Wednesday, September 1, 2010

Anyone Missing Their Shoes?

When you're on the road as much as I am you learn to savor humor when it finds you. For example, the airport announcement I heard this past week that urged a traveler to return to the security checkpoint to collect their shoes. You'd think you'd notice that you were in your stocking feet (or barefooted) as you scurried off to the boarding gate, but I guess this traveler was in a hurry. My guess is that they simply boarded their flight (because the announcement was repeated more than once) before they noticed their shoes were missing. If you're in a rush and preoccupied with multitasking, unless you suddenly step onto wet grass, gravel, or hot pavement, you, too, might not even notice that you've left your shoes behind. 

There's an old saying that "the devil is in the details," which you might have the misfortune of experiencing if you get caught flat-footed by rushing into a PACS installation without taking the proper precautions. I've seen it happen at more than one facility: Institutions rip out their dark-room and hurry to go digital without recognizing their dependence on the new technology and its infrastructure. What if the network goes dark because someone accidentally cuts a cable? What happens if the PACS archive goes down? What's the operational plan for a software upgrade requiring the database to be down for a weekend? What if two or more RAIDs on the SAN simultaneously fail? 

All these scenarios can be analyzed, their risk assessed, and mitigation procedures put in place. These procedures, which should cover scheduled as well as unscheduled downtime, modality (CR, DR, etc.) failure, a RIS being unavailable, PACS down, network failures, and so on should be thoroughly documented. 

Operating procedures for technologists, radiologists, physicians, and PACS support personnel should be detailed in a step-by-step manner. Redundancy and back-up equipment and procedures have to be tested on an on-going basis so they are available when needed. This can be as simple as burning a CD at an acquisition modality for STAT cases (if, for example, a PACS or facility network is down) and walking the disc over to a radiologist for review. In fact, I worked on one RFP that that required a CD writer at each modality QA station (just remember to ensure that blank CDs are readily available). 

The message is simple: Prepare for the worst and strive for the best. That way, when the unforeseen and unexpected happens—which it will—you won't find yourself shoeless and unprepared for the elements; not in an airport and not when managing and supporting a PACS. 

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