PACS introductionPACS introduction
Facilitator:Facilitator:
Edward WongEdward Wong
What is the role of PACSWhat is the role of PACS
Administrator?Administrator?
PACS Administrator’s rolesPACS Administrator’s roles
 Implementing a PACSImplementing a PACS
 System MaintenanceSystem M...
PACS Administrator’s rolesPACS Administrator’s roles
 Implementing a PACSImplementing a PACS
- Financial and workflow stu...
PACS Administrator’s rolesPACS Administrator’s roles
 Implementing a PACSImplementing a PACS
 System MaintenanceSystem M...
PACS Administrator’s rolesPACS Administrator’s roles
 Implementing a PACSImplementing a PACS
 System MaintenanceSystem M...
What is PACS ?What is PACS ?
PP: Picture, Images & Reports: Picture, Images & Reports
AA: Archive, Online, Near line, Offl...
PACS: Small or LargePACS: Small or Large
Web Server Distribution
Scale of PACSScale of PACS
 No. of Beds in Hospital/ Exams per yearNo. of Beds in Hospital/ Exams per year
 No. of Modal...
Types of imagesTypes of images
 1D, 2D, 3D, 4D1D, 2D, 3D, 4D
 Different DICOM Modality type: Cardiac / PET / 4DDifferent...
1D, 2D, 3D, 4D, fusion1D, 2D, 3D, 4D, fusion
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
1.2...
Properties of imageProperties of image
• Bit depthBit depth
• Grayscale or colorGrayscale or color
• Resolution in pixelRe...
PACS ArchitecturePACS Architecture
Data Base
Server
CR/ DR QA
WorkstationComputed
Radiography
or DR
Gateway or
Frame Grabber
Film
Digitizer
Non-DICOM
Modalit...
Central ArchitectureCentral Architecture
 Image Server and Database Manager isImage Server and Database Manager is
the HE...
Data Base
Server
CR QA
Workstation
Computed
Radiography
Gateway or
Frame Grabber
Film
Digitizer
Non-DICOM
Modality
Archive...
Distributed ArchitectureDistributed Architecture
 Exams are routed from modality toExams are routed from modality to
sele...
Components of PACSComponents of PACS
 HIS/ RISHIS/ RIS
 BrokerBroker
 ePR gatewayePR gateway
 Database ServerDatabase ...
Components of PACSComponents of PACS
 Acquisition GatewaysAcquisition Gateways
 Non-DICOM modality gatewayNon-DICOM moda...
PACS layout 1PACS layout 1
PACS layout 2PACS layout 2
PACS layout 3PACS layout 3
HIS/RIS I/F (SQL)
(Mitra Broker)
Tuen Mun Hospital PACS SystemTuen Mun Hospital PACS System- Ambulatory Care Center- Amb...
PACS layout 4PACS layout 4
Data Base
Server
CR/ DR QA
WorkstationComputed
Radiography
or DR
Gateway or
Frame Grabber
Film
Digitizer
Non-DICOM
Modalit...
CRCR USUSXRAYXRAY
RISRIS
PCsPCsW/SW/S FilmFilm
DigitizerDigitizer
CR QACR QA FrameFrame
GrabberGrabber
HIS/RISHIS/RIS
Inte...
Role of Acquisition gatewayRole of Acquisition gateway
 Compression/ decompression andCompression/ decompression and
secu...
CRCR USUSXRAYXRAY
RISRIS
PCsPCsW/SW/S FilmFilm
DigitizerDigitizer
CR QACR QA FrameFrame
GrabberGrabber
HIS/RISHIS/RIS
Inte...
Database Server (PACS controller)Database Server (PACS controller)
 The Heart of the systemThe Heart of the system
 Inte...
Image Server (RAID)Image Server (RAID)
 Online (rapid access) exam storage andOnline (rapid access) exam storage and
dist...
Redundant Array of Independent DisksRedundant Array of Independent Disks
Bandwidth equal to sum of disk transfer ratesBand...
RAID 5 configurationRAID 5 configuration
 If disk fails, disk can beIf disk fails, disk can be
rebuilt- fault tolerantreb...
Bandwidth is a measure of theBandwidth is a measure of the
information (data) carrying capacity of ainformation (data) car...
Network BottleneckNetwork Bottleneck
The bandwidth of an information delivery system isThe bandwidth of an information del...
Data compression reduces the information rateData compression reduces the information rate
a network must supporta network...
Decompressed image is identical to originalDecompressed image is identical to original
imageimage
JPEG lossless compressio...
JPEG 2000 CompressionJPEG 2000 Compression
 Selected parts of the image can be defined asSelected parts of the image can ...
JPEG 2000 imagesJPEG 2000 images
CRCR USUSXRAYXRAY
RISRIS
PCsPCsW/SW/S FilmFilm
DigitizerDigitizer
CR QACR QA FrameFrame
GrabberGrabber
HIS/RISHIS/RIS
Inte...
Types of storage mediaTypes of storage media
MediaMedia DVDDVD MODMOD
WORMWORM
DLTDLT 98409840 AIT2AIT2
GBGB 3.83.8 5.25.2...
Long Term ArchiveLong Term Archive
Used to store digital data for longerUsed to store digital data for longer
periods of ...
CRCR USUSXRAYXRAY
RISRIS
PCsPCsW/SW/S FilmFilm
DigitizerDigitizer
CR QACR QA FrameFrame
GrabberGrabber
HIS/RISHIS/RIS
Inte...
Storage Area NetworkStorage Area Network
 SAN is a high-speed sub-SAN is a high-speed sub-
network of shared storagenetwo...
Network Area StorageNetwork Area Storage
 NAS is a class of dedicated hard disk-based storageNAS is a class of dedicated ...
SAN Vs NASSAN Vs NAS
 Difference between NAS and SAN is subtleDifference between NAS and SAN is subtle
 NAS devices are ...
CRCR USUSXRAYXRAY
RISRIS
PCsPCsW/SW/S FilmFilm
DigitizerDigitizer
CR QACR QA FrameFrame
GrabberGrabber
HIS/RISHIS/RIS
Inte...
WorkstationsWorkstations
 Four Primary CategoriesFour Primary Categories
- Advanced Analysis: Used by specialists for adv...
Standalone Vs direct PACS w/sStandalone Vs direct PACS w/s
Standalone Workstation Direct PACS Client
Workstation
Hard Disk...
Web distributionWeb distribution
High availability, low costHigh availability, low cost
Reports / select images to refer...
RIS, HIS, ePR and PACSRIS, HIS, ePR and PACS
integrationintegration
CRCR USUSXRAYXRAY
RISRIS
PCsPCsW/SW/S FilmFilm
DigitizerDigitizer
CR QACR QA FrameFrame
GrabberGrabber
HIS/RISHIS/RIS
Inte...
Hospital Information SystemHospital Information System
 Support clinical and medical patient careSupport clinical and med...
Clinical System in HA, HKClinical System in HA, HK
 Patient Administration
 In-Patient and Out-Patient Administration Sy...
Non-Clinical System in HANon-Clinical System in HA
 Human Resources and Payroll Systems
 Hospital Based Financial System...
Radiology Information SystemsRadiology Information Systems
 Similar to HIS but of smaller scaleSimilar to HIS but of smal...
Exam
Order
Exam
Order
Exam
Scheduled
Exam
Scheduled
RISRIS Patient Exam
Is Performed
Patient Exam
Is Performed
Modality Wo...
Broker serviceBroker service
HA
HIS
HA
RIS
HA CMS Clinical visit
ADT
Mitra
PACS
Broker
interface
Appt.,
X-ray
request
DR
C...
Broker serviceBroker service
 A restricted access account will be created atA restricted access account will be created a...
Broker serviceBroker service
 Broker main function:Broker main function:
- Worklist generation- Worklist generation
- Rep...
ePR ArchitectureePR Architecture
 Selected images fromSelected images from
individual hospital’sindividual hospital’s
PAC...
Data Flow DiagramData Flow Diagram
RIS ePR
RIS operational
data
RIS statistical
data
ePR
Data
warehouse
Appointment
Attend...
Characteristics of ePRCharacteristics of ePR
 Near instant image reviewNear instant image review
 Web distribution can b...
Guidelines for HIS, RIS, PACSGuidelines for HIS, RIS, PACS
interfaceinterface
 Each system remain unchanged in itsEach sy...
Typical patient and data flowTypical patient and data flow
 Admission: Patient registration, notify HIS (HL7)Admission: P...
http://www.pacs.hkhttp://www.pacs.hk
Thanks!Thanks!
Upcoming SlideShare
Loading in …5
×

PACS introduction, components and architecture, HIS/RIS/ePR ...

7,461 views

Published on

0 Comments
10 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
7,461
On SlideShare
0
From Embeds
0
Number of Embeds
14
Actions
Shares
0
Downloads
533
Comments
0
Likes
10
Embeds 0
No embeds

No notes for slide
  • Connection among various hospital information system, open architecture,
    Data migration is painful enough if you have money
  • IOD=information object definition; Mammo CAD use SR output; DICOM waveform IOD; DICOM visible light IOD; Digital Envelop over Digital Signature
  • Microcalcification need 130 µm resolution
  • All in blue must mention
  • PACS introduction, components and architecture, HIS/RIS/ePR ...

    1. 1. PACS introductionPACS introduction Facilitator:Facilitator: Edward WongEdward Wong
    2. 2. What is the role of PACSWhat is the role of PACS Administrator?Administrator?
    3. 3. PACS Administrator’s rolesPACS Administrator’s roles  Implementing a PACSImplementing a PACS  System MaintenanceSystem Maintenance  Image and Information ManagementImage and Information Management For a 200,000 exams/year institution, 2-8For a 200,000 exams/year institution, 2-8 full time PACS Administrator is available!full time PACS Administrator is available!
    4. 4. PACS Administrator’s rolesPACS Administrator’s roles  Implementing a PACSImplementing 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
    5. 5. PACS Administrator’s rolesPACS Administrator’s roles  Implementing a PACSImplementing 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
    6. 6. PACS Administrator’s rolesPACS Administrator’s roles  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
    7. 7. 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
    8. 8. PACS: Small or LargePACS: Small or Large Web Server Distribution
    9. 9. Scale of PACSScale 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, reliabilitySystem connectivity, expandability, reliability and cost-effectivenessand cost-effectiveness
    10. 10. Types of imagesTypes of images  1D, 2D, 3D, 4D1D, 2D, 3D, 4D  Different DICOM Modality type: Cardiac / PET / 4DDifferent 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 / SecurityEndoscopic & Microscopic images / ECGs / Security Profiles…..Profiles…..
    11. 11. 1D, 2D, 3D, 4D, fusion1D, 2D, 3D, 4D, fusion
    12. 12. 1D, 2D, 3D, 4D, fusion1D, 2D, 3D, 4D, fusion
    13. 13. 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 MByte 4k x 5k 12 bit 30 MByte
    14. 14. Properties of imageProperties of image • Bit depthBit depth • Grayscale or colorGrayscale or color • Resolution in pixelResolution in pixel  Example imageExample image size ofsize of mammogram = 4kmammogram = 4k x 5k x 12 bit =x 5k x 12 bit = 3030 MBMB
    15. 15. PACS ArchitecturePACS Architecture
    16. 16. Data Base Server CR/ DR QA WorkstationComputed Radiography or DR Gateway or Frame Grabber Film Digitizer Non-DICOM Modality Archive DICOM Modality Web Server RIS Diagnostic Workstations (DICOM) Image Server (RAID) Clinical Workstations (DICOM) PACS – Central ArchitecturePACS – Central Architecture Diagnostic Workstation
    17. 17. Central ArchitectureCentral Architecture  Image Server and Database Manager isImage 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
    18. 18. Data Base Server CR QA Workstation Computed Radiography Gateway or Frame Grabber Film Digitizer Non-DICOM Modality Archive DICOM Modality Web Server Diagnostic Workstation RIS Diagnostic Workstations (DICOM) Clinical Workstations (DICOM) PACS – Distributed ArchitecturePACS – Distributed Architecture
    19. 19. Distributed ArchitectureDistributed Architecture  Exams are routed from modality toExams are routed from modality to selected workstationsselected workstations  Complex routing algorithms based onComplex routing algorithms based on department / user preferencedepartment / user preference  Difficult to support concurrent review ofDifficult to support concurrent review of imagesimages  Less destructive for failure at databaseLess destructive for failure at database serverserver
    20. 20. 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
    21. 21. 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
    22. 22. PACS layout 1PACS layout 1
    23. 23. PACS layout 2PACS layout 2
    24. 24. PACS layout 3PACS layout 3
    25. 25. HIS/RIS I/F (SQL) (Mitra Broker) Tuen Mun Hospital PACS SystemTuen Mun Hospital PACS System- Ambulatory Care Center- Ambulatory Care Center (phase 1)(phase 1) RAID 5 ISU E450 CPU Long Term Archive MOD Jukebox ARC US Logic700 Image Acquisition Modalities in ACC Proteus XR/d Proetus XR/aPrestiges II Radwork5.0 PathSpeed CRQA CR ID Preview 2 PathSpeed MP CR RW Film Digitizer Hospital RIS Network 1 GBit Fiber Link ACC Ortho Dept 1C PathSpeed Review Stations 600m / 12 Core Gbit Fiber Link Kodak Laser Printer 1 PCS2 Kodak Laser Printer 2 PCS 1 HSA 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 MR Network RT Network Layer 3 Sw Layer 2 Sw Server Rm Network Switch Closet KELP 2180DryView 8700 G E M edical System s I T - R adiology System 1CWS / Remote Admin PathSpeed SP CR
    26. 26. PACS layout 4PACS layout 4
    27. 27. Data Base Server CR/ DR QA WorkstationComputed Radiography or DR Gateway or Frame Grabber Film Digitizer Non-DICOM Modality LTS Archive SAN/NAS DICOM Modality Web Server Broker for RIS/HIS Diagnostic Workstations (DICOM) Image Server (RAID) Clinical Workstations (DICOM) PACS ComponentsPACS Components Diagnostic Workstation Media Server ePR gateway W/S QA Server Enterprise Archive Through Acq. gateway
    28. 28. CRCR USUSXRAYXRAY RISRIS PCsPCsW/SW/S FilmFilm DigitizerDigitizer CR QACR QA FrameFrame GrabberGrabber HIS/RISHIS/RIS InterfaceInterface (Broker)(Broker) CC TT R&FR&FMRMR NMNM DGDG Acquisition (DICOM) GatewayAcquisition (DICOM) Gateway
    29. 29. Role of Acquisition gatewayRole of Acquisition gateway  Compression/ decompression andCompression/ decompression and securitysecurity  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 databaseQueue for images (priority) to database server (background)server (background)  Share the workload and no point of failureShare the workload and no point of failure for multiple Acquisition gatewayfor multiple Acquisition gateway
    30. 30. CRCR USUSXRAYXRAY RISRIS PCsPCsW/SW/S FilmFilm DigitizerDigitizer CR QACR QA FrameFrame GrabberGrabber HIS/RISHIS/RIS InterfaceInterface (Broker)(Broker) CC TT R&FR&FMRMR NMNM DGDG Database Server and Image ServerDatabase Server and Image Server DatabaseDatabase ServerServer RAIDRAID
    31. 31. Database Server (PACS controller)Database Server (PACS controller)  The Heart of the systemThe Heart of the system  Integration cross point between HIS/RISIntegration 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 userManage 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
    32. 32. Image Server (RAID)Image Server (RAID)  Online (rapid access) exam storage andOnline (rapid access) exam storage and distribution devicedistribution device  Support simultaneous exam input andSupport 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
    33. 33. Redundant Array of Independent DisksRedundant Array of Independent Disks Bandwidth equal to sum of disk transfer ratesBandwidth equal to sum of disk transfer rates Highest speed disk storage availableHighest speed disk storage available Image Disk Array 2 MB/s 1 2 3 4 5 6 7 8 16 MB/s Hot Swap Parity What is RAIDWhat is RAID
    34. 34. RAID 5 configurationRAID 5 configuration  If disk fails, disk can beIf disk fails, disk can be rebuilt- fault tolerantrebuilt- fault tolerant  High data transfer rateHigh 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
    35. 35. Bandwidth is a measure of theBandwidth is a measure of the information (data) carrying capacity of ainformation (data) carrying capacity of a networknetwork 10/100/1000 MB/sec10/100/1000 MB/sec Information Flow Data Pipe (Network) BandwidthBandwidth
    36. 36. Network BottleneckNetwork Bottleneck The bandwidth of an information delivery system isThe bandwidth of an information delivery system is limited to the bandwidth of the slowest componentlimited to the bandwidth of the slowest component in the systemin the system Network Bottleneck
    37. 37. Data compression reduces the information rateData compression reduces the information rate a network must supporta network must support Uncompressed Data Compressed Data Data CompressionData Compression
    38. 38. Decompressed image is identical to originalDecompressed 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
    39. 39. JPEG 2000 CompressionJPEG 2000 Compression  Selected parts of the image can be defined asSelected parts of the image can be defined as Regions of Interest, they can then be deliveredRegions 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 lesswhilst other parts of the image that are less critical use normal lossy compressioncritical use normal lossy compression  JPEG 2000 codestream can be ordered toJPEG 2000 codestream can be ordered to deliver images of lower resolution before the fulldeliver images of lower resolution before the full image can be transmittedimage can be transmitted  Motion JPEG 2000 does not have any form ofMotion JPEG 2000 does not have any form of extrapolation (and hence potential distortion) inextrapolation (and hence potential distortion) in the time domain. Each frame is a separatethe time domain. Each frame is a separate JPEG 2000 coded imageJPEG 2000 coded image
    40. 40. JPEG 2000 imagesJPEG 2000 images
    41. 41. CRCR USUSXRAYXRAY RISRIS PCsPCsW/SW/S FilmFilm DigitizerDigitizer CR QACR QA FrameFrame GrabberGrabber HIS/RISHIS/RIS InterfaceInterface (Broker)(Broker) CC TT R&FR&FMRMR NMNM DGDG Storage Device (Long Term)Storage Device (Long Term) DatabaseDatabase ServerServer RAIDRAID MODMOD DLTDLT
    42. 42. Types of storage mediaTypes of storage media MediaMedia DVDDVD MODMOD WORMWORM DLTDLT 98409840 AIT2AIT2 GBGB 3.83.8 5.25.2 3535 2020 5050 CostCost LessLess Expen.Expen. Expen.Expen. Expen.Expen. CheapCheap MostMost Expen.Expen. Load +Load + AssessAssess VeryVery fastfast VeryVery fastfast 113 sec113 sec 15 sec15 sec 45 sec45 sec Max. TMax. T raterate MB/sMB/s 55 5.15.1 55 1010 66
    43. 43. Long Term ArchiveLong Term Archive Used to store digital data for longerUsed to store digital data for longer periods of timeperiods of time Storage ranges from 100 MB to 10 TBStorage ranges from 100 MB to 10 TB Optical 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 andDLT used for longer term storage and redundancyredundancy ISP moduleISP module
    44. 44. CRCR USUSXRAYXRAY RISRIS PCsPCsW/SW/S FilmFilm DigitizerDigitizer CR QACR QA FrameFrame GrabberGrabber HIS/RISHIS/RIS InterfaceInterface (Broker)(Broker) CC TT R&FR&FMRMR NMNM DGDG Storage Device (Near line)Storage Device (Near line) DatabaseDatabase ServerServer RAIDRAID MODMOD DLTDLT SAN/NAS
    45. 45. Storage Area NetworkStorage Area Network  SAN is a high-speed sub-SAN is a high-speed sub- network of shared storagenetwork of shared storage devicesdevices  Contains storage deviceContains storage device (disk) for storing data(disk) for storing data  SAN's architecture works inSAN's architecture works in a way that makes alla way that makes all storage devices available tostorage devices available to all serversall servers  Use of Fiber ChannelUse of Fiber Channel  High scalability forHigh scalability for additional storage andadditional storage and redundant networksredundant networks PCs Storage devices
    46. 46. Network Area StorageNetwork Area Storage  NAS is a class of dedicated hard disk-based storageNAS is a class of dedicated hard disk-based storage devices which provide LAN users with additional diskdevices 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) receivesIn most cases, a NAS device (or NAS server) receives an IP address, connects to the LAN through an Ethernetan IP address, connects to the LAN through an Ethernet cable, and resides on the LAN as an independentcable, and resides on the LAN as an independent network devicenetwork device  Users are not demanding the server's processing timeUsers are not demanding the server's processing time for mundane storage tasks -- often improving thefor mundane storage tasks -- often improving the performance of local application serversperformance of local application servers  NAS systems also include some onboard memoryNAS 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
    47. 47. SAN Vs NASSAN Vs NAS  Difference between NAS and SAN is subtleDifference between NAS and SAN is subtle  NAS devices are big, single purpose storageNAS devices are big, single purpose storage appliances that you plug into networkappliances that you plug into network  NAS sits between your application server andNAS 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 betweenSAN is a defined architecture that sits between your file system and your underlying physicalyour file system and your underlying physical storagestorage  SAN is data-centricSAN is data-centric
    48. 48. CRCR USUSXRAYXRAY RISRIS PCsPCsW/SW/S FilmFilm DigitizerDigitizer CR QACR QA FrameFrame GrabberGrabber HIS/RISHIS/RIS InterfaceInterface (Broker)(Broker) CC TT R&FR&FMRMR NMNM DGDG DisplayDisplay DatabaseDatabase ServerServer RAIDRAID MODMOD DLTDLT SAN/NAS Diagnostic W/SDiagnostic W/S Dedicate W/SDedicate W/S
    49. 49. 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 readingDiagnostic: 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; 1KER 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 fasterreview application; lossy compressed for faster transmittransmit
    50. 50. 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 purpose 2.for single modality image reviewing and reporting like Radworks in U/S Rm Direct PACS workstation for reporting
    51. 51. Web distributionWeb distribution High availability, low costHigh availability, low cost Reports / select images to referringReports / select images to referring physician desktopphysician desktop Point of integration with electronic patientPoint of integration with electronic patient recordrecord Lossy compression for performanceLossy compression for performance Potential for TeleRadiologyPotential for TeleRadiology Security issues to be resolvedSecurity issues to be resolved
    52. 52. RIS, HIS, ePR and PACSRIS, HIS, ePR and PACS integrationintegration
    53. 53. CRCR USUSXRAYXRAY RISRIS PCsPCsW/SW/S FilmFilm DigitizerDigitizer CR QACR QA FrameFrame GrabberGrabber HIS/RISHIS/RIS InterfaceInterface (Broker)(Broker) CC TT R&FR&FMRMR NMNM DGDG Broker HIS/RIS and PACSBroker HIS/RIS and PACS interfaceinterface
    54. 54. Hospital Information SystemHospital Information System  Support clinical and medical patient careSupport clinical and medical patient care activities in the hospitalactivities in the hospital  Administer the hospital’s daily businessAdminister the hospital’s daily business transactions like finance, payroll etctransactions like finance, payroll etc  Evaluate hospital performances and costsEvaluate hospital performances and costs and make long-term forecastand make long-term forecast
    55. 55. 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
    56. 56. 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
    57. 57. 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
    58. 58. Exam Order Exam Order Exam Scheduled Exam Scheduled RISRIS Patient Exam Is Performed Patient Exam Is Performed Modality Worklist Demographics Downloaded Database server /Archive Database server /Archive Order Event Prefetch Exams From Storage Images transferred in STS PACS Worklist Updated PACS Worklist Updated Images / Prior Reports Image migration STS to LTA Exam Transcribed Exam Transcribed Report Verified Report Verified Final report available Final report available Exam Read Exam Read Dictated status Preliminary status Im ages copied on web-server Web distribution to referring physicians RIS workflow
    59. 59. Broker serviceBroker service HA HIS HA RIS HA CMS Clinical visit ADT Mitra PACS Broker interface Appt., X-ray request DR CR US DF Modalities: Get WORKLIST Get REPORT, Get INFO Database server
    60. 60. Broker serviceBroker service  A restricted access account will be created atA restricted access account will be created at Sybase that gives limited authority for theSybase that gives limited authority for the DICOM Broker solely for the purpose of theDICOM Broker solely for the purpose of the interfacesinterfaces  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 tableand the Broker polls against the events table and calls the associated stored procedures forand calls the associated stored procedures for the conversion to DICOM messagesthe conversion to DICOM messages
    61. 61. Broker serviceBroker service  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!!
    62. 62. ePR ArchitectureePR Architecture  Selected images fromSelected images from individual hospital’sindividual hospital’s PACS are sentPACS are sent  make use of the ePRmake use of the ePR record indexing andrecord indexing and browsing capabilitiesbrowsing capabilities to read the radiologyto read the radiology images through CMSimages through CMS workstationsworkstations
    63. 63. Data Flow DiagramData Flow Diagram RIS 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
    64. 64. Characteristics of ePRCharacteristics of ePR  Near instant image reviewNear instant image review  Web distribution can be within hospital, toWeb 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
    65. 65. Guidelines for HIS, RIS, PACSGuidelines for HIS, RIS, PACS interfaceinterface  Each system remain unchanged in itsEach system remain unchanged in its configuration and function, only data areconfiguration and function, only data are sharedshared  Identify the subset data to be shared andIdentify the subset data to be shared and set up access rights/ authorizationset up access rights/ authorization  Convert the subset data to HL7 standardConvert the subset data to HL7 standard  Define transfer protocol (TCP/IP orDefine transfer protocol (TCP/IP or DICOM)DICOM)
    66. 66. 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 updatedBroker notified and PACS database server updated (prefetch)(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 throughInformation/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/PACSDictation, 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
    67. 67. http://www.pacs.hkhttp://www.pacs.hk Thanks!Thanks!

    ×