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 Communication with HIS / RIS / workstation Communication with referring physician 2 Call Barbaras l, Parker JA, Donohoe KJ, Kolodny GM: The All-Digital Department Moves to the Web. RSNA ej 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 MRNLastFirstMiddleSex AdelsteinS.JamesM HolmanB.LeonardM ParkerJ.AnthonyM ParkerJ.ScottM ParkerM.JaneF TrevesS.TedM

Table Example: Study Table MRNStudy NoTypeReport Bonehttp:// /R html Brainhttp:// /R html Lung /R html Bone /R html Lung /R html Heart /R html

Table Example: Dataset Table Study NoDataset NoNameDataset Anthttp:// /Im tiff Post Flow Dyn Stat Delay

Index: Rapid Table Access MRNLast NameFirst NameMiddle NameSex AdelsteinS.JamesM HolmanB.LeonardM ParkerJ.AnthonyM ParkerJ.ScottM ParkerM.JaneF TrevesS.TedM 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 MRNNameSexDOB... MRN Study #DateType Study #...Dose #IsotopeForm Isotope... 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

Communication How to Choose a Database You don’t care

HIS: Hospital Information System ADT ChemistryBilling RIS NMIS Interface Engine Protocols: SQL HL7 Distributed database

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 CGIBrowser Table HTML

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) HIS NMISRIS miniPACSmaxiPACS ADT Reports Order entry Report Images 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 (

DICOM PennState College of Medicine, Department of Radiology

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 ed (MIME format) Report can be accessed using WWW

Multimedia Reporting

Communication with Physician How to Choose Method(s) Traditional report Mail, fax, Include a half tone image World wide web ( 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