1

Image or Magic ???

Analog Images

Analog vs. Digital Image

New ParadigmMoving from traditional film-screen(analog) toward electronic mediaIn electronic imaging the functional parts of conventional radiology have been separated:

Image Capture , Storage & Display

Digital System

FilmDeveloped

AndFixed

Detector ReadingViewedDisplay

DigitalProcessing

StoredPACS

QC of the digital systems is an additional requirement – in addition to the usual x-ray performance tests

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Image CharacteristicsEach pixel is

assigned a numeric value

(bit depth) that represents a shade of gray based on the attenuation

characteristics of the volume of tissue

imaged

Advanced Applications

Multiplanar Navigation

MIP

Hospital

Conventional PACS

DiagnosticModality

ArchivingDevice

ArchivingMedia

PACSServer

Modern View on PACSPACS is the “Imaging” part of Healthcare

Information and Communication Technology (HICT). Can be integrated into EPR via RIS/HIS.

The coverage is virtual location independent: Intra- and Multi-site working area of PACS. More than radiology alone.

Technological basis: “PACS rides many horses” from web-based light PACS to dedicated performant systems is depending on the customer’s wishes and needs.

80-ties80-ties: MODALITY PACS = CT & MRI radiologists,advanced 3D systems.

90ties:90ties: departmental PACS + RIS = film-less radiology and organ-based radiology specialties, film still used documents in clinics. Cost-effective??

>2000>2000: Enterprise-PACS+RIS+PACS = film-less hospitals.

>2007>2007: Newest achievements: Multi-site PACS using MPI (Master Patient Index) to allow the patient’s access on all sites

Hospitals will skip historical steps and adopt to state of the art PACS and HIS.

Historical Evolution

1980 2012

PICTURES

Archiving

Communication

Systems

2D

tapes

ATM, video

Hardware + show an image

Represent 5D datasets

SAN/NAS/grids

Internet/web/

Wifi

Functionality+ knowledge

ModalityQC

PACS

Patient arrives

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ADT2

Study ordered and scheduled3

Order/schedulestatus notification

4

Report approval14

Reportstatus notification

15

Report13

Reporttranscription

12

Studystatus notification

9Modality worklist7 Order/schedule

status notification5 Report

status notification16

Image store10

Images wavelet compressed by curator

1Ob

Diagnostic review and report dictation

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Pre-fetching (images)

6

Images to long term archive17Patient is examined8

Non diagnostic review19

In hospital, Out hospital Distribution

Workflow Management Connectivity Manager

HIS RIS

Verification

10a

Information systems in the hospital workflow HIS (Hospital Information System)

Central administration and financial system of the hospital Keeps the central patient registration

patient identification holds the demographic data

RIS (Radiology Information System) Dedicated radiology information system, taking care of

exam ordering exam planning study reporting passing billing related information

not automatically included not available for every country

Holds the study information

PACS (Picture Archiving and Communication System) Dedicated system for archiving and

communication of study related images Communicates with the outside world

HIS

RIS

PACS

HL7

HL7

DICOM

Connectivity Manager

Information exchange standards HL7 (Health Level 7)

Provides standards for the exchange, management and integration of data that support clinical patient care and for the management, delivery and evaluation of healthcare services.E.g. patient demographics, appointment schedules, insurance policies, financial transactions, clinical data, clinical treatment plans, observation reports, …

DICOM (Digital Imaging and Communication in Medicine)

DICOM is a standard, to enable efficient and flexible integration and communication of image data between components (modalities, printers, storage, databases, …) in a medical networkHowever: DICOM does not guarantee the interoperability of systems that claim to be DICOM conformant

???

RIS

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Do you speakDICOM ?

Translate HIS/RIS messages (e.g. HL7) to DICOM

CM

PACS Connectivity Services (Connectivity Manager)

• Consolidation of image data information provided by multiple sources

• Multi-modality (MRI, CT, Ultrasound…)• Multi-Vendor

How ?

• DICOM gateway : Paxport (for non DICOM modalities)

• Film scanner

Image acquisition Objective

Image data storage and archiving• Storage (.dcm files)

•Type of media (disks, UDO, LTO)

•Everything on line solutions, near-line, off-line

• Data compression

• Data availability

Modality

Internal & ExternalClients

Workflow Manager

ArchiveServer

DatabaseRIS

ConnectivityManager

HIS

Curator

ApplicationServer

PACS Architecture

At ModalityPACS Viewing

Station

Web Viewer

Webserver

CD/DVD RobotRAID

Archive

Workstation 1

Workstation 2

Workstations

..…

PACS and Network

Hub Switch

PACS Beyond RadiologyOther Types of Images:

Vascular AngiographyCardiac AngiographyEchocardiographyObstetric UltrasoundMedical PhotographyRetinal ImagingColposcopy / Cytology…..

May be more of a RIS Issue than PACS

New Advances

Imaging Informatics Laboratory

The Bottom Line• Modern Image Processing • Automated CAD with interpretation and

reporting• Portable medical records – perhaps imbedded

in patient• Integrated RIS-PACS-HIS through I.T.• Robotic imaging• Molecular Imaging• Image guided chemotherapy and gene therapy• ………….

Take Home Point:

Beyond Bytes & Bits :

Healthcare IT ;When needed , Where needed

Integrated & Enterprise

Take Home Point:Healthcare IT ;Beyond one person , one department , one ….. , it is across …

It needs collaboration , communication & decision making

THANK YOU FOR YOUR NICE ATTENTION