When the Indianapolis Veterans Affairs Medical Center changed Picture Archiving and Communication Systems (PACS) vendors, we chose to use "on demand" image migration as the more cost effective solution. The legacy PACS stores the image data on optical disks in multi-platter jukeboxes. The estimated size of the legacy image data is about 5 terabytes containing studies from ~1997 to ~2003. Both the legacy and the new PACS support a manual DICOM query/retrieve. We implemented workflow rules to determine when to fetch the relevant priors from the legacy PACS. When a patient presents for a new radiology study, we used the following rules to initiate the manual DICOM query/retrieve. For general radiography we retrieved the two most recent prior examinations and for the modalities MR and CT we retrieved the clinically relevant prior examinations. We monitored the number of studies retrieved each week for about a 12 month period. For our facility which performs about 70,000 radiology examinations per year, we observed an essentially constant retrieval rate of slightly less than 50 studies per week. Some explanations for what may be considered an anomalous result maybe related to the fact that we are a tertiary care facility and a teaching hospital.
Proc. SPIE. 5033, Medical Imaging 2003: PACS and Integrated Medical Information Systems: Design and Evaluation
KEYWORDS: Human-machine interfaces, Medicine, Computing systems, Computer programming, Medical imaging, Software development, Radiology, System integration, Standards development, Picture Archiving and Communication System
The enterprise distribution of radiology images should be integrated into the same application that physicians obtain other clinical information about their patients. Over the past year the Roudebush Veterans Affairs Medical Center has provided enterprise access to radiology images after integrating a commercial web-based image distribution system (Stentor, Brisbane, CA) with the Department of Veterans Affairs internally developed Computerized Patient Record System (CPRS). The application, CPRS, serves as the foundation for the VHA to implement an electronic medical record (EMR). We developed the necessary program communications between the CPRS application and the image distribution application to link the request for a report to a request for the corresponding images. When a physician selects a given radiology report in CPRS the text of the report displays in CPRS and the image application loads the corresponding image study. We found that the requests for film jackets decreased over fifty percent six months after full implementation of the enterprise image distribution system. We have found the integration of the image access and display application into an existing patient information system to be very successful.
During the past year, the Department of Radiology, School of Medicine, Indiana University designed, specified, and installed a campus wide network. The network supports three functions: a laser camera network to allow the transfer of hard copy images across the campus; a positron emission tomography (PET) network to allow the interconnection of the workstations comprising the PET system; and a future personal computer network to allow support of departmental administrative functions with an upgrade path to allow the display of soft copy images in physician offices and other locations in the department.
Proc. SPIE. 1654, Medical Imaging VI: PACS Design and Evaluation
KEYWORDS: Imaging systems, Networks, Medical imaging, Data archive systems, Telecommunications, Integration, Optical fiber cables, Positron emission tomography, Standards development, Picture Archiving and Communication System
Our Medical Center is faced with the problem to design a cable wiring system today, install it by the middle 1990''s, and allow for upgrades and enhancements for the next ten to fifteen years. The cable plant must be able to support functions and activities which are poorly defined today, but will include the hospital information system (HIS), a future picture archiving and communication system (PACS), and possibly an electronic patient chart with integrated image data. The cable plant must also connect to a future campus wide Medical Network of the Indiana University Medical center with the first component being a positron emission tomography system (PET) located approximately one mile away. To meet these goals the proposed cable plant will be a structured wire cabling system following existing and proposed standards for building wiring architectures including the Electronics Industries Association (EIA) and the Telecommunications Industries Association (TIA) 568 Commercial Building Wiring Standard and the proposed Federal Telecommunication Standard 1090. The structured wiring system approached has been evaluated with emphasis on the present and future network topologies that can be implemented, the type and size of fiber optic cable to install, and the need to install fiber optic cable to individual workstations.
Graphical User Interfaced (GUI) workstations are now available from commercial vendors. We recently installed a GUI workstation in our nuclear medicine reading room for exclusive use of staff and resident physicians. The system is built upon a Macintosh platform and has been available as a DELTAmanager from MedImage and more recently as an ICON V from Siemens Medical Systems. The workstation provides only display functions and connects to our existing nuclear medicine imaging system via ethernet. The system has some processing capabilities to create oblique, sagittal and coronal views from transverse tomographic views. Hard copy output is via a screen save device and a thermal color printer. The DELTAmanager replaced a MicroDELTA workstation which had both process and view functions. The mouse activated GUI has made remarkable changes to physicians'' use of the nuclear medicine viewing system. Training time to view and review studies has been reduced from hours to about 30-minutes. Generation of oblique views and display of brain and heart tomographic studies has been reduced from about 30-minutes of technician''s time to about 5-minutes of physician''s time. Overall operator functionality has been increased so that resident physicians with little prior computer experience can access all images on the image server and display pertinent patient images when consulting with other staff.
A digital image network has been installed in the James Whitcomb Riley Hospital for Children on
the Indiana University Medical Center to create a limited all digital imaging system. The total system
is composed of commercial components, Philips/AT&T CommView system, and connects an existing
Philips Computed Radiology (PCR) system to viewing workstations located in the intensive care unit
and the new born nursery.
The purpose and design of the system is to input the portable chest images from the PCR system,
and to display these images at the remote workstations on high resolution monitors for direct viewing
by referring clinicians, thus eliminating some of their visits to the radiology department three floors
away. The design criteria includes the ability to centrally control all image management functions on
the remote workstations to relieve the clinicians from any image management tasks except for
recalling patient images.
The principal components of the system are the Philips PCR system, the acquisition module (AM),
and the PCR interface to the data management module (DMM). Connected to the DMM are a
display workstation (DW), a optical disk drive, and a fiber optic to ethernet gateway. The ethernet
link is the network connection to the two results viewing stations (RVS) located approximately 100
meters from the DMM. The DMM acts as an image file server and image archive device. The
DMM manages the image database and can load images to both the DW's and the two RVS's.
The system has met the initial design specifications and can successfully capture images from the PCR
and direct them to the RVS's. Additional studies are beginning to determine the optimal image
management procedures such as when to archive and purge images from the DMM.