The document discusses the role of a PACS administrator at a 200,000 exam/year institution. Key responsibilities of a PACS administrator include implementing the PACS system, performing system maintenance like contingency planning and problem escalation, and managing image and information like quality assurance and storage. An overview of PACS components and architecture is also provided, including image server, database server, acquisition gateways, and diagnostic workstations.

1. PACS introductionPACS introduction
Facilitator:Facilitator:
Edward WongEdward Wong

2. What is the role of PACSWhat is the role of PACS
Administrator?Administrator?

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. 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. 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. 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. 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. PACS: Small or LargePACS: Small or Large
Web Server Distribution

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. 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. 1D, 2D, 3D, 4D, fusion1D, 2D, 3D, 4D, fusion

12. 1D, 2D, 3D, 4D, fusion1D, 2D, 3D, 4D, fusion

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. 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. PACS ArchitecturePACS Architecture

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. 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. 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. 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. 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. 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. PACS layout 1PACS layout 1

23. PACS layout 2PACS layout 2

24. PACS layout 3PACS layout 3

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. PACS layout 4PACS layout 4

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. JPEG 2000 imagesJPEG 2000 images

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. RIS, HIS, ePR and PACSRIS, HIS, ePR and PACS
integrationintegration

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. http://www.pacs.hkhttp://www.pacs.hk
Thanks!Thanks!