Date post: | 20-Aug-2015 |
Category: |
Health & Medicine |
Upload: | tomographdpua |
View: | 2,809 times |
Download: | 1 times |
Why PACS in Modern Medicine?
2nd European Tutorial of Radiology
LVIV/Ukraina January 2011
Frans Dhaenens MD
AGFA PACS/RIS.
МРТ
КТ
УЗ
Ангио
Яд.мед.
Рентген Дигитайзер
Сервер управления потоками
Сервер Базы ДанныхPACSАрхив 1 год
Архивный сервер
Архив на 10 лет
Диагностическиестанции
Web cервер
Рабочие станцииклиницистов Web
Серверкоммуникации
Сервер RIS
Cтанции RIS
PACS
RIS
Cтанции RIS
Some other abbreviations
• RIS : Radiological Information System
• HIS : Hospital Information System
• EPR: Electronic Patient Record = EHR = Electronic Health Record
HIS
RIS PACS
EPR
History of PACS(1980) and Tele-radiology (1960)
• PACS= Picture Archiving & Communication System started in 1980, hospital & radiology based, today part of the Hospital Information System (HIS), images and data stored in the Electronic Patient Record (EPR).
• Tele-radiology part of Tele-medicine = much older (1960), “feeling” of low quality & remote connections.
• Every PACS has “tele-radiology” capabilities through its Wide Area Network connections and DICOM web-viewers: enables home-radiology, mammography screening programs.
What is PACS ?? History
• PACS = Picture Archiving and Communication System• DICOM =Digital Imaging and Communication in Medicine
A short history of PACS: standards & control
CONTROLCONTROL
PACS 1982PACS 1982 PACS 2012PACS 2012
Standards & Standards & SecuritySecurity
Modality->Departmental->Hospital->Multi-site->GRID-PACSModality->Departmental->Hospital->Multi-site->GRID-PACS
NEMA/DICOM cardio, dental, RT, visual-lightNEMA/DICOM cardio, dental, RT, visual-light
HL7 + IHEHL7 + IHE
MPI + XDSMPI + XDS
RIS = Radiological Information SystemRIS = Radiological Information System
HIS = Hospital I.S.HIS = Hospital I.S.
EPR = Electr. Pat. Rec.EPR = Electr. Pat. Rec.
“CODE”
VirtualityVirtuality
Technical evolution of all PACS functions
1980 2012
PICTURES
Archiving
Communication
Systems
2D
tapes
ATM, video
Hardware + show an image
Represent 5D datasets
Internet archives
Internet/web/
Wifi
Functionality+ knowledge
Drivers for the PACS evolution
• Modality Technology and IT: e.g. MDCT• Subspecialization in Radiology : neuroradiology• Economical: cost, speed, access,..• Up scaling = mergers, cooperation between
hospitals
• Clinical and Research needs: Personalized Medicine, Molecular Imaging, clinical trials
• Patient: mobility and consumerism
Mayo: Image Information Overload of MDCT, PACS visualization
– 2002: 16,000 CT images per day per radiologist, approx. 2 seconds per image
– Projected 2006: 80,000 CT images per day about 0.45 seconds per image
– At 1 image per second would take >22 hours to review all of the CT images
01000020000300004000050000600007000080000
1994
2002
2006
Radiology: the Analog Workflow
Experience
SpecialtiesSpecialties
KnowledgeKnowledge
PatientPatient
Process Turnaround TimeProcess Turnaround Time
IMAGES
Information
Report
DATA
ModalityModality
IMAGESIMAGES
DATADATA
InformationInformation
Hospital/ World
Radiology: the Digital Workflow
Experience
SpecialtiesSpecialties
KnowledgeKnowledge
PatientPatient
Process Turnaround TimeProcess Turnaround Time
IMAGES
Information
Report
DATA
ModalityModality
IMAGESIMAGES
DATADATA
InformationInformation
Hospital/ World
PACSPACS
RISRIS
HISHIS
EPR EPR
-50%
Databases + WEBDatabases + WEB
Business Intelligence Server Kit
From Modalities to Multi-Site PACS
PACSDepartmental
“enterprise”
Radiologist
Specialist
Clinical Workstation EPR
HIS/RIS
Hospital 1
Hospital 2
Hospital 3
Multi-site PACS
Teleradiology
$$
Starting a PACS: several steps
1. In the radiology department: integration of the modalities on a workstation = modality PACS
2. Add the clinics : clinical workstation
3. Add all departments in the hospital: film and paperless = enterprise PACS
4. Later: several hospitals together = MULTI-SITE PACS
HÔPITAL EUROPÉEN GEORGES POMPIDOU - PARISHÔPITAL EUROPÉEN GEORGES POMPIDOU - PARIS
R E S E A U I M A G E
10/100 Mbits ATM
10/100 Mbits
RIS
RADOS
INTERPRETATION DIAGNOSTIC
4XVIDEO
Bloc Opératoire
see more do more
URGENCES
1er ETAGE2ème ETAGEMédecine Nucléaire
3ème ETAGEPTI - PTNI
6ème - 7ème ETAGE
ACQUISITION - TRAITEMENTACQUISITION - TRAITEMENT REPROGRAPHIE VISUALISATION
SALLES CONFERENCE
VISUALISATION
10XPC DICOM
IMPAX CS500
100 à 300clients WEB
25IMPAX
DS 3000
LUMYSIS75
TS 5
ADC
ID
VIPS
VIPS
ADC
VIPS
VIPS
ADC
ID
TS 5LUMYSIS
ADW
LUMYSISTS 5
NM
NM
NM
NM
NM
NM
GESTION et COMMUNICATION
A 5200E 4500
SERVEUR DATA BASE
DLT 9710ARCHIVE SERVEUR 1 + WORFLOW
MANAGER 1
E 450
ARCHIVE SERVEUR 2 + WORFLOWMANAGER 2E 450
E 250
E 250
E 250
HP LH4
WEB 1000 SERVER
WORKFLOW MANAGER 3
WORKFLOW MANAGER 4
WORKFLOW MANAGER 5
PACSBROKER
HP LH4
INTEGRATION
DRYSTAR 3000
DRYSTAR 2000
Hospital –Doctors Office: HIS-PACS communication
• Different types of data, including images.
• Generic mechanisms for security and access control.
Does hospital-wide PACS work ?
• Thousands of proven and working cases.
• In all sizes.(from 10.000 to >10million ex/year)
• PACS is serious, not a toy !! Be aware of ”out of the box PACS”, plug-in and cheap PACS.
• Proven benefits: diagnostic, clinical and economical = faster diagnosis.
• Protection of future PACS developments: Multi-Site PACS and GRID PACS
Benefit of PACS: faster diagnosis
Mean transit time 1998.
90 90
0
10
20
30
40
50
60
70
80
90
R - EX EX - R R - D Total patient Total exam
waiting Before activity waiting After Total
Mean transit time with soft copy reading. (Test Impax)
32 36
0102030405060708090
R - EX EX - R R Total patient Total exam
waiting Before activity waiting After Total
Benefit of PACS: faster diagnosis
How to buy a PACS?
• Cheap and Toy-like ??
• Serious with perspective on growth and expansion (in capacity and capabilities) .
• Need for experienced partner for long-term cooperation. You buy experience.
• Home-made is no longer an option: slow and vulnerable…
Business Intelligence Server Kit
From Modalities to Multi-PACS
PACSDepartmental
“enterprise”
Radiologist
Specialist
Clinical Workstation EPR
HIS/RIS
Hospital 1
Hospital 2
Hospital 3
Multi-site PACS
Teleradiology
$$
Reasons for MULTI-SITE PACS
• Organ-based sub-specialties in radiology requires:– Integration of multi-modality
images in 1 place= PACS-workstation.
– Cover more territory: expert covers large geographic area
– Better communication between specialists; (EBM)
• Hospitals cooperate/merge.• Patient movement between
hospitals• Government benefit (U.K.)
Agfa experience with PACS
• Agfa has thousands of PACS installations in all kind of clinics and hospitals in all countries.
• Since 90-ties
• In all sizes: from 10.000 exams/yr to 10 million exams/yr.
• In all kind of environments: military, mountains, ships,…
• Some examples….
Adventist Health System, Florida
• All sites have PACS infrastructure• 17 total sites (so far)
– Plus FRI Clinics – referring into Florida Hospital• Imaging Center Solution w/ Promedicus• IMPAX MPI managing cross-reference of Patient IDs
• Multiple HIS/RIS– Multiple RIS transitioned into a single Cerner RIS across health
system
• ~2 mil exams per year
Toronto East Network Canada
• 16 Hospital Corporations• 26 Clinical Sites• 3 Local Health Information Networks
– LHINS 7,8 and 9
• 1.9 Million exams annually • Multi-vendor
– PACS: Agfa, GE, Siemens, Philips– HIS/RIS: McKesson, Meditech, Cerner, Medisolution
United Kingdom: all hospitals digital
• England is divided in 5 clusters:– London– Southern– North West & West Midlands– North Eastern– Eastern
• Cost between 10-20 b£
Agfa PACS in 2 clusters
• 2 clusters• 30 trusts• 75 hospitals• Servicing a population
of 17 million• Image Data Volume
– 10.000.000 exams/year– 300 Terabyte/year
• Hub and Spoke model
Tele-radiology based on PACS
• Every PACS can do Teleradiology
• Uses the Local Area Network (LAN) and Wide Area Network (WAN) for point to point Communication (via VPN)
• of (Anonymous) images =internet and reports + data = e-mail.
• Security levels : Information is sent via e-mail
64 % -> 18 % NEWS: AGFA rewarded NEWS: AGFA rewarded HIS for 100 million EuroHIS for 100 million Euro
Overview of a large Tele-radiology site in Germany
Villingen-Schwenningen
Tuttlingen
Rottweil
Singen
Konstanz
Donaueschingen
VPN
VPN
VPN
VPNVPN
Internet
Workflow Kliniken Villingen-Schwenningen: satellite asks help
DICOMPseudonymisation
Firewall+VPN
DICOMC-STORE
DICOMC-STORE
Automatic pseudonymisatio
nWorkstation
Modality
HTTPe-mail notificatio
n
DICOMC-STORE
I
nte
rnet
AGFA Teleradiology
client
AGFA SA Workstation
DICOMC-FIND/MOVE
AGFA WEB1000
server
HTTP
Remote
opinion
Satellite Site
Central Site
IPSec
SAT-ID + SAT-PIDSAT-ID + SAT-ACC#Anonymous patient
Firewall+VPN
SAT-PIDSAT-ACC#SAT-Patient nameSAT-Patient address
SMTP
@
URL acces
s
Central repository of
pseudonymised studies
Workflow Kliniken Villingen-Schwenningen: central radiology answers
Firewall+VPN
Workstation
HTTP
I
nte
rnet
AGFA Teleradiology
client
AGFA teleradiology
server
HTTP
Satellite Site
Central Site
IPSec
Firewall+VPN
SMTP
@
Mail server
SMTP
Report
ReportTemplate
Images
HTTP
Report
Report storage
on filesystem
Report
How far can PACS go ??
• Images can be stored outside the hospitals: in data-centers or in internet grids.
• PACS can be come virtual: patient and doctor can be everywhere but connected by internet.
• Radiologist will have access to all radiology knowledge available in the world.
“Virtual” GRID-PACS: the future coming now
• GRID = network of databases (anonymous images, knowledge, experts) and application software (CAD), hosted in many universities and private companies, in NON-DICOM format. Mostly related to cancer and mammography.
• Virtual PACS: User PACS interface = DICOM and transparant
• Examples:– ACRIN: Am College of Radiology Imaging Network = digital mammo– Nat. Cancer Institute: lung cancer with MDCT = Lung Imaging
Database Consortium >1000 peer-reviewed and documented lung cancers, approved by FDA, Agfa, Siemens, GE, Philips =members
– UK and USA: Mammo-Grid = CAD and second reading.
Secure transmission of massive datasets: MDCT, cardio, angio
Cine Images Transmission of Encrypted Cine Images
PACS the basis for the future of “Diagnostic Imaging”
• PACS becomes the network for dissemination of Imaging and Knowledge in a world of “personalized medicine”. (Molecular Imaging).
• Think in terms of patient, cost, time, speed and access to an accurate diagnosis.