PACS introduction

PACS introductionPACS introduction

Facilitator:Facilitator:

Edward WongEdward Wong

What is the role of PACS What is the role of PACS Administrator?Administrator?

PACS Administrator’s rolesPACS Administrator’s roles

Implementing a PACS Implementing a PACS System MaintenanceSystem Maintenance Image and Information ManagementImage and Information Management

For a 200,000 exams/year institution, 2-8 For a 200,000 exams/year institution, 2-8 full time PACS Administrator is available!full time PACS Administrator is available!


Implementing a PACS Implementing a PACS - Financial and workflow study- Financial and workflow study- Request for Proposal and Tender drafting- Request for Proposal and Tender drafting- Workflow modification including job reallocation - Workflow modification including job reallocation and resource relocationand resource relocation- Training and Operation Manuals- Training and Operation Manuals- Acceptance of system- Acceptance of system

System MaintenanceSystem Maintenance Image and Information ManagementImage and Information Management


Implementing a PACS Implementing a PACS System MaintenanceSystem Maintenance

- Contingency plan- Contingency plan

- Incompatibility handling- Incompatibility handling

- First line support and problems escalating- First line support and problems escalating

- System security and Performance - System security and Performance monitoringmonitoring

Image and Information ManagementImage and Information Management


Implementing a PACSImplementing a PACS System MaintenanceSystem Maintenance Image and Information ManagementImage and Information Management

- Maintain high Image Quality- Maintain high Image Quality- Data Integrity- Data Integrity- Quality Assurance program- Quality Assurance program- TeleRadiography- TeleRadiography- Anytime Available Storage Management- Anytime Available Storage Management

What is PACS ?What is PACS ?

PP: Picture, Images & Reports: Picture, Images & Reports

AA: Archive, Online, Near line, Offline: Archive, Online, Near line, Offline

CC: Communication, Networking, Transfer Protocols: Communication, Networking, Transfer Protocols

SS: System, Components & Architecture: System, Components & Architecture

PACSPACS: for storage and distribution of images and : for storage and distribution of images and information when necessaryinformation when necessary

PACS: Small or LargePACS: Small or Large

Web Server Distribution

Scale of PACS Scale of PACS

No. of Beds in Hospital/ Exams per yearNo. of Beds in Hospital/ Exams per year No. of ModalitiesNo. of Modalities No. of SwitchesNo. of Switches

Considerations:Considerations:

System connectivity, expandability, reliability System connectivity, expandability, reliability and cost-effectivenessand cost-effectiveness

Types of imagesTypes of images

1D, 2D, 3D, 4D1D, 2D, 3D, 4D Different DICOM Modality type: Cardiac / PET / 4D Different DICOM Modality type: Cardiac / PET / 4D

U/S…..U/S….. Image size: Resolution and bit depthImage size: Resolution and bit depth Image quality: Bit Depth and resolutionImage quality: Bit Depth and resolution Color / MonochromaticColor / Monochromatic Exam. Size: image size x no. of imagesExam. Size: image size x no. of images Structured ReportsStructured Reports New DICOM IOD:New DICOM IOD:

Endoscopic & Microscopic images / ECGs / Security Endoscopic & Microscopic images / ECGs / Security Profiles…..Profiles…..

1D, 2D, 3D, 4D, fusion1D, 2D, 3D, 4D, fusion

Image Resolution/ Bit depthImage 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

7.5 MByte4k x 5k

12 bit

30 MByte

Properties of imageProperties of image

• Bit depthBit depth

• Grayscale or colorGrayscale or color

• Resolution in pixelResolution in pixel

Example image Example image size of size of mammogram = 4k mammogram = 4k x 5k x 12 bit = x 5k x 12 bit = 30 30 MBMB

PACS ArchitecturePACS Architecture

Data Base Server

CR/ DR QAWorkstation Computed

Radiographyor DR

Gateway orFrame Grabber

FilmDigitizer

Non-DICOMModality

Archive

DICOMModality

Web Server

RIS

DiagnosticWorkstations (DICOM)

Image Server(RAID)

Clinical Workstations (DICOM)

PACS – Central ArchitecturePACS – Central Architecture

DiagnosticWorkstation

Central ArchitectureCentral Architecture

Image Server and Database Manager is Image Server and Database Manager is the HEARTthe HEART

Any image, any where, any timeAny image, any where, any time Unique central copyUnique central copy Easy update of dataEasy update of data Requires high performance serversRequires high performance servers Potential single point of failure at serverPotential single point of failure at server Bandwidth demandingBandwidth demanding

Data Base Server

CR QAWorkstation

ComputedRadiography


FilmDigitizer

Non-DICOMModality

Archive

DICOMModality

Web Server


RIS

DiagnosticWorkstations

(DICOM)

Clinical Workstations

(DICOM)

PACS – Distributed ArchitecturePACS – Distributed Architecture

Distributed ArchitectureDistributed Architecture

Exams are routed from modality to Exams are routed from modality to selected workstations selected workstations

Complex routing algorithms based on Complex routing algorithms based on department / user preferencedepartment / user preference

Difficult to support concurrent review of Difficult to support concurrent review of imagesimages

Less destructive for failure at database Less destructive for failure at database serverserver

Components of PACSComponents of PACS

HIS/ RISHIS/ RIS BrokerBroker ePR gatewayePR gateway Database ServerDatabase Server Image Server (RAID)Image Server (RAID) Long Term/ Near line ArchiveLong Term/ Near line Archive NetworksNetworks DigitizerDigitizer

Components of PACSComponents of PACS

Acquisition GatewaysAcquisition Gateways Non-DICOM modality gatewayNon-DICOM modality gateway DICOM Print ServerDICOM Print Server Media ServerMedia Server Reporting ServerReporting Server Monitor QC ServerMonitor QC Server Web ServerWeb Server WorkstationsWorkstations

PACS layout 1PACS layout 1

HIS/RIS I/F (SQL)(Mitra Broker)

Tuen Mun Hospital PACS SystemTuen Mun Hospital PACS System- Ambulatory Care Center (ph- Ambulatory Care Center (phase 1)ase 1)

RAID 5ISU

E450 CPU

Long Term Archive MOD Jukebox

ARC

US Logic700

Image Acquisition Modalities in ACC

Proteus XR/d

Proetus XR/aPrestiges II

Radwork5.0PathSpeed CRQA

CR ID Preview 2

PathSpeedMP CR

RW Film Digitizer

Hospital RIS

Network

1 GBit Fiber Link

ACC Ortho Dept

1C PathSpeedReview Stations

600m / 12 Core Gbit Fiber Link

Kodak Laser Printer 1

PCS2

Kodak Laser Printer 2

PCS 1HSA 1

PARIS 1

MIU1 MIU2 MIU3

PARIS 2

CR ID Preview 1

PathSpeed 1CWS PathSpeed 1CWS

Main Block Radiology Department

2B Diagnostic Workstations

2B Diagnostic Workstations

CT Network

MRNetwork

RTNetwork

Layer 3 SwLayer 2 Sw

Server Rm Network Switch Closet

KELP 2180DryView 8700

GE Medical Systems

IT - Radiology System

1CWS / Remote Admin Server

PathSpeedSP CR

Data Base Server

CR/ DR QAWorkstation Computed

Radiographyor DR


FilmDigitizer

Non-DICOMModality

LTS ArchiveSAN/NAS

DICOMModality

Web Server

Broker for

RIS/HIS

DiagnosticWorkstations (DICOM)

Image Server(RAID)

Clinical Workstations (DICOM)

PACS ComponentsPACS Components


Media Server

ePR gateway

W/S QA Server

Enterprise Archive

Through Acq. gateway

CRCR USUSXRAYXRAY

RIRISS

PCsPCsW/SW/S Film Film DigitizerDigitizer

CR QACR QA Frame Frame GrabberGrabber

HIS/RISHIS/RISInterfaceInterface(Broker)(Broker)

CCTT

R&FR&FMRMR NMNM

DGDG

Acquisition (DICOM) GatewayAcquisition (DICOM) Gateway

Role of Acquisition gatewayRole of Acquisition gateway

Compression/ decompression and securityCompression/ decompression and security Check the images for integrityCheck the images for integrity Convert to PACS format (header, byte-Convert to PACS format (header, byte-

order, matrix size)order, matrix size) Queue for images (priority) to database Queue for images (priority) to database

server (background)server (background) Share the workload and no point of failure Share the workload and no point of failure

for multiple Acquisition gatewayfor multiple Acquisition gateway

CRCR USUSXRAYXRAY

RIRISS




CCTT

R&FR&FMRMR NMNM

DGDG

Database Server and Image ServerDatabase Server and Image Server

DatabaseDatabaseServerServer RAIDRAID

Database Server (PACS controller)Database Server (PACS controller)

The Heart of the systemThe Heart of the system Integration cross point between HIS/RIS Integration cross point between HIS/RIS

and PACS (status update)and PACS (status update) Create and manages patient foldersCreate and manages patient folders Manage reading worklists and user Manage reading worklists and user

profilesprofiles Manage data transfer within the systemManage data transfer within the system Support data mining and teaching foldersSupport data mining and teaching folders

Image Server (RAID)Image Server (RAID)

Online (rapid access) exam storage and Online (rapid access) exam storage and distribution devicedistribution device

Support simultaneous exam input and Support simultaneous exam input and output transfer operationsoutput transfer operations

Up to Three months of storage capacityUp to Three months of storage capacity Scalable capacityScalable capacity

Redundant Array of Independent DisksRedundant Array of Independent Disks

Bandwidth equal to sum of disk transfer rates Bandwidth equal to sum of disk transfer rates

Highest speed disk storage availableHighest speed disk storage available

Image

Disk Array

2 MB/s1

2

3

4

5

6

7

8

16 MB/s

Hot Swap

Parity

What is RAIDWhat is RAID

RAID 5 configurationRAID 5 configuration

If disk fails, disk can be If disk fails, disk can be rebuilt- fault tolerantrebuilt- fault tolerant

High data transfer rate High data transfer rate for read, write slowerfor read, write slower

Min. 3 disks to startMin. 3 disks to start Array capacity is N-1Array capacity is N-1

Bandwidth is a measure of the information Bandwidth is a measure of the information (data) carrying capacity of a network(data) carrying capacity of a network10/100/1000 MB/sec 10/100/1000 MB/sec

Information Flow

Data Pipe (Network)

BandwidthBandwidth

Network BottleneckNetwork Bottleneck

The bandwidth of an information delivery system is The bandwidth of an information delivery system is limited to the bandwidth of the slowest component limited to the bandwidth of the slowest component in the systemin the system

Network Bottleneck

Data compression reduces the information rate Data compression reduces the information rate a network must supporta network must support

Uncompressed Data

Compressed Data

Data CompressionData Compression

Decompressed image is identical to original Decompressed image is identical to original imageimage

JPEG lossless compressionJPEG lossless compression

Average compression of 2:1 for x-ray imagesAverage compression of 2:1 for x-ray images

I

C

D

I - D = 0

Lossless Image CompressionLossless Image Compression

JPEG 2000 CompressionJPEG 2000 Compression

Selected parts of the image can be defined as Selected parts of the image can be defined as Regions of Interest, they can then be delivered Regions of Interest, they can then be delivered before other parts of the image, or losslessly, before other parts of the image, or losslessly, whilst other parts of the image that are less whilst other parts of the image that are less critical use normal lossy compression critical use normal lossy compression

JPEG 2000 codestream can be ordered to JPEG 2000 codestream can be ordered to deliver images of lower resolution before the full deliver images of lower resolution before the full image can be transmitted image can be transmitted

Motion JPEG 2000 does not have any form of Motion JPEG 2000 does not have any form of extrapolation (and hence potential distortion) in extrapolation (and hence potential distortion) in the time domain. Each frame is a separate the time domain. Each frame is a separate JPEG 2000 coded imageJPEG 2000 coded image

JPEG 2000 imagesJPEG 2000 images

CRCR USUSXRAYXRAY

RIRISS




CCTT

R&FR&FMRMR NMNM

DGDG

Storage Device (Long Term)Storage Device (Long Term)

DatabaseDatabaseServerServer RAIDRAID MODMOD DLTDLT

Types of storage mediaTypes of storage media

MediaMedia DVDDVD MODMODWORMWORM

DLTDLT 98409840 AIT2AIT2

GBGB 3.83.8 5.25.2 3535 2020 5050

CostCost Less Less Expen.Expen.

Expen.Expen. Expen.Expen. CheapCheap Most Most Expen.Expen.

Load + Load + AssessAssess

Very Very fastfast

Very Very fastfast

113 sec113 sec 15 sec15 sec 45 sec45 sec

Max. T Max. T rate rate MB/sMB/s

55 5.15.1 55 1010 66

Long Term ArchiveLong Term Archive

Used to store digital data for longer periodUsed to store digital data for longer periods of times of time

Storage ranges from 100 MB to 10 TBStorage ranges from 100 MB to 10 TBOptical disk most common mediaOptical disk most common media

- 5 1/4” MOD- 5 1/4” MOD- 2.6 GB and 5.2 GB Capacity- 2.6 GB and 5.2 GB Capacity

DLT used for longer term storage and redDLT used for longer term storage and redundancyundancy

ISP moduleISP module

CRCR USUSXRAYXRAY

RIRISS




CCTT

R&FR&FMRMR NMNM

DGDG

Storage Device (Near line)Storage Device (Near line)

DatabaseDatabaseServerServer RAIDRAID MODMOD DLTDLT SAN/NAS

Storage Area NetworkStorage Area Network

SAN is a high-speed sub-SAN is a high-speed sub-network of shared storage network of shared storage devicesdevices

Contains storage device Contains storage device (disk) for storing data(disk) for storing data

SAN's architecture works in SAN's architecture works in a way that makes all storage a way that makes all storage devices available to all devices available to all serversservers

Use of Fiber ChannelUse of Fiber Channel High scalability for additional High scalability for additional

storage and redundant storage and redundant networksnetworks

PCs

Storage devices

Network Area StorageNetwork Area Storage

NAS is a class of dedicated hard disk-based storage NAS is a class of dedicated hard disk-based storage devices which provide LAN users with additional disk devices which provide LAN users with additional disk storage through a standard network connectionstorage through a standard network connection

In most cases, a NAS device (or NAS server) receives In most cases, a NAS device (or NAS server) receives an IP address, connects to the LAN through an Ethernet an IP address, connects to the LAN through an Ethernet cable, and resides on the LAN as an independent cable, and resides on the LAN as an independent network devicenetwork device

Users are not demanding the server's processing time Users are not demanding the server's processing time for mundane storage tasks -- often improving the for mundane storage tasks -- often improving the performance of local application serversperformance of local application servers

NAS systems also include some onboard memory NAS systems also include some onboard memory (RAM) to cache network data to or from the disks (RAM) to cache network data to or from the disks

SAN Vs NASSAN Vs NAS

Difference between NAS and SAN is subtleDifference between NAS and SAN is subtle NAS devices are big, single purpose storage NAS devices are big, single purpose storage

appliances that you plug into networkappliances that you plug into network NAS sits between your application server and NAS sits between your application server and

your file systemyour file system As perform only 1 task, can serve files very fastAs perform only 1 task, can serve files very fast NAS is network-centricNAS is network-centric SAN is a defined architecture that sits between SAN is a defined architecture that sits between

your file system and your underlying physical your file system and your underlying physical storagestorage

SAN is data-centricSAN is data-centric

CRCR USUSXRAYXRAY

RIRISS




CCTT

R&FR&FMRMR NMNM

DGDG

DisplayDisplay

DatabaseDatabaseServerServer RAIDRAID MODMOD DLTDLT

SAN/NAS

Diagnostic W/SDiagnostic W/S Dedicate W/SDedicate W/S

WorkstationsWorkstations

Four Primary CategoriesFour Primary Categories- Advanced Analysis: Used by specialists for advanced - Advanced Analysis: Used by specialists for advanced

diagnosis - 3D, volume renderingdiagnosis - 3D, volume rendering- Diagnostic: For primary diagnosis; located in reading Diagnostic: For primary diagnosis; located in reading

rooms; high-end 2K monitorsrooms; high-end 2K monitors- Clinical: Used by clinicians and staff to consult; ICU / Clinical: Used by clinicians and staff to consult; ICU /

ER applications; less costly than diagnostic; 1K ER applications; less costly than diagnostic; 1K monitorsmonitors

- At Home Review: low-end; PC based; cost-effective; At Home Review: low-end; PC based; cost-effective; review application; lossy compressed for faster review application; lossy compressed for faster transmittransmit

Standalone Vs direct PACS w/sStandalone 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 purpose2.for single modality image reviewing and reporting like Radworks in U/S Rm

Direct PACS workstation for reporting

Web distributionWeb distribution

High availability, low costHigh availability, low costReports / select images to referring physiciReports / select images to referring physici

an desktopan desktopPoint of integration with electronic patient rPoint of integration with electronic patient r

ecordecordLossy compression for performanceLossy compression for performancePotential for TeleRadiologyPotential for TeleRadiologySecurity issues to be resolvedSecurity issues to be resolved

RIS, HIS, ePR and PACS RIS, HIS, ePR and PACS integrationintegration

CRCR USUSXRAYXRAY

RIRISS




CCTT

R&FR&FMRMR NMNM

DGDG

Broker HIS/RIS and PACS Broker HIS/RIS and PACS interfaceinterface

Hospital Information SystemHospital Information System

Support clinical and medical patient care Support clinical and medical patient care activities in the hospitalactivities in the hospital

Administer the hospital’s daily business Administer the hospital’s daily business transactions like finance, payroll etctransactions like finance, payroll etc

Evaluate hospital performances and costs Evaluate hospital performances and costs and make long-term forecast and make long-term forecast

Clinical System in HA, HKClinical System in HA, HK Patient Administration In-Patient and Out-Patient Administration System Accident & Emergency Information System Medical Record Abstract System Medical Record Tracking System Clinical Support Laboratory Information System Radiology Information System Pharmacy Management System Dietetics Catering Management System Clinical Management Clinical Management System (In-Patient) Discharge Summary Clinical Management System (Out-Patient) Electronic Patient Records Clinical Data Analysis and Reporting System

Non-Clinical System in HANon-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 codesCode 9 and view codes

Radiology Information SystemsRadiology Information Systems Similar to HIS but of smaller scaleSimilar to HIS but of smaller scale Interfaces to PACS based on HL7Interfaces to PACS based on HL7 Department administrative managementDepartment administrative management

- - Scheduling and Film trackingScheduling and Film tracking

- Resource management and reporting- Resource management and reporting

- Monitor patient status- Monitor patient status Link to Hospital Information System (HIS)Link to Hospital Information System (HIS)

- - Billing and Master RecordBilling and Master Record Link to Clinical Management System (CMS)Link to Clinical Management System (CMS)

- - Prefetch for Clinical visitPrefetch for Clinical visit

- ePR integration- ePR integration

ExamOrderExamOrder

ExamScheduled

ExamScheduled

RISRIS Patient ExamIs PerformedPatient ExamIs Performed

Modality WorklistDemographicsDownloaded

Database server

/Archive

Database server

/Archive

Order Event

Prefetch ExamsFrom Storage

Imagestransferred in STS

PACS WorklistUpdated

PACS WorklistUpdated

Images /Prior Reports

Image migration STS to LTA

ExamTranscribed

ExamTranscribed

ReportVerifiedReportVerified

Final reportavailable

Final reportavailable

ExamReadExamRead

Dictatedstatus

Preliminary status

Imag

es

copie

d on

web-s

erve

r

Webdistributionto referringphysicians

RIS workflow

Broker serviceBroker service

HAHIS

HARIS

HA CMS Clinical visit

ADT

MitraPACSBroker interface

Appt., X-ray request

DR

CR

US

DF

Modalities: Get WORKLISTGet REPORT, Get INFO

Database server


A restricted access account will be created at A restricted access account will be created at Sybase that gives limited authority for the Sybase that gives limited authority for the DICOM Broker solely for the purpose of the DICOM Broker solely for the purpose of the interfaces interfaces

In general, for data flow from RIS to the Broker, In general, for data flow from RIS to the Broker, the RIS write the supported events to the table, the RIS write the supported events to the table, and the Broker polls against the events table and the Broker polls against the events table and calls the associated stored procedures for and calls the associated stored procedures for the conversion to DICOM messages the conversion to DICOM messages


Broker main function:Broker main function:

- Worklist generation- Worklist generation

- Reports storage- Reports storage

Registration + Post exam data capture (RIS)

Acc # generation + call broker for update

Broker poll RIS event table and convert to DICOM info

Modalities query Broker for worklist update

Need SOME time!!

ePR ArchitectureePR Architecture

Selected images from Selected images from individual hospital’s Pindividual hospital’s PACS are sent ACS are sent

make use of the ePR make use of the ePR record indexing and brecord indexing and browsing capabilities to rowsing capabilities to read the radiology imread the radiology images through CMS wages through CMS workstationsorkstations

Data Flow DiagramData Flow DiagramRIS ePR

RIS operational data

RIS statistical data

ePR

Data warehouse

Appointment

Attendance

Exam records

Reports (15mins)

Attendance

Exam & workload units (daily)

HA system

CMS

Non clinical system

Web ServerPACS

Characteristics of ePRCharacteristics of ePR

Near instant image reviewNear instant image review Web distribution can be within hospital, to Web distribution can be within hospital, to

other hospitals or even private clinicsother hospitals or even private clinics TeleRadiography possibleTeleRadiography possible Update of patient informationUpdate of patient information Lossy Vs losslessLossy Vs lossless Broken pathwayBroken pathway 15 minutes time lag15 minutes time lag

Guidelines for HIS, RIS, PACS Guidelines for HIS, RIS, PACS interfaceinterface

Each system remain unchanged in its Each system remain unchanged in its configuration and function, only data are configuration and function, only data are sharedshared

Identify the subset data to be shared and Identify the subset data to be shared and set up access rights/ authorizationset up access rights/ authorization

Convert the subset data to HL7 standard Convert the subset data to HL7 standard Define transfer protocol (TCP/IP or Define transfer protocol (TCP/IP or

DICOM)DICOM)

Typical patient and data flowTypical patient and data flow Admission: Patient registration, notify HIS (HL7)Admission: Patient registration, notify HIS (HL7) Order entry/Arrival: Schedule exam and notify RISOrder entry/Arrival: Schedule exam and notify RIS Broker notified and PACS database server updated (prefetch)Broker notified and PACS database server updated (prefetch) DICOM worklist to modalityDICOM worklist to modality Exam completed: data to DICOM gateway (MPPS)Exam completed: data to DICOM gateway (MPPS) Information/images to database/image server through Information/images to database/image server through

gateway (DICOM store)gateway (DICOM store) Images stored in PACS archiveImages stored in PACS archive Images to workstations from PACS archiveImages to workstations from PACS archive Dictation, transcription etc: workstation to RIS/PACS Dictation, transcription etc: workstation to RIS/PACS RIS reporting and PACS updated for reportsRIS reporting and PACS updated for reports Transfer: HIS/RIS to PACS, images to other PACSTransfer: HIS/RIS to PACS, images to other PACS Discharge: HIS/RIS to PACS, images rub outDischarge: HIS/RIS to PACS, images rub out

http://www.pacs.hkhttp://www.pacs.hk

Thanks!Thanks!

PACS introduction

Documents

Transcript of PACS introduction