Unit 8 Exam

Enterprise Imaging

Set of strategies, initiatives and workflows implemented across a healthcare enterprise to consistently and optimally capture, index, manage, store, distribute, view, exchange and analyze all clinical imaging/multimedia content  

What does enterprise imaging use instead of PACS?

Vendor Neutral Archive (VNA)

Advantages of Enterprise Imaging

All medical images into a single archive, increase efficiency, reduce storage costs

Image Distribution and Viewing

CD/DVD; cloud-based exchange giving remote access to PACS system and VPN

Integrating the Healthcare Enterprise (IHE)

Initiative by healthcare professionals/industry to improve the way computer systems in healthcare share information

Health Level Seven Standard (HL₇)

Standards developed to provide a comprehensive framework and related standards for the exchange, integration, sharing and retrieval of electronic health information; allows interoperability between patient administration, laboratory information systems, billing systems, electronic medical record and health record systems

Cloud-Based Computing

Reduces operational and maintenance costs for data storage combining data from different sources

Database Health Monitoring

Ensures the integrity of data and IT operations and enterprise security as errors of fraudulent data contained in databases may be used by cybercriminals as a vector for attack

Advantages of Database Health Monitoring

Reduce organization costs, shifts from reactive to proactive monitoring, improve performance

Cybersecurity

A centralized network, while offering substantial efficiency gains and savings on storage solutions, is more vulnerable to cybersecurity threats than networks acting individually  

Cybersecurity Incidents

Computer virus, ransomware, theft/publication of patient data

Prevention of Cyber Attacks

Close monitor, staff education, operational/stategic plans, firewalls, whitelisting, user authentication

Network Configuration

The process of assigning network settings, policies, flows and controls

LAN – Local Area Network

Computerized communications network generally contained within a single building or business; devices share one server

WAN – Wide Area Network

Extends to other businesses or locations that may be at great distances (ex. internet); allows different LANs to communicate

Radiology Information System (RIS)

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

What assigns the accession number?

Radiology Information System (RIS)

Hospital/Health Information System (HIS)

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

What assigns MRN?

Hospital/Health Information System (HIS)

Electronic Medical/Health Record (EMR/EHR)

Electronic version of patient’s medical history that is maintained by the provider and may include all the key administrative clinical data including demographics, progress notes, problems, medications, vitals, medical history, immunizations, laboratory/radiology reports

Advantages of EMR/EHR

Efficient workflow, support other care-related activities, strengthen the relationship between patients and clinicians

Network Architecture

Physical and logical design of the software, hardware, protocols and media of the transmission of data; how computers are organized/how tasks are allocated to the computer  

What are the two types of network architecture?

Peer-to-peer network and client/service network

Network Protocols

Network languages computers use to communicate; set of established rules that dictate how to format, transmit and receive data

What are the three types of network protocols?

Communication, management, security

Transmission Protocols

Known as TCP, can be combined with IP; communication standard used with DICOM to enable application programs and computing devices to exchange messages over a network amongst systems

NIC (network interface card)

Hardware component used to connect a computer with another computer onto a network

HUB  

Simplest method of connection, hardware device that divides the network (LAN) connection among multiple devices; sends a broadcast request to all devices connected

Switch  

Hardware device that connects multiple devices on a computer network; can send data only to the device that made the initial request

Router  

Hardware device which is used to connect a LAN with an internet connection 

Modem  

Hardware device that allows the computer to connect to the internet over the existing telephone line 

Cable  

Transmission media used for transmitting a signal 

Raw Data

Data that has not be compressed, encrypted or processed in any manner

Image Data

Reconstructed data  

Medical Image Management and Processing System (MIMPS) 

Formerly PACS; comprehensive computer network that is responsible for electronic storage and distribution of medical images

What are the components of PACS (MIMPS)?

Image acquisition, display workstations, archive servers

Image Acquisition

First point of entry into PACS; image acquired in a digital format  

Display Workstations

Most interactive part of PACS; any computer used to view digital images

Archive Servers

File rooms of PACS; contains all historic and current data  

Navigation Functions

Customizable worklists dependent on the technologists’ selections during a procedure; ED, verbal reports, image check

Hanging Protocol

Controls the display of images on 1 or more monitors

Study Navigation  

Allows images to be viewed individually or in a cine run  

Image Manipulation & Enhancement  

Annotations, magnify, window/level, flip/rotate, measurements

Image Management  

Edit patient demographics for proper correlation; query/retrieve - locate images based on patient demographics  

What is the “heart” of PACS?

Image manager

Image Manager

Contains master database of everything in the archive; controls the receipt, retrieval and distribution of the images & all DICOM processes running within the archive

Vendor Neutral Archives (VNA)

Allows for images and data from different systems and in different formats to be stored using a singular system on a common infrastructure

What does DICOM stand for?

Digital Imaging and Communication in Medicine

DICOM

A joint commission between ACR and NEMA; standardizes programming languages between modalities, servers, workstations; different modalities can now share data with one another or a central server

Multiplanar reconstruction

Creates multiple planes of view from a single scan

Maximum intensity projections (MIP)

Enhancement of small vessels  

Minimum intensity projections (MinIP)

Enhancement of air-filled structures

Volume rendering technique (VRT)

Assists in differentiating between anatomical structures by adding color shades based on pixel intensity  

Shaded surface display (SSD)

Creates a 3D, moveable image based on the pixel intensity of choice

Computer aided diagnosis/detection (CAD)  

Used as a “second opinion” in assisting radiologists’ image interpretations

What modality is CAD used in?

Mammography

Annotation

Describes the meaning in images

Markup

Visual presentation of the annotation

AIM Project (Annotation and Image Markup)

Pull images from a bank with the same annotations and markups 

Teleradiology

Allows remote transmission and viewing of radiographic images via modems over phone or cable lines  

Network attached storage (NAS) 

Dedicated file storage that enables multiple users and heterogenous client devices to retrieve data from a centralized disk capacity; users on LAN access shared storage via an ethernet connection  

Storage area network (SAN) 

Dedicated, independent high-speed network that interconnects and delivers sharped pools of storage devices to multiple servers

Direct attached storage (DAS)  

Server or storage device that is not connected to a network; computer internal HDD

What is the required storage time of a patient’s images?

5-7 years

What is the required storage time of a pediatric patient’s images or images involved in litigation?

Indefinitely

Short-term storage

RAID

Long-term storage

RAID, optical discs, tapes

RAID

Several magnetic disks or hard drives that are linked together in an array (RAID 5 is most common level used for a PACS archive)  

Cloud-Based Storage  

Offsite storage and servers supported by a secure network  

Service object pair (SOP)  

2-way communication between a pair of objects; made up of service class user (SCU) and service class provider (SCP)

Image compression  

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

Lossless (reversible) compression

Defined as “visually acceptable” images; example: PNG, TIFF 

Lossy (irreversible) compression

Example: JPG  

Compression ratio  

Lossless compression ratios are those at less than 8:1 and are defined as “visually acceptable” for medical imaging community  

What is the standard communication between HIS and RIS?

HL₇

Allows interoperability between different systems including patient administration, laboratory information systems, billing systems, electronic medical record and health record systems, and more

HL₇

What allows a company to avoid the need to purchase/invest in new IT equiptment?

Cloud-based computing

LAN

WAN

What allows different LANs to communicate?

WAN

RIS, HIS & EMR is a type of (LAN or WAN)?

LAN

What is the patient’s general medical file (RIS or HIS)?

HIS

TCP

Transmission Control Protocol

IP

Internet Protocol

What is a network switch that examines all data and limits the scope of data by identifying the sender and the receiver?

Router

What is the first point of entry to PACS?

Image Acquistion

What is the most interactive part of PACS?

Display workstation

Hanging protocol

What is the file room of PACS?

Archive servers

What are the two components of PACS archive servers?

Image manager and image storage

What is an enterprise storage system that requires images to be stored in nonproprietary format?

VNA

What is the main function of PACS?

Act as a database

All information in a DICOM header is stored as ___________.

Metadata

DICOM header

MinIP

MIP

Volume Rendering Technique (VRT)

Shaded Surface Display (SSD)

CAD