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by Aisha Ibrahim on 14 April 2013

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Picture Archiving and Communication System Outline... Introduction

History of PACS

Purpose of PACS

Imaging Modality

Electronic Communication System components

How PACS works

PACS Components

Summary

References Introduction Picture Archive and Communication Systems (PACS) is a medical imaging technology Have comprehensive networks of digital devices designed for acquisition, transmission, storage, display, and management of diagnostic imaging studies Computer Networks Dr.Homam Shraif Done By: Aiysha AlMuhaish
Fatimah AlBaker
Norah AlDossary
Shatha Alotiabi History The concept of a digital image communication
and display system was devised 1970s 1982 principles of PACS were first discussed at meetings of radiologists 1992 first large-scale PACS in the United States by The U.S. Army Medical Research and Materiel Command Since that time, PACS technology has grown through the support of InfoRAD.

Journal of Digital Imaging, devoted to research in digital technology.

PACS have become widely used by hospitals.

influenced by new technologies, faster network connections and other technical improvements To replace hard film copies with digital images.

Long-term cost savings in radiology services.

Available at all stations and on any time .

Much more efficient and greatly reducing the turn around time for report dictation. Why PACS ? Component of Electronic Communication System Picture Archiving and Communication system (PACS) Digital Imaging and Communications in Medicine (DICOM) Hospital Information System (HIS) Radiology Information System (RIS) Health Level Seven (HL7) DICOM A standard for the facilitation of electronic medical imaging, consisting of a standardized image(American College of Radiology, 2001). Developed by the National Electrical Manufacturers Association (NEMA).

The backbone of modern image display, It includes a file format definition and a network communications protocol.

Use TCP/IP to communicate between systems. 

DICOM enables the integration of scanners, servers, workstations, printers, and network hardware from multiple manufacturers into a picture archiving and communication system(PACS). DICOM plays an integral role in the digital medicine by providing A universal standard of digital medicine

Excellent image quality

Full support for numerous image-acquisition parameters and different data types

Clarity in describing digital imaging devices and their functionality HIS An integrated system of both hardware and software that is used by a health care provider to support and conduct all information aspects of providing quality patient care and the business of health care (Englebardt & Nelson, 2002). Support of Clinical and Medical Patient Care Activities in the Hospital

Includes many applications addressing the needs of various departments in a hospital.

Modern hospital information systems typically use fast computers connected to one another through an optimized network.

Produce relevant and quality information to support decision making RIS An electronic system that is used by radiology departments to manage medical imaging information such as diagnostic imaging orders, scheduling, and diagnostic imaging interpretations/ reports and to prepare billing information . RIS is usually based on the HL7 standard Hint While a PACS is managing the imaging data, the RIS is managing administrative tasks HL7 An electronic communication standard for health care applications that facilitates clear communication in the health care community through an agreed upon format or protocol for exchange. , integration, sharing, and retrieval of electronic health information The name "Health Level-7" is a reference to the seventh layer of the OSI Reference model also known as the application layer. The name indicates that HL7 focuses on application layer protocols for the health care domain. HL7 effectively considers all lower layers merely as tools. Imaging Modality Computed Tomography (CT) Magnetic Resonance Imaging (MRI) Ultrasound (US) Nuclear Medicine (NM) Computed Radiography (CR) One or many imaging modalities can be connected on the network.

All these modalities should generate images in DICOM format and be able to send images to a remote server using the standard DICOM format Digital Radiography (DX) How PACS Works With Other Systems The following example of an average chest x-ray illustrates how PACS, RIS, and other systems might operate together in a fully interfaced environment. 1) The patient’s doctor requests a chest x-ray, and it is scheduled in the RIS.

2) The patient arrives at Imaging Department reception desk and is registered, and the chest x-ray is ordered in the RIS, creating a unique exam number. 3) The RIS system sends an interface message to the PACS system providing demographic information about the patient and the exam requested.

4) The technologist,receives patient and exam demographics via the RIS/PACS interface. 5) The x-ray is performed and the digital image is transferred to the PACS server, where the RIS/PACS interface provides verification that the patient and exam information is valid.

6) Digital copies of the x-ray are queued for long-term storage. 7) The radiologist reports the x-ray using a diagnostic-quality PACS workstation and dictates the result into the RIS system .

8) The text result is stored in the RIS; once the radiologist signs the report, it is sent to the requesting physician and passed to the RIS/PACS interface, and the exam and report can then be viewed by authorized clinicians. The “Before and After” of a PACS Implementation PACS Components To understand the benefits of PACS, one must first understand the fundamentals of how this technology works together and components of PACS. Network Workstations Image Acquisition Component The images of a PACS are produced by several radiologic imaging modalities. The images can be transmitted from the modalities using a specied interface. A DICOM interface is the most frequently used standard. Due to the fact that many imaging equipments are not supporting industrial standards, like the DICOM standard, acquisition computers (also called acquisition gateways) are needed to enable the digital exchange of the images. So, computer is placed between the modalities and the PACS network. The computer receives the picture from the imaging modality through its specified interface, preprocessing it and converting it to a standard, which is supported by the PACS (i.e. the DICOM standard Figure 3. shows a simple model of the image acquisition process. PACS Controller The main engine of the PACS, It controls all transactions in the system between components and its database server and an archive system. The images and the patient information are transmitted from the imaging modalities or an acquisition computer, the radiology information systems (RIS) and the hospital information system (HIS) to the PACS controller. After receiving the data the controller continuous the processing of the data, consisting of the following tasks: Extracting text information describing the received studies
Determining the workstations to which the newly generated studies have to be forwarded
Automatically optimization of the pictures (optimal contrast, brightness and correct orientation)
Performing image data compression
Archiving the picture and deleting archived pictures from the acquisition computers
Serving archive requests from workstation or other controllers The most important property of the PACS controller in cooperation with its archiving system is to fulfill data integrity and system efficiency.

It must ensure that no data is lost after receiving it from the imaging modalities. As long as an image is not archived in the long-term archive, PACS always keeps two copies of it in different storages . Data Base Server and Archiving System The PACS database ensure that all images are automatically grouped into the correct examination , are chronologically order , correctly orientated and labeled , and can be easily retrieve [strickland 2000] The PACS database server should consist of redundant databases with identical reliable commercial database software (e.g Oracle , MySQL). Is part of PACs controller. PACS database system should be interfaced to the radiology information system and HIS. The hardware of database system should use an fast multiple central processing unit and performance interfaces, like SCSI and S-ATA[Huang 1996]. Storage component separated in fast short term and slower long term. Workstations are the human interfaces of PACS. Kim et al [Kim 1991] wrote the workstations are the point of contact of the radiologist and referring physicians. The workstation computers are running software for communication, database access, displaying the images, resource management and for processing. With this software the following fundamental operations are performed on a PACS workstation (see [Huang 1996]): Case preparation (Accumulation of all relevant images and information belonging to a patient examination).

Image arrangement (Selection of cases for a given subpopulation)

Tools for arranging (Tools for arranging and grouping images for easy review)

Interpretation (Measurement tools for facilitating the diagnosis)

Documentation (Tools for image annotation, text, and voice reports)

Case presentation (Tools for a comprehensive case presentation.) Heitmann [Heitmann 2006] distinguishes between four different types of workstation: Workstations for primary diagnosis with high resolution monitors (at least 2500x2000 pixel)

Workstations for writing reports with a lower resolution (at least 1000x1000 pixel),

Workstations for detailed evaluation with high resolution and faster graphic acceleration

and a Workstation for digitalizing and printing, including a laser printer and a laser-film scanner Many of such network are connected by a wide area network (WAN), provided by an regional Internet service provider. In the future increasing WAN speed will allow hospitals to work together over larger distances sharing one PACS system. [Knig and Klose 1999]. For keeping a network simple and scalable for standard UNIX and Microsoft Windows based computers, the TCP/IP protocol is recommendable. As technologies for the local area network, the Ethernet protocol following the IEEE 802.x standard or asynchronous. Transfer mode (ATM) can be used; ATM allows priorisation of certain data, but is harder to implement as the technologies differ from vendor to vendor.

Ethernet provides higher network speed with up to 10 Gigabit/s, while ATM runs with up to 2.2 Gigabit/s. Video: PACS at BRCH- Before and After Thank You ... Any Question Summary The benefits of PACS system are clear. Within seconds after an image is acquired, it can be viewed by the radiologist and any number of referring and treating physicians simultaneously. There is no film to be lost or stolen.
Virtual private networks can transmit whole examinations across the globe within seconds for remote consultations.
Today’s archives can keep decades of images online in a cost-effective manner and in a much more organized and accessible manner DICOM is an object oriented principle which is using data and services in medical field. The Data is divided into two parts; text data and pixel data. These data is creating DCM files The services in DICOM principles are related to handling DCM files in the networks. The two most important principles in service are called SCP and SCU. SCP means the device which is listening or receiving. SCU is the device which is speaking or transmitting in the network. a DICOM session is created by commands like Get, Store, Find and Move References Maureen N. Hood, MS, RN; and Hugh Scott, MS. Introduction to Picture Archive and Communication Systems. 2006 Jun; 25(3). doi: 10.1016/j.jradnu.2006.06.003

IAN D. ROBERTSON, TRAVIS SAVERAID .Hospital, radiology, and picture archiving and communication systems.2008 Jan; 49(1). doi: 10.1111/j.1740-8261.2007.00329.x

Dr Strickland. PACS (picture archiving and communication systems): filmless radiology.2000 Jan; 83(1):82-86. doi:10.1136/adc.83.1.82

Dr. Samir H. Abdul-Jauwad, Senior Member, IEEE, and Eng. Mansour I. AlJaroudi. Developing a Wireless DICOM for Osirix.2012 Jan.89-92.doi: 10.1109/BHI.2012.6211514

Mximilian Hecht. PACS - Picture Archiving and Communication System [Internet].2013.march.27 < http://www.cg.tuwien.ac.at/courses/Seminar/WS2009/PACS.pdf> Margaret Rouse, picture archiving and communication system (PACS) [Internet].2010[updated June 2010] < http://searchhealthit.techtarget.com/definition/picture-archiving-and-communication-system-PACS>

PACS - Picture Archiving and Communication System [Internet].2013.march.25 < http://www.aheconline.com/mktg/Course_Materials/Dig_Facts_Fiction/6-Dig_Facts_Fiction.pdf>

PACS Fundamentals chapter 1 [Internet].2013.march.25
< http://www.otechimg.com/pdf/pacsfundamentals_ch1.pdf>

How does PACS technology affect health care IT [Internet].2013.march.27 <http://searchhealthit.techtarget.com/tutorial/FAQ-How-does-PACS-technology-affect-health-care-IT>

Picture archiving and communication system [Internet].2013.march.27
<http://en.wikipedia.org/wiki/Picture_archiving_and_communication_system#History>

PACS - Picture Archiving and Communication System [Internet].2013.march.27
< http://www.cg.tuwien.ac.at/courses/Seminar/WS2009/PACS.pdf >

SNWombat. PACS at BRCH- Before and After[Youtube Video]. South Florida:Boca Raton Community Hospital; 2001.1 video: 4:37 min., sound, colour, 4 ¾ in. Figure 1. DICOM Commands. Figure 2. Flow of work Figure 4. Network Model of PACS.
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