France may be the latest European nation to pursue a large-scale PACS initiative if a digital image management proposal is adopted by the French government. If approved, the plan would implement a countrywide framework for storing medical image data, encompassing national, regional, and local levels.
France currently produces more than 61 million radiology exams a year (more than 5 petabytes worth of data), read by more than 7,800 radiologists at 1,845 sites. Although 70% of private radiology practices in France have PACS, only 20% of public institutions do. Overall, 910 sites, including 250 private practices and 660 public hospitals, currently do not utilize PACS.
With the goal of achieving widespread adoption and saving money over current practice, the proposal would include the creation of a national image archive. In addition, hospitals without PACS could gain access to a Web-based PACS through a common regional PACS deployed via a software-as-service model. As for hospitals that currently have PACS, they could archive their images for long-term storage in the national archive.
The goal is for all long-term images (older than five years) generated at private practices, private hospitals, and public hospitals to be stored in the national archive, according to project director Laurent Tréluyer.
"We chose that because archiving is an IT project, it's not a medical project," he said. "We know that after five years, the utilization of [images] is very small. It's for a legal point of view that we need to archive the exam."
Images will be stored for five years on either a local or regional basis. Regional and national platforms would communicate via DICOM standards, and studies from the long-term national archive will be available to be fetched as needed, Tréluyer said.
University hospitals would be inclined to use local storage for their recent images, while the regional platform might be more suitable for smaller hospitals, he said.
On a national level, the ASIP Santé (agency for shared health information) would establish the general framework for interoperability and provide the specifications for common PACS functions. It would also manage the archive program. The regional PACS would be managed on a regional level, with their own tender programs for vendor consortiums.
The separation of the archiving function of PACS is a key element of the proposed program, Tréluyer said. The project will also emphasize the use of a vendor-neutral archive (VNA) and standards such as DICOM, HL7, and the Integrating the Healthcare Enterprise (IHE) Cross-Enterprise Document Sharing XDS-i profile.
The proposal estimates savings of more than 70 million euros ($90 million U.S.) a year from the program. The average cost of a radiological exam with a shared PACS software-as-a-service model would be 2.15 euros ($2.76 U.S.), compared with 2.63 euros ($3.38 U.S.) with a standardized PACS on an institution-by-institution basis, and 3.23 euros ($4.16 U.S.) with the current archiving methods, according to the proposal.
A pilot project involving 24 hospitals in the Paris region is currently in development, with a vendor consortium including GE Healthcare of Chalfont St. Giles, U.K.; storage firm EMC of Hopkinton, MA; and Orange (France Telecom). Launched in May, the five-year, 30 million euro ($38.6 million U.S.) pilot project will test the PACS software-as-a-service model on a large-scale basis, handling 1.3 million exams per year.
The economic model for the overall project relies on savings from current storage methods and is not dependent on government funding, but some initial investment is required to begin, Tréluyer said. A decision is expected by the end of the year.
Under the proposal, radiology practices would not be obligated to join the program. However, public funding would only be provided to those who fall within its framework, according to the proposal.
By Erik L. Ridley
AuntMinnie.com staff writer
September 14, 2010
Related Reading
Shared imaging repositories bring access challenges, August 11, 2010
Software glitch shuts down VA-DoD EMR data exchange, March 12, 2010
First hospital joins Ontario imaging network, December 17, 2009
MGH's Render app finds images in PACS databases, November 23, 2009
GE lands Ontario archive deal, June 22, 2009
Copyright © 2010 AuntMinnie.com
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![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
