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| PACS System Administrator: An Excellent Job Opportunity for 'Geeky' |
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| Contributed by Herman Oosterwijk |
| Published Jun 15, 2004 |
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When talking with an administrator about people with the best qualifications to support the PACS systems in radiology, he told me that he had his best experience with hiring "geeky" techs, meaning RT's that have a knack for computers. I tend to agree with him: It would be very hard to teach someone, with merely an IT background, the ins and outs of image quality, how to map certain procedure codes to selections on a user interface, and workflow issues. On the other hand, a “geeky” tech, i.e. someone who is not afraid of computers, can take some classes and quickly learn the basics of a PACS to get by. PACS training is also provided by several institutions and organizations, either on- line or as a training seminar. Noting that PACS is a fast growing area, only 20-30 percent of US institutions have a PACS system right now, while many of them that are “left behind” will be planning to purchase a system soon, creating are plenty of job opportunities in this area.
What does a PACS System Administrator (SA) do anyway? Here are the most important activities:
· Project Management
Comprehensive coordination of a new PACS installation is a big undertaking. Understanding the workflow directly impacts successful project management. Creating a map of information flow, and thoroughly understanding the interaction, as well as information storage and retrieval will help define system placement, configuration,
routing, testing, and maintenance. Mapping would commence with collecting the patient information, go through the examination process, and end with image viewing, storage, and diagnostic report generation. Post- installation management includes software upgrades, adding new modalities, workstations, interfaces, or users to the system. Successful management of these jobs involves anticipating cause and effect relationships. For example, if a software upgrade is scheduled at noon on Sunday, will all users be trained on the new features within an acceptable timeframe?
· Training
Training is important for the smooth daily operations and management of a PACS system. SA’s will work with vendors to train users on new releases and upgrades, as well as develop materials and curriculums for the staff.
· Support
Support follows training. Hardware and software issues, operator questions and errors, system bugs or failures, and emergency situations all require hands-on, immediate support. The SA must provide access to an “on-call” system in the event of a support need. Most support activities fall under the job description category of system maintenance; the second key area of responsibility of a PACS SA.
· Managing Software and Hardware Configurations
Documenting, and physically mapping the system prevents potential compatibility issues whenever making a change to the system i.e. adding a new CT, or upgrading Ultrasound software. Recording new and upgrade software releases goes hand- in-hand with this process. It’s important to know which devices run with which software for future upgrade purposes. Lastly, hardware configuration, and changes should be documented regularly.
· Configuration Control Board
The PACS system works in tandem with the Radiology Information System (RIS), and acquisition modalities. As such, it is important that the people managing these systems and devices communicate regularly. These groups of people make up a “configuration control board”, and are responsible for planning events that will collectively affect their system(s), or device(s). They discuss the potential impact of any new addition or change to their system (or device), and how it may result in a functionality issue with another system (or device).
· Preventive Maintenance
Preventive maintenance drastically reduces problems and issues with the PACS system. Several components comprise preventive maintenance, and can be managed with a simple checklist. Monitoring image quality among modalities, workstations, and printers; checking unresolved study queues; making sure the network is up and running; and checking critical processes such as the database, are functions commonly found on a preventive maintenance checklist.
· General System Maintenance
This task can be described as cataloguing users, and assigning them appropriate security access. It goes hand- in-hand with the Health Insurance Probability and Accountability Act (HIPAA), which deals with patient privacy and security. Hospital employees are provided with varying degrees of access based upon their authorization level.
· Modality Acceptance Testing
This activity is performed with every new piece of equipment added to the system. The best way to execute acceptance testing is to maintain a “shadow system” which reflects the same characteristics as the main PACS system, but operates in a “dummy” mode.
· Image Quality
Proper acquisition of an image is the first step in achieving good image quality. The skill level of an RT, whether they over- or under-expose a patient, impacts how the image appears. The patient, unbeknownst to them, also affects image quality. Movement during an exam can contribute to “fuzziness” of an image. It is critical to be able to identify whether a “noisy” image represents a malady in the bone, tissue or organ, or if it is related to a quality issue. A noisy image could very well be caused by under-exposing a patient, or an image processing error. When troubleshooting an image quality issue, a PACS SA must consider all of these factors.
· Data Integrity
This term refers to the information that is typically stored in the “image header”. When correctly combined, an image properly shows the corresponding patient demographics on the viewing system, and allows for unambiguous storage and retrieval. When this fails to happen, and some element is missing - usually some part of the patient information, it results in what most users refer to as a “broken study”. A broken study is when an image or set of images is not properly identified. Broken studies must be resolved or placed in a temporary folder, or holding area. Otherwise, a queue forms at the PACS gateway and/or archive, and prevents images from being available for physician viewing. It is the SA’s job to implement a process to handle broken studies, and manage problems associated with them.
· Image Communication
Digital images can be transferred from a hospital to a doctor’s home using compression. Common types of compression include lossy, in which the image may lose some of it’s detail, and lossless which maintains the integrity of the image. Managing image quality through this process is important, and if a problem occurs, it needs to be determined whether it lies with the compression, or the image acquisition. The ability to determine the root of the problem is essential for a PACS SA.
· Manage Off-line Storage
Short-, mid- and long-term storage solutions, e.g. to archive images that are a few months old for immediate access, up to a few years old for access within minutes, are an essential part of the PACS system. In case an institution decides to have certain studies off- line, the SA typically “mounts” the specific media on a reader depending on whether the images have to be used as comparison for a new study. The challenging work of a PACS System Administrator has numerous and varied tasks. A PACS SA is often someone with interdisciplinary skills, the ability to multi-task, be a forward thinker, and handle crisis management well. It requires clinical, technical, training and people skills, a fun and challenging job. |
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