From Digital Revolution to Evolution: Why Radiology PACS Needs a New Wave of Innovation
October 27, 2024
Since the transformative shift from film to digital imaging in radiology, the so-called innovations we’ve seen over the past two decades have, in my opinion, been limited from a clinical standpoint. The opportunities that digital imaging opened were extraordinary, but we failed to fully seize this opportunity and turn it into something truly groundbreaking. I hesitate to classify anything in radiology PACS (Picture Archiving and Communication Systems) as a significant innovation since its introduction to the market. I’d love to be proven wrong and welcome a conversation around this.
The original shift from film-based workflows to digital solutions like PACS had a monumental impact on diagnostic imaging and other clinical specialties across healthcare. It sparked a revolution, encouraging the adoption of innovative methods to improve both clinical and patient outcomes. This groundbreaking technology laid the foundation for meaningful advancements, benefiting patients, clinical organizations, and staff. PACS was a creative, outside-the-box solution that delivered real value, solved critical problems, and contributed to new NEEDS.
When I reflect on what innovation truly means, PACS epitomizes it for me. It was a radical departure from the norm with significant potential for the future of radiology. Innovation is not just about industry disruption or novel inventions; it’s about bringing new concepts to life in practical, impactful ways, enhancing existing solutions, and opening doors to new possibilities.
While much has happened in the last two decades, it hasn’t been as transformative as I anticipated. I was fortunate to be at the forefront of this digital revolution in radiology and healthcare, starting my journey when the first PACS systems were being developed and deployed across U.S. health systems. I was even more privileged to be part of the amazing team that delivered the world’s first web-based PACS system to the market. Since then, I’ve had the opportunity to engage with nearly every facet of the clinical healthcare environment.
What I’ve observed over these years is more advancement in the core technology stack than in clinical workflows or outcomes. The transition from film to digital opened the floodgates for tech stack innovation, but despite this, the lack of equivalent progress in the clinical environment is puzzling. To me, it feels like we've merely ridden the coattails of tech innovation, presenting it as though it were innovation within Radiology PACS itself.
Some might argue that the last two decades have brought significant changes, which it has, but have these changes been truly innovative? Have they embodied the kind of outside-the-box thinking that breaks from established norms? Or have they merely been continuous improvements; logical evolutions that are expected, understood, and routine?
To illustrate this, let’s consider the evolution of cell phones. When they first entered the market, cell phones were futuristic, something out of a sci-fi movie. They were expensive, exclusive, and hard for many to grasp. Yet today, cell phones are indispensable, fundamental to communication, collaboration, and information access. Over the past two decades, we’ve witnessed many innovations in cell phone technology, including:
Portability
Usability
Capabilities
Ease of adoption
Ease of transition
Cell phones started out clunky, with poor reception and high costs. But with innovation, they became smaller and more powerful. First, we made phone calls, then we sent text messages. Then came cameras, apps, and more. These were breakthrough innovations. But in recent years, what we see is mostly evolution; logical enhancements such as:
More storage
Faster processing
Enhanced displays
More cameras
Cell phones, for the most part, have reached their pinnacle of innovation. While we may still see breakthroughs, recent changes have been more evolutionary than revolutionary. People no longer feel the need to upgrade annually because the changes are no longer significant enough to justify the cost. At one-point consumers were upgrading their cell phones every 12 months or less. The average time, as of 2024, for consumers to upgrade their cell phones is 2.67 years. PACS, in my opinion, is much like cell phones. It has evolved, but it hasn’t seen the rate of innovation that it once did. The changes we’ve seen are expected and should have happened years ago, in my opinion.
There are still PACS vendors lagging behind, struggling to upgrade their tech stacks and bring meaningful innovation to the market. This is puzzling after almost every PACS vendor has spent two decades of refinement. So, when we look at PACS, those leading and those lagging, what significant innovations have truly shaped the industry in the last ten years?
Here’s a brief list of where PACS has evolved over the last two decades:
Speed improvements
New radiology reading tools and features such as: Spine Labeling, Rib Labeling and so on.
Improved structured reporting
Enhanced third-party integration with on-prem solutions
Streamlined enterprise viewers
Data management layers capable of handling structured and unstructured data
Virtualization support
Clinical collaboration tools
Improved communication with referring physicians
Patient portals
More accurate dictation
Advanced analytics and reporting
Improved data migrations
Smaller datacenter footprints
Cloud, off-prem hosting support
Simplistic health information and image exchange
Before anyone points to the cloud as an innovation, let me clarify, cloud technology itself was innovative. Moving an application like PACS to the cloud, however, is not innovation; it’s evolution. As previously stated, riding the coattails of tech. The shift to the cloud was inevitable; the question was only when and how fast the market would be ready. Some may also state that AI is an innovation, and in this, I agree - - AI is groundbreaking. However, it faces similar challenges to early cell phones, and adoption has been slower than initially expected.
Distinguishing between evolution and innovation can be challenging, and some might argue that innovation is simply an extension of evolution. I believe innovation is born from evolution, but it requires bold thinking and a departure from the expected.
I challenge you to take a deep dive into radiology PACS and diagnostic imaging over the past decade. Set aside AI for now and think about your PACS solution; whether you’re a vendor or a customer. Has your PACS merely evolved, or has it truly innovated? I suspect many would agree that diagnostic imaging hasn’t seen substantial change over the past ten years or even twenty years for that matter. The PACS market is currently playing a feature-for-feature game, but it doesn’t have to be. There’s an opportunity for incredible innovation in workflows, solutions, and accessibility; innovation that’s yet to be realized. This includes innovation outside of the introduction of AI.
Unlike cell phones, I believe diagnostic imaging is far from reaching its full potential. I think the industry has been in a state of hibernation, with vendors reluctant to pursue new innovations outside a few niche use cases. Eventually, growth will stagnate, and a newcomer will step in and revolutionize diagnostic imaging in ways we haven’t yet imagined.
The potential for innovation in diagnostic imaging is immense. We need to think beyond established norms and address the problems we’ve failed to solve over the past two decades. Only then do I believe; we will see the true innovation of AI in this space be fully understood and realized. Rather than riding the coattails of technology and claiming innovation, lets us use technology to create radiology innovations of the future.
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Jim Conyers