PACS

AGENDA ITEM NO: 9
LANCASHIRE TEACHING HOSPITALS NHS FOUNDATION TRUST
BOARD OF DIRECTORS
27 SEPTEMBER 2006
PICTURE ARCHIVING AND COMMUNICATION SYSTEMS (PACS)

DRAFT BUSINESS CASE
The attached draft business case has been prepared to support investment in a
Picture Archiving and Communications System, which is a core component of the
National IT Strategy. A Government target is in place for all Trusts to be using PACS
by the end of 2007.
Board members are asked to approve the draft business case.
PAUL HAVEY
FINANCE DIRECTOR
PICTURE ARCHIVING AND
COMMUNICATION SYSTEMS
(PACS)
BUSINESS CASE
September 2006
CONTENTS
1.0 EXECUTIVE SUMMARY .......................................................................................1
2.0 INTRODUCTION ...................................................................................................2
3.0 WHAT IS PACS? ..................................................................................................2
4.0 OBJECTIVES AND BENEFITS.............................................................................3

4.1 Main Objectives .......................................................................................................................... 3
4.2 Benefits........................................................................................................................................ 3
4.3 Drivers for Investment ............................................................................................................... 4
5.0 ASSUMPTIONS & CONDITIONS .........................................................................5
6.0 IMPLEMENTATION AND MANAGING RISK .......................................................6

6.1 Cultural Change .......................................................................................................................... 6
6.2 Technical ..................................................................................................................................... 7
6.3 General ........................................................................................................................................ 7
7.0 FINANCE...............................................................................................................8
7.1 Costs of the System ................................................................................................................... 8
7.2 Revenue Savings ........................................................................................................................ 9
7.3 Impact on Service Configuration ............................................................................................ 10
7.4 Economic and Affordability Summary ................................................................................... 10
APPENDIX A1:- REVENUE SAVINGS .........................................................................11
APPENDIX A2:- ECONOMIC ASSESSMENT ..............................................................11
APPENDIX A3:- AFFORDABILITY ASSESSMENT.....................................................12
APPENDIX B:- THE CASE FOR INCLUSION OF RADIOTHERAPY IN PACS ...........13
APPENDIX C: - GOVERNANCE AND STAKEHOLDERS ...........................................17
APPENDIX D: - TERMS OF REFERENCE...................................................................19
APPENDIX E: - RADIOLOGY FACILITIES ..................................................................23
APPENDIX F: - PROJECT MANAGEMENT METHODOLOGY ...................................25
APPENDIX G: - EPR MODEL.......................................................................................26
APPENDIX H: - BENEFITS...........................................................................................27
APPENDIX I: - PACS EQUIPMENT LIST .....................................................................28
GLOSSARY ..................................................................................................................35
Picture Archiving and Communication System (PACS)
1.0 Executive Summary

This document is the Business Case to support the local investment in a Picture
Archiving and Communication System (PACS) and seeks to gain approval and
commitment from the Board of Lancashire Teaching Hospitals NHS Foundation
Trust.
The implementation of PACS is now defined as a “core” part of the national

strategy for delivering a NHS Care Records Service. Contracts are in place with
Local Service Providers, responsible for delivery of the National Programme for
IT (NPfIT), to provide PACS services for Trusts in line with achieving the
Government’s target of all NHS Trusts using PACS by the end of 2007.
Although the national procurement for an integrated NHS-wide PACS solution

has achieved significant capital cost reductions on PACS equipment, additional
capital resources will be required to implement it. Central capital funding of
£3.5m has been made available to fund the programme.
Over the lifetime of the project costs incurred by Lancashire Teaching Hospitals
will be £13 million as shown in Appendix A3. Costs include VAT where applicable
and exclude the future impact of inflation. This will be funded from significant
costs reductions that have already been identified as well as additional resources
specifically identified in the tariff for the implementation of the NPfIT.
* See appendices A1, A2 & A3
Critical to the success of the implementation is clinical involvement. The PACS

Programme Board, which includes clinicians, has actively involved other
clinicians in the process of producing this Business Case, in particular through
the PACS Clinical Advisory Group. Once approval has been granted to proceed
to implementation a more detailed programme for clinical involvement will be
produced to ensure clinicians are able to utilise PACS to its optimum.
In summary the programme is affordable in both capital and revenue terms.

Additionally, clinicians have been involved in the planning stages and will be
more involved as the system is implemented.
Approval is therefore requested to support the implementation of PACS at

Lancashire Teaching Hospitals Foundation Trust, commencing in November
2006 with an April 07 Go-live.
Author: Venkata Padala

DRAFT GE PACS Business Case 2006 v0 6h1 PACS Business Case Page 1 of 37
21 September 2006
2.0 Introduction
This Business Case aims to demonstrate how a Picture Archiving and
Communication System (PACS) investment supports the clinical, business and
strategic objectives of the Trust and wider health community.
The Connecting for Health (CfH) PACS solution will be deployed by Computer
Sciences Corporation Alliance (CSCA), the Local Service provider for the North
West and West Midlands. CSCA have selected GE Centricity to supply the PACS
IT system and Kodak will be providing the associated radiology equipment.
The PACS contract will run until 30 June 2013 in line with other mandatory
National IT contracts to enable Trusts to develop their infrastructure towards a
level 6 Electronic Patient Record (See APPENDIX G: - EPR Model).
PACS will provide considerable operational benefits in terms of improved

workflow, for all those using medical images. An electronic PACS solution is
more efficient than dealing with radiological films that can only be available in
one place at a time. PACS improves turn round and accessibility of images and
will therefore help to contribute to achieving central targets such as the maximum
four hour waiting in A&E departments. Patients will also benefit through fewer
delays, such as no repeat visits due to lost x-ray films which also leads to
reduced radiation dose
3.0 What is PACS?

The Picture Archiving & Communications System (PACS) is a computer system
that is used to capture, store, distribute and display medical images. Initially the
project will focus on X-Rays and other Radiological images. The main benefits
are easier access to and sharing of images, reduction in lost images and in use
of film, improved ways of working, and reduced waiting times, as well as
supporting the Trust’s modernisation and service improvement plans.
The process of radiology includes 5 elements;
The capture of images.

The interpretation and reporting of the study.
The delivery of the report.
The archiving of both films and report.
The subsequent retrieval of both film and report as required.
A simple PACS system digitises three of these steps so that:

21 September 2006
Images captured digitally include CT scans, MRI scans, or Plain X-Rays.
The images are viewed on a high-resolution computer screen and can be
reported immediately.
The images along with the report are stored in an electronic format for
easy retrieval.
A PACS system and its impact on speeding up patient turnaround time would
input into a smoother workflow and a simplified patient care pathway.
4.0 Objectives and Benefits

4.1 Main Objectives
The project will develop a Picture Archiving Communication System in

order to meet the objectives as listed below.
Improved diagnostic accuracy and reduced clinical risk.

Reduced radiation exposure for patients.
Fewer delays for patients; increased turnover and throughput.
Reduced admin time in terms of both medical staff and clerical
officers.
Reduced film and chemistry costs.
Reduced physical storage costs.
Improved speed of access to images for all Clinicians and Nursing
staff on all wards and in each department.
Development of improved imaging links with other Trusts, GP’s and
Community.
Records will not have to be physically taken to another site (which
happens on average 12 times per site each week).
4.2 Benefits
X-Ray film currently used for distribution and archive purposes is a major
impediment to the development of more efficient clinical processes. Films
need to be transported to those that need them and can only be viewed at
one location at a time. Implementation of PACS will provide on-line
electronic access to images when and where required.

21 September 2006
PACS is a mature technology with a number of successful
implementations operating in the NHS and has proven to be a low-risk
route to the modernisation of radiological services.
PACS provides for a faster delivery of medical images to the clinicians that
evaluate and report on them. This can lead to speedier availability of
results. Images will no longer be lost or misplaced thus eliminating the
potential need to postpone or cancel patient consultations or operations
due to images not being available. Fewer unnecessary re-investigations
will result, which will in turn reduce the amount of radiation to which
patients are exposed.
Images and results will be viewable from anywhere across the two hospital
sites on mobile, wall mounted and stand alone PC’s which will be sited on
wards, in outpatient departments, X-Ray, A&E, Theatres and so on.
By improving accessibility to information and supporting the analysis of

care, a PACS system will ultimately support the concept of clinical
governance. Clinical risk will reduce as an effect of a reduction in loss of
images and a reduction in duplicate images. Diagnostic reporting will also
be enhanced by improved electronic images and the ability to manipulate
those images as required.
In summary, this development facilitates improved clinical care and

throughput of patients requiring radiographic examinations and aids the
ability to respond to changes in clinical demand and to work towards the
achievement of clinical excellence.
For a more comprehensive breakdown of benefits see APPENDIX H: -

Benefits and descriptions.
The potential long-term implementation of a PACS system will also impact

directly on all departments across the two hospital sites as well as the
community as requests made on paper will be replaced with an electronic
system. The Project Board has agreed that the first stage to this process
should be a PACS system across the Trust with the capability of extending
into the community in the future.
4.3 Drivers for Investment
Expanding on the core benefits, PACS can deliver many key drivers for
investment including:-
Increased patient satisfaction through fewer delays associated with

image management procedures e.g. outpatients and the fact there are
no repeat visits.
Reduced errors in examination requests.

21 September 2006
Improved diagnostic accuracy and reduced clinical risk.
Providing more information on line.
Reduced radiation dose to patients through fewer repeat
examinations.
Efficiency and Effectiveness would be improved by:
Reduced film and chemistry costs as PACS will reduce the need for
printing film.
Cut down on repeat images.
A reduction in film storage costs.
A reduction in Clerical staff required to pull, file and distribute films
around the hospital.
A reduction in time spent by Medical staff on administrative tasks.
The ability to streamline working practice
Seamless care with other NHS agencies.
5.0 Statements and Conditions

The Business Case covers current patient activity and imaging services position.
Since service change will occur, the Trust will, where appropriate, include any
new costs associated with PACS as part of the each new scheme. For example,
future developments involving imaging schemes such as the procurement of a
PET Scanner, will include any additional costs to connect to PACS.
The Scope of the National Contract allows PACS to be implemented in Main X-

Ray, Neurology, Ultrasound, CT and MRI. The cost of implementing in other
areas during the future development of PACS through the Trust will be funded
from the associated cash releasing savings.
As with any major IT system, future releases of PACS will occur to improve the
service throughout the period of this contract. As changes cannot be defined at
this stage the Business Case does not include any financial assumptions.
Additional electrical equipment is being introduced in the offices of the Consultant
Radiologists and the associated heat output is of an acceptable level, hence no
air conditioning units will be required. This has been agreed with the Clinical
Director however the decision will be reviewed after six months.
The crossover of the Trust’s current X-Ray method to the new PACS system will
occur on an agreed date, once acceptance to ‘go live’ has been made.

21 September 2006
Directorates will agree a mutually agreeable programme for releasing appropriate
staff for PACS training.
The sizing is based on Imaging commencing storage of images at go-live, hence
does not account for digitising and storing historic X-ray films, other than those
associated with current episodes of care. The storage and destruction protocols
currently in place and approved by the Clinical Governance Committee will
remain unchanged and active for historical records.
The PACS deployment charge will become payable by the Trust after go-live and
the issue of a Milestone Achievement Certificate (MAC) as certified by the
Regional Implementation Director (RID).
No Transfer Undertakings for the Protection of Employment (TUPE) implications
have been identified as there will be no transfer of existing staff to a new
employer as a result of the implementation of PACS.
6.0 Implementation and Managing Risk

6.1 Cultural Change
It has been recognised that it is essential to secure the commitment to

cultural change amongst Clinicians as the objective of PACS is to be “film-
less” from day one. Securing commitment is already well underway.
A lead Clinician, Dr Ian Harris, Consultant Radiologist, supported by

Martin Letheren, Associate Medical Director (IT), agreed to drive clinical
engagement. Dr Harris is a member of the North West & West Midlands
PACS Clinical Reference Group and through a network of clinical
colleagues maintains an up-to-date understanding of PACS
implementation and associated requirements.
Dr Harris has to date liaised with every Clinical Directorate through an

introductory ‘road-show’. A cross directorate Clinical Advisory Group,
chaired by Dr Harris, also meets regularly to discuss and agree PACS
deliverables such as the types, numbers and locations of viewing stations
needed to provide ‘film-less’ viewing at the point of care. Martin Letheren
chairs the PACS Project Board ensuring clinical requirements are met.
This clinical ownership and drive will continue to be a priority, supported

by the production of advisory and educational material. Training, open
days and visits to Directorates will be co-ordinated during implementation
to ensure clinical readiness and understanding. An allowance of £50,000
has been made within the Business Case to bring in external change
management support and to produce educational aids to facilitate the
cultural change process.

21 September 2006
The Project Board has sought to ensure that any potential barriers to
change and implementation are addressed. Clinical, managerial and
technical staff are working collaboratively to ensure the project success
and acceptability across the Trust sites.
Imaging is playing a vital part in this process and together with wider
clinical input will ensure an effective change management process and
implementation strategies are agreed.
Detailed ‘Acceptance Testing’ will be performed by the Trust before go-live

to remove any risk of failure. During PACS post go-live the Trust enters a
30-day formal acceptance period with CSCA to ensure the deployment
has been a success. After this 30-day period, with agreement of the Trust
and the RID, the Milestone Achievement Certificate is issued enabling
CSCA to request payment. The on-going support for the PACS system
after go-live will be provided by the existing IT Service Desk as well as the
new resources identified in the Business Case.
6.2 Technical
Misys has formally agreed to develop an interface between PACS and

CPR. Further work is on-going to develop fully an integrated solution that
allows Clinical users to access images through CPR.
6.3 General Governance
Following the principles of the PRINCE 2 project management

methodology a formal project structure is in place. PRINCE is further
explained in Appendix F and key groups are responsible for taking the
project forward and minimising risk, in particular the PACS Project Board
chaired by Dr Martin Letheran and the PACS Clinical Advisory Group,
chaired by Dr Ian Harris. In relation to the day-to-day management of the
project a PACS Central Working Group will monitor and manage the
project and associated issues.
The membership of the PACS groups, their roles and responsibilities and
the relationship to broader Trust governance are shown in Appendix C
and D.
The NHS PACS programmes are based on nationally agreed plans and
contracts hence broader Connecting for Health governance will also
monitor progress at Strategic Health Authority and cluster level (North
West and West Midlands).
Once approval to proceed is given then the first formal action will be to
agree a joint PACS project initiation document between the Trust and CSC

21 September 2006
Alliance. This will formalise arrangements, plans and project resources to
ensure both parties have a clear understanding of timescales and the way
forward.
In order to learn lessons and minimise risks there is close collaboration
with other Trusts via a PACS forum which includes PACS representatives
from all involved Trusts in the Cumbria & Lancashire region.
7.0 Finance
7.1 Costs of the System
The following costing is based on a traditional NHS procurement

methodology of capital purchase of the system with the annual revenue
costs including capital charges equating to the depreciation of the asset
and a 3.5% charge for the use of capital. The Trust has asked it’s Auditors
to work with the National Programme for IT, to identify which elements of
the national contract should be capitalised.
All costs relate to a PACs system covering both Royal Preston Hospital
and Chorley & South Ribble Hospital with the capability of expansion to
provide a full community wide PACs system. Radiotherapy is included
based on the recommendation shown in Appendix B
All costs are at 2006/07 prices.
7.1.1 Capital costs
The following table shows the anticipated capital cost of outright

purchase of the core system –
£000s
CSC Deployment Charge 2577
Kodak Catalogue Items *** 403
Non Kodak Catalogue Items (GE Kit) 65
Additional PACS Kit (outside Imaging) 289
IT Infrastructure **** 166
Modality Upgrades (Dicom) ** 182
Contingency Fund 300
Dicom Radiotherapy Archive + High End PCS + Power Sockets 80
Refresh calculated from CSC Quotation Form v1.0 267
Capital Expenditure Subtotal 4330
A system of this type is considered to have a usable life of 8.25

years. Due to the nature of the contract capital charges have been
calculated over 6.25 years, for those elements deemed to be
capital and having a cost exceeding £5000.

21 September 2006
Assuming a Quarter charge in year 2 the annual costs are as
follows: -
£000s Yr 1 Yr 2 Yr 3 Yr 4 Yr 5 Yr 6 Yr 7 Yr 8 Yr 9
Return on Capital 0 0 131 110 87 64 43 20 3
Depreciation Charges 0 0 497 663 663 663 764 764 189
Total 0 0 628 773 750 727 807 784 192
7.1.2 Revenue costs
This section includes the cost of a Project Manager for the initial
planning and implementation phases of the project, a PACS System
Manager and a PACS Administrator and Assistant to ensure
maximum availability of the system on an on-going basis. Costs
also include initial and on-going user training, change management,
benefits realisation, EPR (RIS) linkages and the provision of on-site
management and maintenance (in addition to the central on-site IT
support).
Costs are estimated as follows –

Yr 0 Yr 1 Yr 2 Yr 3 Yr 4 Su b s e q u e n
t
£000s 04/05 05/06 06/07 07/08 08/09 Y ear s
Staffing 23 50 138 85 85 85
Interface Costs (EPR - PACS &
NCRS Compliance) 150
Interface Costs (EPR -
Radiotherapy) 150
Interface Costs (DICOM
Radiotherapy Archive - PACS & 2
x AW Workstations) 52
Maintenance on Catalogue Items 46 46 46 46
Teleradiology 30 8 8 8
CSC Accommodation 9
Building Work (Radiotherapy &
Radiology) 264
Central Archive / Storage 0 0 0 0
GE Man Days / Training for 60
CSC Service Charge 0 321 321 321
Revenue Expenditure Subtotal 23 50 637 460 722 460
7.2 Revenue Savings
Significant savings are anticipated from the operation of a PACS system

which emanate from -
The elimination of the use of X-Ray chemicals and materials

21 September 2006
The electronic storage and retrieval of records
Increased efficiency of the service.
Major elements will be cash releasing and support the new expenditure
outlined above, while others will not release cash but could allow for an
expansion of service to occur at no additional cost.
Savings of £400,000 are expected to start in Year 3 when the system is

fully operational, increasing to £563,000 in Year 4, and progressively to
£655,000. Appendix A1:- Revenue Savings gives the analysis year by
year, the final annual savings being made up as follows –
Revenue savings – cash releasing £000s
Radiotherapy 34
Clerical staff 219
X-Ray materials 394
Transport of records 1.5
Postage 1
Stationery 5
Sub total 654.5
Revenue savings – non cash releasing
Efficiencies/Reduced repeat X-Rays 422
Reduction in storage space 10
Reduction in patient transfers 8
Earlier discharge of patients 25
Sub total 465
Total revenue savings 1119.5
7.3 Impact on Service Configuration
In general terms the potential impact on the current service configuration

and costs will arise from the shift towards community care and reductions
in outpatients and A&E attendances.
7.4 Economic and Affordability Summary
The economic appraisal has involved calculation of the actual annual cash
flows, both capital and revenue, and the calculation of the Net Present
Value of the project over its assumed life of 6.25 years.
Details of the calculation of the Net Present Value are contained in

Appendix A2:- Economic Assessment.
Affordability of the project depends on the availability of both capital and

any additional annual revenue sums required.
Affordability has been assessed as the difference between additional

revenue cost, including capital charges, and cash releasing revenue
savings. Appendix A3:- Affordability Assessment shows the annual

21 September 2006
projections and demonstrates that additional revenue support would be
needed throughout the project.
Appendix A1:- Revenue Savings

V2.9r
Year 0 Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9
'000s 2004/5 2005/6 2006/7 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13 2013/14 TOTAL
Cash Releasing
Savings
Radiotherapy 34 34 34 34 34 34 4.875 209
Staff 0 0 64 128 192 219 219 219 55 1,096
X-Ray Materials 0 0 296 394 394 394 394 394 99 2,364
Transport Of
Records 0 0 0.5 1.0 1.5 1.5 1.5 1.5 0.4 8
Stationary 0 0 5.0 5.0 5.0 5.0 5.0 5.0 1.3 31
Postage 0 0 1.0 1.0 1.0 1.0 1.0 1.0 0.3 6
Subtotal Cash
Releasing Savings 0 0 0 400 563 628 655 655 655 160 3714
Non Cash
Releasing Savings
Release of Storage
Space 5 7.5 7.5 10 2.5 33
Reduced repeat X-
Rays 105.5 211 316.5 422 422 422 105.5 2,005
Reduced Patient
Transfers 8 8 8 8 8 8 2 50
Earlier Discharges 10 25 25 25 25 25 6.25 141
Subtotal Non Cash
Releasing Savings 0 0 124 244 355 463 463 463 465 116 2228
Total 0 0 124 644 918 1090 1117 1117 1120 276 5942
Appendix A2:- Economic Assessment

V 2.9r
Year 0 Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Total
000s 2004/5 2005/6 2006/7 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13 2013/14
Capital 0 0 -4002 0 0 -20 -69 -227 -20 0 -4338
Revenue Cost -23 -50 -638 -460 -722 -460 -460 -460 -460 -131 -3864
Revenue Savings 0 0 124 644 918 1,090 1,117 1,117 1,120 276 6405
Total Cash Flow -23 -50 -4517 184 196 610 588 430 640 145 -1797

21 September 2006
Appendix A3:- Affordability Assessment
A B C D E F G H I J K L M N
1 GE PACS Affordability Assessment *

2 Figures Based on April 07 Go - Live Year 0 Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9
3 '000s 2004/5 2005/6 2006/7 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13 2013/14 TOTAL
4 Staffing (Revenue Cost)
5 PACS Project Manager (Sept 2004 Start) 20 34 43 97
6 PACS System Manager 43 43 43 43 43 43 11 268
7 PACS Project Support (Band 3) (Dec 2004 Start) 3 16 20 20 20 20 20 20 20 5 160
8 PACS System Administrator (Band 4) (Jan 07 Start) 6 23 23 23 23 23 23 6 149
9 PACS IT Trainer 19
10 Change Management 51 51
11
12 Other Revenue Expenditure
13 Interface Costs (EPR - PACS & NCRS Compliance)** 150 150
14 Interface Costs (EPR - Radiotherapy)** 150 150
15 Interface Costs (DICOM RT Archive - PACS & 2 x AW Wks)** 52 52
16 Maintenance on Catalogue Items 46 46 46 46 46 46 46 12 335
17 Teleradiology 30 8 8 8 8 8 8 8 86
18 Disaster Recovery 5 5
19 Encryption of data over Network 5 5
20 CSC Accommodation & Temporary Storage Containers 9 9
21 Building Work ** (Radiotherapy & Radiology) 264 264
22 C Central Archive / Storage ***** 0 0 0 0 0 0 0 0 0
23 O GE Man Days / Training for Radiotherapy integration 60 60
24 S CSC Service Charge 0 321 321 321 321 321 321 80 2,005
25 T Revenue Expenditure Subtotal 23 50 638 460 722 460 460 460 460 131 3,866
26 S
27 Capital Expenditure
28 CSC Deployment Charge 2,577 2,577
29 Kodak Catalogue Items *** 333 69 403
30 Non Kodak Catalogue Items (GE Kit) 65 65
31 Additional PACS Kit (outside Imaging) 289 289
32 Additional Storage (Local) 0
33 IT Infrastructure **** 166 166
34 Modality Upgrades (Dicom) ** 182 182
35 Contingency Fund 300 300
36 Dicom Radiotherapy Archive + High End PCS + Power Sockets 80 80
37 Refresh calculated from CSC Quotation Form v1.0 20 227 20 267
38 Capital Expenditure Subtotal 0 0 3993 0 0 20 69 227 20 0 4329
39
40 Return on Capital 0 0 131 111 87 64 43 20 3 460
41 Depreciation Charges 0 0 499 665 665 665 767 767 189 4,218
42
43 Costs Subtotal 23 50 4631 1091 1499 1233 1259 1497 1267 324 12872
44
45 Capital Funding
46 CfH - Deployment 924 924
47 DOH ****** 2,571 2571
48 F Trust Capital Funding Programme 387 20 227 20 654
49 u Capital Funding Subtotal 0 0 3,882 0 0 20 0 227 20 0 4149
50 n
d
51
i
Revenue Funding
52 n PCT Funding 23 50 62 62 62 62 62 62 62 16 525
53 g PCT Tariff 680 680 680 680 580 580 580 145 4605
54 Revenue Funding Subtotal 23 50 742 742 742 742 642 642 642 161 5130
55 /
56 Radiotherapy 34 34 34 34 34 34 9 215
S
57 Staff 64 128 192 219 219 219 55 1,096
a Cash
58 v X-Ray Materials 296 394 394 394 394 394 99 2,364
Releasing
59 i Savings
Transport Of Records 0.5 1.0 1.5 1.5 1.5 1.5 0.4 8
60 n Stationary 5.0 5.0 5.0 5.0 5.0 5.0 1.3 31
61 g Postage 1.0 1.0 1.0 1.0 1.0 1.0 0.3 6
62 s
63 Subtotal Cash Releasing Savings 0 0 0 400 563 628 655 655 655 164 3,720
64
65 Funding Subtotals 23 50 4624 1143 1306 1390 1297 1524 1317 324 12999
66
67 Affordability Gap 0 0 7 -52 193 -158 -38 -27 -51 -1 -127
68
69
70
71

21 September 2006
Appendix B:- The Case for Inclusion of Radiotherapy in
PACS
Summary
The inclusion of Radiotherapy within a Trust wide PACS solution is not in doubt, the only
questions to remain are when and how. Whereas there has been a great deal of planning
nationally on how to include radiology images in a PACS system, very little thought has gone
into a radiotherapy solution.
Given this uncertainty nationally, some radiotherapy departments have opted for their own
solution as an interim means of capturing and storing radiotherapy images and objects in a
central database. We are proposing that such a solution will be beneficial to Lancashire
Teaching Hospitals overall implementation of PACS and will provide radiotherapy with a
workable system with immediate effect.
When PACS is implemented in the Trust, it is essential that radiotherapy continues to be able to
import data from Trust scanners into the treatment planning systems (otherwise the
radiotherapy department will not be able to function).
Rationale
One of the greatest benefits afforded by PACS is the centralisation of all images associated with
a patient’s history. For radiotherapy patients, a wide variety of images need to be viewed and,
more importantly, used for diagnosing, staging, planning, computing and verifying (using
registration methods) the overall treatment. Images are also vital for follow-up of the patient
after therapy; both for looking for residual or recurrent disease and also for knowing exactly
where previous, high doses of radiation have been delivered. This follow-up is performed both
at RPH and also at clinics all around the cancer network (e.g. Trusts in Morecambe Bay and
East Lancashire).
Radiotherapy uses many different imaging modalities and formats; images are not simply
acquired and reported on; image data is used to compute radiation interactions, perform image
registration, indicate areas (fields) treated etc. The extra information associated with a
radiotherapy treatment can be stored with the images in an extended form of DICOM known as
DICOM-RT.
PACS programme
The inclusion of radiotherapy into the national PACS programme has always been on the NPfIT
roadmap through the use of DICOM-RT. DICOM-RT and the display of the associated objects
and images is highly complex, and support for DICOM-RT will only be possible through the GE
PACS software in Release 2 or Release 3 (Release 1 is the version which has been
implemented by GE in the southern cluster). None of the releases (including Release 4) include
provision for full display of the DICOM-RT objects themselves, although a basic display of some
objects should eventually be provided.
Although there is a commitment to support DICOM-RT within the PACS solution, there is no
agreed framework as yet for how this can be achieved. Specifically, the PACS providers have
not yet appreciated the differences between the ways in which radiology and radiotherapy
departments operate. The imposition of work lists and accession numbers in radiotherapy would
hinder rather then streamline workflow. Given that imaging and data transfer in radiotherapy is
becoming increasingly and almost exclusively digital, some departments have already set up

21 September 2006
their own local solution. This makes use of an intermediate, local DICOM storage facility. Such
systems are already in place in Leeds and Clatterbridge.
There are two main options for radiotherapy: one is to wait until radiotherapy DICOM RT objects
are fully supported within the PACS solution offered by CSC; the second is to implement a
temporary solution at the same time as radiology. These options are explored below.
Option1: Include radiotherapy later

Here radiotherapy would wait for DICOM-RT to become fully available from CSC/GE within the
NWWM Cluster. As stated above, initial information would indicate that even release 4 of the
software would not include the full use of the DICOM-RT information. Increasing pressure from
radiotherapy departments nationally and regionally may bring forward the full use of DICOM-RT
information, but it is unknown when that would be
Benefits
• All images and information associated with a patient’s course of radiotherapy planning,
verification and treatment would be stored within the PACS system.
• This would be available for viewing within radiotherapy and, eventually, throughout the
cancer network; especially useful for our clinicians at peripheral clinics.
• Data could be imported into the radiotherapy computer systems for planning patients’
treatments.
Risks
• It is not known when or how this full integration will occur.
• Multiple interfaces would be necessary to link directly between the many different
computer systems used (by necessity) within radiotherapy and the PACS system. It is
possible that some may not link at all.
• Alternative solutions must be sought now for transferring images from the Trust CT
scanners (in particular) to the radiotherapy computer systems. This is vital –
radiotherapy patients cannot be treated without this data actually imported into
our planning system electronically. It is not sufficient simply to view these
images in radiotherapy.
• Data transfer may have to be performed using CDs/DVDs which is extremely inefficient
and much less secure for data transfer. This has increased administration and
consumable costs, as well as implications for reduced efficiency and security for the data
transfer and hence the workflow. The process may lengthen the time it takes to get a
patient ready for treatment – this may affect the 31/62-day targets for radiotherapy.
There has been no advice at all from CSC/GE as to how this would be done.
• Radiotherapy would become a single, small user of X-ray films and materials.
Radiotherapy would be the only department within the Trust using film. Costs of
consumables would increase significantly, and service contracts would have to be
upgraded to instant response since there would be no ‘backup processor’ facilities within
the Trust. This is vital for technical films that are legally required for ensuring that
treatment machines are fit for clinical purpose following breakdowns.
• It is unclear how the Radiology System (in our case Misys) and the PACS systems will
work together; RT has never been included in these discussions, even though we must

21 September 2006
acquire patient CT data on the Trust scanners for RT purposes. If DICOM work lists
must be generated first within Misys in order to use the scanners, then radiographers in
RT will have an additional administrative task to perform once PACS is enabled.
Option 2: Include radiotherapy now

Proposed solution
• A CR System for Radiotherapy (Kodak 2000RT Plus – see below). Has been
available for Simulator images in radiotherapy for over 5 years. This would make
RT completely filmless, with all the associated benefits and savings indicated in
the PACS Business Case for replacing radiographic media.
• A Local DICOM archive. The system listed below is fully compatible with all the
images we presently produce and use in RT, including support for DICOM-RT.
Its technology can communicate with all other healthcare systems such as RIS,
PACS, PAS and EPR. A DICOM archive system is being successfully used in
the GE PACS implementation in Kent in the southern cluster, and is also used in
Clatterbridge and Cookridge hospitals. It enables all RT images to be stored and
archived locally plus the download of images (such as CT and MR) from the
PACS system.
• Diagnostic Viewing Workstations (simple, single monitor systems) for simply
viewing diagnostic images from the PACS system (particularly for data acquired
on the CT, MR and PET scanners in Diagnostic Radiology, RPH)
• Alternatively, interface software for importing (not just viewing) CT, MR and PET
images from the PACS system into systems in RT (such as the GE Advantage
Sim workstations in RT). Again, this is possible in Kent in the southern cluster
implementation with GE.
All radiotherapy data would be digitised and sent to the DICOM store from the many
radiotherapy systems, where it would be ‘packaged’ or tied together as part of the same
treatment episode. It should be possible to download images from the Trust PACS system to
radiotherapy, but not to upload DICOM-RT data from radiotherapy. If a more flexible approach
is taken by the PACS suppliers, then two way data transfer will be possible.
Benefits
• Patients. All the advantages of a filmless radiology department (in terms of instant
access, reduced time for processing) would manifest in time savings within the RT
department. This would provide a smoother patient care pathway with a consequent
improvement in patient throughput. Clinical decisions regarding treatment will become
more precise if all diagnostic and therapy images are available instantly and centrally
(e.g. in having all information available for diagnosis, staging, planning and re-
treatment). Centrally stored digital simulator images and DRRs would be more readily
available for import into our imaging database. This affords more precise and efficient
methods for treatment verification, improving the quality of care and being available to
more patients.
• Forthcoming (Oct 06) Radiotherapy CT Scanner. The new RT CT scanner would
have a secure means of archiving data. Without the temporary solution archive will be to
numerous CDs or Magnetic Optical Disks (MOD).
• Forthcoming (DEC 06) RT Treatment Planning system. The new treatment planning
system would have a vendor independent means of data archive. Alternatives would be
to buy a DICOM-RT archive within the planning system tender or rely on archive to
media (CD, DVD, DAT). Archive to media is usually vendor specific, so we would have
future problems in retrieving data.

21 September 2006
• DICOM Data flow. A local DICOM archive would smooth the flow of DICOM data
around the radiotherapy department.
• Central Archive for simulator image data. As simulator images are part film and part
digital at present, this would enable us to place all images in one store and to have a
proper archive. The current digital system has no archive solution.
• Reduced film retakes. Digital imaging instead of film will provide patient radiation dose
benefits in terms of reduced retakes, and time savings in not having to use the film
scanner for verification films.
• Central Archive for Portal Images. Digital imaging of portal films will ensure that all
images are in the same database rather than some film and some electronic. It will be
easier to locate images in future.
• Improved treatment verification. Digital imaging of portal films will mean that images
will be able to be matched to the gold standard using software (template matching),
rather than by eye. This will result in more consistent and accurate treatment.
• Staff. Reduced exposure to chemicals etc. from film processing, reduced administration
in storing, locating and retrieving hardcopy images. More widespread and efficient
methods of treatment verification become available, freeing up clinical radiographer time.
Risks
• A single link between the PACS system and the local DICOM archive would be a point of
weakness; lose the link and data could not be uploaded to the archive for dissemination
to the other RT computers. In these circumstances data would have to be transferred by
removable media (CD/DVD). This is a common backup plan for contingent purposes
and is acceptable for short-term use.
• It is possible that the local DICOM archive for radiotherapy might not interface to PACS
in 2-3 years when the PACS DICOM-RT radiotherapy option is available. As
radiotherapy is already a customer of GE, and this may well be the case in future, we
feel it is unlikely the GE will be inflexible. If it is not possible to interface the DICOM
archive to PACS directly, it should still be possible to get the data into PACS, but will be
more time consuming.
Conclusion
Given that option 2 is able to deliver benefits to the radiotherapy process in the short term and
avoids the risks and unknowns associated with the ‘wait and see’ approach of option 1, it is
recommended that option 2 is the most viable route for the Trust to take.
Radiotherapy Department
Rosemere Cancer Centre
Royal Preston Hospital
Lancashire Teaching Hospitals NHS Trust
August 2006

21 September 2006
Appendix C: - Governance and Stakeholders
The Project Groups
PACS Project Board

Dr Martin Letheren – Associate Medical Director (IT) (CHAIR)
Dr Ian Harris – Consultant Radiologist
Peter Aspinall – IT Business Development Manager
Catherine McGourty – Project Accountant / Deputy Director of Finance
Margaret Mallon – Directorate Manager, X-Ray
Mark Greenwood – Head of Property Services
Venkata Padala – PACS Project Manager
Paul Havey – Director of Finance
Denise Whittaker – IT Director
Mike Kirby – Consultant Physicist
PACS Central Working Group

Margaret Mallon – Directorate Manager, X-Ray (CHAIR)
Peter Aspinall – IT Business Development Manager
Caroline Mee – Clinical Manager (RPH)
Margaret Barrow – Clinical Manager (CDH)
Venkata Padala – PACS Project Manager
David Ramage – Medical Illustration Manager
Chris Lamb – Chief Medical Engineer (CDH)
Alison Butler – IT Trainer for Radiology
Cliff Howell – Estates Project Manager
Julie Haworth – Radiology Service Improvement Facilitator
PACS Clinical Advisory Group

Dr Ian Harris Consultant Radiologist (Chair)
Mr Charles Davis Consultant Neurosurgeon
Mr Martin Edgell Consultant – A&E
Martin Letheren Anaesthetics
Tony McEvoy Consultant – Orthopaedic & Rheumatology
Mohammad Munavvar Consultant - Medical
Philip Shields Consultant - Medical
George Thomson Consultant – Surgery / Head & Neck
Mr Jon Whittaker Consultant / Clinical Director – A&E
Dr Marcus Wise Consultant - Oncology
Venkata Padala PACS Project Manager
Dave Ramage Medical Illustration
Staff Grade Representative
Specialist Registrar Representative
The Information Development Board is responsible and accountable to the Trust

Management Team and ultimately to the Board of Directors for the overall direction and
management of both the EPR project and the PACS project.

21 September 2006
Governance Arrangements and PACS Structure September 2006
Lancashire Teaching Hospitals NHS Foundation Lancashire Teaching Hospitals NHS Foundation
Trust Risk Management Commitee Trust Board of Directors
Information Development Board
Financial Review Group
PACS Project Board
EPR Advisory Group

Multidisciplinary
PACS Central PACS Clinical Clinical Review Team
Working Group Advisory Group
EPR Project Management
Team
Quality Review Team
Reports/Logs Project Teams
Project Plan
Communication Plan
Issues log/s (including request
for change)
Lessons learnt log/s
Risk log/s
Benefits log/s
Change log/s

21 September 2006
Appendix D: - Terms of Reference
Information Development Board
Group Information Development Board

Purpose • Strategic oversight for PACS Programme
(PACS • Ownership of the PACS Programme
Perspective) • Control of PACS investment
Structures • Sole Purpose Group
Reporting Direct to:
Lines • Community Governance Structure (tba)
• Trust Board of Directors
• Trust Risk Management Committee
• Strategic Health Authority PACS Implementation
supervision arrangements
Links None
Sub-groups PACS Project Board
Membership • Chief Executive
• Director of Finance
• Associate Medical Director (IT)
• Clinical Director – Medicine
• Associate Director of Operations
• Associate Director of Business Development
• IT Director
• Director of Professional Support Services
• Nursing Director
• Clinical Director of Orthopaedics
• Director of Business Development
• Consultant Obstetrics and Gynaecology
Terms of • Account to Trust Board and Risk Management Committee
Reference to whom its Minutes will be sent
• Ensure that the Trust Board are kept fully briefed on all
relevant matters and that an agreed schedule of specific
decisions are referred to the Trust Board for determination
by them e.g. approval of Business Case
• Consider issues related to the impact of the wider
Programme on clinical objectives and operational activities
of the Trust and advise accordingly
• Approve the Programme Plan and monitor overall progress
on achieving the Plan
• Take responsibility for the agreed financial framework, and
monitor the progress of the Project to ensure financial
targets are met to agreed timescales
• Receive regular reports on the progress of the Project from
the PACS Project Board

21 September 2006
PACS Project Board
Group PACS Project Board
Purpose • Detailed oversight for PACS Programme
• Financial management of PACS Programme
• Programme plan monitoring and management
• Decision forum for progressing unresolved project related
issues
Structures • Combined with Quality Assurance Group
Reporting Information Development Board
Lines
Links Quality Assurance Group
Sub-groups Clinical Advisory Group & Central Working Group
Membership • Associate Medical Director (IT)
• Director of Finance
• Consultant Radiologist
• IT Business Development Manager
• Project Accountant
• IT Director
• Directorate Manager – Imaging
• Head of Property Services
• PACS Project Manager
Terms of 1. Act as a decision making forum for all matters related to the
Reference PACS Project ensuring that Project implementation plans
are viable and monitoring progress against those plans
2. Account to the IM&T Programme Board to whom its Minutes
will be sent
3. Be chaired by the Associate Medical Director (IT), agreed to
by the Project members
4. Consider change management issues related to clinical
processes or operations generated by or impacting on the
Programme and advise accordingly
5. Monitor detailed progress on achieving the Programme Plan
and agree detailed amendments
6. Commission communication about the objectives of the
PACS Programme and its progress against the anticipated
timetable to staff.
7. Monitor detailed financial expenditure and commitments
within the agreed financial framework, to agreed timescales
8. Receive regular reports on the progress of the Programme
from the PACS Central Working Group
9. Delegate all tasks necessary to the successful
implementation of PACS to key team members
10. Receive reports on progress from key team members
11. Liaise with the LSP and PACS Supplier as required on
matters concerned with the implementation of PACS
12. Record and report on detailed progress on achieving the
Programme Plan
13. Action detailed financial expenditure and commitments
within the agreed financial framework, to agreed timescales

21 September 2006
PACS Central Working Group (PCWG)
Group PACS Central Working Group (PCWG)

Purpose • Day-to-day management of implementation of PACS
• Detailed local Project plan monitoring and management
• Deal with implementation issues whenever possible and
minimise risk
• Monitoring the delivery of training plans
• Preparing updates for the PACS Project Board and other
forums as required
• Maintenance of issue and risk logs
Structures • Sole Purpose Group
Reporting PACS Project Board
Lines
Links PACS Clinical Advisory Group
Sub-groups None, but short-term specialist groups may be set-up to aid
progress
Membership • Directorate Manager, Imaging
• Clinical Manager (All Imaging areas)
• Medical Illustration Manager
• Chief Medical Engineer
• IT Trainer for Radiology
• Estates Project Manager
• Radiology Service Improvement Facilitator
Terms of 1. Manage local PACS implementation working with the LSP
Reference and PACS Supplier
2. Account to the PACS Project Board
3. Be chaired by the Directorate Manager, Imaging
4. Manage the Project on a day-to day basis
Project and advise on impact
6. Record and report on detailed progress on achieving the
local Project Plan
7. Produce regular reports on the progress of the Project to the
PACS Project Board
8. Develop PACS training plans to meet training needs and
monitor delivery
9. Ensure project implementation tasks are completed

21 September 2006
PACS Clinical Advisory Group (PCAG)
Group PACS Clinical Advisory Group

Purpose • Consideration of local clinical users needs in relation to
local implementation of PACS
• Consideration of change management issues related to
clinical processes or operations generated by or impacting
on the Programme and advise on impact on local clinical
users
• Clinical advice on local implementation plans
• Monitoring the delivery of PACS
Structures Sole Purpose Group
Reporting PACS Project Board
Lines
Links PACS Central Working Group
Sub-groups None
Membership • Consultant – Radiologist
• Consultant – Neurosurgeon
• Consultant – A&E
• Consultant – Anaesthetics
• Consultant – Orthopaedic & Rheumatology
• Consultant - Medical
• Consultant – Surgery / Head & Neck
• Consultant – A&E
• Consultant - Oncology
• Medical Illustration
• Staff Grade Representative
• Specialist Registrar Representative
Terms of 1. Act as a source of clinical feedback and clinical decision
Reference making on the PACS project
2. Account to the PACS Project Board
3. Be chaired by a senior clinical representative of Radiology
4. Consider clinical users needs in relation to implementation
of PACS
project and wider Programme and advise on impact on local
clinical users
6. Provide clinical advice on implementation plans
7. Monitor the delivery of PACS and report on clinical issues to
the PACS Central Working Group and PACS Project Board
8. Review regular reports on the progress of the Project from
the PACS Project Manager
9. Promotion of the project and benefits to clinical and other
requested staff

21 September 2006
Appendix E: - Radiology Facilities
RPH Neuro
1 fluoroscopy room mainly used for Neuro-angiography
2 CT scanners
2 MRI scanners
RPH Nuclear Medicine

3 gamma camera rooms providing a nuclear medicine service for all patients
Trust wide
RPH X-Ray
8 general rooms providing a general radiography service for A/E, Outpatients, In-
patients etc
Room 1 – Shimadzu (UK) Ltd CH309/UK150B-10
Room 2 – Shimadzu (UK) Ltd CH30 GX30/UD150L
Room 3 – Odel/Mecal Argostat
Room 4 – Shimadzu (UK) Ltd CH306 GX30/UD130L
Room 5 – Argostat X-Ray Tube and Zenith Table
Room 8 – Odel/Mecal Argostat
Room 9 – GE Digital Screening Intervention Suite
A&E Resus – Philips Optumus
3 fluoroscopy rooms providing general/vascular and interventional service for

out/in patients and GP's.
Room 6 – GE Medical Advantx/DR
Room 10 – Shimadzu / Infimed C-Vision / Gold 1
Room 7 – Toshiba KXO-60G/E1 – to be installed
3 ultrasound rooms providing an ultrasound service to outpatients, in-patients

and GP's
US Room 1 – ATL HDI 5000
2 dental rooms providing a service to local dentists, max fax outpatients and A/E
Room 2 – Siemens OPG3 (palomex)
Room 11 – X-Ograph OC100
Mobile X-Ray machines

− 2 Siemens Compact Image Intensifier – Theatres
− GE Image Intensifier – Theatres
− 2 GE CD 38 mobile units ICU & Lower Ground Floor
− Picker Explorer – Special Care Baby Unit
− 4 Acomas Non-Motorised mobile units – Wards

21 September 2006
− GE AMX IV motorised mobile unit - Wards
Sharoe Green Unit (SGH) X-Ray

4 rooms providing ultrasound services for obs/gynae, GPs and maternity.
CDH
3 general X-Ray rooms
− Room 1 A&E, OPD, Wards
− Room 2 A&E, OPD, Wards
− Room 3 GP booked appointments and walk-ins
2 Digital fluoroscopy rooms

− Room 4 Bariums (all sources), special procedures (venograms,
sialograms, tubograms, etc)
− Room 6 Angiography, interventional, venograms and ‘clean’ barium
procedures, ERCP, joint injections and all other clean procedures
Room 5 – general room with tomography used mainly for IVU but also
wards/OP’s etc
Room 7 – dental room – OPG/Cephalometry, intraoral X-Rays
Room 8 – mammography – specialised plain films/localisation/biopsy procedures
Room 9 – medical ultrasound

− Phillips ATL HDI5000 digital
Room 10 – CT Siemens Somotron 16 Slice
Mobile X-Ray machines

− IGE explorer stored in A&E resuscitation area
− IGE advantax – stored in ICU
− Siemens Mobile stored A&E
− SIAS U-arm Image Intensifier inside coronary care for pacing
− Siemens Sirmobil 2002Plus digital image intensifier – in Lythgoe Theatre
Suite
− Siemens Arcadis – in Lythgoe Theatre Suite
− Explorer – Brindle Ward
Mobile Ultrasound for ICU etc – Toshiba stored in main X-Ray
Mobile Ultrasound for Breastwork stored in Room 8
Maternity Ultrasound (two rooms)

− Phillips ATL HDI5000 digital
IGE Logix 500 digital

21 September 2006
Appendix F: - Project Management Methodology
PRINCE 2
The Trust utilise the PRINCE 2 project management approach, for all IT and IT
associated projects.
PRINCE 2 is a project management method covering the organisation, management

and control of projects. PRINCE was first developed by the Central Computer and
Telecommunications Agency (CCTA) in 1989 as a UK Government standard for IT
project management. Since its introduction, PRINCE has become widely used in both
the public and private sectors and is now the UK’s de facto standard for project
management. Although PRINCE was originally developed for the needs of IT projects,
the method has also been used on many non-IT projects.
The latest version of the method, PRINCE 2, was designed to incorporate the
requirements of existing customers and to enhance the method towards a generic, best-
practice approach for the management of all types of projects.
PRINCE 2 is a process-based approach for project management providing an easily

tailored, and scaleable method for the management of all types of projects. Each
process is defined with its key inputs and outputs together with the specific objectives to
be achieved and activities to be carried out.
A PRINCE 2 project is driven by the project’s Business Case that describes the
organisation’s justification, commitment and rationale for the deliverables or outcome.
The Business Case is regularly reviewed during the project to ensure the business
objectives, which often change during the lifecycle of the project, are still being met.
PRINCE 2 is a structured method providing organisations with a standard approach to

the management of projects. The method embodies proven and established best
practice in project management. It is widely recognised and understood, and so
provides a common language for all participants in the project.
PRINCE 2 methodology will allow the project to have:
A controlled and organised start, middle and end;

Regular reviews of progress against plan and against the Business Case;
Flexible decision points;
Automatic management control of any deviations from the plan;
The involvement of management and stakeholders at the right time and
place during the project;
Good communication channels between the project, project management,
and the rest of the organisation.
21 September 2006
APPENDIX G: - EPR Model
Level 6 Advanced multi-media and telematics
Level 5 plus:
Telemedicine, other multi-media applications (e.g.
Picture archiving and communications systems)
Level 5 Speciality specific support

Level 4 plus:
special clinical modules, document imaging
Level 4 Clinical knowledge and decision support

Level 3 plus:
interactive care pathway support, electronic access to
knowledge bases, embedded guidelines, rules,
electronic alerts, expert system support
Level 3 Clinical activity support

Level 2 plus:
electronic clinical ordering, results reporting,
prescribing, passive multi professional care pathways
Level 2 Integrated clinical diagnosis and treatment support

Level 1 plus:
integrated master patient index, departmental systems
Level 1 Clinical administrative data

Patient administration and independent departmental systems

21 September 2006
APPENDIX H: - Benefits
CfH PACS Benefits

21 September 2006
APPENDIX I: - PACS Equipment List
Item /
Model Qty Location
Equipment
Workstation Section
Syed Ali
(X-Ray – RPH)
John Howells
(X-Ray – RPH)
Steve D’Souza
(X-Ray – RPH)
Ian Harris
(X-Ray – RPH)
Mike Dobson
3 Mega Pixel (X-Ray – RPH)
3MP RADIOLOGICAL Diagnostic Dual
Dual Display Dare Seriki
monochrome portrait TFT screen (inc. base) 11
(Greyscale) (X-Ray – RPH)
GE RA 1000 Radiologist Workstation
(20.8”) S Cox
(RPH)
Chris Spinks
(X-Ray - CDH)
Janet Stringfellow
(X-Ray - CDH)
Rob Stockwell
(X-Ray – CDH)
Reporting Room
(NEW Build - RPH)
Specialist Registrars
(Neuro – RPH)
Chris Coutinho
(Neuro – RPH)
W Gunawardena
(MRI – RPH)
T Patankar
2 Mega Pixel (RPH)
2MP RADIOLOGICAL Diagnostic Dual
Dual Display R Padkhe
monochrome portrait TFT screen (inc. base) 9
(Greyscale) (RPH)
GE RA 1000 Radiologist Workstation
(20.3”) Specialist Registrars
(X-Ray – RPH)
(X-Ray – RPH)
(X-Ray – CDH)
(X-Ray – CDH)
1 Mega Pixel 1MP RADIOLOGICAL Diagnostic Dual colour John Coffey
5
Dual Display landscape TFT screen (inc. base) (Nuclear – RPH)
(Colour) (19”) GE RA 1000 Radiologist Workstation Jonathan Hill
(Nuclear – RPH)
(Nuclear – RPH)
Radiotherapy Planning

21 September 2006
Radiotherapy Planning
MDT GE RA 1000 Radiologist Workstation + 2 Education Centre RPH
2
Workstations colour screens Education Centre CDH
Main A&E Resus RPH
A&E Processing CDH
Courtyard RPH
Kodak
Kodak CR Quality Assurance Workstation 6 Theatres RPH
Masterpage
Main X-Ray RPH
Wards Mobile &
Theatre
Main X-Ray RPH
Kodak
Kodak CR Quality Assurance Workstation Chest X-Ray RPH
Masterpage 4
with CD Burner and DICOM Export Software Main X-Ray CDH
(CD)
A&E Processing CDH
Digitiser RA600 GE DICOM Workstation (required for digitiser Main X-Ray RPH
2
Workstation solution) Main X-Ray CDH
System administration workstation RPH
System Admin Recommended general purpose
2
Workstation DICOM/teleradiology/capture/ CD export,
machine for system administrator use CDH
A&E RPH (Minor)
A&E RPH (Resus)
A&E RPH (Major)
A&E RPH (Major)
A&E RPH (Fracture)
A&E CDH (Minor)
A&E CDH (Resus)
19” Clinical
A&E CDH (Major)
Single
NON GE Workstation & Single 19” Clinical A&E CDH (Fracture)
(Greyscale / 18
TFT Colour Screen Brindle Ward
Colour) TFT &
Workstation Brindle Ward
ICU RPH
ICU RPH
ICU CDH
ICU CDH
Endoscopy Suite RPH
MAU – RPH
MAU - CDH
Chest Clinic – RPH
19” Clinical Dual
Chest Clinic – RPH
(Greyscale / NON GE Workstation & Dual 19” Clinical
5 Chest Clinic – CDH
Colour) TFT & TFT Colour Screen
Workstation Orthopaedic Clinic – CDH
Orthopaedic Clinic – RPH
19” Clinical Dual 19” Single Clinical TFT Monitor upgrade to 125 5 x Deepdale – RPH
(Greyscale / existing pcs in clinics 5 x Chest Clinic – RPH
Colour) TFT 5 x Lostock - RPH
(clinic) 5 x Fulwood – RPH
5 x ENT Suite – RPH
5 x Broughton – RPH
5 x Eye Assessment - RPH
5 x Oral Surgery – RPH
5 x Rosemere – RPH
5 x Fracture Clinic – RPH
5 x Children’s Clinic – RPH
10 x SGU - RPH

21 September 2006
5 x Ribblesdale – RPH
20 x Outpatients – CDH
5 x Sumner Ward – CDH
5 x Oral Surgery - CDH
5 x Fracture Clinic - CDH
5 x Maternity Unit - CDH
15 x Other Clinical
Day Case Unit – A - RPH
Day Case Unit – B – RPH
Day Case Unit – C – RPH
SGU - 1 RPH
SGU - 2 RPH
SGU - 3 RPH
X-Ray Processor Room –
RPH
19” Clinical Surgeons Room (East) –
Single RPH
(Greyscale / 19” Single Clinical TFT Monitor upgrade to Surgeons Room (East) –
23
Colour) TFT existing pcs in Theatre Areas RPH
Upgrades Recovery Main Theatres
(Theatre) – RPH
SGU Anaesthetics - RPH
SGU Recovery – RPH
SGU Surgeons Room –
RPH
Gynae Theatres – CDH
Longton Day case - CDH
8 x Chorley Theatre areas
(To be confirmed)
PC + 19” Surgeons Room (West) –
Clinical Single RPH)
PC + 19” Single TFT Monitor upgrade to
(Greyscale / 2 Original Surgeons Room
existing pcs in Theatre Areas
Colour) TFT (East) – RPH
(theatres) 0 x Chorley (TBC)
Wall Mount 19” Theatres 1 (RPH) –
Clinical Single Fixed Wall mounts 19” Clinical Single Ophthalmology
2
(Greyscale / (Greyscale / Colour) TFT Charles Beard Theatre
Colour) TFT (RPH)
Wall Mount 19” Fixed Wall mounts 19” Clinical Dual Theatres 2 (RPH) –
12
Clinical Dual (Greyscale / Colour) TFT Plastics
(Greyscale / Theatres 3 (RPH) –
Colour) TFT General Surgery
Theatres 4 (RPH) – ENT
Theatres 5 (RPH) – Oral /
ENT
Theatres 6 (RPH) –
Plastics
Theatres 7 (RPH)–
Urology
Emergencies
Theatres 10A (RPH) –
Plaster Room
Day Case “Unit D” - RPH
Theatres 4 (CDH) –
Orthopaedics

21 September 2006
General Surgery
General Surgery
General Surgery
Orthopaedics
Theatres 11(RPH) –
Wall Mount 21” Neurosurgery
Clinical Dual Fixed Wall mounts 21” Clinical Dual Theatres 12 (RPH) –
7 Neurosurgery
(Greyscale / (Greyscale / Colour) TFT
Colour) TFT Theatres 1(CDH) -
Orthopaedic
Theatres 2 (CDH) -
Orthopaedic
Theatres 3 (CDH) -
Orthopaedic
Day Case (A/B/C) RPH
Mobile Trolley SGU Theatres (1/2/3)
Fixed Wall – RPH
mounts 19”
Mobile Trolley 19” Clinical Dual (Greyscale / Gynae Theatres &
Clinical Dual 5
Colour) TFT Longton Day Case
(Greyscale /
Colour) TFT & (CDH)
Workstation Theatres 1 – 12 – RPH
Theatres 1 – 12 – RPH
T Patankar
(RPH)
R Padkhe
(RPH)
Dare Seriki
(X-Ray – RPH)
Steve D’Souza
3D Suite
(X-Ray – RPH)
Hardware 9
Upgrades W Gunawardena
(MRI – RPH)
(X-Ray – RPH)
(X-Ray – CDH)
(Nuclear – RPH)

21 September 2006
Printer Section
KODAK Dryview 8900, 650 dpi, 3 film sizes on
Dry Laser
line, 200 films per hour 1 Chorley Main X-Ray
DV8900
Installation included within the unit charge
KODAK Dryview 8200, 2 film sizes on line, 55
Dry Laser
films per hour 0
DV8200
Installation included within the unit charge
Digitisers Section
up to 4K x 5K resolution, max 570dpi, 8"-14" in
width; 8"-51" in length; 6-sheet film feeder,
Vidar
0.00-3.850 OD, Inputs 32 bits; outputs 8 or 12
DiagnosticPro™ 1 Main X-Ray RPH
bits normally or up to 16 bits; 256 or 4096 for
Film Digitiser
12 bits; capable of 65,356 grey levels.
Vidar Diagnostic Pro Ad
Software Section
T Patankar
(RPH)
3D post processing AW Suite 'Lite' software
R Padkhe
option - additional (pack = 1 concurrent user)
(RPH)
3D Suite “Lite” Additional GE 3D Image Post Processing 4
License, including MPR, MIP, MinIP and Rob Stockwell
Segmentation tools (X-Ray – CDH)
Dare Seriki
(X-Ray – RPH)
Main X-Ray CDH
A&E Processing CDH
A&E Processing CDH
Main X-Ray RPH
Grid detection & Main X-Ray RPH
Suppression of grid line artefact 11
Suppression s/w Wards Mobile & Theatre
Courtyard RPH
Main A&E Resus RPH
Theatres RPH
Chest X-Ray RPH
Main X-Ray CDH
A&E Processing CDH
A&E Processing CDH
Main X-Ray RPH
Reject Analysis & Main X-Ray RPH
Can allow detailed QA on rejected images 11
Trauma s/w Wards Mobile & Theatre
Courtyard RPH
Main A&E Resus RPH
Theatres RPH
Chest X-Ray RPH
Procedure Allows procedure mapping via RIS codes to 11 Main X-Ray CDH
Mapping s/w save key presses A&E Processing CDH
A&E Processing CDH
Main X-Ray RPH
Main X-Ray RPH
Wards Mobile & Theatre
21 September 2006
Courtyard RPH
Main A&E Resus RPH
Theatres RPH
Chest X-Ray RPH
Remote Patient Only required in the absence of RIS and allows
1
Data Entry work lists to be generated.
Capture Link
Capture Interface
Server
Capture Link
Capture Interface Software 1
Licence
Orthoview 2 Orthopaedic Templating Software 5
CR Section
CR500 including software bundle (note that
this software bundle includes EVP software).
CR Readers - Excludes QA workstation and standard pack of
0
Table Top plates.
Device capable of processing over 60
cassettes per hour
Main X-Ray RPH
CR850 including software bundle (note that Courtyard RPH
this software bundle includes EVP software). A&E Resus RPH
CR Readers - Excludes QA workstation and standard pack of New A&E Build
8
Single Plate plates. Theatres RPH
The device is a Single cassette floor standing Chest X-Ray RPH
system Main X-Ray CDH
Theatres CDH
CR950 including software bundle (note that Main X-Ray CDH
this software bundle includes EVP software).
CR Readers -
Excludes QA workstation and standard pack of 3 Main X-Ray RPH
Multi Plate
plates.
Multiple cassette floor standing system Main X-Ray RPH
Main X-Ray CDH
Main X-Ray CDH
Main X-Ray CDH
Main X-Ray RPH
Remote Main X-Ray RPH
Kodak DirectView Remote Operation Panel 11
operations panel Main X-Ray RPH
Main X-Ray RPH
Main X-Ray RPH
Wards & Theatres RPH???
Neo Natal
Includes cassette holder, front cover, grid, 4
cassettes and s/w for 1 CR reader (LLI not Main X-Ray CDH
CR long length supported on CR500), note LLI will not work
option (H/W - without EVP and additional project 2
cassettes/frame) management and application consulting could
be required, only standard installation is Main X-Ray RPH
quoted.
CR long length Main X-Ray CDH
Secondary radiation grid to minimise scatter
option (H/W 2
artefacts. Main X-Ray RPH
option - grid

21 September 2006
CR 850/950 LW cassette 18 x 24 cm w/ GP-25
CR Plates 18x24 Phosphor screen 35
CR High Res
5
Plates 24x30 CR Plates - 18 x 24 (HR)
CR High Res
5
Plates 18x24 CR Plates - 24 x 30 (HR)
CR Mammo
CR Mammo Plates 18x25 0
Plates 18x24
CR Mammo
CR Mammo Plates 24x31 0
Plates 24x30

21 September 2006
GLOSSARY
Choose and Book
Will allow patients, in partnership with health and care professionals, to book first
outpatient appointments at the most appropriate date, time and place for the patient.
Cluster
A group of strategic health authorities working together by region to implement the new
technology and information systems.
Cluster board
Endorses the reasons for and objectives of the local programme at senior management
level and promotes and supports any changes. It also ensures that benefits and desired
outcomes are achieved, and sorts out any disagreements that may arise.
Community PACS (CPACS)

CPACS is an extension of the PACS concept across several acute Trusts and out into
the Community. CPACS delivers a community wide digital radiology service along with
a core IT infrastructure for the health community.
DICOM
DICOM is an abbreviation for Digital Imaging and Communications in Medicine. It is an
accepted standard for transmitting medical images and associated information between
devices in a medical environment.
Enterprise-wide arrangements
Arrangements with key suppliers in the IT industry. Given its size, the National
Programme can procure quality IT services from suppliers to the NHS on a greater
scale and at a more competitive rate than any single NHS organisation.
Legacy systems suppliers

These are the commercial companies that supply the current/existing IT systems and
software in use in the NHS. Also known as existing systems suppliers.
Local implementation
A NPfIT management group and individual project teams have responsibilities
for implementation in each SHA. They coordinate and manage the progress of the
programme by dealing with a variety of issues, including progress monitoring, problem
solving, risk management, planning, good practice and allocating resources.
Local Service Providers (LSP)

Responsible for making sure the new systems and services delivered through the NPfIT
meet local requirements and are implemented efficiently.

21 September 2006
Milestone Achievement Certificate (MAC)
Milestone Achievement Certificate means certification made in writing that the Work
associated with a Milestone Date has met the applicable Acceptance Criteria;
Modernisation Agency
Created as part of the NHS Plan to help local clinicians and managers redesign local
services around the needs and convenience of patients.
N3 - The National Network

The new fast, broadband communications network for the NHS. N3 is delivered by BT
and replaces the existing private NHS network, NHSnet.
National Application Service Providers (NASPs)

Groups of commercial suppliers who are contracted to deliver national services such as
Choose and Book and the Electronic Transmission of Prescriptions.
National Programme Board

Has overall responsibility for all areas of work within the National Programme for IT.
National Supplier Board

Focuses on development and technology, implementation, service and contract
management.
NHS Care Records Service (NCRS)

Currently under development. This will be an electronic store of over 50 million health
and care records which can be accessed by health professionals where and when they
are needed. It will also give patients secure Internet access to their own health record.
National Programme for IT (NPfIT)

Responsible for procurement and delivery of the multi-billion pound investment in new
information and technology systems to improve the NHS.
National Service Frameworks (NSFs)

NSFs set national standards and service models for a specific service or care group.
They set up programmes of implementation and performance management against
which progress in an agreed timescale can be measured.
Primary Care Trust (PCT)

Responsible for commissioning all health care in their community.
Programme management group

Each regional cluster has a programme management group comprising chief
information officers and programme managers from each Strategic Health Authority
area, plus the Regional Implementation Director and key members of the cluster
programme support team. Local Service Provider programme managers and senior
representatives are also part of this team.

21 September 2006
Regional Implementation Directors (RID)
Responsible for managing implementation of the new national services across a
geographic area.
Strategic Health Authorities (SHA)
The headquarters of the local NHS. Their role is to ensure that the Primary Care Trusts
are both effective and efficient in managing the delivery of services.
Spine
The Spine is the name given to the national database of key information about a
patient's health and care and forms the core of the NHS Care Records Service. It will
include patient information like NHS number, date of birth, name and address, and
clinical information such as allergies, adverse drug reactions and major treatments.
Supplier Liaison
The function of Supplier Liaison is to assist IT suppliers to locate information on the
National Programme and to provide contact details for those organisations that have
been awarded contracts.
TUPE
Transfer of Undertakings - Protection of Employment
A safeguard of employees' rights where businesses change hands between employers.

21 September 2006

PACS

Caricato da

Informazioni sul documento

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

PACS

Caricato da

Copyright:

Formati disponibili

AGENDA ITEM NO: 9

LANCASHIRE TEACHING HOSPITALS NHS FOUNDATION TRUST

PICTURE ARCHIVING AND COMMUNICATION SYSTEMS (PACS)

Board members are asked to approve the draft business case.

1.0 EXECUTIVE SUMMARY .......................................................................................1

2.0 INTRODUCTION ...................................................................................................2

3.0 WHAT IS PACS? ..................................................................................................2

4.0 OBJECTIVES AND BENEFITS.............................................................................3

6.0 IMPLEMENTATION AND MANAGING RISK .......................................................6

APPENDIX A2:- ECONOMIC ASSESSMENT ..............................................................11

APPENDIX A3:- AFFORDABILITY ASSESSMENT.....................................................12

APPENDIX B:- THE CASE FOR INCLUSION OF RADIOTHERAPY IN PACS ...........13

APPENDIX C: - GOVERNANCE AND STAKEHOLDERS ...........................................17

APPENDIX D: - TERMS OF REFERENCE...................................................................19

APPENDIX E: - RADIOLOGY FACILITIES ..................................................................23

APPENDIX F: - PROJECT MANAGEMENT METHODOLOGY ...................................25

APPENDIX G: - EPR MODEL.......................................................................................26

APPENDIX I: - PACS EQUIPMENT LIST .....................................................................28

1.0 Executive Summary

The implementation of PACS is now defined as a “core” part of the national

Although the national procurement for an integrated NHS-wide PACS solution

Critical to the success of the implementation is clinical involvement. The PACS

In summary the programme is affordable in both capital and revenue terms.

Approval is therefore requested to support the implementation of PACS at

Author: Venkata Padala

PACS will provide considerable operational benefits in terms of improved

3.0 What is PACS?

The process of radiology includes 5 elements;

The capture of images.

A simple PACS system digitises three of these steps so that:

Author: Venkata Padala

4.0 Objectives and Benefits

The project will develop a Picture Archiving Communication System in

Improved diagnostic accuracy and reduced clinical risk.

Author: Venkata Padala

By improving accessibility to information and supporting the analysis of

In summary, this development facilitates improved clinical care and

For a more comprehensive breakdown of benefits see APPENDIX H: -

The potential long-term implementation of a PACS system will also impact

4.3 Drivers for Investment

Increased patient satisfaction through fewer delays associated with

Author: Venkata Padala

Efficiency and Effectiveness would be improved by:

5.0 Statements and Conditions

The Scope of the National Contract allows PACS to be implemented in Main X-

Author: Venkata Padala

6.0 Implementation and Managing Risk

It has been recognised that it is essential to secure the commitment to

A lead Clinician, Dr Ian Harris, Consultant Radiologist, supported by

Dr Harris has to date liaised with every Clinical Directorate through an

This clinical ownership and drive will continue to be a priority, supported

Author: Venkata Padala

Detailed ‘Acceptance Testing’ will be performed by the Trust before go-live

Misys has formally agreed to develop an interface between PACS and

6.3 General Governance

Following the principles of the PRINCE 2 project management

Author: Venkata Padala

The following costing is based on a traditional NHS procurement

All costs are at 2006/07 prices.

7.1.1 Capital costs

The following table shows the anticipated capital cost of outright

A system of this type is considered to have a usable life of 8.25

Author: Venkata Padala

7.1.2 Revenue costs