PACS -How to Choose One
PACS Communication:
RIS, HIS, Internet, and Doctors
J. Anthony Parker, MD PhD
Beth Israel Deaconess Medical Center
Boston, MA
Society of Nuclear Medicine
St Louis, MO
Monday, June 5, 2000, 3:00-3:30
Caveat Lector
Beth Israel Deaconess Medical Center
Department of Nuclear Medicine
1982 All digital
1987 Filmless
1995 Web-based
PACS Communication
Database 1011
Communication with HIS / RIS / workstation
Communication with referring physician2
Call3
1. http://www.med.harvard.edu/JPNM/Lectures/Database101/Database101.html.
2. Barbaras l, Parker JA, Donohoe KJ, Kolodny GM: The All-Digital Department
Moves to the Web. RSNA ej 1996.
3. Parker JA, Barbaras L, Donohoe KJ, Biedron WE, Kolodny GM: Cable Modemassisted Tele-Nuclear Medicine. RSNA ej 1997.
Database: Tables
Simple two dimensional
Hold all the data
Rows called “records”
Columns called “fields”
Organize data / application
Examples: order, invoice, product
A record is often represented by a form
RIS examples: patient, study, dataset
Table Example: ADT
MRN
Last
First
Middle
Sex
1274829 Adelstein S.
James
M
1756983 Holman
B.
Leonard M
6432235 Parker
J.
Anthony M
7824824 Parker
J.
Scott
M
7832134 Parker
M.
Jane
F
7354851 Treves
S.
Ted
M
Table Example: Study Table
MRN
Study No
Type
Report
1274829
960345
Bone http:// 144.134.206.52/R960345.html
1756983
960346
Brain http:// 144.134.206.52/R960346.html
6432235
960347
Lung http:// 144.134.206.52/R960347.html
1756983
960348
Bone http:// 144.134.206.52/R960348.html
1756983
960349
Lung http:// 144.134.206.52/R960349.html
1274829
960350
Heart http:// 144.134.206.52/R960350.html
Table Example: Dataset Table
Study No Dataset No Name
Dataset
960345
125785
Ant
http://144.134.206.52/Im960345.tiff
960345
125786
Post http://144.134.206.52/Im960346.tiff
960346
125787
Flow http://144.134.206.52/Im960347.tiff
960346
125788
Dyn
960346
125789
Stat http://144.134.206.52/Im960349.tiff
960346
125790
Delay http://144.134.206.52/Im960350.tiff
http://144.134.206.52/Im960348.tiff
Index: Rapid Table Access
MRN Index
MRN
1756893
3234252
6432235
7832134
7834453
3259204
Last Name
Adelstein
Holman
Parker
Parker
Parker
Treves
First Name
S.
B.
J.
J.
M.
S.
Middle Name
James
Leonard
Anthony
Scott
Jane
Ted
Sex
M
M
M
M
F
M
Database: Relations
Connect two tables
One field from each table
e.g. ADT.MRN = Study.MRN
Record(s) with the same field value are associated
Relations provide application complexity
Relational Database
Studies
Patients
MRN
Name
Sex
DOB
MRN
...
Study #
Date
Type
...
1526872
1526872
1526872
1526872
1994-6184
Dose
Inventory
...
Isotope
...
Isotope
Dose #
Form
Study #
Tc-99m
1994-6184
Xe-133
1994-6184
Tc-99m
Xe-133
...
Database Concepts
Tables are simple
Table design provides application structure
Indexes allow rapid access to tables
Relations provide richness to application
Communication
How to Choose a Database
You don’t care
HIS:
Hospital Information System
Distributed
database
ADT
Chemistry
Protocols:
SQL
HL7
Billing
Interface
Engine
RIS
NMIS
Let’s have a little talk
about tweetle beetles ...
Suess: Fox in Sox. 1965
Jargonology
PACS - Picture Archiving and Communication System
HIS - Hospital Information System
ADT - Admission Discharge Transfer
RIS - Radiology Information System
NMIS - Nuclear Medicine Information System
HL7 - Health Level 7
SQL - “Structured Query Language”?
DICOM - Radiology communications protocol
ACR/NEMA 3 for European sensibilities
Database Access
Old paradigm
Middleware - SQL
Some cross platform
New paradigm
The web - Java, JavaScript
Total cross platform
Web Server
HTML
Table
CGI
Browser
PACS / RIS / Workstation
PACS
Image Server
HIS / RIS / NMIS
Database
Workstation
User Interface
Communication Between Systems:
A Case Study
Workstations only connect to Radiology maxiPACS
Radiology maxiPACS includes some RIS work flow functions
Order entry (HL7) -> image data (DICOM) -> report (HL7)
ADT
NMIS
miniPACS
HIS
Reports
Images
RIS
maxiPACS
Workstation
Communication: The Web
The Web provides a very easy method for linking the Nuclear
Medicine Information System, PACS, and workstations.
This paradigm extends easily to larger departments or to an
entire health care enterprise.
Use of public domain communication protocols and data
formats means that communications can be
implemented using mass market systems.
Communication
How to Choose a Protocol
No brainer:
Internet
World wide web (http:, https:)
DICOM
Me dical Im aging Application
DICOM Application Entity
ISO Uppe r
Layer Se r vice
boundar y
Se s s ion /
Tr ans por t /
Ne tw ork
(STN)
Data Link
ISO As s ociation Contr ol
DICOM
Uppe r laye r Se r vice Ele m e nt (ACSE)
pr otocol
ISO PRESENTATION
for TC P/IP
ISO SESSION KERNEL
TCP
IP
ISO TRANSPORT
ISO NETWORK
LLC
Phys ical
(50-pin)
Ethe r ne t, FDDI, ISDN, e tc.
Point-to-point
Ne tw ork Environm e nt
PennState College of Medicine, Department of Radiology
http://www.xray.hmc.psu.edu/dicom/basicinfo.html
Communication
How to Choose a Data Format
Radiology niche format (Interfile, DICOM)
Often within modality
Rarely between modalities
Almost never outside Radiology
General format (jpeg, gif, tiff)
Whenever possible
Film
Disadvantages - overwhelming
No cine, windowing
No SPECT visualization
Single original
Loossable
Expensive - infrastructure, expertise
Advantage - communication
View boxes widely available
Good quality static picture
Multimedia Report
Demographics are already captured in RIS
Typist enters text using a word processor
Demonstration(?) images, cines
Selected at report time
Stored in PACS
URL stored in RIS
Report can be e-mailed (MIME format)
Report can be accessed using WWW
Multimedia Reporting
Communication with Physician
How to Choose Method(s)
Traditional report
Mail, fax, e-mail
Include a half tone image
World wide web (http:, https:)
Workstation functions (Java)
Security
Yes
Cable Modem
Fast
1.5 Mbits/second download
Always available
No dialing
Cable Modem
Tele-Nuclear Medicine
Web-based Nuclear Medicine
Integrate NMIS and miniPACS
Integrate with HIS / RIS and maxiPACS
Provide multimedia reports
Implement high speed tele nuclear medicine
Communication
How to Choose a PACS
maxiPACS
Single vendor
Better integration (?)
miniPACS
Special needs of modality
Better bandwidth utilization
Redundancy
Take Home Points
HIS / RIS is just a distributed database
Communications: Internet and web
General data format when possible
Multimedia reporting
Web based call
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PACS -- How to Choose One