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PACS introductionPACS introduction
Facilitator:Facilitator:
Edward WongEdward Wong
What is the role of PACS What is the role of PACS Administrator?Administrator?
PACS Administrator’s rolesPACS Administrator’s roles
Implementing a PACS Implementing a PACS System MaintenanceSystem Maintenance Image and Information ManagementImage and Information Management
For a 200,000 exams/year institution, 2-8 For a 200,000 exams/year institution, 2-8 full time PACS Administrator is available!full time PACS Administrator is available!
PACS Administrator’s rolesPACS Administrator’s roles
Implementing a PACS Implementing a PACS - Financial and workflow study- Financial and workflow study- Request for Proposal and Tender drafting- Request for Proposal and Tender drafting- Workflow modification including job reallocation - Workflow modification including job reallocation and resource relocationand resource relocation- Training and Operation Manuals- Training and Operation Manuals- Acceptance of system- Acceptance of system
System MaintenanceSystem Maintenance Image and Information ManagementImage and Information Management
PACS Administrator’s rolesPACS Administrator’s roles
Implementing a PACS Implementing a PACS System MaintenanceSystem Maintenance
- Contingency plan- Contingency plan
- Incompatibility handling- Incompatibility handling
- First line support and problems escalating- First line support and problems escalating
- System security and Performance - System security and Performance monitoringmonitoring
Image and Information ManagementImage and Information Management
PACS Administrator’s rolesPACS Administrator’s roles
Implementing a PACSImplementing a PACS System MaintenanceSystem Maintenance Image and Information ManagementImage and Information Management
- Maintain high Image Quality- Maintain high Image Quality- Data Integrity- Data Integrity- Quality Assurance program- Quality Assurance program- TeleRadiography- TeleRadiography- Anytime Available Storage Management- Anytime Available Storage Management
What is PACS ?What is PACS ?
PP: Picture, Images & Reports: Picture, Images & Reports
AA: Archive, Online, Near line, Offline: Archive, Online, Near line, Offline
CC: Communication, Networking, Transfer Protocols: Communication, Networking, Transfer Protocols
SS: System, Components & Architecture: System, Components & Architecture
PACSPACS: for storage and distribution of images and : for storage and distribution of images and information when necessaryinformation when necessary
PACS: Small or LargePACS: Small or Large
Web Server Distribution
Scale of PACS Scale of PACS
No. of Beds in Hospital/ Exams per yearNo. of Beds in Hospital/ Exams per year No. of ModalitiesNo. of Modalities No. of SwitchesNo. of Switches
Considerations:Considerations:
System connectivity, expandability, reliability System connectivity, expandability, reliability and cost-effectivenessand cost-effectiveness
Types of imagesTypes of images
1D, 2D, 3D, 4D1D, 2D, 3D, 4D Different DICOM Modality type: Cardiac / PET / 4D Different DICOM Modality type: Cardiac / PET / 4D
U/S…..U/S….. Image size: Resolution and bit depthImage size: Resolution and bit depth Image quality: Bit Depth and resolutionImage quality: Bit Depth and resolution Color / MonochromaticColor / Monochromatic Exam. Size: image size x no. of imagesExam. Size: image size x no. of images Structured ReportsStructured Reports New DICOM IOD:New DICOM IOD:
Endoscopic & Microscopic images / ECGs / Security Endoscopic & Microscopic images / ECGs / Security Profiles…..Profiles…..
1D, 2D, 3D, 4D, fusion1D, 2D, 3D, 4D, fusion
1D, 2D, 3D, 4D, fusion1D, 2D, 3D, 4D, fusion
Image Resolution/ Bit depthImage Resolution/ Bit depth
U/S DF CR CR Mammogram
256 x 256
8 bit
65 KBytes
1k x 1k
10 bit
1.25 MByte 2k x 2.5k
12 bit
7.5 MByte4k x 5k
12 bit
30 MByte
Properties of imageProperties of image
• Bit depthBit depth
• Grayscale or colorGrayscale or color
• Resolution in pixelResolution in pixel
Example image Example image size of size of mammogram = 4k mammogram = 4k x 5k x 12 bit = x 5k x 12 bit = 30 30 MBMB
PACS ArchitecturePACS Architecture
Data Base Server
CR/ DR QAWorkstation Computed
Radiographyor DR
Gateway orFrame Grabber
FilmDigitizer
Non-DICOMModality
Archive
DICOMModality
Web Server
RIS
DiagnosticWorkstations (DICOM)
Image Server(RAID)
Clinical Workstations (DICOM)
PACS – Central ArchitecturePACS – Central Architecture
DiagnosticWorkstation
Central ArchitectureCentral Architecture
Image Server and Database Manager is Image Server and Database Manager is the HEARTthe HEART
Any image, any where, any timeAny image, any where, any time Unique central copyUnique central copy Easy update of dataEasy update of data Requires high performance serversRequires high performance servers Potential single point of failure at serverPotential single point of failure at server Bandwidth demandingBandwidth demanding
Data Base Server
CR QAWorkstation
ComputedRadiography
Gateway orFrame Grabber
FilmDigitizer
Non-DICOMModality
Archive
DICOMModality
Web Server
DiagnosticWorkstation
RIS
DiagnosticWorkstations
(DICOM)
Clinical Workstations
(DICOM)
PACS – Distributed ArchitecturePACS – Distributed Architecture
Distributed ArchitectureDistributed Architecture
Exams are routed from modality to Exams are routed from modality to selected workstations selected workstations
Complex routing algorithms based on Complex routing algorithms based on department / user preferencedepartment / user preference
Difficult to support concurrent review of Difficult to support concurrent review of imagesimages
Less destructive for failure at database Less destructive for failure at database serverserver
Components of PACSComponents of PACS
HIS/ RISHIS/ RIS BrokerBroker ePR gatewayePR gateway Database ServerDatabase Server Image Server (RAID)Image Server (RAID) Long Term/ Near line ArchiveLong Term/ Near line Archive NetworksNetworks DigitizerDigitizer
Components of PACSComponents of PACS
Acquisition GatewaysAcquisition Gateways Non-DICOM modality gatewayNon-DICOM modality gateway DICOM Print ServerDICOM Print Server Media ServerMedia Server Reporting ServerReporting Server Monitor QC ServerMonitor QC Server Web ServerWeb Server WorkstationsWorkstations
PACS layout 1PACS layout 1
PACS layout 2PACS layout 2
PACS layout 3PACS layout 3
HIS/RIS I/F (SQL)(Mitra Broker)
Tuen Mun Hospital PACS SystemTuen Mun Hospital PACS System- Ambulatory Care Center (ph- Ambulatory Care Center (phase 1)ase 1)
RAID 5ISU
E450 CPU
Long Term Archive MOD Jukebox
ARC
US Logic700
Image Acquisition Modalities in ACC
Proteus XR/d
Proetus XR/aPrestiges II
Radwork5.0PathSpeed CRQA
CR ID Preview 2
PathSpeedMP CR
RW Film Digitizer
Hospital RIS
Network
1 GBit Fiber Link
ACC Ortho Dept
1C PathSpeedReview Stations
600m / 12 Core Gbit Fiber Link
Kodak Laser Printer 1
PCS2
Kodak Laser Printer 2
PCS 1HSA 1
PARIS 1
MIU1 MIU2 MIU3
PARIS 2
CR ID Preview 1
PathSpeed 1CWS PathSpeed 1CWS
Main Block Radiology Department
2B Diagnostic Workstations
2B Diagnostic Workstations
CT Network
MRNetwork
RTNetwork
Layer 3 SwLayer 2 Sw
Server Rm Network Switch Closet
KELP 2180DryView 8700
GE Medical Systems
IT - Radiology System
1CWS / Remote Admin Server
PathSpeedSP CR
PACS layout 4PACS layout 4
Data Base Server
CR/ DR QAWorkstation Computed
Radiographyor DR
Gateway orFrame Grabber
FilmDigitizer
Non-DICOMModality
LTS ArchiveSAN/NAS
DICOMModality
Web Server
Broker for
RIS/HIS
DiagnosticWorkstations (DICOM)
Image Server(RAID)
Clinical Workstations (DICOM)
PACS ComponentsPACS Components
DiagnosticWorkstation
Media Server
ePR gateway
W/S QA Server
Enterprise Archive
Through Acq. gateway
CRCR USUSXRAYXRAY
RIRISS
PCsPCsW/SW/S Film Film DigitizerDigitizer
CR QACR QA Frame Frame GrabberGrabber
HIS/RISHIS/RISInterfaceInterface(Broker)(Broker)
CCTT
R&FR&FMRMR NMNM
DGDG
Acquisition (DICOM) GatewayAcquisition (DICOM) Gateway
Role of Acquisition gatewayRole of Acquisition gateway
Compression/ decompression and securityCompression/ decompression and security Check the images for integrityCheck the images for integrity Convert to PACS format (header, byte-Convert to PACS format (header, byte-
order, matrix size)order, matrix size) Queue for images (priority) to database Queue for images (priority) to database
server (background)server (background) Share the workload and no point of failure Share the workload and no point of failure
for multiple Acquisition gatewayfor multiple Acquisition gateway
CRCR USUSXRAYXRAY
RIRISS
PCsPCsW/SW/S Film Film DigitizerDigitizer
CR QACR QA Frame Frame GrabberGrabber
HIS/RISHIS/RISInterfaceInterface(Broker)(Broker)
CCTT
R&FR&FMRMR NMNM
DGDG
Database Server and Image ServerDatabase Server and Image Server
DatabaseDatabaseServerServer RAIDRAID
Database Server (PACS controller)Database Server (PACS controller)
The Heart of the systemThe Heart of the system Integration cross point between HIS/RIS Integration cross point between HIS/RIS
and PACS (status update)and PACS (status update) Create and manages patient foldersCreate and manages patient folders Manage reading worklists and user Manage reading worklists and user
profilesprofiles Manage data transfer within the systemManage data transfer within the system Support data mining and teaching foldersSupport data mining and teaching folders
Image Server (RAID)Image Server (RAID)
Online (rapid access) exam storage and Online (rapid access) exam storage and distribution devicedistribution device
Support simultaneous exam input and Support simultaneous exam input and output transfer operationsoutput transfer operations
Up to Three months of storage capacityUp to Three months of storage capacity Scalable capacityScalable capacity
Redundant Array of Independent DisksRedundant Array of Independent Disks
Bandwidth equal to sum of disk transfer rates Bandwidth equal to sum of disk transfer rates
Highest speed disk storage availableHighest speed disk storage available
Image
Disk Array
2 MB/s1
2
3
4
5
6
7
8
16 MB/s
Hot Swap
Parity
What is RAIDWhat is RAID
RAID 5 configurationRAID 5 configuration
If disk fails, disk can be If disk fails, disk can be rebuilt- fault tolerantrebuilt- fault tolerant
High data transfer rate High data transfer rate for read, write slowerfor read, write slower
Min. 3 disks to startMin. 3 disks to start Array capacity is N-1Array capacity is N-1
Bandwidth is a measure of the information Bandwidth is a measure of the information (data) carrying capacity of a network(data) carrying capacity of a network10/100/1000 MB/sec 10/100/1000 MB/sec
Information Flow
Data Pipe (Network)
BandwidthBandwidth
Network BottleneckNetwork Bottleneck
The bandwidth of an information delivery system is The bandwidth of an information delivery system is limited to the bandwidth of the slowest component limited to the bandwidth of the slowest component in the systemin the system
Network Bottleneck
Data compression reduces the information rate Data compression reduces the information rate a network must supporta network must support
Uncompressed Data
Compressed Data
Data CompressionData Compression
Decompressed image is identical to original Decompressed image is identical to original imageimage
JPEG lossless compressionJPEG lossless compression
Average compression of 2:1 for x-ray imagesAverage compression of 2:1 for x-ray images
I
C
D
I - D = 0
Lossless Image CompressionLossless Image Compression
JPEG 2000 CompressionJPEG 2000 Compression
Selected parts of the image can be defined as Selected parts of the image can be defined as Regions of Interest, they can then be delivered Regions of Interest, they can then be delivered before other parts of the image, or losslessly, before other parts of the image, or losslessly, whilst other parts of the image that are less whilst other parts of the image that are less critical use normal lossy compression critical use normal lossy compression
JPEG 2000 codestream can be ordered to JPEG 2000 codestream can be ordered to deliver images of lower resolution before the full deliver images of lower resolution before the full image can be transmitted image can be transmitted
Motion JPEG 2000 does not have any form of Motion JPEG 2000 does not have any form of extrapolation (and hence potential distortion) in extrapolation (and hence potential distortion) in the time domain. Each frame is a separate the time domain. Each frame is a separate JPEG 2000 coded imageJPEG 2000 coded image
JPEG 2000 imagesJPEG 2000 images
CRCR USUSXRAYXRAY
RIRISS
PCsPCsW/SW/S Film Film DigitizerDigitizer
CR QACR QA Frame Frame GrabberGrabber
HIS/RISHIS/RISInterfaceInterface(Broker)(Broker)
CCTT
R&FR&FMRMR NMNM
DGDG
Storage Device (Long Term)Storage Device (Long Term)
DatabaseDatabaseServerServer RAIDRAID MODMOD DLTDLT
Types of storage mediaTypes of storage media
MediaMedia DVDDVD MODMODWORMWORM
DLTDLT 98409840 AIT2AIT2
GBGB 3.83.8 5.25.2 3535 2020 5050
CostCost Less Less Expen.Expen.
Expen.Expen. Expen.Expen. CheapCheap Most Most Expen.Expen.
Load + Load + AssessAssess
Very Very fastfast
Very Very fastfast
113 sec113 sec 15 sec15 sec 45 sec45 sec
Max. T Max. T rate rate MB/sMB/s
55 5.15.1 55 1010 66
Long Term ArchiveLong Term Archive
Used to store digital data for longer periodUsed to store digital data for longer periods of times of time
Storage ranges from 100 MB to 10 TBStorage ranges from 100 MB to 10 TBOptical disk most common mediaOptical disk most common media
- 5 1/4” MOD- 5 1/4” MOD- 2.6 GB and 5.2 GB Capacity- 2.6 GB and 5.2 GB Capacity
DLT used for longer term storage and redDLT used for longer term storage and redundancyundancy
ISP moduleISP module
CRCR USUSXRAYXRAY
RIRISS
PCsPCsW/SW/S Film Film DigitizerDigitizer
CR QACR QA Frame Frame GrabberGrabber
HIS/RISHIS/RISInterfaceInterface(Broker)(Broker)
CCTT
R&FR&FMRMR NMNM
DGDG
Storage Device (Near line)Storage Device (Near line)
DatabaseDatabaseServerServer RAIDRAID MODMOD DLTDLT SAN/NAS
Storage Area NetworkStorage Area Network
SAN is a high-speed sub-SAN is a high-speed sub-network of shared storage network of shared storage devicesdevices
Contains storage device Contains storage device (disk) for storing data(disk) for storing data
SAN's architecture works in SAN's architecture works in a way that makes all storage a way that makes all storage devices available to all devices available to all serversservers
Use of Fiber ChannelUse of Fiber Channel High scalability for additional High scalability for additional
storage and redundant storage and redundant networksnetworks
PCs
Storage devices
Network Area StorageNetwork Area Storage
NAS is a class of dedicated hard disk-based storage NAS is a class of dedicated hard disk-based storage devices which provide LAN users with additional disk devices which provide LAN users with additional disk storage through a standard network connectionstorage through a standard network connection
In most cases, a NAS device (or NAS server) receives In most cases, a NAS device (or NAS server) receives an IP address, connects to the LAN through an Ethernet an IP address, connects to the LAN through an Ethernet cable, and resides on the LAN as an independent cable, and resides on the LAN as an independent network devicenetwork device
Users are not demanding the server's processing time Users are not demanding the server's processing time for mundane storage tasks -- often improving the for mundane storage tasks -- often improving the performance of local application serversperformance of local application servers
NAS systems also include some onboard memory NAS systems also include some onboard memory (RAM) to cache network data to or from the disks (RAM) to cache network data to or from the disks
SAN Vs NASSAN Vs NAS
Difference between NAS and SAN is subtleDifference between NAS and SAN is subtle NAS devices are big, single purpose storage NAS devices are big, single purpose storage
appliances that you plug into networkappliances that you plug into network NAS sits between your application server and NAS sits between your application server and
your file systemyour file system As perform only 1 task, can serve files very fastAs perform only 1 task, can serve files very fast NAS is network-centricNAS is network-centric SAN is a defined architecture that sits between SAN is a defined architecture that sits between
your file system and your underlying physical your file system and your underlying physical storagestorage
SAN is data-centricSAN is data-centric
CRCR USUSXRAYXRAY
RIRISS
PCsPCsW/SW/S Film Film DigitizerDigitizer
CR QACR QA Frame Frame GrabberGrabber
HIS/RISHIS/RISInterfaceInterface(Broker)(Broker)
CCTT
R&FR&FMRMR NMNM
DGDG
DisplayDisplay
DatabaseDatabaseServerServer RAIDRAID MODMOD DLTDLT
SAN/NAS
Diagnostic W/SDiagnostic W/S Dedicate W/SDedicate W/S
WorkstationsWorkstations
Four Primary CategoriesFour Primary Categories- Advanced Analysis: Used by specialists for advanced - Advanced Analysis: Used by specialists for advanced
diagnosis - 3D, volume renderingdiagnosis - 3D, volume rendering- Diagnostic: For primary diagnosis; located in reading Diagnostic: For primary diagnosis; located in reading
rooms; high-end 2K monitorsrooms; high-end 2K monitors- Clinical: Used by clinicians and staff to consult; ICU / Clinical: Used by clinicians and staff to consult; ICU /
ER applications; less costly than diagnostic; 1K ER applications; less costly than diagnostic; 1K monitorsmonitors
- At Home Review: low-end; PC based; cost-effective; At Home Review: low-end; PC based; cost-effective; review application; lossy compressed for faster review application; lossy compressed for faster transmittransmit
Standalone Vs direct PACS w/sStandalone Vs direct PACS w/s
Standalone Workstation Direct PACS Client Workstation
Hard Disk Storage Yes, varies Minimal
Query PACS number
All PACS system (CT, ACC, Angio.)
Single PACS system (ACC PACS)
Retrieval mechanism
DICOM Q/R and association made with different vendors
Direct attached, same vendor
Retrieval time Slower Faster
Diagnostic value Depends on Monitor Grade and Modules like MPR, 3D etc
Depends on Monitor Grade and Modules like MPR, 3D etc
Suggested usage 1.for meeting/museum purpose2.for single modality image reviewing and reporting like Radworks in U/S Rm
Direct PACS workstation for reporting
Web distributionWeb distribution
High availability, low costHigh availability, low costReports / select images to referring physiciReports / select images to referring physici
an desktopan desktopPoint of integration with electronic patient rPoint of integration with electronic patient r
ecordecordLossy compression for performanceLossy compression for performancePotential for TeleRadiologyPotential for TeleRadiologySecurity issues to be resolvedSecurity issues to be resolved
RIS, HIS, ePR and PACS RIS, HIS, ePR and PACS integrationintegration
CRCR USUSXRAYXRAY
RIRISS
PCsPCsW/SW/S Film Film DigitizerDigitizer
CR QACR QA Frame Frame GrabberGrabber
HIS/RISHIS/RISInterfaceInterface(Broker)(Broker)
CCTT
R&FR&FMRMR NMNM
DGDG
Broker HIS/RIS and PACS Broker HIS/RIS and PACS interfaceinterface
Hospital Information SystemHospital Information System
Support clinical and medical patient care Support clinical and medical patient care activities in the hospitalactivities in the hospital
Administer the hospital’s daily business Administer the hospital’s daily business transactions like finance, payroll etctransactions like finance, payroll etc
Evaluate hospital performances and costs Evaluate hospital performances and costs and make long-term forecast and make long-term forecast
Clinical System in HA, HKClinical System in HA, HK Patient Administration In-Patient and Out-Patient Administration System Accident & Emergency Information System Medical Record Abstract System Medical Record Tracking System Clinical Support Laboratory Information System Radiology Information System Pharmacy Management System Dietetics Catering Management System Clinical Management Clinical Management System (In-Patient) Discharge Summary Clinical Management System (Out-Patient) Electronic Patient Records Clinical Data Analysis and Reporting System
Non-Clinical System in HANon-Clinical System in HA
Human Resources and Payroll Systems Hospital Based Financial System Materials Management System Patient Billing and Revenue Collection
System Executive Information System
Code 9 and view codesCode 9 and view codes
Radiology Information SystemsRadiology Information Systems Similar to HIS but of smaller scaleSimilar to HIS but of smaller scale Interfaces to PACS based on HL7Interfaces to PACS based on HL7 Department administrative managementDepartment administrative management
- - Scheduling and Film trackingScheduling and Film tracking
- Resource management and reporting- Resource management and reporting
- Monitor patient status- Monitor patient status Link to Hospital Information System (HIS)Link to Hospital Information System (HIS)
- - Billing and Master RecordBilling and Master Record Link to Clinical Management System (CMS)Link to Clinical Management System (CMS)
- - Prefetch for Clinical visitPrefetch for Clinical visit
- ePR integration- ePR integration
ExamOrderExamOrder
ExamScheduled
ExamScheduled
RISRIS Patient ExamIs PerformedPatient ExamIs Performed
Modality WorklistDemographicsDownloaded
Database server
/Archive
Database server
/Archive
Order Event
Prefetch ExamsFrom Storage
Imagestransferred in STS
PACS WorklistUpdated
PACS WorklistUpdated
Images /Prior Reports
Image migration STS to LTA
ExamTranscribed
ExamTranscribed
ReportVerifiedReportVerified
Final reportavailable
Final reportavailable
ExamReadExamRead
Dictatedstatus
Preliminary status
Imag
es
copie
d on
web-s
erve
r
Webdistributionto referringphysicians
RIS workflow
Broker serviceBroker service
HAHIS
HARIS
HA CMS Clinical visit
ADT
MitraPACSBroker interface
Appt., X-ray request
DR
CR
US
DF
Modalities: Get WORKLISTGet REPORT, Get INFO
Database server
Broker serviceBroker service
A restricted access account will be created at A restricted access account will be created at Sybase that gives limited authority for the Sybase that gives limited authority for the DICOM Broker solely for the purpose of the DICOM Broker solely for the purpose of the interfaces interfaces
In general, for data flow from RIS to the Broker, In general, for data flow from RIS to the Broker, the RIS write the supported events to the table, the RIS write the supported events to the table, and the Broker polls against the events table and the Broker polls against the events table and calls the associated stored procedures for and calls the associated stored procedures for the conversion to DICOM messages the conversion to DICOM messages
Broker serviceBroker service
Broker main function:Broker main function:
- Worklist generation- Worklist generation
- Reports storage- Reports storage
Registration + Post exam data capture (RIS)
Acc # generation + call broker for update
Broker poll RIS event table and convert to DICOM info
Modalities query Broker for worklist update
Need SOME time!!
ePR ArchitectureePR Architecture
Selected images from Selected images from individual hospital’s Pindividual hospital’s PACS are sent ACS are sent
make use of the ePR make use of the ePR record indexing and brecord indexing and browsing capabilities to rowsing capabilities to read the radiology imread the radiology images through CMS wages through CMS workstationsorkstations
Data Flow DiagramData Flow DiagramRIS ePR
RIS operational data
RIS statistical data
ePR
Data warehouse
Appointment
Attendance
Exam records
Reports (15mins)
Attendance
Exam & workload units (daily)
HA system
CMS
Non clinical system
Web ServerPACS
Characteristics of ePRCharacteristics of ePR
Near instant image reviewNear instant image review Web distribution can be within hospital, to Web distribution can be within hospital, to
other hospitals or even private clinicsother hospitals or even private clinics TeleRadiography possibleTeleRadiography possible Update of patient informationUpdate of patient information Lossy Vs losslessLossy Vs lossless Broken pathwayBroken pathway 15 minutes time lag15 minutes time lag
Guidelines for HIS, RIS, PACS Guidelines for HIS, RIS, PACS interfaceinterface
Each system remain unchanged in its Each system remain unchanged in its configuration and function, only data are configuration and function, only data are sharedshared
Identify the subset data to be shared and Identify the subset data to be shared and set up access rights/ authorizationset up access rights/ authorization
Convert the subset data to HL7 standard Convert the subset data to HL7 standard Define transfer protocol (TCP/IP or Define transfer protocol (TCP/IP or
DICOM)DICOM)
Typical patient and data flowTypical patient and data flow Admission: Patient registration, notify HIS (HL7)Admission: Patient registration, notify HIS (HL7) Order entry/Arrival: Schedule exam and notify RISOrder entry/Arrival: Schedule exam and notify RIS Broker notified and PACS database server updated (prefetch)Broker notified and PACS database server updated (prefetch) DICOM worklist to modalityDICOM worklist to modality Exam completed: data to DICOM gateway (MPPS)Exam completed: data to DICOM gateway (MPPS) Information/images to database/image server through Information/images to database/image server through
gateway (DICOM store)gateway (DICOM store) Images stored in PACS archiveImages stored in PACS archive Images to workstations from PACS archiveImages to workstations from PACS archive Dictation, transcription etc: workstation to RIS/PACS Dictation, transcription etc: workstation to RIS/PACS RIS reporting and PACS updated for reportsRIS reporting and PACS updated for reports Transfer: HIS/RIS to PACS, images to other PACSTransfer: HIS/RIS to PACS, images to other PACS Discharge: HIS/RIS to PACS, images rub outDischarge: HIS/RIS to PACS, images rub out
http://www.pacs.hkhttp://www.pacs.hk
Thanks!Thanks!