Unit 8- Data Management

enterprise imaging

• Our images, photographs, arthroscopes

• Led to healthcare facilities to pivot away from PACS (MIMPS) by using Vendor Neutral Archive (VNA)

• Allows healthcare members to log on to one account and have access to any image not just radiology. 

Advantages of enterprise imaging

1. incorporation of all medical images into a single archive

2. increase in efficiency help improve patient outcomes

3. reduce storage costs

4. easier accessibility

image distribution & viewing

• •CD and DVD have been used since early 90’s to download images onto

• online remote access to PACS (MIMPS) systems & VPN (virtual private networks)

  • provides a login & password, external users can access & review images

• cloud base exchange (off site server, not within the facility)

cost per CD

$8-$15

cloud base exchange- concern

data privacy issues

integrating healthcare enterprise (IHE)

• An initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information.

• helps care providers envision a day when vital information can be passed seamlessly from system to system within and across departments and made readily available at the point of care. 

  • “how can we best apply existing standards to make the best way for future outcomes”

health level seven standard (HL7)

• Manages non-imaging data, and provides protocols for exchange, management, and integration of clinical and administrative electronic health data.

• All information outside of radiology- the communicating device

• allows the hospital to give us all patient info within our radiology systems

health level seven standard (HL7) examples:

• patient administration

• laboratory information systems

• billing systems

• electronic medical record and health record systems

what is the standard communication between HIS & RIS?

HL7

cloud-based computing

• Reduces operational and maintenance costs for data storage

• Combines data from different resources

• Flexibility of archive size

• De-identify personal and healthcare information contained in DICOM metadata and pixels

• Label of all information attached to the pictures

_______avoids the need for a company to purchase and invest in new IT equipment

cloud computing

database health monitoring

• process of tracking & managing the condition, performance, & integrity of databases to prevent downtime, data loss, or workflow delays

• helps catch issues early- before they affect anyone

radiology uses databases:

1. patient demographics

2. imaging orders

3. modality worklists

4. images & reports

5. billing information

example of database health monitoring

RIS→ making sure orders, schedules, & reports are synced & available

database health monitoring advantages:

• reduce costs

• shift from REACTIVE to PROACTIVE monitoring !!! (fix the problem BEFORE it happens & helps everything run as smoothly as possible)

• improve the overall performance of your database & application

• analyzes logs & uses this knowledge to improve performance

is a centralized or individual network more vulnerable to attacks?

centralized

__ can quickly spread malware & compromise vital operations

cyber attacks

whitelisting

•proactive cybersecurity strategy that restricts system access to only explicitly pre-approved users, applications, or IP addresses, blocking everything else by default

system architecture- summary

• Integrates enterprise imaging across the healthcare system

• Uses IHE standards for interoperability & workflow consistency

• Exchanges clinical data through HL7 messaging

• Leverages cloud-based computing for scalable imaging storage & access

• Maintains performance through database health monitoring

• Ensures protection of all imaging data with cybersecurity controls

LAN- local area network

• covers SMALL geographic area

  • home

  • office

  • school building

what network (LAN/WAN) is faster & privately managed?

LAN

LAN examples

• computers

• printers

• wifi devices in a company office connected through a router

WAN- wide area network

• covers a very LARGE geographic area, often across cities, countries, or continents

• connects multiple LANs together

WAN example

• the internet is the largest WAN

network architecture definition

• how devices are organized/communicate

peer-to-peer

• All computers are equal (no central server).

• Computer that has all the information (server)

• Each device can share resources directly with others.

• Simple and inexpensive but harder to manage.

• No IT department needed

peer-to-peer example

two computers sharing files directly over a small home network

client/server

• A central server provides services.

• Other computers (clients) request resources from the server.

• Common in businesses and large networks.

client/server example

employees access files from a central file server in an office

RIS & HIS are types of what network?

local area networks (LAN)!!

RIS- radiology information system

• Data system for patient-related functions in the department, such as scheduling of x-ray appointments, tracking of patients, storage and distribution of reports

• Makes info accessible from different locations within the radiology department

• Assigns the accession number (every procedure has an accession number)

what assigns the accession number?

RIS

HIS- hospital/health information system

• performs same functions for the entire institution (patient’s general medical file)

• assigns a unique MRN

what assigns a unique MRN?

HIS

information management

• Electronic version of a patient's medical history:
    Includes: (EMR (electronic medial record) or EHR (electronic health record))

• demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports 

network connectivity in radiology

HIS→RIS→PACS (MMPS)→IMAGING SYSTEMS

(Patient information→ demographics for a foot/ accession number→once we get our x-ray we transfer it into pacs→ then the radiologist can review in the imaging systems to come up with a result)

network protocols

• help transport medical images, patient demographics, reports, and workflow messages across the enterprise.

• Network languages computers use to communicate

• Set of established rules that dictate how to format, transmit and receive data so that computer network devices can communicate, regardless of the differences in their underlying infrastructures, designs or standards.

“THIS IS THE MESSAGE & THIS IS WHAT I NEED TO HAPPEN WITH IT”

why are network protocols important in imaging informatics?

•Ensure secure and accurate transmission of medical images

•Allow different imaging devices and systems to communicate

•Support fast access to patient imaging records

•Maintain data integrity and standardization

transmission protocol (TCP)

Main communication protocol used on networks to send and receive medical imaging data between devices.

• can be combined with IP

IP

internet protocol

• Gives every device on a network a unique address so they can communicate (Ex. 172.811.3.1)

• Think of IP addresses as the street addresses of radiology devices

communication standard

used to move data across networks- including radiology networks

areas TCP (transmission control protocol) is used:

• DICOM

• transmitting HL7 messages between RIS & HIS

• accessing cloud MIMPS/VNA

TCP/IP greatly helps with __ in radiology

workflow

NIC (network interface card)

• Hardware component used to connect to a hospital network and communicate using TCP/IP (transmission code & IP addresses) and DICOM

Switch consists of what 3 things in network components?

1. bridge

2. hub

3. router

hub & bridge purpose

• Connects devices inside the same network (LAN). 

  • A switch is like the hallway of a radiology department—everyone inside can walk directly to each other.

router

• Decides how to move data between different networks, buildings, or remote sites. (LAN→WAN)

  • Uses IP addresses to determine the path 

• Identifies the sender and the receiver

• ex:

  • Connects the Hospital to the Teleradiologists

cable purpose

• Transmission media used for transmitting a signal (Ethernet, fiber optics)

network configuration

how you set up devices on a network so they can talk to each other

raw data file

• acquisition data

  • data that has NOT BEEN PROCESSED yet

  • collected directly by the imaging equipment before any reconstruction

image data file

• reconstructed images

• data that is processed created from RAW data via reconstruction algorithms

• what the radiologist sees, image contains:

  • pixel or voxel values representing anatomy or function

  • DICOM metadata

___ governs how data is formatted & exchanged (communication

network protocols

____ ensure reliable delivery, routing, & error checking (movement of data)

transmission protocols

MIMPS

medial image management & processing sysystem

• previously PACS

• where you can view images & radiologist can manipulate them

• comprehensive computer network that is responsible for the electronic storage and distribution of medical images.

• Allows Radiologists and Technologist to access images from various locations, improving the efficiency of communication

who created MIMPS?

US department of defense

what acts as a database?

MIMPS

3 components of MIMPS

1. image acquisition

2. display workstations

3. archive servers

image acquisition

• Images are acquired in a digital format (taking the x-ray & reformatting in DICOM)

• can look at the patient’s images on the preview monitor (computer we are working on)

  • Image quality?

  • Patient demographics correct?

  • Any annotations need to be added?

**Information acquired is sent to the archive server

what is the first point of entry into MIMPS?

image acquisition

display workstations

• Any computer used to view, interpret, and manipulate digital images

• Radiologists

• Clinical review workstations (ED, ICU)

• Technologists QC stations

• Used inside and out of Radiology

• Has MIMPS application software that allows minor image-manipulation

most INTERACTIVE part of MIMPS?

display workstations (where radiologist dictates)

navigation functions

Customizable worklists dependent on technologists’ selections during a procedure

example of navigation functions

• marking an image as a verbal report for the radiologist

hanging protocol

Set of rules that tells a PACS or viewing workstation how to automatically display images.  It eliminates manual windowing, resizing, and re‑arranging images every time a study is opened.

study navigation

allows images to be viewed individually or in a cine run

image manipulation & enhancement examples

• annotations

• window/leveling

• magnify

• rotate/flip

• measurements

key image

• created when manipulations or enhancements are applied & they want to see a specific area

• like a post it note

archive servers

Central system responsible for storing, indexing, retrieving, and managing DICOM images.

what is the file room of MIMPS?

archive servers

what 2 things does the archive servers consist of?

1. image manager/ controller

2. image storage/ server

**work together, but have very different responsibilities

image manager/ image controller

• BRAINS of the archive system & directs all traffic

• does NOT hold any images itself- only knows where they are

• keeps track of:

  • what images exist

  • where they are stored

  • study/series/image metadata

  • query/search results

what communicates with RIS & HIS & is the BRAINS?

image manager/ controller

image storage/ image server

• the muscle of the archive

• Responsible for the actual storage of the DICOM images

• Stores the following:

  • DICOM files (headers + pixel data)

  • Key images

  • Structured reports

  • Reconstructed data

what is the MUSCLE of the archive system?

image storage/image server

MIMPS emergency contingency plan

• Provides direction when MIMPS goes down/offline on what staff should do so reports can still be created, viewed and delivered to physicians

• ex: network outages, server fails, cybersecurity, power issue

example of what a contingency plan should include:

• alternate image viewing

• alternate image storage

• workflow instructions

• communication plan

• recovery steps

storage architecture

• Network attached storage (NAS)

• Storage area network (SAN)

• Direct attached storage (DAS)

• VNA

archive media & management

• short term digital memory (RAID)

• long-term

NAS (network attached storage)

• Uses local area network to be able to share information through ethernet connection

• Could be backup storage or extra storage

• allows images to live in one place, not on individual computers

• If LAN goes down, so does our NAS

advantages of NAS

• easy access

• high capacity (years of images)

• low cost

SAN (storage area network)

• INDEPENDENT high-speed network- separate from the hospitals network- that holds data- and helps prevent slow downs

• need own IT department however

• main job is to try & move images quicker (Fastest option)

• we use this one!!

DAS (direct attached storage)

• most simplest!!

• Storage that is physically connected to a single computer or server (MIMPS)

  • Ex: plugging an external hard drive directly into a machine

•No network in between

• Only 1 server can access it

•If MIMPS server goes down = unreachable storage

VNA (vendor neutral archives)

• Universal, long-term image archive that stores images and other data in a standard format that work with any MIMPS system

• Can take images & data from different system & different formats & store them in 1 system w/ a common infrastructure

• Used as replacements to existing MIMPS to avoid very expensive transition costs and used to consolidate a number of systems that exist within a single facility or across a system

short-term digital memory

RAID- redundant array of independent discs

• Several magnetic disks or hard drives that are linked together in an array

• striping

striping

• image stored across several hard drives or discs

  • If one drive fails, the images are still safe (like a puzzle, one piece may be missing, but we still can see the whole picture- at a diagnostic level)

radiologists have access to pull what from short-term digital memory?

newly acquired x-rays

recent interpreted studies

high demand images (ED, ICU, OR)

what is the most common level used for a PACS archive because is provides adequate redundancy & fault tolerance?

RAID 5

long-term

• RAID- most cost effective

• optical discs (read w/ laser)

  • ex: CD, DCD, blue ray (most storage)

• Tapes

  • uses jukebox or library robot arm

  • unreliable over multiple use

in the US, storage requirement of patient’s images is how long?

5-7 years

in the US, storage requirement of patient’s images is how long if pediatric or litigation?

indefinitely

cloud-based storage

• Offsite storage and servers supported by a secure network

• 3^rd party vendor

  • Shifts disaster recovery process to the vendor along with maintenance and storage equipment purchase

  • You pay for the service and storage space

DICOM acronym

digital imaging & communication in medicine

DICOM

• Standardizes programming languages between modalities, servers, workstations = different modalities can now share data with one another or a central server

• DICOM is the glue that makes all parts of MIMPS talk to each other.

the pixel data is the “picture” the metadata is the ___

label

dicom metadata

The information attached to an image that tells the system who the patient is, what exam was done, how it was performed, and where the image belongs.

service object pair

dicom is a 2-way communication between a pair of objects

SCU (service class user)

• system that STARTS the action (SENDER)

• initiates request, sends data

  • ex: CT scanner sending images

(SCP) service class provider

• system that receives the request & performs the action (RECEIVER)

• receives request & stores data

  • Ex: MIMPS receiving image

digital image compression

technique applied to digital images to decrease the amount of space required to store an image and increase the speed with which the image can be retrieved or transmitted.

lossless

• reversible

• does NOT take away information

• defined as VISUALLY ACCEPTABLE images