Monday, March 14, 2016

How many PACS SA's do you need?

The quest for the right number of support people for a PACS (Picture Archiving and Communication System)  has been asked many times, and the correct answer is: “it depends.” I have seen organizations that have a single PACS SA (System Administrator) supporting multiple campuses, and others having eight people as part of their SA staff supporting the system 24/7 using three shifts. To be precise, based on a survey, I found that 53 percent of institutions have a single PACS administrator, 23 percent of them have two, 13 percent have three and 11 percent have four or more. 

Here are my top ten criteria that influence the proper PACS SA staffing level:
1.       System size: How large is your institution, what is the number of annual procedures, the number of facilities that you are supporting, additional clinics, and number of radiologists?
2.       Imaging scope: Is your EMR image-enabled, is cardiology included in your support duties, what about surgery, dentistry, and other “ologies”?
3.       System scope: Do you support CR/DR connectivity, RIS, speech recognition?
4.       Provider expectation: Is 24/7 presence required, are you on-call, what about back-up if you go on vacation, get sick or have other personal things to take care of outside work?
5.       Level of management involvement: Are you part of the planning committee, steering committee, change control board, implementation committee, in other words, how much time do you spend in meetings?
6.       Level of organizational support: Does biomed do the modality integration, do your technologists fix their own studies, is medical physics taking care of monitor calibration and image quality verification, and is there an IT help desk to take first call?
7.       Level of vendor support: Do you rely on the vendor to provide troubleshooting, monitoring, providing reports?
8.       Educational support: Does your employer allow you time to attend professional meetings, take an on-line or face-to-face training seminar, pay for you to get certified as a PACS professional, and keep up with your peers and the industry?
9.       Experience and skill level: How much experience do you have? An experienced PACS SA takes less time to deal with an issue, such as doing a quick SQL query to the database, or to find or fix a problem, use a network sniffer to find out the reason a DICOM connection was rejected, or look at a log file of a HL7 transaction to find a missing or duplicated Accession Number.
10.   Last but not least: Budget restrictions: Unfortunately, some organizations do not allocate the proper resources which impacts effectiveness, readiness and, indirectly patient care by not making sure the PACS is properly supported.

Based on feedback from SA’s in our PACS training classes, I have found that if you are spending more than 50 percent on support and maintenance (fixing, putting out fires), you are understaffed. The ideal allocation would be 50 percent support, 35 percent on implementing projects and 15 percent on education and training. If you are too far off from these numbers, I suggest you have an honest talk with your supervisor.


  1. Excellent post Herman- right on the money. In all my years I have yet to see a facility that hasn't been understaffed with PSAs usually by a factor of at least 2. Sadly if a PSA tries to better themselves and gets CIIp or PARCA certified, usually doing so out of their own pockets, it adds little if anything to their pay scale. PSA's are typically understaffed and underappreciated for sure and make all the difference between a smooth running PACS and one that is just running. Your tips are stop on- Good job!

    Mike Cannavo

  2. Part of the problem (IMHO) is that when PACS is run by IT they don't really look at the PACS Analysts as being colleagues - more like super users. And when run by the Radiology Departments, the PACS Analysts are a maintenance overhead expense. We really can be red-headed step children no one wants to claim.

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