Int J CARS

DOI 10.1007/s11548-014-1123-8

ORIGINAL ARTICLE

DICOM data migration for PACS transition: procedure

Received: 3 July 2014 / Accepted: 14 October 2014

Abstract of risk since not all problems can nor will be identified in the
Purpose Transition from one Picture Archiving and Commu- test migration.
nication System (PACS) to the other is costly and disruptive.
Especially the migration of the DICOM data from the legacy
to the new PACS is a very challenging task, and although Keywords PACS · Picture Archiving and Communication
such a migration will happen in every hospital, literature on System · Radiology · Data migration
methodologies to follow and possible problems and pitfalls is
scarce. The objective of this work is to provide insight in the
prerequisites for the legacy PACS before starting the migra- Introduction
tion with respect to vendor and DICOM considerations.
Methods The steps involved in migration, possible method- Being the core infrastructure of the radiology department,
ologies, and areas of specific interest when planning migra- efficiency and availability of the Picture Archiving and Com-
tion are given. Possible challenges and problems are defined munication System (PACS) is of utmost importance. How-
as well as issues that are often overlooked. ever, when in operation for some years with subsequent
Results A step-wise approach should be implemented for data updates and upgrades, the demand for a new PACS environ-
migration. Careful planning and testing, continuous obser- ment tends to get more prominent, and although it is costly
vation of the process, and involvement of all stakeholders and disruptive, many institutions decide to part from their
including the old and new vendors are crucial for a success- legacy PACS vendor and implement a new PACS. Main rea-
ful transition from one PACS to the other. sons are that the old PACS installed was radiology centered
Conclusion A proper test migration is a crucial step in the and not suitable for enterprise deployment and that the state-
PACS transition process, which can eliminate many of the of-the-art PACSs include a higher level of workflow integra-
problems in the actual migration. However, with any migra- tion and not only support radiology but also, for example,
tion, there has to be a willingness to take a limited amount cardiology.
In most cases, the procedure followed will include a ten-
P. M. A. van Ooijen (B) · A. Broekema
Department of Radiology, EB45, University Medical Center
der offer resulting in multiple bids from different vendors
Groningen, University of Groningen, Hanzeplein 1, 9713 GZ from which one vendor is ultimately chosen to implement
Groningen, The Netherlands the new PACS. This involves a major overhaul of hardware
e-mail: [email protected] and software including the transition for the users to a new
P. M. A. van Ooijen · K. Y. Aryanto
user interface and perhaps a new workflow. With this replace-
Department of Radiology, Center for Medical Imaging – North East ment, the old image data present in the legacy PACS must
Netherlands, University Medical Center Groningen, University of also be made available in the new environment. This can be
Groningen, Groningen, The Netherlands done by maintaining the old PACS environment and retriev-
S. Horii
ing data from that system upon request without actual transfer
Department of Radiology, University of Pennsylvania Medical Center, to the new PACS. Maintaining the old PACS has the down-
Philadelphia, PA, USA side that, although partly solvable by performing prefetching

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and autorouting of data, direct on-the-fly access to old data for a migration methodology along with possible problems
will always be slow compared to the data natively stored in and challenges that can occur during the migration of data
the new PACS. Furthermore, the technical maintenance and from one PACS to another.
support on the old PACS from the old vendor poses an extra
cost on the available budget. Since two systems must be kept
operational and up-to-date in hard- and software, the costs of
Staffing issues
running both systems in both money and manpower will be
high. Still running the legacy PACS will also lead to prob-
To plan a PACS migration, the planning committee should
lems with failing hardware that should be replaced requiring
be a multidisciplinary team composed of radiologists, tech-
budget that should be preferably invested into the new PACS.
nicians, relevant other physicians, PACS administrators, and
Furthermore, maintaining a sufficient level and quality of ser-
IT staff. Besides this, people with knowledge about legal
vice and maintenance from the legacy PACS vendor will be
issues and risk management should also be involved. This
challenging part because of the most probably downgraded
planning committee should determine the scope of the PACS
contracts and part because of the diminished involvement and
migration project and make decisions on critical issues such
loyalty of the legacy PACS vendor.
as the amount of data to be transferred and how to handle
Because of these obvious disadvantages, most hospitals
data cleanup.
will opt for a migration of the required history from the legacy
The migration to a new PACS can be as complicated or
PACS to the new PACS and dismantle and remove the old
even more complicated than the deployment of the original
PACS altogether also removing the obsolete, nonmigrated,
PACS. Therefore, knowledge is required and should be made
data contained in the old PACS.
available with respect to resources in several areas includ-
Therefore, in PACS transition, the correct and timely
ing networking, database migration, project management,
migration of the data from the current to the new PACS is
archives, DICOM, and HL-7. If local or new PACS ven-
one of the key success factors of the transition. However, the
dor personnel do not have the requisite expertise, this is a
correct migration is also one of the major concerns [1] and
good argument for including a migration provider in the ini-
can be a process of which the time required is often under-
tial planning. If this decision is made, ideally, it should be
estimated [2]. The time required is not only dictated by the
part of the contract negotiations with the new PACS vendor,
actual transfer itself, but also because there will undoubt-
so that the cost of employing a migration provider is not a
edly be errors that have to be handled and/or corrected. If
“surprise” later (more on a migration provider in the next
the legacy PACS has to be kept operational until the replace-
section). If your own personnel are responsible for the tech-
ment is installed and has sufficient historical data migrated
nical and operational aspects of the migration process, it may
so as to be clinically useful, the impact of the migration
require work beyond their normal hours or tasks. If so, there
process on operation of the legacy PACS also has to be con-
may be additional labor costs involved for overtime and this
sidered. Further, the Digital Imaging and Communications
should be included in new PACS implementation costs.
in Medicine (DICOM) interface may not always be optimal
and information such as annotations, key images, and cor-
rections of patient demographics may cause problems. Since
the DICOM standard evolves over time, migration of the data Prerequisites legacy PACS solution overview: vendor
from modalities stored in the old environment could cause and DICOM considerations
problems due to the DICOM changes that were made.
To increase complexity of the whole migration process, First, the full cooperation of the legacy PACS vendor is essen-
the legacy PACS must be migrated while maintaining full tial to maintain the system in operation throughout the migra-
normal operation. This complexity could partly be reduced tion process, to provide requested information and databases
by using the redundancy present in the legacy PACS to per- concerning the legacy PACS, and to assist in resolving issues
form the migration, e.g., by using the backup system. concerning the migration.
Despite all these issues with data migration, only very few Although DICOM is the standard for the image file for-
publications on the topic of PACS data migration that provide mat and the communication of those images, the underlying
either the theoretical background or the practical experience database structure within the PACS that actually manages the
[1–5] are available. General advice is to carefully prepare a system is not dictated by the DICOM standard. The imple-
migration plan that is tailored to the local situation of the mentation of this managing database is left to the individual
individual hospital [1]. vendor, and thus, a wide variety of different, more or less pro-
Although the general conception is that the data migration prietary, systems are used. For example, many vendors take
is one of the most difficult parts of the PACS transition, the apart the DICOM data and store it in a proprietary format, or
published literature is scarce. This paper provides a proposal store the DICOM data but record changes, annotations, and

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measurement in the database merging the information only To ensure the correct transfer of possible changes to
during DICOM export of the images from the PACS. images made in the legacy PACS, it should support DICOM
The most prominent technical prerequisite for the legacy Presentation State.
PACS is the proper implementation of DICOM both for the It could be beneficial to compare the DICOM confor-
file storage and for the transfer protocol [3]. More specifi- mance statements of both the current and the new PACS.
cally, the old PACS environment should conform to at least These DICOM conformance statements will provide infor-
the ability to perform a database search and move of image mation about the capabilities with respect to storage and com-
data based on the DICOM standard (DICOM C-FIND and munication of DICOM images. This can help to determine
C-MOVE services as an SCP (Service Class Provider)). This the overlap in supported DICOM functionality and to identify
DICOM capability should be provided by the old PACS possible caveats of missing functionality in one of the sys-
throughout the migration project in order to allow the full tems causing the data exchange from legacy to new PACS to
transfer of the required imaging data. fail.
The PACS query mechanism (C-FIND) should support
queries on study data using range matching and at least return
the complete list of studies that meet the query criteria. PACS Migration steps and methodologies
might have a limited number of possible replies under nor-
mal operation conditions to avoid data overload to users that The whole migration process should be prepared carefully
accidentally query large amounts of data. Therefore, if so and thoroughly investigated with regards to required time,
configured, this limitation should be removed for the migra- manpower, and equipment resources [1].
tion. In some cases, dedicated migration software tools are pro-
During the transfer of the DICOM image data (C-STORE) vided or created by either one of the PACS vendors (mostly
in response to a DICOM image data move request (C- the new one), the hospital [1,4], or third parties. These soft-
MOVE), the legacy PACS should return meaningful status ware tools usually also tackle (part of) the data cleansing
codes and a full unique identifier (UID) list when failures and correction functions. Figure 1 shows a typical setup for
occur. a migration using a dedicated migration tool.
Another important issue is the maximum number of The following steps are most commonly defined in the
threads for DICOM image data transfer (C-MOVE/C-STORE) migration protocol (Fig. 2):
allowed and configured by the old PACS. This number of
threads defines the number of DICOM image data transfers Phase 1 Preparation phase
that can run in parallel. Prior to the migration, it is advised to
configure the old PACS to the maximum number of threads The preparation phase contains a number of sub-phases:
to allow fast transfer of data.
The availability of the legacy PACS for data migration
Phase 1.1 Determining the scope of the migration
should be determined. If the PACS is used clinically 24 h
by 7 days per week (24 × 7), then the impact of the migra- In this step, it has to be determined what data should
tion process on operation should be fully evaluated and, at be transferred; further, the possible “cleanup” of data
best, tested since migration will typically slow down PACS should be determined. This requires defining methods
operation. If the legacy PACS is not used 24 × 7, then the and rules as to how to determine which data are obso-
timing and duration of idle periods should be fully reviewed lete or incorrect and thus should be removed or cor-
with the new PACS vendor (or the migration provider). In rected during the data transfer. Analysis of legacy PACS
either case, availability of the legacy PACS for the migra- stored information may also require an investigation of
tion process will directly affect the time it will take to the archived data to estimate how much of the data will
migrate the information in the current system. A common need cleanup. This investigation should be more than a
error made by the new PACS vendor is that the migration projection based on analysis of the DICOM metadata
process can use the legacy PACS full time. This assumption and database tables and should involve at least a sample
may result in a serious underestimate of the time required for of the existing archived information.
migration.
Phase 1.2 Hardware setup
If, due to functional or technical issues, the DICOM query
of the data is impossible, full information about the database In this step, technical tasks such as implementation and
(typically, but not exclusively, SQL) of the legacy PACS installation of the required hard- and software as well as
should be obtained to determine database connection, data configuration and testing of the connectivity have to be
syntax, and data semantics to allow transition to the new done. It is important that interfaces to other systems (the
PACS environment. RIS, HIS, reporting, electronic medical record (EMR),

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Fig. 1 Standard setup for a migration using a dedicated migration tool. letter” file) that could be searched for any studies found to be miss-
The migration tool will retrieve nonpixel data (metadata) from the old ing at some later time. The RIS can also be used to retrieve reports
PACS and validate the nonpixel data with the content of the RIS. After for inclusion in the new PACS environment. Within the migration tool,
validation, correct studies are sent to the new PACS by instructing the rule-based exclusion can be configured to transfer certain data to the
old PACS to perform a DICOM send of those studies, and incorrect garbage bin (e.g., test patient and research related data)
data are registered and possibly transferred to a “garbage bin” (or “dead

Fig. 2 Phases of the migration process. Phases 1.1 should be the first step after which 1.2 and 1.3 can be performed in parallel

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etc.) have to be tested as well, not just the DICOM inter- background. Ad hoc queries of data not available yet in the
faces to imaging equipment. new PACS should be possible.
Another strategy involves the building of the whole data-
Phase 1.3 Analysis of the migration process
base in the new PACS by DICOM queries to the old PACS
Impact analysis and planning of the migration process getting all nonpixel data into the new PACS’s database. After
should be determined. This also includes transfer speed this, the transfer of the pixel data is started. Again, it is prefer-
benchmarking to determine how fast the data migration able that at least 1–2 years of image data are available on the
can be completed and should factor in availability of the new system [6]. This initial startup data volume could be
archive of the legacy PACS. estimated by an analysis of requests for prior studies in the
legacy PACS; a startup volume that satisfies at least 80–90 %
The migration plan should result from the preparation and
of the requests for prior studies is likely to be satisfactory.
should contain information on how the migration will be
If possible, the migration process should accommodate ad
performed, what kind of monitoring and validation will be
hoc requests for prior studies and should a request be in the
done, and the responsibilities of the parties involved (cur-
10–20 % of the studies not included in the startup migrated
rent and new PACS vendors and, if employed, a migration
volume. This is especially essential for the emergency depart-
service provider). It should also include how the reporting
ment and a dedicated procedure should be in place to transfer
on progress, any schedule changes, and problems should be
data from the legacy PACS to the new PACS with the highest
done.
priority in case they are required for evaluation of an emer-
Phase 2 Test migration phase gency patient.
A test migration is used to identify possible problems that In both strategies, it is important to realize that most
could occur during migration and to configure and adjust the PACSs make demographic and other changes only in the
migration plan and data cleanup protocol. Possible problems database and not in the DICOM header of the corresponding
should be fixed in this phase and the migration tested again image data. Therefore, either way the information contained
to ensure they will not occur during the actual migration. in the database of the legacy PACS should be included into
the new database. This can be done either by querying the
Phase 3 Migration phase
legacy PACS through the database, thus receiving the updates
This involves installation and configuration of possible
with the DICOM transfer or by re-applying all changes to the
migration tools and the actual data cleanup and migration.
new database by retrieving them from change messages and
During the whole process, monitoring and quality assur-
logs. Careful evaluation is required to assure that all data-
ance should be executed resulting in periodic reports on
base contained information is indeed transferred to the new
the migration results. The frequency and nature (electronic,
environment.
Web, or paper) of the reports as well as their content (for
Because of these database issues, some vendors or spe-
example, total volume and percentage migrated, number of
cialized migration companies will not use a DICOM-based
problem studies fixed, and number of studies sent to the
approach but a database approach. When the database scheme
garbage bin or dead letter file) should be negotiated with the
of both the legacy PACS and the new PACS are known, a
new PACS vendor and migration provider (if employed).
conversion of the legacy database to the new PACS could be
During this migration phase, hard- and software belonging
performed. After this conversion, DICOM files can be trans-
to the legacy PACS that is no longer required can be shut-
ferred to the new PACS including renaming and rearrange-
down and removed.
ment of directories as required by the new PACS. Finally,
Phase 4 Validation phase the pointers to the files in the new database are updated to
In this step, a final evaluation of the validity of the data in the point to the copies DICOM files. This option is worthwhile
new PACS environment should be performed to determine to explore since it could significantly speed up the migration
correctness and completeness of the data received and to process. However, it requires an in-depth knowledge of the
provide final acceptance of the data cleanup and migration. database structure of both PACSs which could be difficult to
obtain, especially from the legacy PACS vendor.
There are two common ways of performing a DICOM
migration. First, the DICOM data are transferred from the
old to the new PACS by DICOM send. A large amount (a Involving the RIS
typical recommendation being 1–2 years [6]) of the previous
study data has to be transferred before the new PACS is used To ensure the correctness of data, the information contained
to ensure that most of the requested data will be available in the RIS could be involved in the data migration process.
in the new PACS at startup. At that point in time, the new The information in the RIS, which is the original data entry
PACS will be in use and data transfer will commence in the point in many installations, could be used for validation of the

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data migration. Using the historic information from the RIS, media involving tape, magneto-optical disk (MOD), com-
the new PACS can obtain information about all studies regis- pact disk (CD), and DVD [2,8]. In some cases, very old data
tered in the HIS or RIS and compare this list to the retrieved on off-line media are proprietary and with current hardware
information from the PACS. This can be used to perform (e.g., MOD) or calculated time to migrate are very long [9].
the validation of the received data, to complement missing When media are still accessible, the question arises if all
information from the PACS, and to determine incorrect and DICOM data included on those media can still be read and
obsolete studies for data cleanup. copied into the new PACS since previous publications show
Another way to employ the RIS that could speed up the that off-line stored digital media might include defects ham-
transition to the new PACS with lower migration progress pering the proper transition of the data even if medical grade
is to use a DICOM Modality Worklist (DMWL) to deter- media were used [8]. Furthermore, transferring data from
mine the patients that are scheduled for examination in the older online storage (e.g., tape robots) or off-line media can
coming days and to migrate data related to these patients be quite time-consuming and as such a limiting factor in
with the highest priority. By doing so, relevant priors will the time required for transfer of all available data [3]. Espe-
always be readily available in the new PACS for the sched- cially in the case of off-line stored media, manual actions will
uled patients, and thus, less historical migration has to be be required to manage the media which can be very time-
done subsequently. The historical migration of data from the consuming and costly since this might require someone to
old PACS can be done in the background with the new PACS load new media on a daily basis for a long period of time. In
already fully operable. As noted, this could include an initial such cases, one should carefully consider if the old data con-
startup migration volume together with the DMWL and ad tained on the off-line media are still relevant and if making
hoc requests also accommodated. it available in the new PACS is still worth the effort. Another
approach could be to only retain the knowledge of the exis-
tence of the data, for example, by making the corresponding
Reporting
database entries and only uploading data upon request.
From the test migration, several issues may arise that ham-
During the migration process, continuous reporting of the
per the proper migration of the image data from one PACS
status of the data migration process is crucial since it is a
to the other. These issues need to be solved before the actual
critical time line in the whole PACS migration project.
migration starts. If this is not strictly discussed with the cur-
From the data migration, a final report should be made con-
rent and future PACS vendors, this could be a significant
taining information about both the number of studies that are
delay in the whole PACS transition process. The final respon-
successfully migrated and the number of studies that are not
sibility for solving the problems should be assigned to one of
successfully migrated. For each failure, the reason for failure
the parties involved, and both PACS vendors should address
and a possible solution or work-around should be defined.
sufficient resources to solve the issues and/or define work-
arounds as quickly as possible. An advantage of a migration
Possible problems and challenges provider is that such a vendor can be an “honest broker”
when it comes to resolve migration problems and reduce
Very common problems that occur during the migration are delays that could result from disagreements between the
due to a difference in interpretation of the DICOM standard PACS vendors. This is particularly true if the cost of the
by different vendors [7]. Although the different interpreta- migration provider’s services is determined by a separate
tions may be valid according to the DICOM standard, they contract and not bundled with the contract for the new PACS
may complicate correct data migration or even successful vendor.
connection between the two PACS vendors. An example When performing a test migration, there are a number of
in this is the use of proprietary fields that contain vendor- issues that deserve special attention to avoid problems in the
specific information that can be essential to the functioning actual migration. These issues are the transition of measure-
of the current PACS or even hampering efficient operation ments and other overlays, the correct transition of patient
of the new PACS. Other examples are the different interpre- IDs, and proper filling of DICOM header tags to support dis-
tation of how to store measurements and annotations into play protocols of the new PACS. To allow identification of as
the PACS and the use of other file types encapsulated into much of the issues as possible, a wide variety of studies from
DICOM ‘containers’ possibly resulting in DICOM files that different modalities throughout the PACS history should be
can be received and stored into the new PACS environment checked technically and visually. Although there are initia-
but are not interpretable by the viewing workstations of the tives to achieve standardization of image markup such as
new PACS. DICOM Structured Report and Annotated Image Markup
Another of the challenges of an image data migration is (AIM), not many vendors support this for their markup and
the availability of old image data on either online or off-line measurements but use proprietary solutions.

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Going live with the new PACS is possible when access Considerations
can be guaranteed to the historical data. This can be done
by performing a full migration before going live but a more Although transition to a new PACS vendor can be a necessity,
preferable solution is to start migration, go live after hav- it has to be kept in mind that migration costs and the lifespan
ing about 1–2 years available on the new PACS [6], keep of the new PACS should be taken into account. Although the
on migrating the old data 24 × 7 (or as feasible based on transition to the new PACS should result in improvements,
operational schedule and performance degradation during the fact that new solutions tend to bring new problems can-
migration), and provide advanced prefetching capabilities to not be ignored. In 1998, Behlen [10] already reported a net
ensure the availability of the old data from the patients that are cost of about USD $230,000 for DICOM data migration of
scanned during a return visit. This prefetching can be done 10.09 TB from a legacy PACS archive. Although he projected
based on the schedule of patient from the DICOM Modality a migration duration of multiple years which is not the cur-
Worklist, if available old data from each patient scheduled rent standard, with the enormous increase of data production
for radiology in the next 2 days will be migrated with priority since then caused by increase in imaging in general and the
to ensure availability. However, this does not cover the walk- introduction of new modalities [11], it can be perceived that
in and emergency patients. For those patients, an active on the costs for migrating data from one PACS to the other will
demand retrieval from the old PACS should be possible. be significantly higher. This especially holds when cost of
Defining what data to include in the data cleanup is dif- migration is based on either number of studies migrated or
ficult. Basically, the data cleanup concerns three categories. volume of data migrated. In such cases, decisions on data
The first category is the data that are obsolete (garbage) such cleansing in the PACS transition process could also partly be
as test images. The second category is the data that can- cost-driven since using a more strict approach to data cleans-
not be identified properly because of incorrect patient IDs ing could reduce the amount of data to be transferred from
and/or accession numbers. The third category is data that the legacy PACS and thus the cost involved. When deciding
are regarded to be bad because they are using incorrect or upon a new PACS, it is also advised to make sure it is flexi-
unsupported SOP classes or corrupted or invalid DICOM ble and open and allows easy migration when it is replaced
header information. It is likely that in each migration, all sometime in the future.
three categories will be present and need to be dealt with. When the transition to another PACS is made, this can also
The problem surrounding data cleanup is what to do with the have a major impact on the whole enterprise and not only
rejected data. Test images can easily be discarded, but data on the radiology department. This might hold for the situa-
with improper identification or bad data have to be handled tion where the transition to another PACS requires the tran-
somehow. Are these data simply discarded? Fixed? or Saved sition to another DICOM image viewer embedded into the
in a separate storage where they can be found and accessed Electronic Health Record (EHR) or the necessity to properly
when needed? These decisions need to be made based on the connect the DICOM image viewer of the EHR vendor to the
numbers of such studies, their age, and what the local facil- new PACS database. Another issue that might influence the
ity legal department (risk management) may require. Stud- entire enterprise is the shift to a centralized enterprise PACS
ies that are past the time of required retention can likely be instead of having PACS solutions at different departments.
discarded. Sites have taken another approach of creating a This transition adds a whole new dimension to the migration
folder for these that can be searched if necessary, but are not when not only the old radiology PACS has to be migrated
included in the new PACS normal retrieval process. When to the new environment but also other PACS solutions have
planning the cleanup of data, it is very important to realize to be integrated into the new PACS. Every additional PACS
that most cleanup is manual, time-consuming, labor and thus added to this equation introduces new challenges, complex-
could require up to multiple full-time jobs to perform this ity, and requirement for data validation. It is therefore wise
task. to first migrate the large bulk of data from radiology and
Even though the benchmarking is performed to determine subsequently start adding other environments one by one.
the migration speed, this still remains a problem and should A test migration is an essential step in the migration
be monitored constantly over the whole migration. At each process. Conducting such a test migration does take a con-
point in time, either the old or the new PACS will be in daily siderable amount of time and other resources, but can save
operation and thus unable to dedicate all resources to the a lot of time, stress, and negative experience of the users in
migration. Therefore, migration speed will depend on the the new PACS environment since most of the critical prob-
overcapacity in both the old and new PACS and the moment lems should already be identified during the test migration.
of switching to the new PACS for daily operation. When Between the test migration and the actual migration, enough
doing so enough, history should be available on the new time should be available to allow the current and new PACS
PACS to avoid the retrieval on demand from the old PACS vendor to solve the issues found in order to avoid these during
as much as possible. the actual migration.

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Migration requires a lot of human effort in both imple- width becomes the limiting factor during the migration
mentation and validation/verification. This means in most process. To identify possible bottlenecks in the network such
cases that key users and PACS admins are reallocated to the as latencies and bandwidth utilization at different days and
migration project and not available for other tasks thus lay- times, transfer speed benchmarking should be performed.
ing a heavy burden on the normal PACS operation during the Such a benchmark not only identifies possible bottlenecks but
migration time. Therefore, the moment of going live with could also help in avoiding over utilization of the network by
the new PACS requires careful consideration to determine strategically planning the migration. In the computer room,
the optimal switch-over time. space for the new PACS server has to be available along with
A possible method to reduce the amount of data to be sufficient power for it. The power has to be, as for the legacy
migrated and thus the migration time and cost could be to PACS, uninterruptible.
decide to only migrate data less than n years old, where n With respect to storage, the legacy PACS is operating
is the legal storage requirement. The possible pitfall would with—possibly multiple—storage environments that are in
be that some data could be required to be kept on the legacy most cases gradually expanded and thus contain storage parts
PACS archive longer which increases the complexity of the of different age and size. Some of these storage systems could
migration rules and could even be a serious delay in the still have useful life left and are not economically depreci-
migration process. ated yet. Furthermore, these still useful storage systems are
A way to avoid many of the problems associated with most probably the most recently acquired ones and thus will
the PACS data migration is to already make a “prenuptial also contain the most recent and thus most important imaging
agreement” with the new PACS vendor when buying the data. Transferring all data from the legacy to the new PACS
PACS. However, what to include in such an agreement can requires an equal amount of storage in both systems. There-
be difficult to decide upon by both customer and vendor. fore, having to duplicate all data could become very costly
In the future, this could be tackled by having a Integrating and very inefficient. Possible solutions could be to limit the
the Healthcare Enterprise (IHE) profile covering the require- amount of data being transferred by throwing away the old-
ments for PACS data migration. A brief proposal entitled est, no longer required, data or by planning the data migration
“Radiology Data Migration” dated October 2012 can be such that the most recent data are first transferred to the new
found on the IHE Wiki [12]. However, it is not clear when this PACS after which the most recently purchased storage from
will be included in the roadmap and formed into a definitive the legacy PACS could be reused in the new PACS to store
IHE profile, until then mutual agreement between vendor and less recent imaging data.
customer should be made to ensure PACS data migration. For example, if a facility has 150 TB of legacy data stored,
A technical development that could reduce the challenges it could be that 50–100 TB of that storage still has useful life.
with PACS data migration in the future is the transition to the If the facility purchases only 50 TB of storage to accommo-
use of Vendor Neutral Archives (VNA) as a more indepen- date migrated data, then that facility could migrate the first
dent storage layer that is not necessarily tied directly to the 50 TB of data, incorporate those 50 TB into the new PACS,
vendor of the PACS [13]. Although a VNA is still tied to the move the next 50 TB, and then repeat that process. In the
legacy PACS, the new PACS would not require a new storage end, this means that the facility purchases only 50 TB of new
but utilize the same storage layer. However, in this case, the storage rather than 150 TB of storage. That can be substantial
problems related to the database transition from one PACS savings for the facility but it requires a lot of careful planning
to the other still remains. to achieve that goal.
In the reading room, furniture may need to be provided
for the new workstations alongside the old if the new work-
Some potentially overlooked problems stations cannot run both current and new software. If addi-
tional workstations are needed, it may not be possible to
Operating two PACS in parallel (the current and new ones) accommodate them in existing reading rooms. This means
has a number of requirements beyond just the updating, main- that additional space, at least on a temporary basis, needs to
tenance, and service of the systems. It may be possible to run be allocated. If more workstations are to be used, the furniture
the old and new workstation software on the same worksta- requirement may be temporary (unless an overall increase in
tions, but if not, and if the new system is to be operated during the number of workstations for the new PACS is planned).
the migration process, then accommodations for two sets of Leasing, rather than purchasing, such furniture is an alterna-
PACS hardware will have to be made. tive.
There will need to be additional network drops and pos- Challenges can also arise for the PACS users when the
sibly additional routers and switches installed. Not only for legacy PACS and new PACS are running in parallel during
the new PACS but changes might also be required for the a migration period. It can be difficult for users to find data
legacy PACS environment when available network band- across two systems (i.e., not realizing that relevant prior stud-

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ies exist on the legacy system that have not been migrated Finally, there are disposal costs for computer hardware.
yet) and potential legal or risk issues associated with avail- Because of the materials used in workstation components,
able data being overlooked. particularly if the legacy PACS workstations use cathode ray
During its lifetime, a PACS tends to become ‘polluted’ tube monitors, are considered environmental hazards in some
with data that does not belong inside the PACS. Examples countries, there are fees involved in disposing of the old hard-
are research studies, outside data brought into the hospital on ware. Also, since any disk drives in the workstations may con-
CD and imported into the PACS without proper validation, tain patient personal information (referred to as “protected
quality control examinations, etc. During a PACS migration, health information”, or PHI, in the USA) those drives may
one of the considerations should be whether to include these require separate disposal steps that ensure that no data can
examinations into the migration or not. By removing these be retrieved from them. In some instances, the legacy PACS
studies from the migration, extensive data cleansing can be provider, or third-party specialty recyclers, may offer a recy-
achieved. cling service for the old hardware, though this is likely to
Pollution of the data could also arise from the fact that the have a cost associated with it.
legacy PACS, although setup as a radiology centric PACS,
is used to also store DICOM images originating from other
departments (e.g., cardiology or nuclear medicine). How-
ever, if no constraints are defined for this storage to standard- Conclusion
ize the image metadata (e.g., accession number, patient ID),
reconciliation of this data can be a considerable challenge. PACS migration is a very difficult and challenging process
Therefore, this data originating outside radiology should also that involves many stakeholders including radiologists, IT
be tested extensively as a separate group in the test migra- staff, business office, and vendors. The only way to achieve
tion. the migration of the old DICOM data into the new PACS in a
Besides the pollution, differences in data can also be reasonable amount of time is with careful planning and con-
caused by the natural process of replacement, updates and tinuous observation of the process. A proper test migration is
upgrades. When imaging equipment changes due to replace- a crucial step in this process which can eliminate many of the
ment, updates, or upgrades, things such as the study descrip- problems in the actual migration. However, with any migra-
tions used, modality type, could also change. Therefore, plan- tion, there has to be a willingness to take a limited amount
ning for data migration also requires a detailed analysis of of risk since not all problems can nor will be identified in the
the history of the legacy PACS about what modalities have test migration.
been in operation over the years to be migrated and how they
Conflict of interest None of the authors have conflicts of interest to
were configured. report with respect to the content of this manuscript.
Another cause of differences in data can be lack of stan-
dardization causing different equipment of the same modality
type to use different descriptions and ID for the same exami-
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