Transcript Integrating a PACS

PACS - How to Choose
Integrating a PACS Interfacing Computers,
Doctors and IT Personnel
Robert E. Zimmerman
Joint Program in Nuclear Medicine
Harvard Medical School
Boston MA
Integrating Cameras
Each camera has to be included in the
mini-PACS (ideally)
– analog cameras
– older “digital” cameras
– Newer digital cameras
Not Rocket Science!
Not much computer science either
• NM mini-PACS is (for the most part)
standard, everyday computer technology
except for...
– Format of camera/computer to
archive/database
– Reverse flow of data to
camera/computer
– Medical workstation considerations
Let’s examine some of the issues
cameras
workstations
Archive
&
database
cameras
workstations
?
Archive
&
database
DICOM?
Other?
3 cases
1. Analog camera
2. Existing NM computer
3. New camera/computer purchase
Example 1
workstations
analog camera
NM computer
w/ ADC
$15-25K
DICOM $
other
Archive
&
database
Example 2
workstations
existing NM
computer
NM computer
w/ ADC
$0
other
Archive
&
database
Example 3
workstations
new camera and
computer
Integrated
camera/computer
~$500k
DICOM $
other
Archive
&
database
Archive and database
Should it be DICOM?
– DICOM - v. expensive - still
– But it is the future for image transfers
between modalities and vendors
– It will integrate to Radiology PACS
– Will require DICOM workstations
• v. expensive
• no to poor color support
Archive and database - 2
Could be a conventional database
with a DICOM export facility
– export could be manual or automatic
based on some rules
cameras
workstations
computer
computer
DICOM $
other
computer
computer
computer
computer
Archive
&
database
Dicom?
Other?
Do you want your data
back?
Archive back to camera/computer for
re-processing?
– big problem
– little support by major companies
• unless single vendor
– Once it is DICOM no more processing
• at present
• exceptions at this meeting?
IT Personnel
Network infrastructure
HIS data
RIS data
May need separate workstation or
window for this data
How to interface to the
radiology PACS?
DICOM
DICOM
DICOM
Archive/database must have DICOM
export feature
Some examples
1. A (nearly) single vendor situation.
2. A multivendor situation
Single vendor
All computers on the cameras come
from same vendor
– maybe a costly but possible solution
Single vendor example
workstations
ICONs +
MedView
Siemens
cameras
ICONs
computer
computer
computer
computer
Archive
&
database
Mac server
and std Mac
hardware
Discussion
How do you add another vendor?
– E.g. Siemens ECAT
Solution
– Separate but equal mini-PACS using Sun
hardware and ECAT software
Poor integration
Duplication
– but it works well
Multivendor
Computers on the cameras come
from different vendors
– problems in understanding the different
proprietary file formats
– Interfile and DICOM are not full
solutions
– Reversibility issues
DICOM
• A complex messaging protocol that
includes file formats of various types
• DICOM is specified for each modality,
including nuclear medicine.
• It is clumsy, costs a lot and is
generally unnecessary
• Except when talking to a “big” PACS
Network Protocol
Medical Im aging Application
DICOM Application Entity
ISO Upper
Layer Service
boundary
ISO Association Control
DICOM
Upper layer Service Element (ACSE)
Session /
protocol
ISO PRESENTATION
Transport / for TCP/IP
Netw ork
ISO SESSION KERNEL
(STN)
Data Link
TCP
IP
ISO TRANSPORT
ISO NETWORK
LLC
Physical
(50-pin)
Ethernet, FDDI, ISDN, etc.
Point-to-point
Netw ork Environm ent
PennState College of Medicine, Department of Radiology
http://www.xray.hmc.psu.edu/dicom/basicinfo.html
Interfile
• Interfile is a simple definition of a file
format
• Useful for exchanging files with others
• No definition for gated files
• Consists of a descriptive header
followed by raster format image file
• Two flavors: 1 file or 2 files
Multivendor-2
Format issues are not solved with
Interfile and DICOM.
– Neither is suitable as a “working” format
– No color
– No gated
– not reversible
– vendor differences
Cameras/computers
workstations
A
computer
B
computer
C
computer
D
computer
E
computer
F
computer
Archive
&
database
Wintel +
proprietary
conversion
software
Discussion
• Maximum flexibility
• Keep full options for new camera
purchase
• Requires close cooperation between
miniPACS vendor and NM clinic
• Increased complexity
Hidden Costs
• DICOM
• Your own
engineer/physicist/computer
programmer/system manager may be
required
Acceptance testing
Camera to archive and back again
Archive to workstation
Workstation image quality e.g. SMPTE
pattern
Workstation Issues
• Monitor Brightness/contrast
• Work area (ergonomics)
• Room
– layout
– illumination
• Periodic test of resolution, brightness,
contrast
• optical transfer function (gray level
mapping)
Workstation Issues -2
• Color?
• DICOM workstations and DICOM
implementations do not have good
color support
• Cine support
Some PACS vendors for NM
Marconi
Sudbury Systems
Siemens
ADAC
MedImage
Apple
Sun
NUMA
Segami
Soft medical
SMV
Microsoft
HP