One of the oldest universities in Europe, the University of Pisa in Pisa, Italy, has a long-standing tradition of excellence in medical care. Its hospital, Azienda Ospedaliero-Universitaria Pisana (AOUP), provides healthcare services to residents of Pisa and is affiliated with a network of hospitals that serves the area vasta, or surrounding area, of approximately one million people. The radiology department at AOUP performs hundreds of thousands of exams annually. Images associated with these exams must be retained and made available for fast access by doctors and clinicians in the surrounding area. Data loss is not an option, and any significant delay in image access can have a direct impact on patient care.

Prior to 2008, AOUP and its ten associated local hospitals maintained separate data silos for radiology images; sharing images between hospital locations required physically transporting images on film or CD, which could take hours or even up to a day.

A group of hospital engineers had maintained the open-source PACS and associated SAN in Pisa, but due to their other responsibilities, it was difficult to ensure that the system would be supported 24/7. Although the hospital kept a backup image archive for each modality, sporadic data loss often occurred in the central SAN archive, either due to electrical failures or human error. When this happened, exams had to be reloaded from the modality level, which could take as long as two hours. “In a clinical practice, two hours can be a very long time,” says Professor Davide Caramella, chairman of the university’s radiology section. “Clinicians are justifiably breathing down your neck and saying they need the report, and you can only say, ‘Well, I have to reload the previous exam.’”

Scaling storage capacity to keep pace with the PACS image archive — which was growing by 25TB a year in Pisa and by twice that much across the hospital network — was also a major challenge. “Our storage space was insufficient, and we were constantly adding more,” says Caramella.

“We wanted a secure, reliable, scalable PACS solution that could be managed 24/7 without burdening our engineers.” He adds, “We also knew that this would be a requirement for the future, since new modalities are coming out very quickly. Also, one of our goals is to extend the PACS to our cardiology department as well, which will involve many, many more terabytes of image data.”

Following an evaluation of multiple PACS vendors, in 2008 AOUP deployed the Synapse PACS from Fujifilm Medical Systems, a managed global PACS solution that could serve all 11 locations with one centrally administered system. The PACS was leveraged in concert with NetApp virtualized storage to enable a more efficient approach to data protection and image sharing. “The Fujifilm engineers are very experienced at managing the application and the storage, so we no longer have to rely on our own engineers to volunteer their time,” says Caramella. “We know that our data is secure.”

“Our engineers are now able to focus on image-assisted surgery, which uses preoperative and intraoperative imaging to guide laparoscopic surgeons,” Caramella explains. “This is an area where our hospital is innovating.”

Radiologists and clinicians can now access images and reports located anywhere within the hospital network across the WAN within minutes. Clinicians belonging to the area vasta can request an opinion from a remote radiologist with a simple phone call, improving quality of care. “Transporting images to the medical wards used to take hours, even days in some cases,” says Caramella. “Those delays were very disappointing, because, although we were very efficient in the radiology department, often the clinician didn’t benefit from that work. Now, as soon as we sign our report, the images and the report are immediately available.”

Additionally, AOUP is now able to accommodate new modalities and higher resolution images to stay at the forefront of medicine. “Our storage needs continue to increase at a very fast pace, so it’s extremely important to us to have a scalable solution that is always available,” says Caramella. “We will be adding two more hospitals within the area vasta and also bringing non-radiological imaging into the PACS so that we can extend these benefits to our cardiologists and other physicians.”

In 2011, the Synapse PACS will begin providing further access to images and results through implementation of Integrating the Healthcare Environment (IHE) standards, Cross Enterprise Document Sharing for Images (XDS-I) and the associated technical frameworks, enabling fast, secure access to images by any of the healthcare providers in the area vasta. Fujifilm has selected Pisa to be the first site in Italy to deploy the newly released frameworks, and will collaborate with the University for further product enhancements. This partnership will ensure the continued improvement in healthcare delivery throughout the region. The expanded adoption of the IHE frameworks will allow access to registered exams and their reports from any affiliated participant in the region. Using the Web, participants will be able to share information between various applications compliant with the underlying IHE framework.

Although Caramella points out that the implementation of PACS is not the only factor, the hospital has observed a 15% reduction in patient stay time over the three years that the Synapse solution has been in place. “In the past, we had patients staying longer in the hospital due to the inefficiencies of information transfer from the clinical ward to the imaging department and back, and one of the factors that is consistently reducing the length of that stay is the introduction of the global PACS,” Caramella concludes. “We’ve been able to successfully use technology to improve patient care.”