1. 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

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

3. 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

4. Let’s examine some of the issues

5. cameras workstations Archive & database

6. cameras workstations Archive & database DICOM? Other? ?

7. 3 cases 1. Analog camera 2. Existing NM computer 3. New camera/computer purchase

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

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

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

11. 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

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

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

14. 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?

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

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

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

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

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

20. 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

21. 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

22. 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

23. Network Protocol PennState College of Medicine, Department of Radiology http://www.xray.hmc.psu.edu/dicom/basicinfo.html

24. 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

25. 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

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

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

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

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

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

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

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