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Evaluation and critique of the ACR-NEMA standard for picture archiving and communications systems

The ACR-NEMA standard for communications in digital radiology has been a topic for much discussion lately. The standard was developed to facilitate the development of multivender products which can communicate using a point-to-point standard interface. In this paper we describe, the combined experiences of Toshiba, Radiology, and Electrical and Computer Engineering at the University of Anzona with the ACR-NEMA standard. We also offer a candid evaluation and critique of the standard, for consideration by implementors of the current standard. The paper summarizes a prototype development effort using a high speed fiber optic network and the ACR-NEMA standard interface. We discuss the overall architecture of the prototype and the software design based on the International Standard Organization (ISO) upper layers. The transport layer and below was implemented using a Matrix-developed ACR-NEMA interface board. The paper discusses the problems encountered in the application of the ACR-NEMA standard in a networking environment for Picture Archiving and Communications Systems (PACS). We conclude that the current form of the ACR- NEMA standard does not provide a workable foundation for the development of cost effective and efficient digital radiology interfaces, especially in a networked PACS. We also discuss the PACS environment beyond the current ACR-NEMA standard and make recommendations for the feature direction of the standard.