PACS and Multislice PACS and Multislice CTCT

current issuescurrent issues

Stephen G DaviesStephen G Davies

Royal Glamorgan HospitalRoyal Glamorgan Hospital

BackgroundBackground

PACS reprovisionPACS reprovision Multislice CT procurementMultislice CT procurement Question to discussion boardQuestion to discussion board

– Where to report?Where to report?– What is stored?What is stored?– What is sent to web?What is sent to web?– Teleradiology?Teleradiology?

Historical perspectiveHistorical perspective

Data volume has always been a Data volume has always been a problemproblem– Glass plates (mass and volume)Glass plates (mass and volume)– Multiple views – a noveltyMultiple views – a novelty– Film – expanding range of studiesFilm – expanding range of studies– Space limitationsSpace limitations– Microchip and digital image productionMicrochip and digital image production– Networks, processing and storage.Networks, processing and storage.

Current problemCurrent problem

Data volume increase inexorablyData volume increase inexorably New approaches needed – TRIPNew approaches needed – TRIPTMTM = =

Transforming the Radiological Transforming the Radiological Interpretation ProcessInterpretation Process

Data volumes from MDCT rise faster Data volumes from MDCT rise faster than existing PACS systems can cope than existing PACS systems can cope with them.with them.

Phone a friendPhone a friend

Strickland: “MDCT what do we do with all Strickland: “MDCT what do we do with all the images generated?” the images generated?” BJR 77(2004) S14-19BJR 77(2004) S14-19

Presented four options:Presented four options:

 

 

                            

                   

                                                                                                                                                                

                                                                  

                      

     

 

Option 1Option 1

Store everything as acquiredStore everything as acquired– Overwhelm archiveOverwhelm archive– Too many images at workstation and for Too many images at workstation and for

cliniciansclinicians– Network capacity?Network capacity?

Do we really need the full data set Do we really need the full data set for reporting?for reporting?

Option 2Option 2

Store selection of imagesStore selection of images– Is this possible?Is this possible?

Option 3Option 3

Report “thin” sections at CT Report “thin” sections at CT workstationworkstation

Store “thick” sectionsStore “thick” sections

Becoming more practicalBecoming more practical– Data load on network and for archiveData load on network and for archive– Data load for cliniciansData load for clinicians

BUT ??workflowBUT ??workflow ALSO thin vs thick for fine detail??ALSO thin vs thick for fine detail??

Option 4Option 4

Report “thin” sections at CT WS; Report “thin” sections at CT WS; Store thin sections at WSStore thin sections at WS

?still export thick sections to archive?still export thick sections to archive ?Workflow?Workflow ?need to report thin sections?need to report thin sections

Ask the audienceAsk the audience

Variety of responses depending on Variety of responses depending on network capacity, archive and local network capacity, archive and local practicepractice

Summary:Summary:– Export thick (5mm) sections in primary Export thick (5mm) sections in primary

(axial) plane and secondary (usually (axial) plane and secondary (usually coronal) planecoronal) plane

– Specialist processing at modality Specialist processing at modality workstationworkstation

AdvantagesAdvantages

Radiologist workflow preservedRadiologist workflow preserved– ?preferred reporting environment?preferred reporting environment

PACS workstations very fastPACS workstations very fast– Voice, RIS integratedVoice, RIS integrated– Hanging protocolsHanging protocols

What happens when the data from What happens when the data from MRI reaches these levels?MRI reaches these levels?

DisadvantagesDisadvantages

Not viewing the full data set for Not viewing the full data set for reportingreporting

Demanding on archive and networkDemanding on archive and network

Problems with linking additional post Problems with linking additional post processed data with original data setprocessed data with original data set

IHE PWP profileIHE PWP profile

Other considerationsOther considerations

How long do we store for How long do we store for – At modalityAt modality– On archiveOn archive

What do we store (?thick slices +/- What do we store (?thick slices +/- compression)compression)

DiscussDiscuss