Organizational dimension 1: strategy and policy
ML 3	(Q1) Short- and long-term (investment) plans concerning PACS are aligned between radiology and other departments/wards
	(Q2) Within the hospital emphasis is on direct display of images from the archive instead of required storage capacity
ML 4	(Q1) Integration of PACS with the electronic patient record is an important strategic objective of the hospital
	(Q2) The basic principle with the usage of PACS is primary interpretation by radiologists using uncompressed (highest resolution) images from all modalities
ML 5	(Q1) The external environment is consciously inquired for new developments and products to optimize PACS functionality
	(Q2) Strategic and operational (multi-year) plans contain impact and opportunities for chain partners with respect to PACS
Organizational dimension 2: organization and processes
ML 3	(Q1) The hospital actively improves its service level using quality standards and measures for digital PACS workflow
	(Q2) All departments of the hospital enterprise can request and plan radiology exams using an electronic order-entry system (that is integrated with PACS/RIS)
ML 4	(Q1) All diagnostic images from other departments (including cardiology, nuclear medicine, endoscopy, gynecology, pathology) are stored into one central PACS archive
	(Q2) At each dedicated workspace radiologists have all required patient information (e.g., lab results, reports, previous studies, etc.) and integrated 2D/3D reconstruction tools
ML 5	(Q1) The hospital exchanges PACS data real time with chain partners using standard exchange protocols (cross-enterprise document sharing/XDS-i) if necessary
	(Q2) Every image (including old images for comparison) is instantly available on any workstation in the hospital for every user at any time
Organizational dimension 3: monitoring and control
ML 3	(Q1) Prognosis concerning the amount of radiology exams and required PACS storage capacity are performed on a recurrent basis
	(Q2) The hospital measures and monitors both financial and non-financial PACS data (e.g., amount of exams, quality, patient satisfaction, productivity, etc.)
ML 4	(Q1) Service level agreements with PACS vendors (for instance concerning maintenance, functionality, costs, and storage capacity) are periodically evaluated
	(Q2) PACS generates comprehensive management information that is always on time
ML 5	(Q1) The hospital confronts PACS vendors if service level agreements are not (or partially) achieved
	(Q2) The hospital has an accurate overview of the contribution of PACS to overall cost prizes per radiology exam (for al modalities)
Organizational dimension 4: information technology
ML 3	(Q1) PACS is compatible with current international standards and classifications (Health Level 7 and Digital Imaging and Communication in Medicine)
	(Q2) PACS exchanges information with the radiology information systems and hospital information system without any complications
ML 4	(Q1) The hospital adopts standard “off-the-shelve”—vendor independent—hardware (for archiving solutions) and software for PACS
	(Q2) The impact on PACS storage capacity and requirements prognosed due to upgrades with respect to modalities and/or when new acquisition devices are acquired
ML 5	(Q1) The hospital applies reagent (security)protocols throughout the hospital enterprise in preserving privacy of patient data, PACS data security, and back-up (including preventing a “single point of failure”)
	(Q2) PACS is integral part the hospitals’ electronic patient record
Organizational dimension 5: people and culture
ML 3	(Q1) The hospital actively involves users of PACS with the development of customizable user interfaces
	(Q2) PACS process and procedure knowledge are extensively applied within the hospital by clinicians and technologists
ML 4	(Q1) End-users of PACS affect the decision making process in selecting a specific PACS vendor
	(Q2) End-users affect digital PACS workflow and functionality improvements
ML 5	(Q1) Radiologist are aware of the fact that PACS has the potential to influence the competitive position of the hospital and service delivery toward chain partners
	(Q2) Innovative solutions (e.g., integration of new tools and applications) with PACS are discussed during clinicoradiological meetings

PACS performances (and ID)	Applied answer scale
Clinical impact
Interpretation time (C1): time to process a series of CT exams (defined as the time interval between availability of full data set on screen and finalization)	Likert 1–7 (<5, 5–8, 8–11, 11–14, 14,17, 17–20, >20 min)
Diagnostic accuracy (C2): sufficiency rate for which current radiology workspaces (including viewing monitors) are sufficient for image interpretation	Likert 1–7 (0–20%, 20–40%, 40–60%, 60–70%, 70–80%, 80–90%, 90–100%)
Communication efficacy (C3): PACS contribution toward communication of critical findings and interdepartmental collaboration	Likert 1–7 (no contribution at all–profound contribution)
Patient management contribution (C4): contribution of PACS toward decision making in diagnostic process or treatment(plan) of patient	Likert 1–7 (no contribution at all–profound contribution)
Organizational efficiency
Report turnaround time (O1): sum of time after execution, reporting and availability of imaging exams’ finalized report of CT exams	Likert 1–7 (<2, 2–4, 4–6, 6–8, 8–10, 10–12, >12 h)
Budget ratio (O2): percentage (over)expenditures of allocated PACS budgets	Likert 1–7 (no over expenditure, 0–10%, 10–20%, 20–30%, 30–40%, >40%)
Service outcomes
Patient waiting time (S1): elapsed time between a patients’ arrival at radiology (on appointment) till subsequent beginning of the radiology exam	Likert 1–7 (<5, 5–10, 10–15, 15–20, 20–25, 25–30, >30 min)
Referring physician satisfaction (S2): satisfaction of referring clinicians on availability of imaging data and associated reports	Likert 1–7 (totally not satisfied–totally satisfied)
Patient satisfaction (S3): satisfaction of patients on service delivery	Likert 1–7 (totally not satisfied–totally satisfied)
User satisfaction (S4): user satisfaction on the current user interface and functionality of PACS	Likert 1–7 (totally not satisfied–totally satisfied)
Technical and IS/IT perspective
Average time to display (T1): average time to display of old CT studies (with approximately 400 images) from PACS (with full data loaded on screen)	Likert 1–7 (<10 s, 10–20 s, 20–30 s, 30–60 s, 60 s–5 min, >5 min, sometimes no retrieval)
Average time to display (T2): Average time to display of newly acquired CT studies (with approximately 400 images) from PACS (with full data set of screen)	Likert 1–7 (<5 s, 5–10 s, 10–20 s, 20–30 s, 30–60 s, 60 s–5 min, >5 min)
Display time (T3): each dedicated workstation is capable of displaying uncompressed CT studies—averaging 1,500–2,000 images—without any delay	Likert 1–7 (totally agree–totally not agree)