Kathmandu: Week 2

Installing Nepal’s first PACS in a government hospital proves more complex than expected.


Read about Dr. Kapalczynski’s first week in Nepal. And check back each week for updates on his project.

Sitting in the radiology department lounge, I sunk deeper into my worn and somewhat dilapidated armchair as I listened to a half dozen phone calls being fielded by the hospital’s elusive IT administrator.

Everything that had been indicated as complete or ready on the hospital’s PACS readiness survey was either incomplete or non-existent. Yet every phone call to IT was met with any number of false reassurances that everything was ready and in place. Dr. Andrew Kesselman and Dr. Michael Bergen from RAD-AID had arrived with an ambitious agenda to install PACS at both Bir Hospital and the adjacent trauma hospital in four days. I was beginning to doubt that Bir’s PACS would be completed.

K1The first day and a half was dedicated to figuring out the true state of PACS readiness at Bir Hospital. The selected PACS server computer, digital radiography machine, CT scanner, and MRI were each on their own one-computer network. Their IP addresses all had different domains and the MRI had no cable connecting it to the hospital network. The ultrasound room also had no network connection or cable. The Phillips engineer had arrived but was unable to configure the scanners, as we did not have IP network addresses ready. It was time to get to work.

Over the next days, the RAD-AID team, Bir’s IT administrator, the Phillips engineer, and I worked tirelessly to install Merge eFilm PACS on the main server in the residents’ classroom. We created viewing workstations in the CT/MRI reading room, MRI scanner room, and plain film reading room. Ethernet cable had to be laid to connect the MRI scanner, ultrasound room, and Dr. Sharma’s computer to the network. Bir IT was able to get the computers on the same domain and the Philips engineer was subsequently able to set up the DICOM nodes on the scanners with the new IP address. Perhaps the biggest stroke of luck for Bir hospital is that the national trauma hospital’s PACS readiness survey was even further from reality than ours. It would not be possible for the RAD-AID team to install PACS at that location during this trip. On the upside, this meant that all efforts could be focused on Bir.


At the end of the week, the PACS was nearly 100 percent operational. It was sending and receiving studies from the DR machine, CT scanner, and MRI room. Ultrasound was still a work in progress, as some licenses were not activated for DICOM transfer. However, the PACS infrastructure in the US room was in place. The faculty, residents, and techs were getting familiar with the system and hundreds of studies were being sent across to the server daily.

We were also able to install DICOM Grid, a second cloud-based PACS. This was a great addition to the eFilm PACS because as the main server memory fills, it deletes older studies from the hard drive. The hospital was given access to an unlimited amount of storage in the DICOM Grid cloud so that older studies will always be available for review at Bir via the Internet. For the first time, a government hospital in Nepal has a PACS!

By Wojciech J. Kapalczynski, MD, University of Texas Health Science Center at San Antonio

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