A paradigm shift in systems thinking for diagnostic imaging

Driven by intense pressures to reduce costs and become more competitive, medical imaging has reached a saddle-point of efficiency where the myriad “islands of automation” can no longer be independently managed. Given the commercial systems available today, however, no single system can meet all end-user and institutional needs. At the same time, the cost of interfaces connecting the different islands of automation can be prohibitively expensive and often is not cost-justified. Picture archiving and communication systems (PACS) continue to be proposed as the solution of the future, yet the concept itself is flawed in its heavy emphasis on images. Because of this emphasis, attention shifts from the more significant business and operational cost problems to viewing diagnostic images on ever more expensive equipment. This paper develops some of the key problems to be addressed while borrowing ideas from the field of factory automation. Chief among these borrowed concepts are the ideas of “process”, “process control”, “bottlenecks” and “capacity”. In order to demonstrate the kind of paradigm shift from islands of automation to process control, an example is given of a process control-oriented user interface for a diagnostic workstation. Perhaps the shopworn and discredited PACS acronym can be retrieved with a new orientation as a diagnostic “process automation and control system”