This document discusses teleradiology and picture archiving and communication systems (PACS) in East Africa. It contains the following key points: 1. PACS and teleradiology allow for digital storage, transmission, and access to medical images across remote locations through secure networks. This improves healthcare quality by enabling faster access to patient histories and reports. 2. AKUHN currently provides teleradiology services to Nairobi, Kenya with a turnaround time of 24 hours for regular exams. Images and reports are stored and transmitted via AKUHN's PACS system over the internet. 3. Plans are underway to expand this teleradiology model to six additional diagnostic centers in East

1. Teleradiology: exploiting the opportunities in
PACS (Picture Archiving and Communication
System) in East Africa
By
Dr Muhammad Kashif Mirza
Manager Radiology & Manager PACS Project
AKUHN
kashifmirza.com

2. Summary
• Basics
–PACS
–Teleradiology
• Teleradiology models
–AKUH,K
–AKUH,N

3. References

4. PACS
• A picture archiving and communication
system (PACS) is a medical imaging technology
which provides economical storage of, and
convenient access to, images from multiple
modalities (source machine types).[1]
1- Choplin, R., (1992). Picture archiving and communication systems: an overview. Radiographics January 1992 12:127-129

5. Network
a secured network for the
transmission of patient
information
Archive
archives for the storage and
retrieval of images and reports.
Workstations
for interpreting and reviewing
images

6. Benefits
Electronic images and reports are transmitted
digitally via PACS; this eliminates the need to
manually file, retrieve, or transport film jackets.
– Better Report Turnaround time -> Better Quality Healthcare
– Fats access to old + recent Films -> Better Quality Healthcare
– No Films printing -> Cost Saving + No Film Loss

7. PACS USE
Films
Replacement
Radiology
Workflow
Management
PACS
Remote
Access
Electronic
Linking with
HIS, RIS and
EHR

8. PACS Use
• Films replacement
(Film less environment):
Films
Replacement
Radiology
Workflow
Management
PACS
Remote
Access
Electronic
Linking with
HIS, RIS and
EHR
– PACS replaces films based
means of managing
medical images.
– With the decreasing price
of digital storage, PACS
provides a growing cost
and space advantage over
film archives in addition to
the instant access to prior
images at the same
institution.

9. PACS Use
• Electronic image
linking:
Films
Replacement
Radiology
Workflow
Management
PACS
Remote
Access
Electronic
Linking with
HIS, RIS and
EHR
– PACS provides a
platform for radiology
images linking with
other information
systems.
• Hospital Information
System (HIS)
• Electronic Health Record
(EHR)
• Radiology Information
System (RIS)

10. PACS Use
• Radiology Workflow
Management:
Films
Replacement
Radiology
Workflow
Management
PACS
Remote
Access
Electronic
Linking with
HIS, RIS and
EHR
– PACS is used by
radiology personnel to
manage the workflow
of patient exams.
• Less Patient waiting
time
• Fast reporting
• Resource utilization
monitoring

11. PACS Use
• Remote access:
Films
Replacement
Radiology
Workflow
Management
PACS
Remote
Access
Electronic
Linking with
HIS, RIS and
EHR
– It expands on the
possibilities of
conventional systems by
providing capabilities of
off-site viewing and
reporting (distance
education, telediagnosis).
– It enables practitioners in
different physical
locations to access the
same information
simultaneously for
teleradiology.

12. Network
a secured network for the
transmission of patient
information
Archive
archives for the storage and
retrieval of images and reports.
Workstations
for interpreting and reviewing
images

13. Network (Internet)
Remote Site
Expert Radiologist

14. • Generally, in Teleradiology, an image is sent
from the examination site to a remote site
where an expert radiologist makes a
diagnosis.
• The report is sent back through various
electronic means. (Fax/Information
system/Email/Verbal)

15. Report
Network (Internet)
Report
Remote Site
Expert Radiologist

16. Report
Network (Internet)
Report
Hospital
Expert Radiologist

17. Report
Report
Network
(Internet)
Network
(Internet)
Network
(Internet)

18. What does radiologist needs for
teleradiology reporting?
Images
•Diagnostic class images
•Either scanned or acquired
•DICOM version 3
compression with agreed
compression(if any)
Clinical
Information
•Patient
Demographics
•History
•clinical information
•condition to be ruled
out
•Lab results
Priors
Workstation
•Prior Exams images
for comparison
And
•Prior Radiology
Reports
•Diagnostic Class
Monitors
•All information
(images+ Data - all
integrated)
•Image manipulation
functions

19. Meeting the goal…
Beside image transfer following are the requirements
Report
Report
management
software
Billing
Agreed Billing
models
Payment
transfer
methods
Image/Report Archive Policy
Manpower
Image
Legal Issues
retention
duration
Radiology
Reports
Trained
manpower
and
Job
satisfaction
Licensing
Credentialing
Insurance
Confidentiality
Standards

20. Models of PACS-based Teleradiology
• One PACS – One RIS/HIS
• One PACS – Multi RIS/HIS
• Multi PACS – Multi RIS/HIS
• With Multi model : One may consider having
Universal Patient ID for Continuity of Care;
sometime called Master Patient Index (MPI)

21. Teleradiology Model
Hub and Spoke
•
•
•
Outreach centers (Imaging machines with no Radiologist)
Diagnostic centers (Imaging machines With Radiologist)
Main Hospital (Imaging machines with Radiologist and other facilities)
Outreach
One PACS –One RIS- One HIS
Diagnostic
Reporting
Diagnostic
Center
outreach
AKUHN
Diagnostic
Center
2nd Opinion
Reporting
Workload
Balancing
Outreach

22. Teleradiology in Pakistan and
Afghanistan

23. Teleradiology between Pakistan and Afganistan
Distance
Road travel
1750 KM (approx)
Air travel
1200 Km(approx)

24. WORKFLOW
Diagnostic Station
CT
DICOM
REMOTE
USER
`
FILE SERVER
DICOM
WEB
APPLICATION
COMMUNICATION
SERVER
Transcriber
Radiologist
Diagnostic Station

25. Video Conferencing

26. Teleconference with FMIC:
Education and Training Session

27. Communication Link
*Current configuration for PTCL or ROSHAN may differ.

28. Teleradiology in East Africa

30. Active Link
Reporting for all Exams: Yes
Turnaround time (regular): 24 Hrs
Turnaround time (urgent): immed.
Image Archive (AKUHN, PACS): Yes
Reporting (Interim): Manual
Connectivity-DICOM : via internet
Integration Model:
One PACS-Multi HIS (under Plan)
Future Link
Current Status: Planning

31. Nairobi

32. Nairobi
Reporting for all Exams: Yes
Turnaround time (regular): 24 Hrs
Image Archive (AKUHN, PACS): Yes
Reporting : Automated
Connectivity-DICOM : via internet
Model: One PACS – ONE HIS
Current Status: Active
Six Diagnostic Centers
Current Status: Under Planning
Model: One PACS – ONE HIS
Avenue Hospital
1KM Approx.
Buru Buru
14 KM Approx.

33. Thank you