Integrating a PACS - Interfacing Computers, Doctors and IT Personnel Robert E. Zimmerman Joint...
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![Page 1: Integrating a PACS - Interfacing Computers, Doctors and IT Personnel Robert E. Zimmerman Joint Program in Nuclear Medicine Harvard Medical School Boston.](https://reader036.fdocuments.us/reader036/viewer/2022062715/56649db05503460f94a9e8b4/html5/thumbnails/1.jpg)
Integrating a PACS - Interfacing Computers,
Doctors and IT Personnel
Robert E. ZimmermanJoint Program in Nuclear Medicine
Harvard Medical School
Boston MA
PACS - How to Choose
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Integrating Cameras
Each camera has to be included in the mini-PACS (ideally)– analog cameras– older “digital” cameras– Newer digital cameras
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Not Rocket Science!Not much computer science either
• NM mini-PACS is (for the most part) standard, everyday computer technology except for...– Format of camera/computer to
archive/database– Reverse flow of data to
camera/computer–Medical workstation considerations
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Let’s examine some of the issues
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camerasworkstations
Archive &
database
![Page 6: Integrating a PACS - Interfacing Computers, Doctors and IT Personnel Robert E. Zimmerman Joint Program in Nuclear Medicine Harvard Medical School Boston.](https://reader036.fdocuments.us/reader036/viewer/2022062715/56649db05503460f94a9e8b4/html5/thumbnails/6.jpg)
camerasworkstations
Archive &
database
DICOM?
Other?
?
![Page 7: Integrating a PACS - Interfacing Computers, Doctors and IT Personnel Robert E. Zimmerman Joint Program in Nuclear Medicine Harvard Medical School Boston.](https://reader036.fdocuments.us/reader036/viewer/2022062715/56649db05503460f94a9e8b4/html5/thumbnails/7.jpg)
3 cases
1. Analog camera
2. Existing NM computer
3. New camera/computer purchase
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workstations
Archive &
database
Example 1
analog camera
NM computer w/ ADC
$15-25K
DICOM $other
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workstations
Archive &
database
Example 2
existing NM computer
NM computer w/ ADC
$0
other
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workstations
Archive &
database
Example 3
new camera and computer
Integrated camera/computer
~$500k
DICOM $other
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Archive and database
Should it be DICOM?– DICOM - v. expensive - still– But it is the future for image transfers
between modalities and vendors– It will integrate to Radiology PACS–Will require DICOM workstations
• v. expensive
• no to poor color support
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Archive and database - 2
Could be a conventional database with a DICOM export facility
– export could be manual or automatic based on some rules
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camerasworkstations
Archive &
database
Dicom?
Other?
computer
computer
computer
computer
computer
computer
DICOM $other
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Do you want your data back?
Archive back to camera/computer for re-processing?– big problem– little support by major companies
• unless single vendor
– Once it is DICOM no more processing• at present
• exceptions at this meeting?
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IT Personnel
Network infrastructure
HIS data
RIS data
May need separate workstation or window for this data
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How to interface to the radiology PACS?
DICOM
DICOM
DICOM
Archive/database must have DICOM export feature
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Some examples
1. A (nearly) single vendor situation.
2. A multivendor situation
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Single vendor
All computers on the cameras come from same vendor
–maybe a costly but possible solution
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Siemens cameras
workstations
Archive &
database
computer
computer
computer
computer
ICONs
ICONs + MedView
Mac server and std Mac hardware
Single vendor example
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Discussion
How do you add another vendor?– E.g. Siemens ECAT
Solution– Separate but equal mini-PACS using
Sun hardware and ECAT software
Poor integration
Duplication– but it works well
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Multivendor Computers on the cameras come
from different vendors
– problems in understanding the different proprietary file formats
– Interfile and DICOM are not full solutions
– Reversibility issues
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DICOM
• A complex messaging protocol that includes file formats of various types
• DICOM is specified for each modality, including nuclear medicine.
• It is clumsy, costs a lot and is generally unnecessary
• Except when talking to a “big” PACS
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Network Protocol
LLC
ISO NETWORK
ISO TRANSPORT
ISO SESSION KERNEL
ISO PRESENTATION
ISO Association Control Service Element (ACSE)
TCP
IP
DICOM Upper layer
protocol for TCP/IP
Session /
Transport / Network
(STN)
Data Link
Physical (50-pin) Ethernet, FDDI, ISDN, etc.
DICOM Application Entity
Medical Imaging Application
ISO Upper Layer Service boundary
Point-to-point Network Environment
PennState College of Medicine, Department of Radiologyhttp://www.xray.hmc.psu.edu/dicom/basicinfo.html
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Interfile
• Interfile is a simple definition of a file format
• Useful for exchanging files with others
• No definition for gated files
• Consists of a descriptive header followed by raster format image file
• Two flavors: 1 file or 2 files
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Multivendor-2 Format issues are not solved with
Interfile and DICOM.
– Neither is suitable as a “working” format– No color– No gated– not reversible– vendor differences
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Cameras/computersworkstations
Archive &
database
computer
computer
computer
computer
computer
computer
A
B
C
D
E
F
Wintel + proprietary conversion software
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Discussion
• Maximum flexibility
• Keep full options for new camera purchase
• Requires close cooperation between miniPACS vendor and NM clinic
• Increased complexity
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Hidden Costs
• DICOM
• Your own engineer/physicist/computer programmer/system manager may be required
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Acceptance testing
Camera to archive and back again
Archive to workstation
Workstation image quality e.g. SMPTE pattern
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Workstation Issues
• Monitor Brightness/contrast
• Work area (ergonomics)
• Room – layout– illumination
• Periodic test of resolution, brightness, contrast
• optical transfer function (gray level mapping)
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Workstation Issues -2
• Color?
• DICOM workstations and DICOM implementations do not have good color support
• Cine support
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Some PACS vendors for NM
Marconi NUMA
Sudbury Systems Segami
Siemens Soft medical
ADAC SMV
MedImage
Apple Microsoft
Sun HP