Poster presented in the RSNA 2008 Meeting in Chicago. Robust multi‐entity multi‐site architecture for Picture and Information Systems in Medical imaging, based on Virtualization and Open Source technologies

1. PACS/RIS as an Application Service Providing approach.
PACS/RIS as an Appli i S i P idi g approach
/ Application Service Providing pp ch. h
Robust multi entity multi site architecture based on Virtualization and Open S
Robust
R b t multi‐entity multi‐site architecture b d on Vi t li ti and Op n Source technologies
lti tity lti it hit t based Virtualization d Open n Source technologies.
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David Gil Pérez, BEng, MSc (dg l
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(dgil@comitas.es); F. Javier García Muñoz, BEng (f
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) Á í g Ál , ; d y , g; y ánchez, MD, PhD; F. H á d Segado, BJ,MBA et al.
g (fjgarmu@gmail.com); Á. Domínguez Álvarez, MD; F. J. de Frutos Mayor, BEng; C. Royo Sá h , , h ; Hernández g d , , l
Philosophy
Phil h
Medical Services Company (RT2S) in need of a turn‐key solution, in order to offer its services through Telemedicine.
Medical Services Company (RT2S) in need of a turn key solution in order to offer its services through Telemedicine
Scalability Personalization to its own particular Workflow and Integration with 3rd party systems: a must
Scalability, Personalization to its own particular Workflow and Integration with 3 party systems: a must.
Resources optimization and development using Open Source: the conducting thread.
Resources optimi ation and development using Open Source the conducting thread
Strict observance of Standards: key to interoperability. IHE profiles as guides for development.
St i t b f St d d k t i t bilit IHE fil id f d l t
Sy t
Syst
tems Architecture
tems A hit t
Architecture
The model developed, offered as an ASP approach to the Spanish Healthcare market.
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Hardware and software owned and maintained by the provider.
Hardware and software owned and maintained by the provider.
User s workflow: personalization and adaption. Service vs System.
User’s workflow: personalization and adaption. Service vs System.
Hosting service of the historical archive: remote backup and reduced onsite equipment.
Hosting service of the historical archive: remote backup and reduced onsite equipment.
Obsolescence management and Preventive maintenance.
Obsolescence management and Preventive maintenance.
Maximum uptime and minimum service loss while optimizing resources.
Maximum uptime and minimum service loss while optimizing resources
Connecting sites from the same organization (multi‐site) multi‐entity collaboration and Telemedicine: immediate
Connecting sites from the same organization ( ), collaboration and Telemedicine: immediate.
Virtualization technology
technology
Distributed Architecture amongst the different Medical Centers:
Distributed Architecture amongst the different Medical Centers:
Resources optimization: many systems running under the same hardware.
Resources optimization: many systems running under the same hardware.
Independence between functionality and hardware:
Independence between functionality and hardware: C lid i H i g i b k p d i g p i f diff C
Consolidation at Hosting site: secure backup and connecting point for different Centers.
A number of servers provide service to many more different clients.
A number of servers provide service to many more different clients. l d l /
Local stand‐alone PACS/RIS system.
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Different logical services can run in different (virtual) machines: Failure isolation.
Different logical services can run in different (virtual) machines: Failure isolation. Permanent contact to Hosting site, consolidating new studies and recovering old or
Permanent contact to Hosting site, consolidating new studies and recovering old or
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Running out of resources? Add more hardware to the pool. Infinite scalability!
Running out of resources? Add more hardware to the pool Infinite scalability! t i di g
another Center’s ones to review or diagnose.
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Each client has an isolated system Access / security provided through network layer!
Each client has an isolated system. Access / security provided through network layer! Communications failure: normal Scheduling, Storage and Reporting. After event,
C i ti f il l S h d li g, St g d R p ti g Aft t,
High Availability: clusters of virtual machines run distributed among servers
High Availability: clusters of virtual machines run distributed among servers. automatic system recovery.
automatic system recovery
Very short recovery time after failure at low cost!
Very short recovery time after failure at low cost! Local archive with the most recent images (i.e. last 6 months).
Local archive with the most recent images (i e last 6 months)
Communications dedicated to the service: leased lines of 1‐10Mbps; back‐up comms.
Communications dedicated to the service leased lines of 1 10Mbps back up comms
Robustness: avoiding single points of failure.
R b t idi g i gl p i t f f il
Evaluation
E l i
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Modular Software. Each client has a particular workflow. Traditional
Modular Software. Each client has a particular workflow. Traditional This model has been successfully deployed within RT2S and at the present moment more than 25 medical centers in Spain
This model has been successfully deployed within RT2S and at the present moment more than 25 medical centers in Spain
p d y f lly d p Why p id k y l i ?
products may not fully adapt to them. Why not provide turn‐key solutions?
h benefit from some or all of its services.
benefit from some or all of its services
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The HA Virtualized architecture implemented was intensively tested in lab:
The HA Virtualized architecture implemented was intensively tested in lab:
S ft di id d i f ti l d l h
Software divided in functional modules, each component t Two servers with 2x Quad processors and 16GB RAM each were used to run 10 fully functional PACS/RIS systems
Two servers with 2x Quad processors and 16GB RAM each were used to run 10 fully functional PACS/RIS systems.
independently chosen from the market
independently chosen from the market. Additional VMs were used for the DB cluster.
Additional VMs were used for the DB cluster.
Seamless integration among components: integration engines
Seamless integration among components: integration engines Each system was filled with 10k studies of 100MB each.
Each system was filled with 10k studies of 100MB each.
and development of nexus components.
and development of nexus components Move orders were given continuously amongst them to test performance.
Move orders were given continuously amongst them to test performance
Continuous development on non‐existing functionalities.
Continuous development on non‐existing functionalities Automatic recovery time from failure was measured as close to 30sec for the Client systems and 1sec for DB.
Automatic recovery time from failure was measured as close to 30sec for the Client systems and 1sec for DB
Each client builds up its own system using those modules.
Each client builds up its own system using those modules Uptime has greatly increased since maintenance stops can be done without service loss (one VM after the other).
Uptime has greatly increased since maintenance stops can be done without service loss (one VM after the other)
User s experience (staff radiologists, client s radiologists, clinicians and technicians) has been very positive. Medical
User’s experience (staff radiologists client’s radiologists clinicians and technicians) has been very positive Medical
personnel actively participates in the development process and new improvements are deployed in a monthly basis.
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personnel actively participates in the development process and new improvements are deployed in a monthly basis.
Open Source
Open Source community
M y h d b d
More eyes on the code = better code.
Communities of collaborating professionals: more efficience than traditional
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competing software companies.
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Testing and development in community. The real‐life issues come up quickly.
T ti g d d l p ti ity Th l lif i p q i kly
Thanks to the Open Source Community:
Thanks to the Open Source Community
Community:
Work supported by:
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• Comitas Comunicaciones Spain
Comunicaciones, Spain www.comitas.es
www comitas es Acknowledgements: to the staff personnel of RT2S and Comitas Comunicaciones, in special to the Operations Department; to external collaborators as J. L. Román and F. J. Solans; to the many
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• Real Time Telemedicine Services, Spain www.rt2s.net
l l d p testers and reviewers at the TM64 Telemedicine Network; to the disinterested support from the Open Source Community, specially at dcm4che.org project Damien Evans and Gunter Zeilinger.
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