PACS --How to Choose One
PACS Communication:RIS, HIS, Internet, and Doctors
J. Anthony Parker, MD PhDBeth Israel Deaconess Medical Center
Boston, MA
Society of Nuclear MedicineSt Louis, MOMonday, 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 Modem-
assisted 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 http://144.134.206.52/Im960348.tiff
960346 125789 Stat http://144.134.206.52/Im960349.tiff
960346 125790 Delay http://144.134.206.52/Im960350.tiff
Index: Rapid Table Access
MRN Last Name First Name Middle Name Sex1756893 Adelstein S. James M3234252 Holman B. Leonard M6432235 Parker J. Anthony M7832134 Parker J. Scott M7834453 Parker M. Jane F3259204 Treves S. Ted M
MRN Index
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
MRN Name Sex DOB ... MRN Study # Date Type ...
1526872
1526872
1526872
1526872
1994-6184
1994-6184
1994-6184
Study # ...Dose #Isotope FormIsotope ......
Tc-99m
Xe-133
Tc-99m
Xe-133
Patients Studies
Inventory Dose
Database Concepts
Tables are simple
Table design provides application structure
Indexes allow rapid access to tables
Relations provide richness to application
CommunicationHow to Choose a Database
You don’t care
HIS:Hospital Information System
ADT
Chemistry Billing
RIS NMIS
InterfaceEngine
Protocols:SQLHL7
Distributeddatabase
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
CGI Browser
Table HTML
PACS / RIS / Workstation
PACSImage Server
HIS / RIS / NMISDatabase
WorkstationUser 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)
HIS
NMIS RIS
miniPACS maxiPACS
ADT
Reports
Order entryReport
ImagesWorkstation
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.
CommunicationHow to Choose a Protocol
No brainer:
Internet
World wide web (http:, https:)
DICOM
LLC
ISO NETWORK
ISO TRANSPORT
ISO SESSION KERNEL
ISO PRESENTATION
ISO Association Control Service Element (ACSE)
TCP
IP
DICOMUpper layer
protocolfor TCP/IP
Session /Transport /
Network
(STN)
Data Link
Physical(50-pin) Ethernet, FDDI, ISDN, etc.
DICOM Application Entity
Medical Imaging Application
ISO UpperLayer Serviceboundary
Point-to-point Network Environment
PennState College of Medicine, Department of Radiologyhttp://www.xray.hmc.psu.edu/dicom/basicinfo.html
CommunicationHow 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 PhysicianHow 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 ModemTele-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
CommunicationHow 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