Introduction to the Paper by H. U. Lemke et al, “Applications of Picture Processing, Image Analysis and Computer Graphics Techniques to Cranial CT Scans”

PACS IN GERMANY

COST CONSIDERATIONS were probably the main reason why picture archiving and communications system (PACS) realizations in Germany were not started before the mid 1980s, although a PACS concept was outlined in a Technical Report at the Technical University Berlin as early as March 1979.¹ This concept incorporated the multimedia electronic Medical Record (MR), Medical Workstations (MWS), and local and global network communication. The MWS was assumed to be part of a distributed ring-based computing network.²

The processing facilities of such a distributed MWS system included word processing, signal and image processing and analysis, computer graphics, and communications. Based on the Cambridge local area ring network, the concept also included appropriate filing and global network facilities. In 1986, it provided the base of a PACS project specification³ and subsequent implementation as part of the BERKOM project.⁴

The BERKOM project was initiated in that year by the German PTT and the Senate of Berlin. Management responsibility for the project was given to Deutsche Telepost Consulting (DETECON). BERKOM served as a test bed for future developments of ATM-based broadband communication services, terminal devices, and applications. This aim was shared by a spectrum of project partners comprising some 40 scientific institutions, 17 industrial companies, and 5 user institutions. The budget made available for the project totaled 110 Million DM (55 million Euros) for services, applications, and end-systems, as well as 65 million DM (33 million Euros) for the network, gateways, and adapter cards. An additional 50% project financing was derived from industry participation.

Siemens AG took an active part in BERKOM, with the first official commissioning of an ATM exchange. In addition to 64-kbit/s services over fiberoptic subscriber lines, several motion-video services with various fixed and variable bit rates were offered via flexible subscriber accesses. This made possible the coupling of PABXs, the intermeshing of local area networks, and the realization of special networks—e.g., for medical applications (such as PACS) and the print media (joint editing).

Within the BERKOM project, special attention was given to end-systems, particularly workstation development with multimedia communication capabilities. Special emphasis was also given to medical applications. Three medical image communication projects in various health care settings were carried out; one example was the Radiological Data Communication System RADCOM.⁵ The aim of this project was to test a fast ISDN-B facility (140 Mbits/s) as the communication facility between PAC systems installed in two different departments of the Berlin Rudolf Virchow University Hospital at Charlottenburg and Wedding. Medical teleconferencing between these two sites, which were more than 10 km apart, was carried out with varying degrees of success.

Taking the first 20 years of European and U.S. PACS experience into account, there is also in Europe a move toward more strategic planning, rather than following a situational solution-seeking approach. In central Europe, this is exemplified by a reference project in Saxony in Germany (SaxTeleMed).⁶ This regional PACS and telemedicine project is aimed at improving health care in Saxony and providing guidelines to other hospitals in this state (and perhaps other federal states in Germany and elsewhere). Seven major hospitals and many other connecting health care institutions and physician practices are being drawn into the digital age. Focusing with the first investment plan of DM 28 million (14 million Euros) between 1999 and 2001 on PACS and telemedicine, a very rigorous request for proposal (RFP) procedure for vendor selection has been developed.⁷ It includes extensive workstation evaluations for radiology and clinical applications. Some of the RFP methodologies developed have since been used for PACS planning for other European hospital sites, starting with Zurich University Hospital. External pre-PACS and post-PACS evaluations are in progress based on the Marburg Model. Other strategic features of the SaxTeleMed project include the introduction of the health professional card (HPC) and the first studies on the feasibility of a (virtual) electronic patient record (EPR).