Unit 5 (PACS)
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Name required amounts of storage for CR, DM, and CT:
- CR: 16 MB of data
- DM: 160 MB of data
- CT: 20 MB of data
the increased need for storage for digital modalities such as cath lab,MRI, and ultrasound have produced what is referred to as:
list five basic capabilities required of PACS:
- viewing and interpretation
- retrieved for retrospective analysis
- transmitted to remote locations within a help system or remote institutions
- general management of patient's medical condition
a network-based central server used for interfacing, image storage, and data acquisition of images produced by a myriad of radiology modalities that exist in hospitals today
PACS (picture archiving and communication system)
PACS allows for images acquired from a patient to be:
- displayed on monitors and allow for post processing of image to take place
- stored and archived in electronic form
- transmitted to other location via computer communication networks
who introduced the term 'digital radiography' and when?
who introduced the idea of digital image communication and when?
- Heinz Lemke (in Berlin)
from 1982 to 2002 several conferences revolutionized the concept of:
who categorized PACS into five models based on how they work and what are the five models?
- Dr. Huang (2004)
- home-grown model
- two-team effort model
- turnkey model
- partnership model
- application service provider (ASP) model
which model of PACS is developed by a radiology department and hospital and is based on technical components from various manufacturers to meet the needs of the hospital
which model of PACS allows for individuals inside and outside the hospital to have a say; implemented by manufacturers to meet the needs of both parties involved?
two-team effort model
which model of PACS did manufacturers create to provide the needs of all involved, such as the radiologic technologists, radiologists, biomedical engineers, medical physicists, and other IT staff?
which model of PACS is the one where the manufacturer and the hospital work together to provide optimum performance and integrity of the system by training individuals, upgrading, and general system maintenance?
which model of PACS provides all IT requirements, relieving clients of this responsibility?
the purpose of ________ is to ensure that all digital imaging systems and information systems from different vendors can communicate with each other using communication standards to integrate all patient clinical information for the purpose of viewing such information collectively.
Integrating the Healthcare Enterprise (IHE)
name the two main communication protocol standards and the specific type of data they cover:
- Digital Imaging and Communication Medicine (DICOM) - addresses the communication of images
- Health Level-7 (HL-7) - addresses the communication of textual data
Mini-PACS are connected to a storage server and viewing workstation via:
LAN ( local area network)
for an imaging modality to be part of PACS, it must be _______ in nature.
_______________ represents the first stage at which data and images are entered into PACS ( errors at this point can have an adverse effect on clinical operations)
digital image acquisition
two types of digital image acquisition include:
- inherently digital
- frame grabbers
a type of digital image acquisition in which the image data is obtained from the receptor in digital format:
a type of digital image acquisition in which the analog signal from the receptor requires digitization:
give two examples of inherently digital image acquisition and one example of frame grabber digital image acquisition:
- CT and MRI (full resolution and grayscale)
- digital fluoroscopy using CCD (conversion required)
____________ are described in terms of matrix size, inherent spatial resolution, bit depth, number of slices, study sizes, and overall image quality.
image data sets
_______________ is any number of computers connected to each other with the ability to exchange data.
name four main connection types that allow for the exchange of data in radiology:
what type of computer network connects computers that are separated by short distances such as in the radiology department, the building or two or more buildings?
local area networks (LAN)
give two examples of the connections used in (LAN):
- coaxial cable
- optical fiber cables
what type of computer network connects computers that are separated by large distances, such as in another state or country?
wide area networks (WAN)
give two examples of WAN that allow for connections to take place, and with what?
- internet and ethernet
- radio wave, microwave, and satellite links
name three types of network topologies or layouts for LAN:
- ring network
- star network
- bus structure
the term ________ refers to a point in a network topology or layout at which lines intersect or branch.
connections among the nodes of a network topology or layout are called:
______ and ________ play an important role in sending packets and ensuring they get to the correct destination computer
bridges and routers
the data transfer rate of the network is referred to as the:
__________ ___________ play a key role in ensuring that hardware and software execute communication protocols.
_________ ___________ allows for the connection between hardware components of PACS and the associated information systems (HIS/RIS).
name two PACS protocols:
- transmission control protocol (TCP)
- internet protocol (IP)
which PACS protocol divides information to be transferred into packets?
TCP (transmission control protocol)
computer networks often include a dedicated computer within the network that is capable of providing various services such as:
- data storage (file server)
- printing (print server)
- e-mail (e-mail server)
- web access (web server)
a computer system that provides essential services across a network, to private users inside a large organization, or to public users and the internet:
server computer/enterprise server
a network based on CP/IP and is used within a single organization:
a network used within the radiology department that is classified according to its data transfer rate, among other things:
long-distance telecommunication links
a major security feature that is a router, a computer, or even a small network containing routes and computers that are used to connect two networks to provide security:
what is referred to as the heart of the system, consists of a "high-end" computer or server, and works as a database server and archive system?
the PACS Main Computer
give three alternate names for the PACS Main Computer:
- PACS controller
- database server
- image server
________ and ________ play a big role in storage requirements and the speed to transmission of data over the network.
various types of storage technologies include (5):
- solid-state memory magnetic data carriers
- optical discs
- random access memory (RAM)
- redundant array of independent disks (RAID)
- digital linear tape (DLT)
_________ storage cannot be removed and provides immediate access to images within seconds
give an example of online storage:
________ storage is removable with long image retrieval time.
give an example of nearline storage:
____________ and ________________ are the current storage technologies for PACS.
one popular storage technology used in PACS is the:
redundant array of independent disks (RAID)
tape that is intended for long-term storage of images:
digital linear tape (usually .5 inch magnetic tape)
__________ storage must be retrieved by an individual and loaded into a drive for access to images.
name two advantages of off-line storage:
- provides the largest storage capacity
two purposes of image compression:
- to speed up transmission of information
- to reduce storage requirements
name two types of image compression and their characteristics:
- lossless compression - reversible compression where no information is lost
- lossy compression - irreversible compression where some of the information is lost in the process
What is DICOM's present compression method?
JPEG (Joint Photographic Experts Group)
JPEG 2000 uses ________ in an effort to decrease the compressed image size and enhance image quality
the ratio between computer storage required to save the original image and that of the compressed image:
as the compression ratio increases, _______ storage space is required and _______ transmission speeds are possible, but at the expense of the _________ __________ ________.
- image quality degradation
image quality is maintained so that image visibility is still acceptable at what compression ratios?
8:1 or less
the maximum compression in which the decompressed images are acceptable for interpretation anesthetics:
what is the name of the workstation that consists of hardware and software to facilitate the display of digital images for diagnostic interpretation and review purposes?
display and analysis workstation
what are the two types of display in the Display and Analysis Workstation?
name some generic hardware components of a PACS workstation (8):
- network interface
- serial controller
- local disk storage
- frame buffers
- display controller
- display device
what are the four types of workstations available in a PACS environment?
- high-resolution display workstations (2.5Kx2.5K) / (3K x 3K)
- medium-resolution display workstations (1.5K x 1.5 K)
- desktop workstations
- hard copy workstations
who uses each of the four types of workstations available in PACS?
- high-resolution display workstations: the radiologist
- medium-resolution display workstations: secondary diagnosis
- desktop workstations: technologist and positions other than radiologist
- hard copy workstations: may become obsolete (image printing)
within what amount of time must PACS workstations be capable of retrieving and displaying images?
within 2 seconds (requires higher bandwidth)
__________ workstations allow for more than one task to be done at the same time. for example, retrieval of images while interpreting another study.
name some types of navigational functions (9):
- work list
- list all
- mark as read
- folder display
- image icons
- next patient (exam)
- previous patient (exam)
what are the most commonly used image manipulation functions?
name some image manipulation functions (9):
- window level
- window width
- boundary detection
- region of interest cleaning (ROI)
- grayscale invert
- pixel statistics
- zoom and scroll
name some image management functions (5):
- mark for teaching
name some image processing functions (6):
- edge enhancement
- histogram analysis
- average gray level measurements
the science and art of design that considers not only the physical aspects of the persons using the system but also their mental capabilities in order to reduce unnecessary effort for those using the machine and mistakes that could be made as a result:
what is usually considered to be the ultimate goal with PACS?
to remain filmless (but some departments still print)
laser printers are available in two categories:
- "wet" printers
- "dry" printers
PACS is concerned primarily with ______ data while RIS is concerned with ______ data.
a device that is needed to translate and allow for PACS and RIS to communicate:
a "broker" or RIS-PACS broker
allows users to access images remotely using internet browser technology and microcomputers that allow access from within and outside the institution:
the _________ provides an organized checklist of events to occur with patients and their information (text or image) as they migrate throughout the healthcare facility.
describe, in order, the sequence of events in a typical workflow (9):
- physician order entry on (HIS)
- transport patient to department
- choose patient from modality worklist
- obtain images
- edit and change images for quality
- transport patient back
- review images and reports
- dictate report with voice recognition system
- report available on HIS
name other information about the patient besides image communication on PACS (3):
- patient demographics
- clinical history
- previous medical reports
a computer-based system that processes data to produce information in a form that can be understood by people using the system in order to solve problems:
what are the five information systems in our radiology department?
- voice-recognition system
- electronic teaching/research file system
HIS gathers textual data about the patient from what areas, to name a few (6)?
- materials management
name some functions performed within RIS (5):
- patient management
- film tracking
- patient tracking
name the two types of RIS/HIS integration schemes available:
between the broker and brokerless integration schemes available, which is the preferred method?
brokerless ( both areas - DICOM & HL-7 - coming back into PACS)
two standards that have become popular and common place are:
______ is the framework which will assist HL-7 and DICOM in becoming commonplace
specifies a non-proprietary data interchange format and transfer protocol for biomedical images, waveforms, and related information:
DICOM is a ____________ ___________ that provides compatibility between digital imaging systems.
what two organizations developed DICOM?
- American College of Radiology (ACR)
- National Electrical Manufacturer's Association (NEMA)
DICOM is made up of _____ parts, with each part dealing with a specific process.
the types of data to be moved around the network and the data format are referred to as:
name seven DICOM services common to PACS:
- transfer and storage of images via the network
- query and retrieval of images
- scheduling and acquisition
- image printing
- transferring reports
with very basic setups of DICOM there are what two devices?
- service class user (Ex. you requesting access to use the internet from anywhere)
- service class provider (Ex. the ISP which allows you access to the internet)
name three key elements of DICOM:
- information object definitions (IOD)
- service object pair (SOP)
- DICOM conference statements
name two problems not addressed by the two communications standards (DICOM and HL-7):
- message sequencing
- problems that relate to connectivity of various equipment from different vendors
IHE is a standards-based initiative of what two organizations?
- Radiological Society of North America (RSNA)
- Healthcare Information and Management System Society (HIMSS)
the major role of _______ is to facilitate communications between various computer-based healthcare information systems and imaging modality and PACS vendors through the integrated use of DICOM and HL-7
IHE ( integrating the healthcare enterprise )
in the IHE technical framework, what are three components that help to accomplish the facilitation of communications?
- data models
- integration profiles
a remote access to radiology images and reports:
enterprise-wide image distribution
name four technologies involved with enterprise-wide image distribution:
- PACS extension
- thin client web-based
- thin client just-in-time
name the two branches of the government that are responsible for regulating PACS:
- Food and Drug Administration (FDA)
- Health Insurance Portability and Accountability Act (HIPAA)
PACS is considered one of the five new classifications for _____________________ set by the FDA.
medical image management devices
what became the law in the United States in an effort to reform healthcare by addressing several objectives relating to the protection of the patient's health information, standards for such information, fraud and abuse of such information, and so forth?
- the Health Insurance Portability and Accountability Act (HIPAA)
the acquisition, processing, storage, and transmission of vocal, pictorial, textual, and numeric information by microelectronics, computers, and telecommunications:
- information technology
- ( defined by the Library of Congress, 2002)
who can be a PACS administrator?
- a senior technologist with some background in computers and IT
- an IT individual from the hospital's IT department
some job responsibilities of a PACS administrator (10):
- ensure that the PACS is working according to the needs of the department and the system specifications
- check that workstations are functioning properly with optimum display of image brightness and contrast
- assign an update passwords for staff
- set up standards for using the system
- maintain effective communications with other departments using the PACS
- communicate with the facility's information system (IS) or IT department
- provide ongoing education and training of system users
- liaise with PACS vendors and relate new developments to the facility's administrators and managers
- map workflow
- perform quality control of system components
an independent organization that is developing skills set for a PACS administrator and providing an access to certification examinations:
PACS Administrators Registry and Certification Association (PARCA)
what are the three types of certificates offered by PARCA?
- Certified PACS Interface Analysis (CPIA)
- Certified PACS System Analysis (CPSA)
- Certified PACS System Manager (CPSM)
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