Promiscuous PACS?

Is your PACS - shudder - promiscuous? Sounds bad, huh? Well, what might be considered taboo in human social terms ends up being a good thing when you are talking about your PACS server!

What is a promiscuous PACS server and why would you want one? A promiscuous PACS server takes DICOM images in from any modality, any time, without regard to the device sending the images. The inside joke with PACS engineers is that a good PACS servers is a "DICOM slut". What this means is that when setting up your PACS server, you don't need to know much information at all about the sending side. You only need to program the information about the DICOM PACS server into the modalities - basically putting in the IP address, AE Title and port number of the PACS server.

If you have a non-promiscuous PACS server it means the server itself has to know detailed information about every single modality that will be sending into it, or the server will reject the images. In a small one or two modality clinic this might not be a big issue, but when you are in a large healthcare facility or worse yet, in a radiology group that reads for multiple unrelated healthcare facilities, it can mean an absolute nightmare in managing your PACS system. Some medium sized radiology groups may have 15 or so facilities sending to their server, each with 3-5 modalities. This means you would have to know in advance all the DICOM information about 75 modalities. Have you ever tried calling GE tech support to find out the AE title of even a single CT? Multiply that effort by 75 or more and you can see the challenges that face customers who install a non-promiscuous PACS server.

And that is just during installation. Once the dust has settled you still have to maintain this mess. Anytime a remote modality changes - say from a software refresh or upgrade, or a modality upgrade, the images no longer will be accepted by the PACS server. Often the person doing the ugprade has no idea why the images won't be accepted, so days can go by with vendors pointing fingers, people waiting on hold for phone support, until someone figures out "oh yea, you gotta reprogram the PACS server to accept this changed information in the modality".

Do vendors tell you if their PACS server is promiscuous? Not unless you know to ask. That is not something you find out about at the demo, or during the planning stages. You don't find out about it until the down payment checks are cashed, the system is shipped, and you are trying to get all these modalities on line and you figure out "this is a nightmare!" Too late then, you are pretty well stuck. And it gets worse as you try to manage this house of cards.

This is a case of "buyer beware". A good vendor will clearly explain all this so you have no surprises. I hate surprises. Especially in regards to PACS!