PACS --How to Choose One :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 CenterDepartment of Nuclear Medicine :Beth Israel Deaconess Medical CenterDepartment of Nuclear Medicine 1982 All digital 1987 Filmless 1995 Web-based


PACS Communication :PACS Communication Database 1011 Communication with HIS / RIS / workstation Communication with referring physician2 Call3 1. http://www.med.harvard.edu/JPNM/Lectures/Database101/Database101.html. 2. Barbaras l, Parker JA, Donohoe KJ, Kolodny GM: The All-Digital Department Moves to the Web. RSNA ej 1996. 3. Parker JA, Barbaras L, Donohoe KJ, Biedron WE, Kolodny GM: Cable Modem-assisted Tele-Nuclear Medicine. RSNA ej 1997.


Database: Tables :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 :Table Example: ADT MRN Last First Middle Sex 1274829 Adelstein S. James M 1756983 Holman B. Leonard M 6432235 Parker J. Anthony M 7824824 Parker J. Scott M 7832134 Parker M. Jane F 7354851 Treves S. Ted M


Table Example: Study Table :Table Example: Study Table MRN Study No Type Report 1274829 960345 Bone http:// 144.134.206.52/R960345.html 1756983 960346 Brain http:// 144.134.206.52/R960346.html 6432235 960347 Lung http:// 144.134.206.52/R960347.html 1756983 960348 Bone http:// 144.134.206.52/R960348.html 1756983 960349 Lung http:// 144.134.206.52/R960349.html 1274829 960350 Heart http:// 144.134.206.52/R960350.html


Table Example: Dataset Table :Table Example: Dataset Table Study No Dataset No Name Dataset 960345 125785 Ant http://144.134.206.52/Im960345.tiff 960345 125786 Post http://144.134.206.52/Im960346.tiff 960346 125787 Flow http://144.134.206.52/Im960347.tiff 960346 125788 Dyn http://144.134.206.52/Im960348.tiff 960346 125789 Stat http://144.134.206.52/Im960349.tiff 960346 125790 Delay http://144.134.206.52/Im960350.tiff


Index: Rapid Table Access :Index: Rapid Table Access


Database: Relations :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 :Relational Database


Database Concepts :Database Concepts Tables are simple Table design provides application structure Indexes allow rapid access to tables Relations provide richness to application


CommunicationHow to Choose a Database :CommunicationHow to Choose a Database You don’t care


HIS:Hospital Information System :HIS:Hospital Information System


Slide 14:Let’s have a little talk about tweetle beetles ... Suess: Fox in Sox. 1965


Jargonology :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 :Database Access Old paradigm Middleware - SQL Some cross platform New paradigm The web - Java, JavaScript Total cross platform


Web Server :Web Server


PACS / RIS / Workstation :PACS / RIS / Workstation


Communication Between Systems:A Case Study :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)


Communication: The Web :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.


CommunicationHow to Choose a Protocol :CommunicationHow to Choose a Protocol No brainer: Internet World wide web (http:, https:)


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


CommunicationHow to Choose a Data Format :CommunicationHow 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 :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 :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 e-mailed (MIME format) Report can be accessed using WWW


Multimedia Reporting :Multimedia Reporting


Communication with PhysicianHow to Choose Method(s) :Communication with PhysicianHow to Choose Method(s) Traditional report Mail, fax, e-mail Include a half tone image World wide web (http:, https:) Workstation functions (Java)


Security :Security Yes


Cable Modem :Cable Modem Fast 1.5 Mbits/second download Always available No dialing


Cable ModemTele-Nuclear Medicine :Cable ModemTele-Nuclear Medicine


Web-based 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


CommunicationHow to Choose a PACS :CommunicationHow to Choose a PACS maxiPACS Single vendor Better integration (?) miniPACS Special needs of modality Better bandwidth utilization Redundancy


Take Home Points :Take Home Points HIS / RIS is just a distributed database Communications: Internet and web General data format when possible Multimedia reporting Web based call