Integrating a PACS - Interfacing Computers, Doctors and IT Personnel Robert E. Zimmerman Joint Program in Nuclear Medicine Harvard Medical School Boston MA PACS - How to Choose

Integrating Cameras Each camera has to be included in the mini-PACS (ideally) –analog cameras –older “digital” cameras –Newer digital cameras

Not Rocket Science! Not much computer science either NM mini-PACS is (for the most part) standard, everyday computer technology except for... –Format of camera/computer to archive/database –Reverse flow of data to camera/computer –Medical workstation considerations

Let’s examine some of the issues

cameras workstations Archive & database

cameras workstations Archive & database DICOM? Other? ?

3 cases 1. Analog camera 2. Existing NM computer 3. New camera/computer purchase

workstations Archive & database Example 1 analog camera NM computer w/ ADC $15-25K DICOM $ other

workstations Archive & database Example 2 existing NM computer NM computer w/ ADC $0 other

workstations Archive & database Example 3 new camera and computer Integrated camera/computer ~$500k DICOM $ other

Archive and database Should it be DICOM? –DICOM - v. expensive - still –But it is the future for image transfers between modalities and vendors –It will integrate to Radiology PACS –Will require DICOM workstations v. expensive no to poor color support

Archive and database - 2 Could be a conventional database with a DICOM export facility –export could be manual or automatic based on some rules

cameras workstations Archive & database Dicom? Other? computer DICOM $ other

Do you want your data back? Archive back to camera/computer for re-processing? –big problem –little support by major companies unless single vendor –Once it is DICOM no more processing at present exceptions at this meeting?

IT Personnel Network infrastructure HIS data RIS data May need separate workstation or window for this data

How to interface to the radiology PACS? DICOM Archive/database must have DICOM export feature

Some examples 1. A (nearly) single vendor situation. 2. A multivendor situation

Single vendor All computers on the cameras come from same vendor –maybe a costly but possible solution

Siemens cameras workstations Archive & database computer ICONs ICONs + MedView Mac server and std Mac hardware Single vendor example

Discussion How do you add another vendor? –E.g. Siemens ECAT Solution –Separate but equal mini-PACS using Sun hardware and ECAT software Poor integration Duplication –but it works well

Multivendor Computers on the cameras come from different vendors –problems in understanding the different proprietary file formats –Interfile and DICOM are not full solutions –Reversibility issues

DICOM A complex messaging protocol that includes file formats of various types DICOM is specified for each modality, including nuclear medicine. It is clumsy, costs a lot and is generally unnecessary Except when talking to a “big” PACS

Network Protocol PennState College of Medicine, Department of Radiology

Interfile Interfile is a simple definition of a file format Useful for exchanging files with others No definition for gated files Consists of a descriptive header followed by raster format image file Two flavors: 1 file or 2 files

Multivendor-2 Format issues are not solved with Interfile and DICOM. –Neither is suitable as a “working” format –No color –No gated –not reversible –vendor differences

Cameras/computers workstations Archive & database computer A B C D E F Wintel + proprietary conversion software

Discussion Maximum flexibility Keep full options for new camera purchase Requires close cooperation between miniPACS vendor and NM clinic Increased complexity

Hidden Costs DICOM Your own engineer/physicist/computer programmer/system manager may be required

Acceptance testing Camera to archive and back again Archive to workstation Workstation image quality e.g. SMPTE pattern

Workstation Issues Monitor Brightness/contrast Work area (ergonomics) Room –layout –illumination Periodic test of resolution, brightness, contrast optical transfer function (gray level mapping)

Workstation Issues -2 Color? DICOM workstations and DICOM implementations do not have good color support Cine support

Some PACS vendors for NM Marconi NUMA Sudbury Systems Segami Siemens Soft medical ADAC SMV MedImage Apple Microsoft Sun HP