"PACS have changed because there were new imaging techniques and new clinical questions that came that have been driving the need for PACS to embrace new IT technologies. We all know what they are: we are talking about the thin client instead of the thick client, client server architectures, web-enabled viewing and virtualization like VMware," says Primo. "These are the technologies that came to help handle these massive datasets."

Developers are getting more creative with image viewing, using applications like Microsoft Silverlight which is also used by the popular movie rental company Netflix for the purpose of streaming film, and more and more of the architecture is disappearing into a "cloud" of open, web-based applications and services.





"Basically, technology is helping to improve efficiency and shorten waiting times for loading images and making sure the viewing doesn't have to be linked to a specific physical place," says Primo. "Once you are web-enabled, the viewing can basically happen from wherever you are on the web, as long as you have qualified diagnostic viewing technology."

Even the hardware is getting to be more integrated. In the beginning, everything was proprietary, but now there is a trend toward applications that can run on common-off-the shelf hardware.

Migrating data

If you're cloud computing or using zero or thin client architecture, keep in mind, there is still something more down-to-earth happening somewhere.

"For all the words you'll hear in the literature and the industry about having a web-based solution, you still have to fall back on a set of standards on the back-end servers," says Kulbago. "We have a cloud technology where we host everything. We can do something that's sort of a no-hardware footprint, and we just put everything in the cloud, but we still have software that has interfaces that make the whole workflow of imaging work. There is always something sitting on the backend that requires care and feeding and configuration and maintenance."

All the pieces of the puzzle are getting to be more streamlined, but that's not to say there aren't still some glitches. Maybe there are some integration issues involving one system, perhaps between a PACS or RIS, and they aren't communicating so well. "All of a sudden, you've got two web-based solutions that can't work together because there were other components that needed to be installed," says Kulbago. "When the rubber hit the road, you either got lucky or you didn't."

More Industry Reports