9New Paradigm Image Capture , Storage & Display Moving from traditional film-screen(analog) toward electronic mediaIn electronic imaging the functional parts of conventional radiology have been separated:Image Capture , Storage & Display
10Digital SystemFilmDevelopedAndFixedDetectorReadingDigitalProcessingStoredPACSViewedDisplayQC of the digital systems is an additional requirement– in addition to the usual x-ray performance tests
19Modern View on PACSPACS is the “Imaging” part of Healthcare Information and Communication Technology (HICT). Can be integrated into EPR via RIS/HIS.The coverage is virtual location independent: Intra- and Multi-site working area of PACS. More than radiology alone.Technological basis: “PACS rides many horses” from web-based light PACS to dedicated performant systems is depending on the customer’s wishes and needs.
20Historical Evolution80-ties: MODALITY PACS = CT & MRI radiologists,advanced 3D systems.90ties: departmental PACS + RIS = film-less radiology and organ-based radiology specialties, film still used documents in clinics. Cost-effective??>2000: Enterprise-PACS+RIS+PACS = film-less hospitals.>2007: Newest achievements: Multi-site PACS using MPI (Master Patient Index) to allow the patient’s access on all sitesHospitals will skip historical steps and adopt to state of the art PACS and HIS.
21Parallel evolution of all PACS functions PICTURESArchivingCommunicationSystemsRepresent 5D datasetsSAN/NAS/gridsInternet/web/WifiFunctionality+ knowledge2DtapesATM, videoHardware + show an image
22In hospital, Out hospital Distribution Patient arrives1Study ordered and scheduled3Reporttranscription12HISRISReport approval14ADT2Report13Reportstatusnotification15Order/schedulestatus notification4Workflow ManagementConnectivity ManagerStudystatus notification9Modality worklist7Order/schedulestatus notification5Verification10aReportstatus notification16PACSModalityQCDiagnostic review and report dictation11Pre-fetching (images)6Image store10Patient is examined8Images to long term archive17Images wavelet compressed by curator1ObIn hospital, Out hospital DistributionNon diagnostic review19
23Information systems in the hospital workflow HIS (Hospital Information System)Central administration and financial system of the hospitalKeeps the central patient registrationpatient identificationholds the demographic dataRIS (Radiology Information System)Dedicated radiology information system, taking care ofexam orderingexam planningstudy reportingpassing billing related informationnot automatically includednot available for every countryHolds the study informationPACS (Picture Archiving and Communication System)Dedicated system for archiving andcommunication of study related imagesCommunicates with the outside worldHISHL7RISHL7Connectivity ManagerDICOMPACS
24Information exchange standards HL7 (Health Level 7)Provides standards for the exchange, management and integration of data that support clinical patient care and for the management, delivery and evaluation of healthcare services.E.g. patient demographics, appointment schedules, insurance policies, financial transactions, clinical data, clinical treatment plans, observation reports, …DICOM (Digital Imaging and Communication in Medicine)DICOM is a standard, to enable efficient and flexible integration and communication of image data between components (modalities, printers, storage, databases, …) in a medical networkHowever: DICOM does not guarantee the interoperability of systems that claim to be DICOM conformant
25PACS Connectivity Services (Connectivity Manager) Translate HIS/RIS messages (e.g. HL7) to DICOMRISPV1||E|TRAUMA|A||||^DOE^JOHN^W.^DR.^|||WAITING ROOMDo you speakDICOM ?CM???
26Image acquisition Objective Consolidation of image data information provided by multiple sourcesMulti-modality (MRI, CT, Ultrasound…)Multi-VendorHow ?DICOM gateway : Paxport (for non DICOM modalities)Film scanner
27Image data storage and archiving Storage (.dcm files)Type of media (disks, UDO, LTO)Everything on line solutions, near-line, off-lineData compressionData availability
32PACS Beyond Radiology Other Types of Images: Vascular AngiographyCardiac AngiographyEchocardiographyObstetric UltrasoundMedical PhotographyRetinal ImagingColposcopy / Cytology…..May be more of a RIS Issue than PACS
38The Bottom Line Modern Image Processing Automated CAD with interpretation and reportingPortable medical records – perhaps imbedded in patientIntegrated RIS-PACS-HIS through I.T.Robotic imagingMolecular ImagingImage guided chemotherapy and gene therapy………….
39When needed , Where needed Integrated & Enterprise Take Home Point:Beyond Bytes & Bits :Healthcare IT ;When needed , Where neededIntegrated & Enterprise
40Take Home Point: Healthcare IT ; Beyond one person , one department , one ….. , it is across …It needs collaboration , communication & decision making