E4534. Stay Ahead of the PACS: Acquiring Proficiency in Image Manipulation and Viewer Navigation
  1. David Gullotti; Johns Hopkins University School of Medicine
  2. Moustafa Abou Areda; Johns Hopkins University School of Medicine
  3. Tae Kyung Kim; Johns Hopkins University School of Medicine
  4. Cheng Ting Lin; Johns Hopkins University School of Medicine
Several PACS-related skills can be considered foundational to radiology residency training. This exhibit will present the progression of PACS-related skills that radiology residents are expected to acquire.

Educational Goals / Teaching Points
Proficiency in PACS can significantly enhance radiologists' ability to navigate medical images and streamline clinical workflow. The assessment of PACS expertise can be challenging due to the lack of standardized methods for evaluating resident milestones. PACS tools may differ across vendor products, so radiologists should be familiar with common tools and functions in order to optimize their efficiency.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
PACS skill levels (suggested radiology residency training level) are as follows: Introductory skills (early 1st year resident): window level and width, pan, zoom, scroll, linear measurement, ROI tools. Basic skills (late 1st year): 2D orthogonal multiplanar reformation (MPR), linking studies (e.g., image registration), 3D position (multiple series), changing layout or display protocols, using hot keys, creating annotations (e.g., arrow, textbox), generating key images, and cine display tools. Intermediate skills (2nd year): on-the-fly maximum intensity projection (MIP) and MPR, exporting images, 3D volume-rendering, removing annotations, image fusion (e.g., PET/CT), anatomy labeling (e.g., spine level labels), and customizing user settings. Advanced skills (3rd/4th year and beyond): 3D curved and straightened MPR, volume measurement tools (e.g., lesion segmentation), importing/exporting studies from/to other servers, examining DICOM meta-data, and DICOM anonymization.

It is important to document whether residents are meeting technological proficiency milestones so that their productivity is not restricted by unfamiliarity with the technology at hand.