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| IT or RT: What Is the Best PACS System Administrator Career Path? |
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| Contributed by Herman Oosterwijk |
| Published Sep 1, 2005 |
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 PACS system administrators (SA) are a new breed for which training, certification, and the definition of skill requirements, are still maturing. The professionals that venture into this new exciting role appear to come from two major backgrounds -- with IT training and prior experience, or through the clinical ranks, most having served as a radiologic technologist. The technologists that make the jump to a PACS SA career often have prior experience with digital modalities such as nuclear medicine, CT, MR, or ultrasound.
There have been debates on whether is better to have a IT or clinical background; however, I would argue that there are many PACS SA professionals that perform equally well whose origins are from either area. Therefore, instead of arguing what is the correct background, it makes sense to focus on what the requirements are for doing the job, define what the training needs are, and match them up with the appropriate certification.
 When defining the SA job requirements, it became clear that the first and foremost important item to address is the baseline knowledge that a professional should have to be able to obtain the additional SA skills. It is not the intention to make computer geeks from RT's or clinical experts from IT people.
However, when defining hanging protocols for a radiologist on a workstation, an IT-SA person should know the difference between body parts preferences and viewing codes. Similarly, when discussing a tricky interface issue, a RT-SA person should be able to look over the shoulder of an engineer and understand a DICOM dump.
What are these baseline SA requirements? Let’s start with the technical ones:
Computer Basics
A PACS SA should know where to find the basic hardware components in a computer, what type of interfaces are used for what purpose, and the impact on performance of these components. Regarding the interfaces, configuration parameters such as IP addresses and port numbers need to be understood as well as how to configure them. The major software components such as applications software, drivers, and operating system need to be understood.
Operating System Basics
Here is where people’s opinions seem to diverge. The knowledge of basic DOS or UNIX commands seems a far fetched requirement to some folks. However, there are basic troubleshooting utilities for Windows are only available using DOS-based utilities. In addition, if a PACS vendor uses UNIX or LINUX for its archive or database servers, it is very useful to check the status of certain processes, utilizing command-line utilities, to ensure that everything is running fine.
Database Basics
The same pre-requisites apply to database knowledge: the system administration utilities provided by a PACS vendor may not be always sufficient. I have met several administrators that have written a set of scripts using simple SQL commands to obtain required management information. For example, what if an exam got lost, even when one is sure it was sent to the archive? A direct search and possible fix of the patient records using database commands, going directly into the database, might be required.
Data Representations
Images are encoded as pixels which, in turn, can be encoded in different manners, ranging from the difference between black/white and color to signed and unsigned pixel values. It is not uncommon for interoperability issues to arise because of the varied options applied for pixel encoding. An understanding of these data representations is therefore very useful.
Networking Technology
This is becoming more and more important, particularly because the network is often managed by a separate IT department. Changes to routing tables, often as simple as whether a router setting link is set to duplex, and the performance impact of network issues often cause service and availability problems for a PACS. An SA should be sufficiently knowledgeable about this subject to have a discussion with the IT department and suggest potential causes for PACS network problems. Interoperability issues and basic troubleshooting skills when connecting remote sites, physician offices, homes, and other facilities using wide-area networks (WANs) need to be understood.
Security concepts
Because of HIPAA security and privacy requirements, this is a critical skill set. Virtual private networks (VPNs) are commonly used to connect to the outside world; passwords and login management, depending on the various environments (such as ER vs. OR) need to be in place. Audit trails need to be enabled and made available and workstation locations need to be carefully selected so as not to expose patient information to those that should not have access to it.
If an SA with a clinical background is able to master the skills referenced above, he or she will have a solid footing on which to start learning how to support the PACS and be able to communicate on a similar level with his or her IT peers.
What about the level of clinical expertise that the PACS SA with an IT background would need to know?
- Basic medial terminology: For example, imagine that an order is placed by a physician, ends up in the Worklist for a modality, is ready for selection by a technologist, and its information needs to be copied into the image header information. The meaning of some of the attributes, such as admitting diagnosis, should be known so that potential issues can be resolved.
- Human anatomy: Lumbar and cervical spine images from a CT might have to be sent to different physicians and show up in different work lists. Body part information is used to determine the appropriate hanging protocol. PACS SA’s are instrumental in configuring and supporting this information.
- Imaging basics: The function and physics of the various modalities, such as the nature of the examination and how it is created -- either via X-ray energy or electro-magnetic energy or other means -- impacts an image`s appearance and header information. All modalities in use should be familiar to a PACS SA.
- Operational procedures: The differences between a nuclear medicine study, ultrasound stress test, conventional chest X-ray, and special procedures impact the workflow of a PACS. Characteristics of all these procedures should be known.
- Imaging characteristics: The characteristics of the image itself impact the selection and use of certain PACS components such as archives and viewers. For example, an ultrasound image can contain color-encoded velocity information acquired using Doppler, or can be part of a cine loop, while a mammography image can be many times the size of a nuclear medicine image are characteristics that need to be addressed by a PACS SA.
- Positioning and viewing techniques: In addition to anatomical information, view codes are also important to define hanging protocols. Left/Right indicators are critical to determine location of certain image characteristics.
- QA/QC procedures: Determining where and what QA/QC procedures are taking place in the overall workflow is important. Reject analysis input is often generated and facilitated by PACS SA information.
- Collimation and shuttering: Collimation of X-ray images may make a major difference in the resulting image quality of some exams. This may require shutters to be applied by a software application to eliminate the impact on viewing performance.
- Typical process flow: the flow from an order to report is important for the PACS SA to have so that he or she can actively participate in the process re-engineering effort that is critical for PACS optimization.
- Prior and outside exam handling: The procedures and processes of handling a patient`s prior exam images, especially when converting from film to softcopy, as well as the handling of external films, is important knowledge for the SA to have.
Ramping up to a base level of either clinical or IT skills is critical in establishing a solid foundation for those interested in becoming a PACS SA. As a matter of fact, that is why OTech has established two brand-new classes to address this need: a two day clinical and IT class for PACS professionals, which precedes the regular PACS admin training (see url). These classes are aligned with the PARCA system administration certification requirements (see url) as well, which means that participants in these classes are prepared to be able to pass the certification.
In conclusion, whether or not you have a clinical or IT background; as long as either professionals are elevated to a certain level of base knowledge, they should be able to support the PACS well. Of course, a IT trained individual will probably do better with troubleshooting a computer and a clinical trained individual might be better suited to troubleshoot image quality problems, but either should be able to stand in for the other. In the best possible scenario, you may have the luxury of several people able to support your PACS, in which case this team approach can rely on the strengths of the various individuals.
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