M6 PACS Archiving and Peripherals

Image Acquisition

Modality used to acquire images

Image Acquisition

Requires the existence of medical devices with the
appropriate interface of PACS, such as CT scan, MRI,
and Digital X-ray machine

TRUE

As long as these modalities are compatible with PACS,
they can send images to the PACS server

digital imaging and communications in
medicine

DICOM

DICOM

international standard for defining the mode of
transmission of medical information and images
that provides interoperability between different
devices

DICOM

used worldwide to store, exchange, and transmit
medical images

DICOM

central to the development of modern radiological
imaging

.dcm

file extension : ___

Interoperability

the ability of computer systems to
exchange information and make use of that info

Medical image converter

Used when the standard is not supported on
medical devices

Medical image converter

Simple and easy-to-use windows application for
converting medical image files between different
image formats

MicroDicom program

Can export whatever DICOM file you have to BMP,
GIF, JPG, PNG, TIF, or WMF

WMV or AVI

If there’s a series of images, it supports saving
them to a video file in __ or ___ format

Communication Network

Transmits images and attached data
Eg. name of the patient, date of birth, etc.

Communication Network

Network structure has a crucial influence on the
efficiency of the entire system

Patient Data

Hospital Information System (HIS) and Radiology
Information System (RIS) must have the same interface
according to the PACS system

PACS

used to view images

RIS

used to view the result and patient’s info

Interface

shared boundary across two or more separate
components of a computer system exchange info

Interface

device or program enabling a user to
communicate with a computer

Health Level 7

Standard that enables HIS and RIS to PACS
System

Health Level 7

Set of international standards used to transfer and
share data between various healthcare providers

Health Level 7

Aims to make sharing data easy, which in turn
reduces the administrative burden on providers
and staff while improving care delivery

Open system interconnection

OSI

Display of images

Done via personal computer in the office

Display of images

Qualities of personal computers in the office are
reflected in the monitor’s physical characteristics

Computers

need to have an interactive user
interface with a possibility to adjust image
contrast, zoom, and move images and display
data of the patient

Recordings Archive

System for archiving recordings should be centralized, with support for DICOM and HL7 standards

Web Server

Application that resides on a web server should provide adequate access and display of data to employees in medical institution and distant uses

1. Saving space and time for archiving x-ray images
2. Search for educational purposes
• X-ray records are stored on computer disks in electronic
form
3. Significant material saving
• There is no need for buying x-ray films because x-ray
images are moved on compact disks (CD) whose price
is lower
4. Improved x-ray image quality and speed of diagnostic
radiology
5. Possibility to view images from remote locations
6. Better utilization of human resources
7. Possibility to networking computers of one or more health
facilities
8. Modernization of work
9. Reduction in service costs and material consumption

Implementation of PACS is reflected in:

Search for educational purposes

X-ray records are stored on computer disks in electronic
form

Significant material saving

There is no need for buying x-ray films because x-ray
images are moved on compact disks (CD) whose price
is lower

Radiology Department Effectiveness

• Less exam time and effort
• Less inefficiency and error

Radiology Department Effectiveness

• Less diagnostic uncertainty
• Less patient risk

Radiology Department Effectiveness

• Less exam inaccuracy
• Less IT footprint/support

Advantages of PACS

• Can solve the issue of image loss, stolen, or misfiled
• Two physicians will be able to view same image at different sites

Advantages of PACS

• Allows full range of tools for better visualization of image
• Economically efficient
• Increase in efficiency of data management

Disadvantages of PACS

• It is not a new technology but still has not been deployed at various healthcare institutions
• Financial cost may be huge, preventing hospitals to install it

Disadvantages of PACS

• Utilize large amounts of bandwidth on a system, can “crash” even a very strong network. Strong internet technology
needed to handle PACS traffic efficiently
• To read PACS report, high resolution monitors are needed and they are too expensive

DICOM

• Standard for handling, storing, printing, and transmission of information in medicine
• Developed in 1985 by American College Radiology (ACR) and National Electrical Manufacturers Association (NEMA)
• Both a protocol for transmitting images and a file format for storing them

DICOM

• Establishes a common language that enables the usage of images and information, made on one type of manufacturers’ equipment, in digital systems of other manufacturers
• Not only a file format, but is directly related to the PACS

DICOM and PACS

• Hard to imagine modern medicine without ___ and ___

DICOM

• Consists of files, definition, and network protocol
communication

.dcm or .dcm30 (DICOM 3.0)

Files in DICOM format are most likely saved with either a __ or ___ file extension, but some may not have an extension at all

Basic Function of DICOM

1. Communication and sharing of digital medical images, regardless of the manufacturer; to enable PACS to become a part of HIS, RIS, and other information systems

Basic Function of DICOM

2. To ensure that the database of medical images become
available irrespective of browser distance

Basic Function of DICOM

3. To enable the functioning of teleradiology

Disadvantages arises in:

1. Searching the database and image processing
2. Simultaneous display of multiple images on the monitor when the quality of individual images is decreased or certain segments are cut off
3. Appearance of false coloring which appears in the adjacent gray level, false coloring in contrasting colors, etc.

Teleradiology

Form of medical information system, which requires the use of telecommunications systems in the form of:
o Satellite
o Internet
o Mobile phones
o Internet

Teleradiology

• For the exchange of data, images, video, audio, or other radiological information in order to secure radiology services between remote locations

o Image recording and sending station
o Secure transmission network (HIPAA compliant and secure data server)
o Image receiving station

How teleradiology works (three essential elements)

data transfer

For ___ ___, teleradiology uses the Global System for Mobile Telecommunications (GSM), General Packet Radio Service (GPRS), and 3G systems, which allow the transmission of multimedia content at high speed

Global System for Mobile Telecommunications

GSM

General Packet Radio Service

GPRS

Information and communication technologies

____ __and__ ____ technologies allow the transfer of relevant medical information at distance with compliance with medical and technological standards, relating to the acquisition, storage, transmission, and retrieval of medical images, video, audio, and other radiological information

Appliance of Teleradiology

is possible in imaging centers that
have digital radiology apparatus, and DICOM

Mobile Radiology

Development is link to Marie Sklodowska Curie

little theory

Developed a mobile radiology, and called it __ __, trained 150 women to operate

WW1

During ___, Curie left behind her Lab behind,
inventing a mobile x-ray unit that could travel to the
battlefront

Mobile Radiology

X-ray machines, CT, MRI, mammogram, and other radiological devices into trucks with trailers, thus making them mobile and accessible to all communities, in all weather conditions, in peace or war

Mobile MIM in 2011

mobile device application viewing
in Radiology

Relevant features of mobile phones for mobile radiology in teleradiology

o 3 inches wide screens
o Light from 250 cdl
o RAM memory of 256 mb
o 800 MHz processor
o Mobile internet that supports HTML5 standard and
JavaScript

digitization of medical equipment

Basis for the introduction of new technologies in medicine is
the

Application of web technology

has made that health services
become available to all, to give fast and effective treatment,
and provide information to others at the right time

Archive

serves as the new file room and
warehouse of all DICOM imaging modalities
o No need for a physical file room because everything is
centralized in a server already

Archive

Place where records or documents are preserved

Magneto-optical disk (MOD)

– example of archive server

PACS Archive

• Stores all patient and image data, often on magnetic tape or optical disk
• Controls the receipt, storage, and distribution of new and historic images

PACS Archive

• Fastest growing component in PACS
o More upgrades

PACS Archive

• Complex arrangement of computers and storage space
• Consists of server components, both hardware and software

Image manager or controller

• Contains the master database of everything that is in the archive
• Controls the receipt, retrieval, and distribution of the images it stores

Image manager or controller

• Controls all the DICOM processes running within the archive
• Runs a reliable commercial database such as Sybase (Sybase Inc., Dublin, CA) or Oracle (Oracle Corp., Redwood Shores, CA) with Structured query
language (SQL)

SQL

– specialized language for updating, deleting,
and requesting information from databases

Database is mirrored

there are two identical databases running simultaneously so that is one goes down; the system can call on the mirror and continue to run as normal

Image manager or controller

• PACS component that integrates with the Radiology and
Hospital Info System (RIS and HIS), allowing PACS
database to collect additional patient info that is
necessary for its effective operation

Electronic Medical Record (EMR)

Image manager or controller Plays a key role in populating image info into the hospital ____

TRUE

Contains DICOM header info, such as patient’s name,
identification number, examination data, ordering
physician, and location

TRUE

Database has pointers associated with each image on the archive server that points back to the data fields within the database

Process

1. An order is placed in the RIS for a radiology study
2. The images are acquired and sent to the archive
3. The image manager strips the image header from
each image and assigns a pointer to each image
or series of images
4. The database files the info in various fields and
communicates back to RIS to verify certain info
5. The study is then queried, and the pointers locate
the images on the archive server and send the
images to the workstation

Image storage or archive server

• Consists of the physical storage device of the archive system
• Consists of two or three tiers of storage

Tier

a level, later, or division of something

short-term, mid-term, or long-term

In an archive server, a tier represents a specific level of archive:

Short-term

▪ being online or available very quickly, 3 – 5s
▪ commonly a RAID

RAID

– composed of several magnetic disks or hard drives that are linked together in an array

500 GB – 3T

o Size ranges from several hundred
gigabyte to terabytes

1998

Term was coined in ___ by David
Patterson, Garth Gibson, and
Randy Katz in an article entitled “A
case for Redundant Arrays of
Inexpensive Disks (RAID)”

David
Patterson, Garth Gibson, and
Randy Katz

Term was coined in 1998 by '__ __, ___ ___, and ___' in an article entitled “A
case for Redundant Arrays of
Inexpensive Disks (RAID)”

Redundant
Array of Independent (Inexpensive)
Disks

RAID

5

Presentation introduced __
levels of RAID

11

Now, there are __ levels, most of which are combinations of the first 5

Long-term

▪ means near line, images that must be
retrieved from a tape or disk storage device

hospitals

Most ___ use RAID storage for both
short-term and long-term archive

Other long-term storage products that are
still widely used are

Other long-term storage products that are
still widely used are

Optical disk and magnetic type
archive

– uses a jukebox to hold the
tapes or disks

Optical disk

▪ any computer disk that uses optical storage techniques and technology to read and write data

Optical disk

▪ a computer storage disk
that stores data digitally
and uses laser bits to read
and write data

Magnetic disk

– uses arrays

1. Magento-optical disk
2. Digital versatile disk
3. Ultra density optical
4. Tape
5. Magnetic disk

Five types of Optical Disk

Magento-optical disk

• Very similar to compact disk (CD) or digital versatile disk
(DVD) in that it is read optically with a laser, but the
disk itself is housed within a plastic cartridge
• More reliable than other long-term storage options

Magento-optical disk

• Disks are robust and withstand many years of reading
• Can store 9.1 GB