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PICTURE ARCHIVING AND COMMUNICATION SYSTEMS (PACS) have so far been studied primarily as a tool to address the problems of electronic radiology. Certainly the trends toward digital imaging within radiology provide strong economic and medical incentives for the development of medical picture networks, but we believe that the applications for picture networks extend far beyond the field of radiology. Architects, engineers, biologists—practitioners of virtually every academic and commercial pursuit—deal with picture information every day, and increasingly these pictures are finding their way into digital form. We believe that industries and universities of the future will utilize sophisticated workstations serving a variety of scientific and commercial needs, and that these workstations will be linked by wideband networks capable of supporting not only text but high-resolution picture transmission as well.  The technical problems are similar both within and outside the field of radiology. In order to develop an electronic picture network, it is necessary to develop high-performance, low-cost components which will serve each of the three major elements of a PACS—archive, network, and display. The high data rates required for picture transmission will stretch performance requirements far beyond those of a typical local area network, and require state-of-the-art technology for many elements of the system design.  We continue to find that it is difficult to define and develop the basic PACS elements independently or without the application area context. Decisions regarding network configuration, for example, affect design decisions for the organization of a display. A comprehensive approach is required and, consequently, prototype PACS networks serve a useful purpose as a test bed for the evolution and evaluation of system concepts and component design.  Washington University has made a significant committment to the development of a prototype PACS network. Initially, in 1981, modeling experiments were carried out to define the requirements of a picture network suitable for radiology.1 A prototype broadband network was designed, built, and installed in the medical center in 1983. Comprising approximately 1.5 miles of cable, the network served as an experimental laboratory for the transmission of video as well as low- and high-speed digital data.2 In 1984, links were established within the Mallinckrodt Institute of Radiology (MIR is the radiology department of Washington University) between the prototype image management system and the comprehensive patient information system developed at MIR, making it possible, at prototype workstations throughout the department, to retrieve image data stored in a prototype central image archive.3  In 1985, the scope of the prototype broadband network was increased as the Institute for Biomedical Computing at Washington University established an image presentation, analysis, and quantification (IPAQ) facility. The goal of this major project is to provide additional network connectivity supported by a center capable of providing tools and computational assistance required for the processing of medical images.  In 1985, based on earlier PACS work at the medical center, a three-year project was begun to design and develop a campus-wide picture network capable of spanning the University from the medical center campus to the hilltop campus, three miles away. The objective of this fifteen-million-dollar project, undertaken in cooperation with Digital Equipment Corporation, was to develop a state-of-the-art wideband network capable of manipulating and transmitting pictures in addition to symbols and graphs. This picture network will cover all schools and departments of the University and will eventually extend outward into the community served by the University.  Throughout this period of aggressive expansion of PACS research at Washington University, the enduring objective has been to establish a “workbench” for PACS development—to provide the tools, the resources, and the environment where experiments can be carried out to evaluate various alternatives for the design of the components required for network, archive, and display. Our goal at this time is not to build the ideal PACS network, but rather, in an ambitious time frame, to design and construct, in cooperation with industry, a large scale PACS prototype that will serve as a proving ground for picture networks of the future.

PACS Experience as a Motivation for a Campus-wide Picture Network