomes.
The term "picture archiving and communication systems" (PACS) is used to describe the technologies that are eliminating film. Other terms that may reflect the PACS concept more accurately include "the film-less radiology department" and the "all-digital radiology department." The PACS concept is not new and, in fact, dates back to the 1950s, when Albert Jutras, MD, first conceived the idea of teleradiology . (Bronson 1998) The US government led the development of this technology, and the first film-less radiology departments in the United States were at military hospitals and the Veterans Administration Medical Centre in Baltimore. A decade ago, imaging studies performed by the military in the Middle East during Operation Desert Storm were transmitted digitally and interpreted by radiologists stationed in the United States.
When used for radiology services, PACS must have images in digital format, be able to store them, and provide access for interpretation by radiologists and review by other physicians. (Huda & Szeverenyi 1999) Images often can be directly acquired in a digital format, but sometimes they must be converted to such a format. Familiar radiographic studies already available as digital data include computed tomography, magnetic resonance imaging, and ultrasound. In recent years, some traditionally film-based imaging techniques (eg, angiography, fluoroscopy, nuclear radiology) have also moved to digital image acquisition.
One of the largest radiology components to convert to digital data is plain radiographs, such as traditional chest and bone films. Conversion can currently be accomplished through one of three technologies--use of a film digitizer, computed radiography, or digital radiography.
The conventional radiography system involves cassettes, containing film, which are exposed to X-Rays at varying exposure levels. The cassette is fed into a daylight developing processor where the film is removed from the cassette and developed. The radiographers then check this developed image (The Hard copy), and if satisfactory the films are labelled, collated and then pigeon-holed for the clerical staff. The clerical staff retrieve old films for the patient, packet the combined films and manually deliver them to the reporting radiologists.
The digital radiology system employs a cassette; similar to conventional radiography, but that is where the similarity ends. The digital cassette contains a reusable intensifying screen that uses photo-stimulable storage phosphors that can retain a latent image. The cassette is electronically tagged with the patient's information and is then processed in a digitizer. There is an observation monitor by the digitizer for the radiographers to check the image acquired. The image is then sent to the radiographer's workstation when post-processing of the image can be undertaken if required. This may involve adjustment of contrast or labelling of the image or, more usually, nothing at all, due to the software of the system which automatically optimizes the density