uccsc v6.pptx

Radiology PACS Department of Radiology and

Biomedical Imaging UCSF

Outline �  PACS Impact

�  PACS Workflow

�  PACS Infrastructure

�  Collaborations

�  Implementation

�  Challenges

PACS Impact �  Distribution of medical images (X-Ray, CT, MRI,

Ultrasound images) for the purposes of:

�  Direct Patient Care

�  Research

�  Teaching

�  Presentations

�  Archive of about 4 million studies

�  Over 1500 studies arrive daily from imaging devices within UCSF and devices from other medical institutions

�  Integrated with RIS, APeX, and surgical navigation devices

Basic PACS Workflow

PACS Workflow Components �  Application Servers

�  Front End Application

�  Database Servers �  Primary and Backup Oracle DB

�  Connectivity Manager Servers �  Interface from Radiology Information System (RIS) �  Modality Worklist Servers

�  Workflow Manager and Archive Servers �  Image Cache and File Services (Short-term and Medium-Term)

�  UCSF Archive �  Locally Developed Long Term Archive (~180TB / ~4 Million Studies)

�  IDC �  Agfa Long Term Image Archive �  Database and Image Server Components

�  Full Test Environment

PACS Infrastructure

XXX-ABCD- 0123XXX-ABCD-0123VIPRION XXX-ABCD- 0123XXX-ABCD-0123VIPRION

GTM1 GTM2

LTM1 LTM2

Viprion1 Viprion2

ParnassusData Center

Cisco UCSVirtual Infrastructure

parnos1

parnsvr1

parnsvr2

minnos1

minnsvr1

minnsvr2

Rad Parnassus Nameserver

Rad MB Nameserver

pacs.radiology.ucsf.edu128.218.152.197

dicom.radiology.ucsf.edu128.218.152.198

mwl.radiology.ucsf.edu128.218.152.200

ModalitiesIP Based (Non-DNS)

NeApp 325011 Disk Shelves

Rad CB Nameserver

MC Nameserver1

MC Nameserver2

Minnesota St.Data Center

Clients & Other PACS Systems(DNS Based)

PACS DICOM64.54.152.254

PACS DICOM64.54.152.253PACS DICOM Alternate

64.54.152.254

PACS DICOM Alternate64.54.152.253

MWL64.54.152.252

MWL64.54.152.251

Load Balancer Pair Load Balancer Pair

vSphere

T4-1 Servers

vSphere

T4-1 Servers

Drawn By

Jeff Block

RadiologyRadiology – IMPAX Dual Data Center Infrastructure Rev

A 3/21/14

PACS Infrastructure Dual Datacenter Design

�  Goal: Redundancy and Enhanced Performance

�  Minnesota Street �  UCSF Campus Networks & Firewall

�  UCSF Campus Load Balancers �  PACS Components

�  Parnassus �  Radiology Networks and Firewall

�  PACS Components

Collaboration – Radiology IT �  Radiology PACS Support Group

�  Configuration of ~150 Clinical Devices �  Configuration / Build / Deployment of ~150 Clinical

PACS Workstations �  Customization of PACS GUI

�  Radiology Information Systems (RIS) Support Group �  RIS Integration �  Powerscribe 360 Voice Recognition Integration

�  Radiology Desktop Support Group �  Deployment of PACS Workstations �  Help Desk Support

Collaboration - ITS �  Datacenter Team

�  Minnesota St. Datacenter

�  Load Balancers (F5 Viprion and GTM)

GTM1 GTM2

LTM1 LTM2

Viprion1 Viprion2

parnos1

parnsvr1

parnsvr2

minnos1

minnsvr1

minnsvr2

Rad MB Nameserver

Rad CB Nameserver

MC Nameserver1

MC Nameserver2

PACS DICOM64.54.152.254

64.54.152.254

MWL64.54.152.252

MWL64.54.152.251

Drawn By

Jeff Block

A 3/21/14

vSphere

T4-1 Servers

vSphere

T4-1 Servers

Collaboration – Global Traffic Managers and Load Balancers

�  Network Team �  Network Monitoring and Performance – Netscout

Probes

CB-Core-R1

CB-Core-R264.54.30.253GI 2/2

64.54.30.249

GI 2/1

GI 1/10MC64.54.30.241

GI 2/1

64.54.30.245GI 2/2

GI 1/10

GI 4/45 – 4/48

PRN-Core3

LRI-R1(VSS stack)

GI 6/4

GI 1/5/2

GI 6/4

PRN-Core4

MCGI 2/5/2

MB-Core_R1

MTZ-Core2

CB China BasinLRI Lab for Radiologic InformaticsMB Mission BayMC Medical CenterMCB Mission Center BuildingR Router Rad Radiology AT&T

GI 2/564.54.1.53

GI 6/2064.54.1.54

MB-Core-R2

GI 3/1564.54.1.34

GI 2/564.54.1.33

GI 3/1564.54.1.57

GI 6/2064.54.1.58

MCB-Core3-R1

MCB-Core4-R1

GI 5/164.54.1.197

GI 5/164.54.1.198

GI 5/164.54.1.193

GI 3/164.54.1.194

MTZ-Core1

GI 1/964.54.1.137

GI 6/1864.54.1.138

GI 5/164.54.1.142

GI 3/464.54.1.141

GI 1/11

MTZ-R1MTZ-R2

Campus - PRN Core

2408-0c50-r05

Campus - PRN Core

2252-00f1-r05

TE 3/6128.218.217.85

TE 1/6/15128.218.217.86

TE 3/6128.218.217.89

TE 2/6/15128.218.217.90 Campus - 654M

3043-0109-r01

Campus - 654M

3043-0109-r02

TE 1/164.54.131.76

TE 1/164.54.131.74

Campus -MB Core

3002-s251-r05TE 1/2

169.230.251.35

TE 1/364.54.131.75

TE 1/2169.230.251.34 Campus - 654M

ISG FirewallCluster

Campus - 654M

3043-0109-r05

Campus - 654M

3043-0109-r05

Radiology

Rack 1Radiology

Rack2Rad

RADRAD

TE 1/164.54.131.77

GI 1/164.54.2.154

GI 1/23

GI 1/264.54.2.158

GI 1/23

GI 1/264.54.2.190

GI 1/24

GI 1/164.54.2.186

GI 1/24

SNMPRouter Stats

NetScout(Clinical VLAN)

NetScout (Clinical VLAN)

SNMPRouter Stats

NetScout (Clinical VLAN)

Radiology

Rack 3Radiology

Rack4SNMP

Router Stats

SNMPRouter Stats

Collaboration – Netscouts for Network Performance Testing and Statistics

�  Network Team �  Network Monitoring and Performance – Netscout

Probes

�  Firewall Policy Access �  New Firewall Installation with 10G Uplinks �  Load Balancers and /32 Routes

GTM1 GTM2

LTM1 LTM2

Viprion1 Viprion2

parnos1

parnsvr1

parnsvr2

minnos1

minnsvr1

minnsvr2

Rad MB Nameserver

Rad CB Nameserver

MC Nameserver1

MC Nameserver2

PACS DICOM64.54.152.254

64.54.152.254

MWL64.54.152.252

MWL64.54.152.251

Drawn By

Jeff Block

A 3/21/14

vSphere

T4-1 Servers

vSphere

T4-1 Servers

Collaboration – Load Balancers and Complex Routing

�  Network Team �  Network Monitoring and Performance – Netscout Probes

�  Firewall Policy Access

�  New Firewall Installation with 10G

�  Load Balancers and /32 Routes

�  Medical Center IT �  Active Directory

Collaboration - Vendors �  Clinical Software / Hardware Vendors

�  AGFA Healthcare – PACS Software

�  NetApp – Storage �  F5 – Load Balancers

�  imorgon – Ultrasound �  Nuance Powerscribe 360 – Voice Recognition �  Philips – iSite

�  TeraRecon – 3D Image Processing

Implementation �  2 Year Process

�  Not an upgrade, a complete replacement

�  Phased Rollout

�  Required Zero Downtime

�  Patient care was unaffected during go-live

Challenges �  Design

�  Running New and Old Systems Simultaneously

�  Load Balancers �  /32 VIPs and Complex Routing

�  Data Migration

�  PACS Workstations �  System Imaging

�  First Few Weeks: �  AD GPO changes �  Firewall changes

Acknowledgements

�  Radiology IT Teams

�  UCSF ITS Teams �  Data Center �  Network �  Medical Center Identity and Access Management

�  Vendors �  AGFA �  Nuance �  NetApp �  F5 �  Philips �  imorgon �  TeraRecon

uccsc v6.pptx

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