An Evaluation Protocol for Picture Archiving and Communication System: a Systematic Review.

Introduction: Picture archiving and communication system (PACS) serves to store, transmit, communicate and manage medical images. A logical evaluation protocol assists to determine whether the system is technically, structurally and operationally fit. The purpose of this systematic review was to propose a logical evaluation protocol for PACS, particularly useful for new hospitals and other healthcare institutions in developing countries.

Methods and Materials: We systematically reviewed 25 out of 267 full-length articles, published between 2000 and 2017, retrieved from four sources: Science Direct, Scopus, PubMed and Google Scholar. The extracted data were tabulated and reviewed successively by three independent panels of experts that oversaw the design of this study and the process by which the PACS evaluation protocol was systematically developed.

Results: The outcome data were ranked by expert panels and analyzed statistically, with the reliability established at 0.82 based on the Pearson's correlation coefficient. The essential components and the best options to establish an optimal PACS were organized under nine main sections: system configuration; system network; data storage; data compression; image input; image characteristics; image presentation; communication link; and system security , with a total of 20 components, each of which capable of working optimally with one or more program options.

Conclusions: This systematic review presents an objective protocol that is an ideal tool for the evaluation of new or existing PACS at healthcare institutions, particularly in developing countries. Despite the significant advantages, the protocol may face minor limitations, largely due to lack of appropriate technical resources in various clinical settings and the host countries.