PARCA CPAS2020 Requirements

PARCA Certified PACS

Associate
(CPAS2020)
Requirements

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Certified PACS Associate (CPAS) requirements

This document contains the detailed requirements for the certification of a CPAS2020 or
Certified PACS Associate. The focus is on general technical and clinical understanding.
CPAS2020 is an update to the original CPAS requirements published in 2005 and
updated in 2014 to include new technologies and developments. The requirements are
split up in two sections: A) Technical (IT) and B) Clinical.

A. Technical (IT) requirements

1. Computer basics (20%)

1.1 Hardware: A computer is made up of various hardware components, i.e., the

CPU, Memory (RAM/ROM), Disk(s), Removable Media, Display Adapter
Card(s), display monitor such as a Liquid Crystal Display (LCD), Input devices
(mouse, keyboard, trackball, dictation microphone), Network Interface Card(s).
There are several data interfaces types used to facilitate communication between
these different pieces of hardware (RS232 Serial ports, Universal Serial Bus
(USB), Network interfaces). Know how to distinguish these devices and the
function of each.
1.2 CPU and Memory: The CPU and memory determine to a high degree the
performance of the computer. Know impact of the number of parallel
processors, their speed and I/O path width (in bits), of the different processor
types, the impact of dedicated processing boards. Memory type and
configuration determines performance, memory speed and capacity. Know the
performance impact of memory speed and capacity.
1.3 Disk technology: Disk performance is typically determined by type and access (I/O
channel, or network). Other important disk parameters are speed, reliability,
redundancy, impact of formatting, capacity, and technology (optical vs. magnetic,
RAID vs. single drives). Know impact of disk parameters on performance.
1.4 IP / MAC Addresses: There are two primary means to identify a computer on a
network – via MAC (Media Access Control) address and IP (Internet Protocol)
address. The MAC address is a unique, hard-coded ID on the network interface
card (NIC) that functions at the Data Link Layer in the OSI (Open Systems
Interconnection) model. An IP address functions at the Network Layer of the
OSI model via software and is not unique since it can be reassigned to other
computers as desired. In addition to an IP and MAC address, an application
requires a port number and sometimes host name to address a networked
resource. Be familiar with IP, IPV4 vs. IPV6, MAC addresses, port numbers
and host names, including how to manage them.

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1.5 Exchange media: Exchange media are MOD, DVD, CD, tape, and removable
memory cards. – Know how the characteristics, differences and when to use either
one of these devices to address these media on a computer, and to distinguish
between Read- Only and Read/Write functionality.

2. Operating system basics (20%)

2.1 Software: Computer software can be divided into the following classifications:
Operating Systems (function as the interface between human operator and the
computer and for managing the hardware resources assigning them to the
different software applications), Drivers (facilitate communication between the
Operating System and the computer’s hardware components), and
Applications (provide utilities for the computer operator to use, such as a
database or word processing program). There are different software
architectures, i.e. client-server, thin and thick clients, as well as zero footprint
applications. Know how to distinguish between each of these types of
computer software and the function of each.
2.2 Unix: Unix, or derivatives (LINUX) is often used for high availability
computers such as servers. – Know basic UNIX/LINUX prompts, difference
between the UNIX shell, kernel and file system.
2.3 Windows: Windows is a common operating system used for desktop and client
computers. – Know basic windows concepts, such as directory structures,
windows task manager, control panel features, settings and network
configurations, and how to change basic settings, including for security.
2.4 DOS prompts: DOS prompts, also known as Command Prompts, are
command-line interfaces used for basic hardware operations and low level
features. Know how to access the elevated DOS prompt and execute basic
network management commands.
2.5 Mobile Applications: Tablets and mobile devices have their own platform
using easily downloadable applications. – Know differences and
characteristics of the different mobile platforms.

3. Core Architecture (20%)

3.1 Databases: Image Managers or databases provide the capability for storing
and retrieving key record information. A database can be based on a flat file
system, or have hierarchical, relational, or object relationships. MUMPS is
its own database language. – Know the difference between, and
characteristics of different database types.
3.2 Basic SQL knowledge: The ANSI SQL language is the most common command
language used for database access and allows for direct access for
troubleshooting, maintenance, and special reporting. – Know basic SQL
commands to access data from a relational database.

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3.3 Archiving architecture: Images and/or other related patient information are
archived on media which can be accessed directly through the computer bus
(DAS) or through a network connection (NAS, SAN, Cloud). – Know the
differences between the various archive architectures and their advantages.
3.4 Archive implementations: Multiple archives can be clustered, one can use an
enterprise archive or VNA, or the archiving can be outsourced as a service
(SSP). Virtualization or cloud hosting can be advantageous. – Know the
advantages and disadvantages of these implementations.
3.5 Core Interfaces: Information such as images, reports and other related
information is exchanged with the core using specific protocols and formats
(DICOM, HL7 and IHE). – Know the basic protocol and file format differences
and how IHE plays a role.

4. Data representations (10%)

4.1 Binary data format: Information is stored in computer memory as zero’s and
ones, i.e. in a binary format. For numbers, each position in a data field can
represent a power of two. – Convert a binary representation to a numeric value.
4.2 Bits, bytes: Each zero/one in a data field is called a “bit” multiple of 8 bits
are called Bytes. – Know actual number of bits represented by KB, MB,
GB, TB, PB, EB.
4.3 Data Representations: Information can be represented as hexadecimal, integers,
floating point, and negative numbers (two’s complement). – Know these
representations so as to interpret type definitions, e.g. from image header
definitions and data dumps.
4.4 Monochrome, color: A data field could represent a certain grayscale value
(Black/White) or a value in a color mapping, for example, RGB. Other color
mappings are possible as well (YBR, CMYK, color by plane and pixel). – Know
how to interpret grayscale and color values and encoding.
4.5 Image representations: Images consist of a matrix of pixels and/or voxels which
are encoded and represented by a specific bit depth. They can also possibly
consist of multiple frames representing a dimension in time. - Know the
difference between the spatial, contrast and time resolution and how they are
encoded in images.

5. Networking technology (20%)

5.1 OSI model: A network connection can be thought of using different peer-to-
peer layers using their own protocols. – Know function and features of each 7
layers of the OSI (Open Systems Interconnection) model and how they apply to
the common health care interface standards.
5.2 LAN/WAN: Network technology is used to either access a local or wide area
network (LAN, WAN) using a specific access bandwidth (OC-xx with each

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their MBit/s) using an access path such as a high speed T1 or T3 circuit, or

using DSL technology. LAN’s typically use switched Ethernet. Wireless
connections have their own protocols. – Know different terminology and
technologies for networks and access connections including packet and circuit
switching.
5.3 Internet: Internet access using internet protocols such as http, udp, ftp and
others is commonly used for e-mail and to exchange information with other
internet users using TCP/IP. – Know function of domains and how to identify
them with a url as well as function of www and http. Know function of RFC’s
and structure of Internet governance.
5.4 Throughput, bandwidth, level of service parameters: Network access is
determined by several critical parameters used for planning and forecasting
the required network topology. – Know meaning and how to characterize
these parameters
5.5 Network components: Networks consists of several physical devices with their
own addressing. – Know function of hubs, bridges, routers, gateways and
different cable types as well as addressing (ports, IP and MAC addresses,
network masks and host names) and exchange modes (full, half duplex).

6. Basic Security Concepts (10%)

6.1 System security in general: Security is an integral part of being HIPAA,

HITECH compliance in the US, GDPR in Europe and whatever local federal
or local requirements dictate. Security is typically characterized as
authentication, authorization, confidentiality and integrity. – Know how to
characterize and identify each of the security components.
6.2 Authentication: First item typically done when accessing data is authenticating
of entity that is doing the access. – Know of authentication methods including
certificates.
6.3 Authorization: Authorization is typically done at application level based on
certain roles. – Know authorization functionality and how it fits in the overall
security scheme. Authorization involves defining access control rules to limit
access to resources to only those who are authorized to access them.
6.4 Confidentiality and integrity: Confidentiality is mostly implemented using
encryption. Data integrity can be implemented with digital signatures, checksums,
etc. – Know strengths of different algorithms and impact of key length as well as
symmetric- asymmetric and public/private key function and how digital signatures
work, including the function of hashing and keys.
6.5 Secure connections: When connecting devices through a public network, one
needs to use encryption. In addition, one needs to address the different security
threats such as viruses and malware. – Know function and set-up of VPN’s, use of
https and SSL/TLS, IDS, firewalls, and DMZ’s.
6.6 Cyber Security: Cyber security, computer security or information technology
security is the protection of computer systems from theft or damage to their

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hardware, software or electronic data, as well as from disruption or misdirection of

the services they provide. Know the different components of cyber security,
notably types of attacks, malware, worms and ransomware. Be aware of IOC’s
(Indicators Of Compromise) and security tools.

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B. Clinical requirements

1. Basic medical terminology (20%)

1.1 History and background: The medical profession is constantly changing. -

Understand its history, the common source of clinical errors and legal terms and
concepts such as the patient Bill of Rights and importance of record keeping.
1.2 Coding: Modern patient care relies heavily on specialized codes to indicate diagnoses,
treatments, fees and reimbursements. Most medical terms are coded such as procedures,
body parts, measurements, diagnosis and diseases. - Know of the most common coding
schemes, vocabularies and how they relate to data models, and how they are used.
1.3 Medical terms: The medical profession uses certain terms that appear in orders, such
as in the diagnosis or pre-condition. – Be familiar with the most common medical
terms.
1.4 Clinical terms: Many terms use abbreviations or acronyms while most of them use
standards pre and suffixes. – Know and understand the most common pre and
suffixes in the context of diseases, tests, etc.

2. Basic human anatomy (20%)

2.1 Nervous system: Imaging is typically done of certain body parts, organs. –
Know the function and parts of the nervous system so that images can be
related back to these body parts.
2.2 Chest/abdomen: The chest/abdomen contains the respiratory and digestive
system. – Know the main organs and function of the respiratory and digestive
system, corresponding terminology and used imaging technologies.
2.3 Bony system: The skeleton and joints provide the body structure and strength.
–Know main parts of the skeleton and used imaging technologies.
2.4 Circulatory system: Vessels, arteries and its core, i.e. the heart, are responsible
for circulating oxygen and other essential elements to every body part. – Know
the parts of the circulatory system and used imaging technologies, especially
for angiography and cardiology.
2.5 The Endocrine/reproductive system: Glands, hormones, reproductive organs
form the endocrine/reproductive system.- Know the main functions of the
endocrine/reproductive system components and how they are imaged.

3. Medical Imaging basics (20%)

3.1 Principles of different modalities (CR, DR, XR, XA, RF, US, IVUS, IV-OCT,
MR, NM, CT, MG, CT/PET, MR/PET,SPECT): Each modality has different
characteristics based on how the images are generated, i.e. using X-ray, electro-

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magnetic energy, radiation, etc. - Need to know the principle of how the energy is
captured and imaged including typical exam types and applications.
3.2 Basic operational procedural knowledge of imaging equipment: Each exam
requires different handling and operation by a technologist and has a specific
length and characteristics. – Need to know typical examination procedures and
technologist handling.
3.3 Image characteristics for each modality: Each image has specific characteristics
regarding noise, resolution, size of image and relationship with others (CINE
loops, functional imaging). – Recognize typical image parameters for each
modality.
3.4 Positioning and viewing techniques and terminology: A patient is positioned in
a certain way (e.g. L/R; PA/LAT) with regard to the imaging equipment. Images
are identified as such. – Know most important viewing and positioning
techniques.
3.5 Other specialties: In addition to radiology, other specialties are generating and
using imaging as well. – Know the modalities and their characteristics used in
cardiology, dentistry, pathology, radiation therapy, and ophthalmology.

4. CR/DR: Computed and Digital Radiography (20%)

4.1 The majority of the procedures are typically created using CR or

DR, i.e. Computerized and/or Digital Radiography. – Know the X-
Ray basics, its characteristics and the impact of exposure and patient
characteristics on the image quality.
4.2 Collimation versus shuttering: Proper collimation is critical to achieve optimal
image quality. – Know about the use of shutters, grids, and the impact it might
have on images.
4.3CR/DR basics: CR and DR have a different workflow as use different
technologies (fixed vs. removable detector plates). – Understand the differences
in technology and impact on workflow.
4.4 Special CR/DR applications: There are special CR/DR systems for specific body
parts and specialties such as digital mammography including tomosynthesis,
dentistry, and radiation therapy. – Know the characteristics and workflow of
special CR/DR modalities.
4.5QA/QC: CR/DR requires dedicated QA/QC programs which include reject
analysis and the use of test plates and phantoms. – Know the components of a
CR/DR QA program.

5. Typical process flow (20%)

5.1 Physician order: Orders should contain all pertinent information to perform an
imaging procedure. – Know what typical orders information consist of, and what
is critical for certain procedures (e.g. allergy, pregnancy status, lab values,
weight, history).

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5.2 Performance of exam: Exams are sometimes scheduled, depending on the

procedure or urgency. Each exam type has a different series of steps to perform. –
Know a typical workflow for each modality.
5.3 Results reporting (dictation & speech recognition): The technologist does a
“hands- off” to a physician who performs a diagnosis using a dictation system or
speech recognition. – Know the workflow for the radiologist using a worklist,
potentially sharing this list with peers, till the report is signed off and approved.
This includes critical results, Peer reviews, and discrepancy reporting.
5.4 Remote system access for image viewing: In many cases, the images with the
requisition are sent to a remote location, e.g. for reading images at night, or are
shared with other locations for consultation and/or viewing by a primary care
provider. – Know the workflow and architectures for remote access.
5.5 Outside studies: Prior exams might have to be fetched, either as film or, if digital,
potentially from an off-line media, read from a CD or from the cloud or storage
service provider. In some cases, the images might have to be digitized. – Know the
digitization workflow, including potential issues with conflicting identifiers in the
case the films are brought in from another institution. Also know the appropriate
workflow and identify common issues with importing CD’s such as the availability
of proprietary data, embedded viewers, and identifiers that could give potential
conflicts.

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