Journal of Digital Imaging

, Volume 8, Issue 4, pp 162–167

Quality assurance and quality control of an intensive care unit picture archiving and communication system

  • Douglas M. Tucker
  • Michael McEachern


Most radiology departments have established quality assurance (QA) and quality control (QC) programs for conventional film-based image management systems. At many institutions, digital image management systems, or picture archiving and communication systems (PACS), are replacing part or all of the film management system. In these situations, it is important to control the quality of the digital images that are produced. The observed frequency of eight types of image-related errors occurring on an image viewing station located in a medical intensive care unit is reported. Images on the viewing station were checked for 12 consecutive weeks. Film images available in the radiology reading room and digital images on the viewing station were compared with a list of completed examinations produced by the radiological information system. Overall, 1,082 patient examinations were encountered. Seventy-six images (7.02% of all images) were observed with errors. In addition, four previously unencountered types of errors were observed in 11 images (1.01% of all images). The majority of the errors are attributed to interfaces either between information systems or between the PACS and the user. It is concluded that QA-QC procedures are necessary for PACS, and that good interfaces, both between information systems and between humans and computer systems, are essential for successful PACS implementations.

Key Words

picture archiving and communication systems (PACS) intensive care unit (ICU) quality control quality assurance 


  1. 1.
    Quality assurance for diagnostic imaging equipment: Recommendations of the National Council on Radiation Protection and Measurements Report 99. Bethesda, MD, National Council on Radiation Protection and Measurements (NCRP), 1988, p 4Google Scholar
  2. 2.
    Quality assurance for diagnostic imaging equipment: Recommendations of the National Council on Radiation Protection and Measurements Report 99. Bethesda, MD, National Council on Radiation Protection and Measurements (NCRP), 1988, p 22Google Scholar
  3. 3.
    Stewart BK, Massoth RJ, Thomas SR: Mini-PACS, in Hendee WR, Trueblood JH (eds): Digital Imaging: Medical Physics Monograph No. 22. Madison, WI, Medical Physics Publishing, 1993, pp 123–156Google Scholar
  4. 4.
    Ravin CE: Initial experience with automatic image transmission to an intensive care unit using picute archiving and communication system technology. J Digit Imaging 3:195–199, 1990CrossRefPubMedGoogle Scholar
  5. 5.
    Witt RM, Cohen MD, Appledorn CR: Initial experience with a radiology imaging network to newborn and intensive care units. J Digit Imaging 4:39–42, 1991PubMedGoogle Scholar
  6. 6.
    DeSimone DN, Kundel HL, Arenson RL, et al: Effect of a digital imaging network on physician behavior in an intensive care unit. Radiology 169:41–44, 1988Google Scholar
  7. 7.
    Gillespy T, Staab EV, Lawrence E: Electronic imaging in a teaching hospital intensive care unit: Evaluation of the clinical review system. J Digit Imaging 3:124–128, 1990PubMedGoogle Scholar
  8. 8.
    Cho PS, Huang HK, Tillish J, et al: Clinical evaluation of a radiological picture archiving and communication system for coronary care unit. AJR 151:823–827, 1988PubMedGoogle Scholar
  9. 9.
    Parsons DM, Kim Y, Haynor DR: Quality-control of cathode-ray tube monitors for medical imaging using a simple photometer. J Digit Imaging 8:10–20, 1995CrossRefPubMedGoogle Scholar
  10. 10.
    Halpern EJ: A test pattern for quality-control of laser scanner and charge-coupled-device film digitizers. J Digit Imaging 8:3–9, 1995CrossRefPubMedGoogle Scholar
  11. 11.
    Marsh DM, Cooney P, Malone JF: An assessment of the variation in image quality with multiformat cameras. Radiat Protection Dosimetey 57:277–280, 1995Google Scholar
  12. 12.
    Freedman M, Steller D, Jafroudl H, Mun SK: Quality control of storage phosphor digital radiography systems. J Digit Imaging 8:67–74, 1995CrossRefPubMedGoogle Scholar
  13. 13.
    Seibert JA, Barnes GT, Gould RG (eds): Specification, Acceptance Testing and Quality Control of Diagnostic X-Ray Imaging Equipment. Woodbury, MA, American Association of Physicists in Medicine, 1994Google Scholar
  14. 14.
    Roehrig H, Yu T, Krupinski E: Image quality control for digital mammographic systems: Initial experience and outlook. J Digit Imaging 8:52–67, 1995CrossRefPubMedGoogle Scholar
  15. 15.
    Tucker DM, Barnes GT, Koehler RE: Picture archiving communication systems in the intensive care unit. Radiology 196:297–304, 1995PubMedGoogle Scholar
  16. 16.
    Wandtke JC: Bedside chest radiography. Radiology 190:1–10, 1994PubMedGoogle Scholar
  17. 17.
    David G, Gregory S: Adding a microcomputer barcode network to a minicomputer-based radiology information system. J Digit Imaging 3:31–33, 1990PubMedCrossRefGoogle Scholar
  18. 18.
    Frank MS, Rowberg AH, Tecotzky R: Integrating a radiology information system with a commercially-available computed radiology apparatus: An example of an interactive gateway, in Boehme JM, Rowberg AH, Wolfman NT (eds): Computer Applications to Assist Radiology. Carlsbad, CA, Symposia Foundation, 1995, pp 587–591Google Scholar
  19. 19.
    Breant CM, Tiara RK, Huang HK: Interfacing aspects between the picture archiving and communication system, radiology information system, and hospital information system. J Digit Imaging 15:88–94, 1993CrossRefGoogle Scholar

Copyright information

© Society for Imaging Informatics in Medicine 1995

Authors and Affiliations

  • Douglas M. Tucker
    • 1
  • Michael McEachern
    • 1
  1. 1.Department of RadiologyUniversity of Alabama, Hospital and ClinicsBirmingham

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