1. PACS and Multislice CT current issues Stephen G Davies Royal Glamorgan Hospital

2. Background PACS reprovision PACS reprovision Multislice CT procurement Multislice CT procurement Question to discussion board Question to discussion board –Where to report? –What is stored? –What is sent to web? –Teleradiology?

3. Historical perspective Data volume has always been a problem Data volume has always been a problem –Glass plates (mass and volume) –Multiple views – a novelty –Film – expanding range of studies –Space limitations –Microchip and digital image production –Networks, processing and storage.

4. Current problem Data volume increase inexorably Data volume increase inexorably New approaches needed – TRIP TM = New approaches needed – TRIP TM = Transforming the Radiological Interpretation Process Data volumes from MDCT rise faster than existing PACS systems can cope with them. Data volumes from MDCT rise faster than existing PACS systems can cope with them.

5. Phone a friend Strickland: “MDCT what do we do with all the images generated?” BJR 77(2004) S14-19 Strickland: “MDCT what do we do with all the images generated?” BJR 77(2004) S14-19 Presented four options: Presented four options:

6. Option 1 Store everything as acquired Store everything as acquired –Overwhelm archive –Too many images at workstation and for clinicians –Network capacity? Do we really need the full data set for reporting? Do we really need the full data set for reporting?

7. Option 2 Store selection of images Store selection of images –Is this possible?

8. Option 3 Report “thin” sections at CT workstation Report “thin” sections at CT workstation Store “thick” sections Store “thick” sections Becoming more practical Becoming more practical –Data load on network and for archive –Data load for clinicians BUT ??workflow BUT ??workflow ALSO thin vs thick for fine detail?? ALSO thin vs thick for fine detail??

9. Option 4 Report “thin” sections at CT WS; Report “thin” sections at CT WS; Store thin sections at WS Store thin sections at WS ?still export thick sections to archive ?still export thick sections to archive ?Workflow ?Workflow ?need to report thin sections ?need to report thin sections

10. Ask the audience Variety of responses depending on network capacity, archive and local practice Variety of responses depending on network capacity, archive and local practice Summary: Summary: –Export thick (5mm) sections in primary (axial) plane and secondary (usually coronal) plane –Specialist processing at modality workstation

11. Advantages Radiologist workflow preserved Radiologist workflow preserved –?preferred reporting environment PACS workstations very fast PACS workstations very fast –Voice, RIS integrated –Hanging protocols What happens when the data from MRI reaches these levels? What happens when the data from MRI reaches these levels?

12. Disadvantages Not viewing the full data set for reporting Not viewing the full data set for reporting Demanding on archive and network Demanding on archive and network Problems with linking additional post processed data with original data set Problems with linking additional post processed data with original data set IHE PWP profile IHE PWP profile

13. Other considerations How long do we store for How long do we store for –At modality –On archive What do we store (?thick slices +/- compression) What do we store (?thick slices +/- compression)

14. Discuss