Transcript PACS introduction - Edward Wong`s PACS Site

PACS introduction
Facilitator:
Edward Wong
What is the role of PACS
Administrator?
PACS Administrator’s roles
 Implementing a PACS
 System Maintenance
 Image and Information Management
For a 200,000 exams/year institution, 2-8
full time PACS Administrator is available!
PACS Administrator’s roles
 Implementing a PACS
- Financial and workflow study
- Request for Proposal and Tender drafting
- Workflow modification including job reallocation
and resource relocation
- Training and Operation Manuals
- Acceptance of system
 System Maintenance
 Image and Information Management
PACS Administrator’s roles
 Implementing a PACS
 System Maintenance
- Contingency plan
- Incompatibility handling
- First line support and problems escalating
- System security and Performance
monitoring
 Image and Information Management
PACS Administrator’s roles
 Implementing a PACS
 System Maintenance
 Image and Information Management
- Maintain high Image Quality
- Data Integrity
- Quality Assurance program
- TeleRadiography
- Anytime Available Storage Management
What is PACS ?
P: Picture, Images & Reports
A: Archive, Online, Near line, Offline
C: Communication, Networking, Transfer Protocols
S: System, Components & Architecture
PACS: for storage and distribution of images and
information when necessary
PACS: Small or Large
Web Server Distribution
Scale of PACS
 No. of Beds in Hospital/ Exams per year
 No. of Modalities
 No. of Switches
Considerations:
System connectivity, expandability, reliability
and cost-effectiveness
Types of images
 1D, 2D, 3D, 4D
 Different DICOM Modality type: Cardiac / PET / 4D
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U/S…..
Image size: Resolution and bit depth
Image quality: Bit Depth and resolution
Color / Monochromatic
Exam. Size: image size x no. of images
Structured Reports
New DICOM IOD:
Endoscopic & Microscopic images / ECGs / Security
Profiles…..
1D, 2D, 3D, 4D, fusion
1D, 2D, 3D, 4D, fusion
Image Resolution/ Bit depth
U/S
DF
CR
CR Mammogram
256 x 256
8 bit
65 KBytes
1k x 1k
10 bit
1.25 MByte
2k x 2.5k
12 bit
4k x 5k
7.5 MByte
12 bit
30 MByte
Properties of image
• Bit depth
• Grayscale or color
• Resolution in pixel
 Example image
size of
mammogram = 4k
x 5k x 12 bit = 30
MB
PACS Architecture
PACS – Central Architecture
DICOM
Modality
Non-DICOM
Modality
Diagnostic
Workstations (DICOM)
Gateway or
Frame Grabber
Clinical
Workstations (DICOM)
Image
Server
(RAID)
Diagnostic
Workstation
Film
Digitizer
Computed
Radiography
or DR
CR/ DR QA
Workstation
Web Server
Data Base
Server
Archive
RIS
Central Architecture
 Image Server and Database Manager is
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the HEART
Any image, any where, any time
Unique central copy
Easy update of data
Requires high performance servers
Potential single point of failure at server
Bandwidth demanding
PACS – Distributed Architecture
DICOM
Modality
Gateway or
Frame Grabber
Non-DICOM
Modality
CR QA
Workstation
Film
Digitizer
Diagnostic
Workstations
(DICOM)
Clinical
Workstations
(DICOM)
Web Server
Diagnostic
Workstation
Data Base
Server
Archive
Computed
Radiography
RIS
Distributed Architecture
 Exams are routed from modality to
selected workstations
 Complex routing algorithms based on
department / user preference
 Difficult to support concurrent review of
images
 Less destructive for failure at database
server
Components of PACS
 HIS/ RIS
 Broker
 ePR gateway
 Database Server
 Image Server (RAID)
 Long Term/ Near line Archive
 Networks
 Digitizer
Components of PACS
 Acquisition Gateways
 Non-DICOM modality gateway
 DICOM Print Server
 Media Server
 Reporting Server
 Monitor QC Server
 Web Server
 Workstations
PACS layout 1
PACS layout 2
PACS layout 3
Tuen Mun Hospital PACS System
(phase 1)
GE Medical Systems
IT - Radiology System
- Ambulatory Care Center
Image Acquisition Modalities in ACC
Prestiges II
ACC Ortho Dept
Proetus XR/a
RW Film Digitizer
PathSpeed
SP CR
PathSpeed
MP CR
CR ID Preview
1
PathSpeed 1CWS
MIU1
MIU2
US Logic700
Proteus XR/d
CR ID Preview
2
PathSpeed 1CWS
PathSpeed CRQA
MIU3
Server Rm Network Switch Closet
Kodak Laser Printer 1
DryView 8700
1 GBit
Fiber
Link
Kodak Laser Printer 2
KELP 2180
E450 CPU
HSA 1
PCS2
1C PathSpeed
Review Stations
Radwork5.0
Hospital
RIS
Network
600m / 12
Core Gbit
Fiber Link
HIS/RIS I/F (SQL)
(Mitra Broker)
ARC
Main Block
Radiology
Department
CT MR
RT
Network
NetworkNetwork
Layer 3 Sw
Layer 2 Sw
PCS 1
Long Term Archive
MOD Jukebox
RAID 5
ISU
1CWS /
Remote Admin
PARIS 2
PARIS 1
2B Diagnostic 2B Diagnostic
Workstations Workstations
PACS layout 4
PACS Components
ePR gateway
Enterprise Archive
DICOM
Modality
Diagnostic
Workstations (DICOM)
Through Acq.
gateway
Non-DICOM
Modality
W/S QA Server
Clinical
Workstations (DICOM)
Image
Server
(RAID)
Gateway or
Frame Grabber
Diagnostic
Workstation
Film
Digitizer
Web Server
Data Base
Server
Computed
Radiography
or DR
LTS Archive
SAN/NAS
CR/ DR QA
Workstation
Broker for
RIS/HIS
Media Server
Acquisition (DICOM) Gateway
HIS/RIS
Interface
(Broker)
DG
W/S
PCs
CR QA
RIS
CT
MR
R&F
NM
C
R
Film
Digitizer
XRAY
Frame
Grabber
US
Role of Acquisition gateway
 Compression/ decompression and security
 Check the images for integrity
 Convert to PACS format (header, byteorder, matrix size)
 Queue for images (priority) to database
server (background)
 Share the workload and no point of failure
for multiple Acquisition gateway
Database Server and Image Server
Database
Server
RAID
HIS/RIS
Interface
(Broker)
DG
W/S
PCs
CR QA
RIS
CT
MR
R&F
NM
C
R
Film
Digitizer
XRAY
Frame
Grabber
US
Database Server (PACS controller)
 The Heart of the system
 Integration cross point between HIS/RIS
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and PACS (status update)
Create and manages patient folders
Manage reading worklists and user
profiles
Manage data transfer within the system
Support data mining and teaching folders
Image Server (RAID)
 Online (rapid access) exam storage and
distribution device
 Support simultaneous exam input and
output transfer operations
 Up to Three months of storage capacity
 Scalable capacity
What is RAID
Redundant Array of Independent Disks
Bandwidth equal to sum of disk transfer rates
Highest speed disk storage available
Hot Swap
1
2
2 MB/s
3
4
5
6
7
Image
8
Parity
Disk Array
16 MB/s
RAID 5 configuration
 If disk fails, disk can be
rebuilt- fault tolerant
 High data transfer rate
for read, write slower
 Min. 3 disks to start
 Array capacity is N-1
Bandwidth
Bandwidth is a measure of the information
(data) carrying capacity of a network
10/100/1000 MB/sec
Information Flow
Data Pipe (Network)
Network Bottleneck
The bandwidth of an information delivery system is
limited to the bandwidth of the slowest component
in the system
Network Bottleneck
Data Compression
Data compression reduces the information rate
a network must support
Uncompressed Data
Compressed Data
Lossless Image Compression
I-D=0
C
I
D
Decompressed image is identical to original
image
JPEG lossless compression
Average compression of 2:1 for x-ray images
JPEG 2000 Compression
 Selected parts of the image can be defined as
Regions of Interest, they can then be delivered
before other parts of the image, or losslessly,
whilst other parts of the image that are less
critical use normal lossy compression
 JPEG 2000 codestream can be ordered to
deliver images of lower resolution before the full
image can be transmitted
 Motion JPEG 2000 does not have any form of
extrapolation (and hence potential distortion) in
the time domain. Each frame is a separate
JPEG 2000 coded image
JPEG 2000 images
Storage Device (Long Term)
Database
Server
RAID
MOD
DLT
HIS/RIS
Interface
(Broker)
DG
W/S
PCs
CR QA
RIS
CT
MR
R&F
NM
C
R
Film
Digitizer
XRAY
Frame
Grabber
US
Types of storage media
Media
DVD
MOD
DLT
9840
AIT2
WORM
3.8
5.2
35
20
50
Less
Expen.
Expen.
Expen.
Cheap
Most
Expen.
Load + Very fast Very fast 113 sec
Assess
5
5.1
5
Max. T
rate
MB/s
15 sec
45 sec
10
6
GB
Cost
Long Term Archive
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Used to store digital data for longer
periods of time
Storage ranges from 100 MB to 10 TB
Optical disk most common media
- 5 1/4” MOD
- 2.6 GB and 5.2 GB Capacity
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DLT used for longer term storage and
redundancy
ISP module
Storage Device (Near line)
Database
Server
RAID
MOD
SAN/NAS
DLT
HIS/RIS
Interface
(Broker)
DG
W/S
PCs
CR QA
RIS
CT
MR
R&F
NM
C
R
Film
Digitizer
XRAY
Frame
Grabber
US
Storage Area Network
 SAN is a high-speed sub
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network of shared storage
devices
Contains storage device
(disk) for storing data
SAN's architecture works in
a way that makes all
storage devices available to
all servers
Use of Fiber Channel
High scalability for
additional storage and
redundant networks
PCs
Storage devices
Network Area Storage
 NAS is a class of dedicated hard disk-based storage
devices which provide LAN users with additional disk
storage through a standard network connection
 In most cases, a NAS device (or NAS server) receives
an IP address, connects to the LAN through an Ethernet
cable, and resides on the LAN as an independent
network device
 Users are not demanding the server's processing time
for mundane storage tasks -- often improving the
performance of local application servers
 NAS systems also include some onboard memory (RAM)
to cache network data to or from the disks
SAN Vs NAS
 Difference between NAS and SAN is subtle
 NAS devices are big, single purpose storage
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appliances that you plug into network
NAS sits between your application server and
your file system
As perform only 1 task, can serve files very fast
NAS is network-centric
SAN is a defined architecture that sits between
your file system and your underlying physical
storage
SAN is data-centric
Display
HIS/RIS
Interface
(Broker)
Database
Server
RAID
MOD
DLT
Diagnostic W/S
Dedicate W/S
SAN/NAS
DG
W/S
PCs
CR QA
RIS
CT
MR
R&F
NM
C
R
Film
Digitizer
XRAY
Frame
Grabber
US
Workstations
 Four Primary Categories
- Advanced Analysis: Used by specialists for advanced
diagnosis - 3D, volume rendering
- Diagnostic: For primary diagnosis; located in reading
rooms; high-end 2K monitors
- Clinical: Used by clinicians and staff to consult; ICU /
ER applications; less costly than diagnostic; 1K
monitors
- At Home Review: low-end; PC based; cost-effective;
review application; lossy compressed for faster
transmit
Standalone Vs direct PACS w/s
Standalone Workstation
Direct PACS Client
Workstation
Hard Disk Storage
Yes, varies
Minimal
Query PACS
number
All PACS system (CT, ACC,
Angio.)
Single PACS system (ACC
PACS)
Retrieval
mechanism
DICOM Q/R and association
made with different vendors
Direct attached, same vendor
Retrieval time
Slower
Faster
Diagnostic value
Depends on Monitor Grade and
Modules like MPR, 3D etc
Depends on Monitor Grade and
Modules like MPR, 3D etc
Suggested usage
1.for meeting/museum purpose
2.for single modality image
reviewing and reporting like
Radworks in U/S Rm
Direct PACS workstation for
reporting
Web distribution
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High availability, low cost
Reports / select images to referring
physician desktop
Point of integration with electronic patient
record
Lossy compression for performance
Potential for TeleRadiology
Security issues to be resolved
RIS, HIS, ePR and PACS
integration
Broker HIS/RIS and PACS interface
HIS/RIS
Interface
(Broker)
DG
W/S
PCs
CR QA
RIS
CT
MR
R&F
NM
C
R
Film
Digitizer
XRAY
Frame
Grabber
US
Hospital Information System
 Support clinical and medical patient care
activities in the hospital
 Administer the hospital’s daily business
transactions like finance, payroll etc
 Evaluate hospital performances and costs
and make long-term forecast
Clinical System in HA, HK
 Patient Administration
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In-Patient and Out-Patient Administration System
Accident & Emergency Information System
Medical Record Abstract System
Medical Record Tracking System
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Laboratory Information System
Radiology Information System
Pharmacy Management System
Dietetics Catering Management System
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Clinical Management System (In-Patient) Discharge Summary
Clinical Management System (Out-Patient)
Electronic Patient Records
Clinical Data Analysis and Reporting System
 Clinical Support
 Clinical Management
Non-Clinical System in HA
 Human Resources and Payroll Systems
 Hospital Based Financial System
 Materials Management System
 Patient Billing and Revenue Collection
System
 Executive Information System
Code 9 and view codes
Radiology Information Systems
 Similar to HIS but of smaller scale
 Interfaces to PACS based on HL7
 Department administrative management
- Scheduling and Film tracking
- Resource management and reporting
- Monitor patient status
 Link to Hospital Information System (HIS)
- Billing and Master Record
 Link to Clinical Management System (CMS)
- Prefetch for Clinical visit
- ePR integration
Exam
Order
Exam
Scheduled
RIS workflow
Web
distribution
to referring
physicians
Modality Worklist
Demographics
Downloaded
RIS
Patient Exam
Is Performed
Images
transferred
in STS
Order
Event
Database
server
/Archive
Prefetch Exams
From Storage
PACS Worklist
Updated
Images /
Prior Reports
Dictated
status
Image migration STS to LTA
Final report
available
Report
Verified
Exam
Read
Preliminary status
Exam
Transcribed
Broker service
DR
HA
HIS
CR
ADT
HA
RIS
HA CMS
Appt.,
X-ray
request
Mitra
PACS
Broker
interface
Clinical visit
US
DF
Database
server
Modalities: Get WORKLIST
Get REPORT, Get INFO
Broker service
 A restricted access account will be created at
Sybase that gives limited authority for the
DICOM Broker solely for the purpose of the
interfaces
 In general, for data flow from RIS to the Broker,
the RIS write the supported events to the table,
and the Broker polls against the events table
and calls the associated stored procedures for
the conversion to DICOM messages
Broker service
 Broker main function:
- Worklist generation
- Reports storage
Registration + Post
exam data capture (RIS)
Acc # generation +
call broker for update
Need SOME time!!
Modalities query
Broker for worklist
update
Broker poll RIS event
table and convert to
DICOM info
ePR Architecture
 Selected images from
individual hospital’s
PACS are sent
 make use of the ePR
record indexing and
browsing capabilities
to read the radiology
images through CMS
workstations
Data Flow Diagram
RIS
ePR
HA system
Appointment
Attendance
RIS operational Exam records
data
Reports (15mins)
CMS
ePR
Web
Server
PACS
RIS statistical
data
Attendance
Exam &
workload units
(daily)
Data
warehouse
Non clinical
system
Characteristics of ePR
 Near instant image review
 Web distribution can be within hospital, to
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other hospitals or even private clinics
TeleRadiography possible
Update of patient information
Lossy Vs lossless
Broken pathway
15 minutes time lag
Guidelines for HIS, RIS, PACS
interface
 Each system remain unchanged in its
configuration and function, only data are
shared
 Identify the subset data to be shared and
set up access rights/ authorization
 Convert the subset data to HL7 standard
 Define transfer protocol (TCP/IP or
DICOM)
Typical patient and data flow
 Admission: Patient registration, notify HIS (HL7)
 Order entry/Arrival: Schedule exam and notify RIS
 Broker notified and PACS database server updated
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(prefetch)
DICOM worklist to modality
Exam completed: data to DICOM gateway (MPPS)
Information/images to database/image server through
gateway (DICOM store)
Images stored in PACS archive
Images to workstations from PACS archive
Dictation, transcription etc: workstation to RIS/PACS
RIS reporting and PACS updated for reports
Transfer: HIS/RIS to PACS, images to other PACS
Discharge: HIS/RIS to PACS, images rub out
http://www.pacs.hk
Thanks!