Impact of cross-enterprise data sharing on portable media with decentralised upload of DICOM data into PACS

Abstract

Objectives

To evaluate portable media utilisation for image data sharing between enterprises. To predict the costs required to keep up with the trend. To identify related problems.

Methods

A software package was developed to include patient image data from CD into our normal workflow. The trend in the workload of CDs that were uploaded into a Picture Archiving and Communication System (PACS) over 89 months was analysed. The average number of images per month (and per investigation) was calculated to provide the estimation of storage and cost required in the whole process.

Results

All Digital Imaging and Communications in Medicine (DICOM) files can be read from compact disc (CD) on any workstation in the hospital, processed quickly to the central server and checked after storage using the software tool. A total of 33,982,404 images from 88,952 CDs have been stored into the PACS system. In recent years, the stored images have reached an average of 4.2 terabytes (TB) uncompressed annually.

Conclusion

Integrated information about patients is clearly needed to provide easy and timely access to these data. The steadily growing storage can be solved by a more automated approach to portable media handling or the installation and acceptance of network-based transfer using cross-enterprise document sharing (XDS).

Get the full paper (Open Access) here.

ECR 2014 - session SS105 - Trends in reporting, image management and mobile computing

10 presentations on different topics were covered in this scientific session:

CAD

Evaluation of a Siemens software tool called FastSpine to perform analysis of the spine with automatic labeling and curved reconstruction. They showed a high percentage of correct automatic labeling of 93.5%. FastSpine took about a minute to perform on average with manual correction where needed. The CAD provided time saving in more complex cases and had a comparable performance.

Two presentations focused on RECIST implementation. One looked at the implementation of dedicated tools for RECIST analysis and showed a clear saving in reading time while maintaing reproducibility. A Japanese group presented a cloud-based Lesion Management Solution that is used to track patients in lung cancer screening workup.

MOBILE DEVICES

This session showed again that mobile devices are of great interest and interesting applications are identified and implemented. Four of the presentations covered this topic.

A by dr von Falk showed that an iPad could be used for diagosis of CT data although screen size and security are still hampering the implementation. Another issue with mobile devices is the diiffering reading environments that cannot be controlled and thus could influence the reading quality. Mobile devices should probably be implemented as additional possibility and not for primary use. 

The dkfz demonstrated the use of an iPad for offline analysis of radiology information at a distant location to be used during autopsy. 

A group from Pisa also evaluated the iPad on CT images and showed the iPad to be faster for evaluation with even higher sensitivity and specificity for the iPad.

An important point to keep in mind with all the evidence for using iPads in radiology is that it is all focused on a limited, well defined, clinical question and mostly limits to CT.

Another group from Germany introduced the iPad in anatomical courses. The developed AnatomyMap a dedicated software tool for interactive exploration of volume rendered data running on a remote server using a web based interface.

QUALITY CONTROL

A group from switzerland showed that after transfer from free text to structured reporting they needed quaity control of those structured reports. They analysed about 250 reports on over 30 criteria. They showed that one third was excellent, one third good and one third non-optimal. The two worst performing radiologists were those not (properly) using the structured reporting. 

USABILITY

A Dutch group presented their work on interface customization. Most PACS systems have an adaptable interface, but the radiologist do not optimally use this capability. The showed that using adaptive support suggestions based on usage could help to improve radiology workflow and workstation usage. 

RSNA 2013 Preview

We are presenting a number of posters and orals from our group at the RSNA 2013 in Chicago later this year. Some of the topics made it to Auntminnie.

Check out the coverage at the AuntMinnie website:

Caution should be used with DICOM data deidentification

and

Before migrating your PACS, do a test run

CARS 2013 - PACS Workflow

In a presentation from the Neterlands, Jorritsma discussed the necessity to introduce usability to the PACS selection process. He stated that in PACS replacement functionality is regarded but not usability, while this should be a major criterion in the PACS selection process. Subjective measures should be complemented with objective usability data to be valuable in the selection process.

Next, Procida from Italy presented on 'PACS independent and IHE-like approach method for the analysis of PACS in a healthcare enterprise'. they noticed that the hospital had over 100, high cost, workstations connected to the PACS. However, the usage of these systems is unknown and many of them might be used only for a small part of the time. The display on/off status was recorded in a database and provided the possibility to record system usage. This method was limited by the fact that the displays had a delay of 10 min inactivity before they turned off automatically. The IHE ATNA (Audit Trail Node Authentication) profile was utilized to determine the exact use of the workstations since information about each exam view was recorded with the user information. A more accurate status was obtained with this second method about the workstation usage per workstation. This allowed reallocation and discontinuation of underused, high cost, workstations. Proposals are made to the IHE to adopt the ATNA profile to fully support this non-intended but very interesting use.

Final presentation was from Japan, presented by Ito on the improvement of clinical workflow of thoracic surgeons in distant hospitals by interactive teleconference using open source software. They used Osirix, VNC, Voice Chatter (voice communication software) and Wireshark (packet analyzer) to setup teleconference with only open source software. Using this they setup a four hospital teleconference system using VPN connection. Instead of travelling up and down they now upload anonymized DICOM data to the university hospital and do the consultation using the teleconference method saving hours of travelling time.

CARS 2013 - PACS-CAD Integration

This session contained four presentations on PACS-CAD integration.

Dr. Regge gave an outlook of a radiologist on how to use the CAD in the clinical workflow. He discussed the problems with double reading with increased recall rate of patients for biopsy and the cost involved in requiring two experts to review all datasets. This provides a good incentive to start using CAD as a second reader. Studies have shown similar performance with increased recall rates but also with reduced cost of the diagnostic process because of having only one reader and the decrease in reading time. Controversies are that radiologists might reject true positive polyps defined by CAD and the influence of CAD on the reading process. Inconclusion CAD is coming to maturity and can be used but still is controversial and the clinical value still needs to be assessed.

Dr. Suárez Cuenca presented on an integration of CAD into the PACS environment using a wide computing infrastructure. They aim to build a sytem for a whole region in Spain to make CAD assessable for multiple hosptials utilizing different PACSs and clinical workstations. They build a standards based platform with which users can request a CAD service and receive the results in their local PACS. The process is running through a webinterface that allows sending their (anonymized) data to the CAD service and receiving a DICOM object with the result.

Next a presentation on Enhancing clinical use of CAD systems in PACS with automation and open-source tools by dr. Summers. They built a system that allows a better integration of CAD into the normal workflow utilizing the clinical information already available in the PACS to automate the utilization of CAD in three different scenario's. Either all studies are processed automatically based on their properties (8 minutes per case), a radiologist selects a specific case and requests processing (6 min per case), or a list of cases is predefined in PACS and processed automatically with notification of completion to the radiologist by email or text message (9 min per case). This method allows non disruptive integration with the ability to utilize the full capabilities of the PACS workstation, such as direct comparison with older data.

The final presentation by dr. Behlen was entitled 'an unexamined assumptionnis not worth assuming: imaging data quality exposed in data migration'. this talk was about PACS data migration by Laitek, a company specializing in this area. They presented figures showing exceptions ranging from almost 0 to 35%. Majority of the migrations will only have 1-2% of exceptions. Many problems occur related to interpretation of the DICOM standard. One of the problems is the utilization of annotations, where everybody is implementing in a different way resulting in difficulties to transfer them from one to another PACS environment.

CARS 2013

The coming days I will be attending the CARS 2013 in Heidelberg, Germany. I will mainly focus my attendence of scientific sessions to the EuroPACS part and the digital OR developments. For more information keep a look on this blog for the coming days.

CARS is running from June 26-29, 2013. For more information visit their website.

Next-gen PACS according to Eliot Siegel

Look at this Diagnostic Imaging interview with Eliot Siegel recorded at SIIM with his vision of the next generation PACS with, what he calls, clinical analytics. http://bcove.me/nfo2uwot

Filmless Regions in France

Although recent reports of the European Union should that France is behind in implementation of PACS they are trying to catch-up with a large projects to achieve filmless regions.
The Région Sans Film (Filmless Region) project is now underway after its launch in 2008 to spur PACS adoption in the greater Paris area. Four hospitals are already utilizing elements of the program's cloud-based RIS, PACS, and archiving platform, with more than 25 additional hospitals scheduled to follow in the next two years.
Check-out the coverage on Auntminnie here. 

Publication: A Situational Aligment Framework for PACS

Last year we published this paper in Journal of Digital Imaging on the situational alignment framework for PACS. Using this framework, it is possible to determine the maturity level of a PACS implementation and to evaluate the current status of this implementation.


A situational alignment framework for PACS.
van de Wetering R, Batenburg R, Oudkerk M, van Ooijen P, Brinkkemper S, Scheper W.
J Digit Imaging. 2011 Dec;24(6):979-92.


Abstract
This paper reports the outcomes of a study on an integrated situational alignment framework for picture archiving and communication systems (PACS) labeled as PISA. Following the design research cycle, complementary validation methods and pilot cases were used to assess the proposed framework and its operationalized survey. In this paper, the authors outline (a) the process of the framework' development, (b) the validation process with its underlying iterative steps, (c) the outcomes of pilot cases, and (d) improvement opportunities to refine and further validate the PISA framework. Results of this study support empirical application of the framework to hospital enterprises in order to gain insights into their PACS maturity and alignment. We argue that the framework can be applied as a valuable tool for assessments, monitoring and benchmarking purposes and strategic PACS planning.

Introduction into PACS movie

A non-branded short presentation on the basics of PACS. Already somewhat older, but the basics stay the same.

ECR - MIR@ECR - Managing Radiology

Three presentations were given in this session.

The first one was on the implications for radiology of Imaging and benchmarking by dr. Schouman. Benchmarking is the comparison to best practices based on measurements. She promoted benchmarking to achieve improvement of the productivity and performance of a radiology department. The current situation with EHR, RIS and PACS starts to enable efficient benchmarking. Problems are
- Cumbersome data capture
- Poor data quality
- Lack of standardization
- Reductive analysis
- Meaningless comparisons
One of the key points is the assurance that manual data entry is done correctly. For example the information going into the RIS.

Second was the added value of in-house radiological IT by dr. Jakobsen. He showed, based on examples, that IT is crucial for the operation of a radiology department and that the absence of IT would take down that complete radiology department. The in-house IT support is critical to keep the IT up and running since they can either solve the problem or knows who to contact. Concluding in-house radiology IT can effectively prevent a stop in workflow.

Finally, dr. Senol talked about Risk management in radiology. As definition of risk he gave: The potential that an chosen action or inaction leads to a negative outcome. Risks in radiology are:
- related to reporting
- direct harm to the patient
- related to decision making
Risks related to reporting are:
- delay
- errors in reporting (up to 4% of reports)
- false positive or negative errors
- incorrect diagnosis
When an error occured patient and hospital should be informed and the root cause of the error should be assessed.

ECR 2012 - MIR@ECR - Communication with our Partners

Three presentations were given in this session.

First dr. Kahn talked about computerized physician order entry and decision support. He approached this from the side of the appropriateness criteria. He stated that those criteria are not meant for the radiologist but for the referring physicians. However, delivering it to them in an enormous pdf file is not very efficient. It should be integrated into the exam ordering process using computerized systems inside the electronic health record. By doing this the referring physician can enter the properties of the patients and get decision support on their order. This should reduce the number of wrong diagnostic tests or may even reduce the number of diagnostic tests. Kahn remarked that we should be talking about a radiology examination request and not an order. Furthermore he stated that decision support should be regarded as advise and not the law and that a physician should be able to reject the advice.

Next, dr. Centoze gave a presentation about communication of urgent and unexpected findings. He started to state that efficient and correct communication is crucial. ESR has release guideliness on communication of urgent and unexpected findings published in insights in imaging. Ideally an automatic alert and feedback system should be implemented. Urgent information should always be communicated directly with the referring physician. Unexpected findings could be communicated with other methods like e-mail .

Finally, a presentation on implications of reporting infrastructure - general reading room vs. Individual office was given by dr. Strickland. She presented her personal preference of a general reporting room and discussed pros and cons of that choice against private offices. The pros are:
- less costs because of maximum use of the workstations
- optimized ergonomics in the central reading rooms
- camaraderie: reporting is a social activity/teambuilding
- facilitates clinician access
- enhances inter-radiologist consultation
The perceived cons are
- noise
- personalized workstation settings lost
- pre-existing building architecture
Extra small reporting rooms could be beneficial to have. But they should not be personal.

ECR 2012 - SS505/B0373 - Automated semantic navigation and synchronized alignment

Semantic navigation is used to synchronize baseline and follow-up CT examinations. The algorithm detects words from the radiology report and puts links on it to automatically travel to the proper region in the images. To achieve this the software automatically detects landmarks in the anatomy and connects this to semantic information using rekationships like 'close to', 'above', 'to the right of', etcetera. this method allows matching of non-corresponding exams and provides clinically sufficient automatic alignment of corresponding findings in consecutive examinations.

EuroPACS Newsletter online

The EuroPACS newsletter is online here. Also visit their website for more information http://www.europacs.org/

Health Imaging News Portals | Healthcare IT | HIMSS: Vendor-neutral archive can solve PACS problems

Implementation of a vendor-neutral archive (VNA) solves most of the problems associated with PACS, can save money over the long term and can prepare an enterprise to participate in a health information exchange (HIE), according to Michael J. Gray of Gray Consulting who presented during a webinar on Jan. 26 hosted by the Healthcare Information and Management Systems Society (HIMSS) and GNAX Health.

Health Imaging News Portals | Healthcare IT | HIMSS: Vendor-neutral archive can solve PACS problems

HIMSS: Solve your PACS problems with a vendor-neutral archive

Implementation of a vendor-neutral archive (VNA) solves most of the problems associated with PACS, can save money over the long term and can prepare an enterprise to participate in a health information exchange (HIE), according to Michael J. Gray of Gray Consulting who presented during a webinar on Jan. 26 hosted by the Healthcare Information and Management Systems Society (HIMSS) and GNAX Health.

HIMSS: Solve your PACS problems with a vendor-neutral archive

French are trying to catchup in PACS by regional cloud-based PACS introduction

Ministère en charge de la santé (the French Ministry of Health) is to deliver cloud-based PACS and archive services to the Île de France, the country’s most populous region.

In total, 30 hospitals are within the scope of this first project phase, beginning with pilot provider Hôspital Simone Veil.

Read more.

RSNA: Merge shows off Honeycomb and iConnect

Merge Healthcare showcased their move to the cloud with Merge Honeycomb and demonstrated its suite of interoperability tools at the 97th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA) held in Chicago Nov. 27 to Dec. 2.

RSNA: Merge shows off Honeycomb and iConnect

PACS market matures, but where's it heading?

Found at AuntMinnieEurope.com:


Most European hospitals with more than 250 beds now have PACS, but many smaller hospitals and imaging centers still lack the technology. While more than 7,400 European sites have PACS, another 3,350 are still without radiology PACS, writes market analyst Theo Ahadome. To read his article about the latest trends, click here.

RSNA: Vendor Neutral Archiving

One of the buzzwords on the RSNA that many companies are using is VNA (Vendor Neutral Archiving). With vendor neutral archiving, the storage is taken care off in a cloud oriented architecture. Any image can be stored into the VNA secure and consolidated regardless of the vendor of the data producing entity (e.g. A PACS).
Advantages can be found in easy sharing of images between healthcare institutes, but also in the fact that PACS replacement can be achieven easier since all data is available in the VNA.

A whitepaper on VNA is availble from Carestream Health