PACS --How to Choose One

PACS Communication:RIS, HIS, Internet, and Doctors

J. Anthony Parker, MD PhDBeth Israel Deaconess Medical Center

Boston, MA

Society of Nuclear MedicineSt Louis, MOMonday, June 5, 2000, 3:00-3:30

Caveat Lector

Beth Israel Deaconess Medical Center

Department of Nuclear Medicine

1982 All digital

1987 Filmless

1995 Web-based

PACS Communication

Database 1011

Communication with HIS / RIS / workstation

Communication with referring physician2

Call3

1. http://www.med.harvard.edu/JPNM/Lectures/Database101/Database101.html.2. Barbaras l, Parker JA, Donohoe KJ, Kolodny GM: The All-Digital Department

Moves to the Web. RSNA ej 1996.3. Parker JA, Barbaras L, Donohoe KJ, Biedron WE, Kolodny GM: Cable Modem-

assisted Tele-Nuclear Medicine. RSNA ej 1997.

Database: Tables

Simple two dimensional

Hold all the data

Rows called “records”

Columns called “fields”

Organize data / application

Examples: order, invoice, product

A record is often represented by a form

RIS examples: patient, study, dataset

Table Example: ADT

MRN Last First Middle Sex

1274829 Adelstein S. James M

1756983 Holman B. Leonard M

6432235 Parker J. Anthony M

7824824 Parker J. Scott M

7832134 Parker M. Jane F

7354851 Treves S. Ted M

Table Example: Study Table

MRN Study No Type Report

1274829 960345 Bone http:// 144.134.206.52/R960345.html

1756983 960346 Brain http:// 144.134.206.52/R960346.html

6432235 960347 Lung http:// 144.134.206.52/R960347.html

1756983 960348 Bone http:// 144.134.206.52/R960348.html

1756983 960349 Lung http:// 144.134.206.52/R960349.html

1274829 960350 Heart http:// 144.134.206.52/R960350.html

Table Example: Dataset Table

Study No Dataset No Name Dataset

960345 125785 Ant http://144.134.206.52/Im960345.tiff

960345 125786 Post http://144.134.206.52/Im960346.tiff

960346 125787 Flow http://144.134.206.52/Im960347.tiff

960346 125788 Dyn http://144.134.206.52/Im960348.tiff

960346 125789 Stat http://144.134.206.52/Im960349.tiff

960346 125790 Delay http://144.134.206.52/Im960350.tiff

Index: Rapid Table Access

MRN Last Name First Name Middle Name Sex1756893 Adelstein S. James M3234252 Holman B. Leonard M6432235 Parker J. Anthony M7832134 Parker J. Scott M7834453 Parker M. Jane F3259204 Treves S. Ted M

MRN Index

Database: Relations

Connect two tables

One field from each table

e.g. ADT.MRN = Study.MRN

Record(s) with the same field value are associated

Relations provide application complexity

Relational Database

MRN Name Sex DOB ... MRN Study # Date Type ...

1526872

1526872

1526872

1526872

1994-6184

1994-6184

1994-6184

Study # ...Dose #Isotope FormIsotope ......

Tc-99m

Xe-133

Tc-99m

Xe-133

Patients Studies

Inventory Dose

Database Concepts

Tables are simple

Table design provides application structure

Indexes allow rapid access to tables

Relations provide richness to application

CommunicationHow to Choose a Database

You don’t care

HIS:Hospital Information System

ADT

Chemistry Billing

RIS NMIS

InterfaceEngine

Protocols:SQLHL7

Distributeddatabase

Let’s have a little talk

about tweetle beetles ...

Suess: Fox in Sox. 1965

Jargonology

PACS - Picture Archiving and Communication System

HIS - Hospital Information System

ADT - Admission Discharge Transfer

RIS - Radiology Information System

NMIS - Nuclear Medicine Information System

HL7 - Health Level 7

SQL - “Structured Query Language”?

DICOM - Radiology communications protocol

ACR/NEMA 3 for European sensibilities

Database Access

Old paradigm

Middleware - SQL

Some cross platform

New paradigm

The web - Java, JavaScript

Total cross platform

Web Server

CGI Browser

Table HTML

PACS / RIS / Workstation

PACSImage Server

HIS / RIS / NMISDatabase

WorkstationUser Interface

Communication Between Systems:A Case Study

Workstations only connect to Radiology maxiPACS

Radiology maxiPACS includes some RIS work flow functions

Order entry (HL7) -> image data (DICOM) -> report (HL7)

HIS

NMIS RIS

miniPACS maxiPACS

ADT

Reports

Order entryReport

ImagesWorkstation

Communication: The Web

The Web provides a very easy method for linking the Nuclear

Medicine Information System, PACS, and workstations.

This paradigm extends easily to larger departments or to an

entire health care enterprise.

Use of public domain communication protocols and data

formats means that communications can be

implemented using mass market systems.

CommunicationHow to Choose a Protocol

No brainer:

Internet

World wide web (http:, https:)

DICOM

LLC

ISO NETWORK

ISO TRANSPORT

ISO SESSION KERNEL

ISO PRESENTATION

ISO Association Control Service Element (ACSE)

TCP

IP

DICOMUpper layer

protocolfor TCP/IP

Session /Transport /

Network

(STN)

Data Link

Physical(50-pin) Ethernet, FDDI, ISDN, etc.

DICOM Application Entity

Medical Imaging Application

ISO UpperLayer Serviceboundary

Point-to-point Network Environment

PennState College of Medicine, Department of Radiologyhttp://www.xray.hmc.psu.edu/dicom/basicinfo.html

CommunicationHow to Choose a Data Format

Radiology niche format (Interfile, DICOM)

Often within modality

Rarely between modalities

Almost never outside Radiology

General format (jpeg, gif, tiff)

Whenever possible

Film

Disadvantages - overwhelming

No cine, windowing

No SPECT visualization

Single original

Loossable

Expensive - infrastructure, expertise

Advantage - communication

View boxes widely available

Good quality static picture

Multimedia Report

Demographics are already captured in RIS

Typist enters text using a word processor

Demonstration(?) images, cines

Selected at report time

Stored in PACS

URL stored in RIS

Report can be e-mailed (MIME format)

Report can be accessed using WWW

Multimedia Reporting

Communication with PhysicianHow to Choose Method(s)

Traditional report

Mail, fax, e-mail

Include a half tone image

World wide web (http:, https:)

Workstation functions (Java)

Security

Yes

Cable Modem

Fast

1.5 Mbits/second download

Always available

No dialing

Cable ModemTele-Nuclear

Medicine

Web-based Nuclear Medicine

Integrate NMIS and miniPACS

Integrate with HIS / RIS and maxiPACS

Provide multimedia reports

Implement high speed tele nuclear medicine

CommunicationHow to Choose a PACS

maxiPACS

Single vendor

Better integration (?)

miniPACS

Special needs of modality

Better bandwidth utilization

Redundancy

Take Home Points

HIS / RIS is just a distributed database

Communications: Internet and web

General data format when possible

Multimedia reporting

Web based call