An Overview ofWorkflow with RIS/PACS

Dr Mark MacenteeMr Ali B Alhailiy

Digital Radiology

• The application of modern information technology to the practice of radiology

• Depends on automated systems for acquiring,transmitting, storing, and displaying digital

images and associated data

Picture Archiving and Communication System(PACS)

• A system capable of acquiring, transmitting, storing, retrieving, and displaying digital images and

relevant patient data from various imaging sources,and capable of communicating the information overa network• Depends on interfaces to other medical informationsystems, such as the Radiology Information System(RIS)

Digital Imaging and Communications inMedicine (DICOM)

An international standard (ISO) describing how radiology images are identified and formatted and how imaging devices communicate with each other

• Jointly developed by the American College of Radiology and the National Electronic Manufacturers Association

• Based on the ISO Open Standards Intercommunications (OSI)

model• http://www.dclunie.com/

Hospital Information System (HIS)

A system used to store and retrieve patient information.

• An integrated computer system that may include or be linked to a radiology information system (RIS)

Four Major PACS Components

• 1- Acquisition 2- Network

• CT ,MRI,X RAY RIS

• 4- Display 3- Archive• LCD IMAGE DATABASE

Examples of errors within and between PACScomponents

1• Acquisition errors– Improper technique

selection– Wrong exam performed– Image deleted2• Network errors– Image lost– Image corrupted– Unable to transmit

3• Archive errors–– Storage failure– Sequestered exams4• Display errors

– Associated data notdisplayed– Artificial shutters

Acquisition: Improper Technique Selection

• Digital detectors are more tolerant of over-exposure than conventional detectors

• Excess digital signal is scaled to provide consistent appearance

• Consequence: is unnecessary radiation exposure to patient

Acquisition: Wrong exam performed

• Radiographer may image thorax using digitalexamination intended for abdomen• Digital signal is rendered inappropriately for

review Consequence: may be repeated examination

and unnecessary radiation exposure to patient

Acquisition: Image deleted

• Radiographer may delete image at acquisition station without transmitting to PACS

• It may not be possible to restore deleted image

• Consequence: may be repeated examination and unnecessary radiation exposure to patient

Network: Image corrupted

• Interruption in network service may degrade image

• It may not be possible to retransmit image from acquisition station

• Consequence: may be repeated examination and unnecessary radiation exposure to patient

Network: unable to transmit

• Interruption in network services prevents transmission of images from acquisition station

• Local storage capacity of acquisition station is limited

• If acquisition continues, images can be lost, causing repeated examinations and unnecessary radiation exposure to patients

Archive: storage failure

• Storage failure can prevent images frombeing archived• If images have already been deleted fromacquisition station, may require repeatedexaminations and unnecessary radiationexposure to patients

Archive: images sequestered

• When demographic and examinationinformation on images does not matchinformation from RIS, images may be hiddenfrom view•radiographer may repeat examination withunnecessary radiation exposure to patients

Display: associated data not displayed

• Data accompanying the image may not be displayed for

the radiologist• If missing data includes information on the

radiographictechnique or patient exposure, the radiologist cannotoversee radiographer practice• Without radiologist oversight, radiographers may

perform examinations with unnecessary radiation exposure to patients

Sources of Errors in PACS

• Mistakes in configuration of PACS• Improper calibration of PACS devices• Discrepancies between PACS and hospitalprocesses• Inherent limitations of human operators• Inadequate training and documentation of

PACSand hospital processes

• Electronic devices and media are im-permanent records: the consequence of loss is greater than one film or one film jacket.

• A single bad electronic image can be proliferated: a single bad film image can be controlled.

• Bad electronic images can disappear without a trace: bad films disappear, but leave a signature. How many

The best maintenance is preventive maintenance.

• Calibrations need to be performed on-schedule.• Operators need to clean, inspect, and

document.Start-of-shift routines or checklists are helpful.• Schedule PM to occur at convenience of clinical

operation.• Software upgrades are major service events that

demand reverification

Conclusions

• Unfortunately, errors will always occur in PACS.• Some of these errors cause unnecessary radiation dose topatients• QC is the key to detecting errors.• Training is key to averting errors.• Reliability engineering is key to continuity of clinicaloperations.• Disaster recovery is key to restoring normal clinicaloperations.• Optimisation includes all of the above.