Images of all sorts can be digitized, then manipulated, compressed, archived and sent between computer workstations over huge distances at speeds limited only by the bandwidth of the line. For radiology and all aspects of medicine dependent on its services, that means a revolution in service delivery is about to take place. Over the next several years, Yale-New Haven Hospital plans to put its own imaging systems online and link into a network within the center. It will very likely be accessible to physicians outside the hospital who hold authorization codes as well. The Picture Archiving and Communications System, or PACS, will allow referring physicians and radiologists to download and discuss patient images at their workstations simultaneously. When radiology goes online, medicine will change dramatically.

"PACS and teleradiology," says Howard P. Forman, M.D., vice chair for finance and administration in the Department of Diagnostic Radiology, "will make more of a change in medical practice in the next 10 years than anything else now on the horizon."

PACS will go a long way toward making the computerized world of medicine, now only partially implemented, complete. "We can call up any number of images anyplace, anytime," says Pradeep Mutalik, M.D., while sitting at a double monitor workstation specially designed for diagnostic imaging. Dr. Mutalik, along with fellow associate research scientist Vladimir P. Neklesa, M.D., is in charge of bringing PACS online at Yale. Eventually, teams of radiologists based at the medical center will review images sent from satellite sites, clinics and private practices throughout a large region.

The completion of PACS will eliminate the need for storing medical film. Where now a vast film archive holds medical records–with only the most recent images kept at the hospital and the rest warehoused off-site–a theoretically infinitely expandable digital-storage system will keep images at constant ready. Worries about confidentiality appear misplaced. One of the major complaints all physicians make today is that when they need patient images, all too often they're simply not to be found. Says Dr. Mutalik of PACS-based storage: "Unlike film, where there is only one copy, it doesn't sprout legs and walk away." Only those with authorization will be able to enter the secure Web site or the PACS system. For those physicians, however, image retrieval will be almost instantaneous, even for much older images. Eventually, all of an individual's medical records could be downloaded onto a "smart card" that the person might carry like a credit card.

Yale-New Haven Hospital already has a partial network established within the hospital. Funding is in place to begin creating the complete PACS. As with any investment in new high-tech systems, the risks of undertaking the $8-10 million build-out of the system are substantial. Some pioneering hospitals created early versions of PACS before the technology was adequately developed, and soon had to scrap the whole thing. "Timing is everything," says Dr. Neklesa. "We think now is a good time to get in." Department of Diagnostic Radiology chair Bruce L. McClennan, M.D., agrees: "We'll be able to display, store and share information in a high-speed, secure fashion. The clinical networking revolution is here."