Journal of Digital Imaging

, Volume 24, Issue 5, pp 814–822 | Cite as

Radiology IT: Applications Integration vs. Consolidation

  • Peter K. KijewskiEmail author


The question of whether Radiology IT systems should be composed of multiple applications integrated using standard data exchange protocols, such as DICOM and HL7, or implemented using consolidation of applications and systems has been debated for the past 30 years. The adequacy of the former approach has become a burning issue because the demands on Radiology IT systems have increased greatly. We report here on the experience of the Radiology Information Technology (IT) implementation at the Memorial Sloan-Kettering Cancer Center (MSKCC) over the past 11 years; during this time, the weekly image accumulation rate increased from 100,000 to 2,000,000 images. During the implementation period, major difficulties were encountered, largely as a result of the inadequacies of the Radiology IT architecture widely used in the healthcare industry. The approach we chose to correct some of these difficulties has been consolidation of some of the multiple systems and applications. Three examples of systems consolidation are discussed: (1) converting a dual-tier image storage system to a single tier, (2) consolidation of Mammography reading into PACS, and (3) enabling 3D visualization and analysis on the PACS workstation. Nevertheless, substantial research and development are needed in order to proceed with more extensive systems consolidation and, thus, a more manageable IT installation.


PACS Radiology Information System (RIS) Radiology reporting Digital Imaging and Communications in Medicine (DICOM) Health Level 7 (HL7) Radiology workflow Cost-effectiveness Databases Imaging informatics Radiology workstation 



The author acknowledges the significant contributions of Kate Lynch, MBA, to the implementation of the Radiology IT installation, and the substantial efforts of Nabila Sobhy, MS, in implementing the many data interfaces among applications.


  1. 1.
    Levine B, Mun S, Benson H, Horii S: Assessment of the integration of a HIS/RIS with a PACS. J Digit Imaging 16:133–140, 2003PubMedCrossRefGoogle Scholar
  2. 2.
    De Azevedo-Marques P, Carita E, Benedicto A, Sanches P: Integrating RIS/PACS: the web-based solution at University Hospital of Ribeirao Preto, Brazil. J Digit Imaging 17:226–233, 2004PubMedCrossRefGoogle Scholar
  3. 3.
    HL7. Available at: Accessed 24 April 2010.
  4. 4.
    Clayton P, Narus S, Huff S, Pryor T, Haug P, Larkin T, Matney S, Evans R, Rocha B, Bowes W, Holston F, Gundersen M: Building a comprehensive clinical information system from components: the approach at Intermountain Health Care. Methods Inf Med 42:1–7, 2003PubMedGoogle Scholar
  5. 5.
    Duerinckx A: Introduction and the PACS ′82 panel discussions. J Digit Imaging 16:32–68, 2003PubMedCrossRefGoogle Scholar
  6. 6.
    DICOM. Available at: Accessed 24 April 2010.
  7. 7.
    Taira R, Stewart B, Sinha U: PACS database architecture and design. Comput Med Imaging Graph 1:171–176, 1991CrossRefGoogle Scholar
  8. 8.
    W3C. Available at: Accessed 24 April 2010.
  9. 9.
    Meenan C, Daly B, Toland C, Nagy P: Use of a thin-section archive and enterprise 3D software for long-term storage of thin slice CT data sets. J Digit Imaging 19:84–88, 2006PubMedCrossRefGoogle Scholar
  10. 10.
    Van Ooijen P, Broekema A, Oudkerk M: Use of a thin-section archive and enterprise 3-dimensional software for long-term storage of thin-slice CT data sets—a reviewers’ response. J Digit Imaging 21:188–192, 2008PubMedCrossRefGoogle Scholar
  11. 11.
    Ewald T, Wolk K: A flexible model for data integration. Archit J 8:6–9, 2006Google Scholar
  12. 12.
    Prior F, Nabijee K: Information management for data retrieval in a picture archive and communication system. J Digit Imaging 2:170–176, 1989PubMedCrossRefGoogle Scholar
  13. 13.
    Wong S, Huang H: Design methods and architectural issues of integrated medical image data base systems. Comput Med Imaging Graph 20:285–299, 1996PubMedCrossRefGoogle Scholar
  14. 14.
    Andriole K, Avrin D, Yin L, Gould R, Arenson R: PACS databases and enrichment of the folder manager concept. J Digit Imaging 13:3–12, 2000PubMedCrossRefGoogle Scholar
  15. 15.
    Luo Y, Jiang L, Zhuang T: A grid-based model for integration of distributed medical databases. J Digit Imaging 22:579–588, 2009PubMedCrossRefGoogle Scholar
  16. 16.
    Clark K, Melson D, Moore S, Blaine J, Moulton R, Clayton W, Peterson C, Vendt B: Tools for managing image flow in the modality to clinical-image-review chain. J Digit Imaging 16:310–317, 2003PubMedCrossRefGoogle Scholar
  17. 17.
    Boonn W, Langlotz C: Radiologist use of and perceived need for patient data access. J Digit Imaging 22:357–362, 2009PubMedCrossRefGoogle Scholar
  18. 18.
    Ralston M, Coleman R: Sharing of a single picture archiving and communications system among disparate institutions: barriers to success. J Digit Imaging 15:3–6, 2002PubMedCrossRefGoogle Scholar

Copyright information

© Society for Imaging Informatics in Medicine 2010

Authors and Affiliations

  1. 1.Department of Medical Physics and Department of RadiologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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