In the world of medical imaging, picture archiving and communication systems (PACS) are computers or networks dedicated to the storage, retrieval, distribution and presentation of images. Typically PACS handles the gamut of medical imaging instruments, including magnetic resonance imaging (MRIs), which uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures; positron emission tomography (PET) scans, which accurately image the cellular function of the human body, and computed tomography (CT) scans, which uses special x-ray equipment to produce multiple images or pictures of the inside of the body and a computer to join them together in cross-sectional views of the area being studied.
A PACS system usually includes a state-of-the-art radiology information system enabling images and data to be delivered to physicians anywhere in the world with access to a high speed broadband Internet connection. As the medium for medical imaging becomes more sophisticated, a PACS system is necessary to take full advantage of the higher level diagnostic studies. Essentially, because the technological advances in MR, CT and PET imaging are so great,
traditional "films" no longer suffice for an accurate patient study.
Translation: The radiology equipment in health care facilities has become so high-tech, doctors now need super-fancy machines to read the results. At least in theory, patients now get a quicker, more accurate diagnosis. Plus, a more precise diagnostic image means the need for less images overall. While concern about the over-utilization of high-end imaging equipment has resulted in recent legislation designed to ensure health care facilities are properly trained to utilize these highly energetic imaging systems, nothing really beats a good old fashioned 64 slice CT scan (the x-ray tube within this scanner completes a 360 degree rotation in 0.4 seconds creating 64, 0.5 mm slices) when the medical need is there.
On the environmental front, PACS means the elimination of film, a darkroom and hazardous chemicals. A typical medical X-ray film consists of a transparent base coated on at least one side with a laminar grain silver halide emulsion and a separate hydrophilic colloid layer containing a developing agent for silver halide in an amount corresponding to at least 0.5 moles per mole of the silver coated on that side of the base. In a vacuum, the elimination of this process altogether probably can't hurt the environment. In return, however, a PACS system does come with a lot of high-tech gadgets that consume a fair share of energy, such as diagnostic workstations, multiple-mega pixel color or grey scale LCD monitors, modality inputs, image gateway software, hard drive back up, external CD burner, and a massive image archive.
So is less more, or is it less, in this case? There's no clear answer on the medical technology front, but perhaps the closest analogy for comparison is the battle between the 35 mm camera and the digital camera. As just one example, the introduction of the digital camera caused in the methylene chloride release from Kodak's plant in Rochester, N.Y., to fall from 3,900 tons in 1987 to 272 tons in 2005. There is also less of a demand for cowhide and bones, the materials used to make the gelatin to hold film's photosensitive silver-halide crystals in suspension. And the silver used in photographic materials was said to be more toxic to water organisms than mercury, according to the Swedish Environmental Board. By 2006, 90 percent of all cameras sold in Sweden were digital, and more digital photography means that there is less developing of conventional silver-halide film. In fact, the SED claimed that silver levels dropped by more than half between 2001 and 2006 in the waters of the Stockholm archipelago.
But even digital cameras come with a price, and it's usually a computer, a photo printer, a need for more storage, additional batteries, and the ongoing "keeping up with the Joneses" battle over the mega pixels. So we may not use toxic film, but we take digital pictures without giving any thought to the possibility, again, that less may be more.
Technology will continue to advance and further complicate this discussion. Although a CT may cost in excess of $1 million, and a PACS system an additional $400,000, the digital camera industry is certainly not anemic given the place it has in everyday lives. Hospitals, doctors, professional photographers and everyday consumers should be mindful that every technological innovation comes with a price. In fact, it may not be possible to properly assess the pros and cons to these decisions in temporal proximity with the purchase. So until technology allows us to see into the future in order to assess the decisions of today, we can only be mindful that nothing is really ever black or white, unless we are talking about the niche market for photographers, and then both 35 mm film and digital cameras hold their own.
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