PACS architecture and reengineering workflow BY, Prashant Falgun khira Sayali kulkarni Kunal mandal Supriya mangalpalli

PACS Picture Archiving and Communication System is a medical imaging technology which provides Economical storage. Convenient access to images from multiple modalities. Electronic images and reports are transmitted digitally via PACS.

PACS The universal format for PACS image storage and transfer is DICOM (Digital Imaging and Communications in Medicine).

NEED OF PACS To obtain images in digital format. Images can be viewed offsite. Interpretation of data is possible immediately. Data storage is done digitally. Hence no file room is needed.

USE OF PACS Hard copy replacement Remote access Electronic image integration platform Radiology Workflow Management

PACS infrastructure Network Archive Modality interface RIS interface Workstation Operational support

Major components Image acquisition PACS core Interpretation workstation

Image acquisition Study Validation Pre-fetching PACS Core Database Manager Image archive Workflow/control Image Distribution Interpretation Workstations RIS Image Acquisition Modalities MR CT CR NUC PET US Enterprise Distribution Modality Worklists Image Archive

PACS core RIS driven workflow PACS driven workflow

Update Radiologist Worklist Display RIS Broker Query PACS Core Modality Worklists Modality Exam Status Update

Update Radiologist Worklist Display RIS Broker Exam data RIS Modality Worklists Modality Exam Status Update

Interpretation Workstations Diagnostic: Primary interpretation of Exam Highest in resolution and brightness Highest level of functionality Review: Direct access to the image along with radiology report Advent of web based workstation

Reengineering workflow Workflow- The steps that employees perform as they are getting their work done, and the relationships between those steps. Reengineering workflow-Analysis and breakdown of individual steps that occur in the performance of a multistep task. e.g. acquisition and interpretation of a radiograph

Dual mission Highest quality of patient care- Well informed selection of imaging techniques Skilled interpretation Timely and clear communication Efficient use of available personnel Maximize income or minimize loss

Analyzing workflow Personnel perspective- Clerical Radiologic technologists Queuing perspective- Arrival Service Radiologist’s perspective- Work lists Access Initial display

What is needed Better coordination with other services. Intelligent ordering and scheduling Electronic study protocol selection Electronic positive patient ID Integration og modalities with RIS /PACS

Advanced integration approaches IHE (DICOM/HL7) Distributed object tools CORBA JAVA ActiveX Web services Service oriented Architecture

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