Complete management of data and images in an integrated system including PACS-RIS connection with Intranet capabilities.
P. Pavone, F. Gavioli*, M. Marsella, S. Punzi*, V. Campanella,
V. Panebianco, R. Passariello
Dept. of Radiology, University of Rome ‘La Sapienza’
and *Imation, Italy
Introduction
The raod towards a complete management of all information generated in a radiological departmen into a single, harmonic and homogeneous system has benn long, and many attempts operated until now have more or less failed to reach their goal. Nowadays technology has reached a stage that can be considered satisfactory to complete solve of our problems in one single informatic solution, merging and integrating different systems.
System architecture.
Our system was developed and implemented considering mistakes performed in the past, both at the University of Rome and at the University of L’Aquila. The main mistake performed has been the utopy to buy a system at once and to solve the problem in one single moment. This is not possible and we learned that we should develope a system that should grow as soon as technology and resources become available. For this reason, we have started a new project where all the three main blocks (PACS, RIS, Intranet) are developed as an integrated part of the whole system.
a. PACS. The system should be user frendly, capable of running the large amount of data generated in a department, but at the same time must be not too expensive, in order to allow diffusion of the system also in peripheral hospitals, and not only in larger and richer departments of radiology. The key word shoud be scalability of the system, to allow the user to start with a simple PACS solution and move, as soon as resources are available, to larger systems, with larger number of high resolution workstations. To achieve this goal we have to allow people to start with simpler solutions with prevalent archiving purposes and a few workstations.
Reduction of the number of workstations can be achieved in two ways: first by having radiologists reporting on the original films or on the consoles of the acquisition systems. In our solution we are still printing films and reports are performed in a convetional way on the viewboxes. In this way we have not changed the routine of the department and have not created a trauma to the radiologists. The films are distributed in the clinical departments and digital archiving allows to satisfy medico-legal needs and allows availability of previous films as soon as they are needed.
The second solution has been achieved by distributing images through the RIS system workstations and through the Intranet, as will be discussed later. On RIS workstations it is also possible to run the viewer software of the PACS, with evaluation at consistent resolution and speed for consultation purposes.
The system we have installed has been developed by Imation.
b. RIS. We have originally implemented and operated the first multimedia RIS, from 1992. In our original idea, the multimedia RIS was supposed to be a system for archiving of selected images, mostly for teaching puroposes. The system has been successful, and the quality of the images presented has been always considered satisfactory for the goal. In the integrated solution, the multimedia RIS has a dominant position. It is in fact the way to distrubute images in the radiological department through a consistent RIS PACS connection.
The connection operates in both ways. RIS sends alphanumeric data to the PACS, allowing to create a list of examinations to be performed that appears on the acquisition workstations of the PACS, in non DICOM connected equipments. The technician is simply asked to click on the name of the patient who is performing the examination to send all images acquired in the PACS archives. In the other direction, a PACS button is present on the RIS reports screen. Clicking the button starts a rapid query to the PACS, using a Windows NT server as connection, with possibility to evaluate images on the RIS software within few seconds.
The multimediality of the RIS workstations is also used to allow direct evaluation of the PACS viewing software. In a multitasking environment both RIS and PACS softwares can be operated at the same time.
RIS workstations are distributed all along the department and also in peripheral radiological units present in our hospital in the Surgical departments and in the Orthopedic departments.
c. Intranet. Diffusion of the information available in the integrated system should be performed towards all units of the hospital, including wards, room of clinicians, labs, etc. Diffusion must be performed on a system easy to operated and without the need to install proprietary softwares and without specific needs for maintanaince. In fact, if we consider that hundreds of computers are present within an hospital and potentially they are users of the PACSand RISfor images and reports evaluation, it would be impossible to run a common viewing software operated by the radiology department.
For this reason, we have decided to implement a Web server to run all our services in an Intranet environment. The system allows evaluation of reports and images, booking of examinations and access to other type of information directly from every site connected to the web within the hospital. A complete optical fiber network has been recently distributed in our hospital and basically every computer is connected. A firewall has been created at the site of connection to the internet, in order to ensure safety of data. Privacy is also guaranteed by the use of passwords for the access to the system. Privileges to access to reports and images is only given to authorised personnel.
Conclusions
We
believe that ours is a valid approach towards the complete and integrated
management of data in the radiological department. The results obtained in
the initial clinical experience and the problems encountered in the preparation
of the system will be presented.
Correspondence:
P. Pavone,
Dept. of Radiology,
University of Rome ‘La Sapienza’
Rome, Italy
email: Pavone(at)uniroma1.it
Oral presentation at EuroPACS'98, Barcelona, Spain