Successful Implementation of a PACS in Tanzania.

INTRODUCTION TO THE PROBLEM Muhimbili Orthopaedic Institute (MOI) is a public, academic tertiary care referral center in Dar es Salaam, Tanzania, East Africa. MOI is the main referral center for orthopedic and neurosurgical patients in Tanzania. In July 2014, the Radiology Department at MOI consisted of two attending radiologists, 10 technologists, and three IT staff with imaging capabilities of radiography, fluoroscopy, and ultrasound. MOI is affiliated with and located on the same campus as Muhimbili National Hospital, the main national referral hospital, which had one four-slice CT scanner, one 1.5-T MRI scanner, four ultrasound units, and one analog radiography/fluoroscopy unit. MOI patients were often transported to Muhimbili National Hospital for cross-sectional imaging. X-ray images acquired at MOI were first converted into the DICOM format by a computed radiography (CR) system. From theCR system, the DICOM data were sent to a laser printer for hard-copy films or a CDROM burner. Each hard-copy film cost approximatelyUS$2.50, resulting in a total of over US $5,000 for an average of 2,000 radiology studies per month at MOI. Hard-copy film was a prohibitive recurrent expense forMOI, resulting in frequent film shortages and disruption of imaging services.