Download pdf - Learning Series: RamSoft Gateway Router -'Yes we can do that

*For RamSoft PACS clients

Gateway Router- System Functions and Features

'Yes our system can do that'

Page 1


Overview

Gateway Router Quick Overview

What is DICOM?

Setting up a DICOM Connection and its Terminology

What Data Cleansing Options Are Possible?

Facility, Issuer of Patient ID, Receive Study Status As

DICOM Tag Mapping/Morphing

DICOM File Format Terminology

Scripting

Transfer of Data

TLS versus Replication

What is PowerCache?

VPN required or not

Multi-thread verses single threaded-sending multiple

Automated Prior Prefetching

DICOM Q/R

Triggered by HL7

Product Offerings

Gateway Router versus Advanced

Gateway QC versus Viewer

Page 2

Gateway Router Quick Overview

Designed for routing images

Flexible with no limits on storage, number of studies or number of modalities

Robust and flexible that it can work with multiple storage volumes, any number of hard drives, NAS or SAN, and can even store images on a flash drive

Full-featured online DICOM vendor neutral archive

Ensures the patient data and study images are stored according to industry standards so they are compatible with any number of disparate RIS and PACS solutions

Page 3

What Is DICOM?

DICOM stands for Digital Imaging and Communications in Medicine

It is a standard for handling, storing, printing, and transmitting information in medical imaging

It includes a file format definition and a network communications protocol

Page 4

Setting Up A DICOM Connection

RamSoft systems offer installation in both promiscuous and non-promiscuous mode, however installation in non-promiscuous mode is the best practice of choice since it will only communicate with a DICOM station that has explicitly identified as a safe station

In order to identify a station you will need the AE Title, it’s IP address, and the port that it uses for DICOM communication

Page 5


AE Title

Application Entity Title

Uniquely identifies a DICOM Device or program

The AE Title can be 16 alphanumeric characters or less

IP Address

Specifies the internet protocol address for the device

An IP address identifies a device on a Transmission Control Protocol/Internet Protocol (TCP/IP) network

Port

Identifies the port for the device's application program that you query, retrieve, receive, and send image files

A port is a logical connection endpoint that is the means that a program uses to identify a specific program running on a computer on a network (such as TCP/IP).

DICOM’s default port is 104

Page 6

DICOM Connection Terminology

What Data Cleansing Options Are Possible?a. Facility, Issuer of Patient ID, Receive Study As

Facility If the facility is filtered, it becomes a

mandatory field, all studies being received from that station will have that particular facility mapped in the DICOM objects

For example, when facility is filtered as “FACILITYRG1”, all studies being received from this station, DICOM tag (0008,0080) for facility will get written as “FACILITYRG1”.

Page 7

Issuer of Patient ID When receiving DICOM data from facilities using different RIS/HIS numbering

systems, it is important to segregate Patient IDs from the two facilities

In this situation, it is likely that the same Patient ID is used to represent different patients in the two facilities

Entering a value for the Issuer of Patient ID field, will result in DICOM objects that have the Issuer of Patient ID field blank or null to be populated with this value.

Since this is part of the primary key field in the patient table, this patient will not be merged with a patient with the same Patient ID received from a different facility

Receive Study As The Receive Study As option determines what status will be assigned to the

received studies

Page 8

What Data Cleansing Options Are Possible?a. Facility, Issuer of Patient ID, Receive Study As

What Data Cleansing Options Are Possible?b. DICOM Tag Mapping/Morphing

This allows individual DICOM tags to be copied, moved, or deleted when DICOM objects are received from a specific station

Typically, this feature is used to correct images from modalities that are missing or incorrectly populating crucial DICOM tags For example, source tag, StudyID (0020,0010), will get copied

to destination tag, AccessionNumber (0080, 0050).

Set the Destination value to 00000000 and check the Delete Source option to remove the source tag without performing any mapping For example, if the NameOfPhysicianReadingStudy tag

(0080,1060) is entered as source tag, while setting destination value to 00000000 and the Delete Source option has been checked. This will result removing the name in the Reading Physician field making it blank as studies are being received.

Page 9

DICOM Header

Stores information about the patient's name, the type of scan, image dimensions, etc., as well as all of the image data

DICOM Tag

The DICOM standard has a special pair of characters with numbers of 2x4 hexadecimal digits enclosed by parentheses and separated by the comma uniquely identify a specific DICOM field or data

For example, (0010, 0010) will always be the tag for patient’s name.

Page 10

DICOM File Format Terminology

What Data Cleansing Options Are Possible?c. Scripting

Used to modify the DICOM object being received from the selected station

Custom scripts are used when modifications of the DICOM objects are more complicated that they couldn’t be achieved by simple DICOM tag mapping/morphing

The Script Editor utilizes Pascal scripts that will conditionally execute a group of statements, depending on the value of an expression

Page 11

What Data Cleansing Options Are Possible?c. Scripting

For example: To change the priority of all studies to ROUTINE when receiving from a station

Page 12

Function DICOM Tag for RequestedProcedurePriority

DICOM Tag for

StudyPriorityID

Write tag as this

This is an example of a simple

script that will overwrite the value

for DICOM tags (0032, 000c)

and (0040, 1003) to LOW and

ROUTINE respectively for all

studies.

And What Data Cleansing Options Are Possible?c. Scripting

For example: To change Comprehensive SR document type from DIAGNOSTIC REPORT to CLINICAL

Page 13

FunctionDICOM Tag for SOPClassUID

Variable SOPCLASS will store the data value found in DICOM tag

(0008, 0016)

DICOM Tag for DocumentType

Write tag as this

This script will read DICOM tag (0008,

0016) and store that value to the variable,

SOPCLASS. If SOPCLASS equals to

‘1.2.840.10008.5.1.4.1.1.88.33’, which is

the UID (Unique Identifier) for

Comprehensive SR then DICOM tag

(311b, 1010) will get changed to

CLINICAL.

Transfer Of Dataa. TLS versus Replication

TLS (Transport Layer Security) Is a protocol that allows two programs to communicate with

each other in a secure way Provides privacy and data integrity between two communicating

computer applications When secured by TLS, connections between client and server

will have one or more of the following properties:Connection is private because symmetric cryptography is used to

encrypt the data transmitted Identity of the communicating parties can be authenticated using

public key cryptographyConnection is reliable because each message transmitted includes a

message integrity check using a message authentication code to prevent undetected loss or alteration of the data during transmission

Default TLS port for DICOM is 2762

Page 14


Replication

Uses a RamSoft proprietary communication protocol

Is used to send image data directly to a PowerCache or PowerServer without the need for DICOM association or use of the DICOM Service

Only send and receive services can be used with Replication

Is preferred for RamSoft to RamSoft communication due to a slight performance boost and ease of use

Is the mandatory communication protocol for Gateway/Gateway Router to PowerCache communication

Page 15

The Replication Service is the method of choice for file transfer when the PowerServer is located at a remote site, regardless of the presence of a PowerCache

If the PowerServer and the Gateway/Router are located on the same site, DICOM transfer should still be used

When using HTTPS Replication, encryption is established using the same SSL Certificate that protects the PowerServer Login Page

Replication is configured on the Station List and monitored via the Replication Tab in the Communication Log

URL Formats:

Page 16

Station Type Example Format

PowerServer (HTTPS Connection) https://<serverURL>/powerreader4/webservice/prisapi.dll/bin

PowerServer (HTTP Connection) http://<serverURL>/powerreader4/webservice/prisapi.dll/bin

PowerCache <PowerCache Machine URL>:12800


What is PowerCache?

Loading of images is the most costly part of a PACS system in terms of CPU usage, disk I/O, network bandwidth, and time

Our software addresses this problem by installing a local image cache (Local Cache) with each PowerReader workstation, allowing a recently opened image on a workstation to be stored locally for faster retrieval while lowering the load on the PowerServer and the network

These locally stored images are fully encrypted and cannot be read outside of the PowerReader program

PowerCache serves a similar purpose to the Local Cache, however, it is not associated with a single PowerReader workstation

PowerCache resides on a dedicated machine (server/workstation) and is shared by multiple PowerReaders, generally located at the same site

PowerCache allows the transfer of images at LAN speed versus across the internet, in most cases this means 1 GB/s versus 20MB/s (which is 50 times faster)

Page 17

What is PowerCache?

PowerReader looks for images in this order:

Page 18

PowerReader s Local Cache

PowerReader

PowerCache

PowerServer

Transfer Of Datab. VPN required or not

VPN (Virtual Private Network) extends a private network across a public network which enables users to send and receive data across shared or public networks as if their computing devices were directly connected to the private network

Created by establishing a virtual point-to-point connection through the use of dedicated connections, virtual tunneling protocols, or traffic encryption

Historically, VPNs were needed to send studies securely over the Internet

Many radiology practices utilize DICOM router and PACS technology that is capable of leveraging TLS protocols for encryption, authentication, and data integrity

Secure connections that utilize 256-bit SSL certificates can commonly be found pushing DICOM studies over the Internet without the need for VPNs

Gateway Router to PowerServer Replication allows secure sending of DICOM over the internet without the need for a VPN Tunnel

Page 19

Transfer of Datac. Multi-thread verses single threaded-sending multiple

Multi-threading techniques sending multiple images or studies

Single-threaded sending multiple images or studies

Sending multiple images or studies simultaneously across the network

Sending one image or study at a time across the network, then will wait for that task to complete before sending the next one

Page 20

Automated Prior Prefetchinga. DICOM Q/R

The Relevant Prior matching subsystem operates in 3 distinct phases when processing studies: Fetching, Matching, and Sending

1. Fetching Phase:DICOM Query and Retrieve operations are performed against the

configured Sources and fetched studies usually satisfy some broad criteria defined in the Query model such as Patient Name, Patient ID and Issuer, Modality, Facility, Status, and Study Date

2. Matching Phase: The constraint group of the Reference Study will serve as a context for

all comparisons and any prior study that matches the Reference Study is considered a Relevant Prior

3. Sending PhaseAll Relevant priors are sent (along with the Reference Study) to each

predefined destination

Page 21

Automated Prior Prefetchingb. Triggered by HL7

HL7 (Health Level 7) is an industry standard data interface widely used in many health care information systems (HIS, RIS, PACS) for exchange of textual information

By utilizing the HL7 interface, it can acquire messages, such as ADT (Admission/Discharge/Transfer) which contains global information about patient’s demographics and ORM (Request for Observation) which would typically contain information about procedure or exam a patient has been scheduled for

ORM messages contain patient information as well as the ordered procedure data, this information can be cross referenced to allow more precise pre-fetching than using ADT messages

Page 22

Product Offeringsa. Gateway Router verses Advanced

Advanced Features: Rapid Routing (Uses multi-threaded DICOM sending)

Is a proprietary RamSoft technology that opens up additional lines of communications from the modalities to the PACS to accelerate the transfer of study images and data over an internet connection

Is an economical solution for practices that have maxed out their bandwidth or in instances, such as Teleradiology, where the timely processing of STAT studies is crucial for diagnosis and treatment of the patient

Custom Scriptable Routing RulesAllow for custom routing and processing to be performed using almost

any tag in a DICOM object that is being received or transmitted This can eliminate time consuming tasks that would otherwise be

performed by a QC / post-processing tech

Workflow Triggers execution upon receiving HL7 messages

Page 23

Product Offeringsb. Gateway QC versus Viewer

Basic Features Gateway QC Viewer

DICOM Printing Optional ☑

Reporting Features

Auto Report Distribution: Email, File, Export Optional ☑

Custom Word Report Templates with DICOM fields Optional ☑

Diagnostic Reporting Optional ☑

Digital Dictation and Transcription Optional ☑

Document Scanning Optional ☑

Dragon Medical Voice Recognition Integration and License

Optional ☑

Electronic Report Signing Optional ☑

Structured Report Templates (based on RSNA guidelines)

Optional ☑

Page 24

Product Offeringsb. Gateway QC versus Viewer

Page 25

Administrative and IT Features Gateway QC Viewer

Searchable Audit Trails -End Users, Patient, and Study ☑ Optional

Automatic DICOM Field Mapping ☑ Optional

Edit Demographics ☑ Optional

Image Storage ☑ Optional

Routing Features

Customizable Scripting Routing Rules Optional Optional

HL7 Triggers for Prefetching Optional Optional

Rapid Routing (Proprietary Technology) Optional Optional

Any Questions?

Page 26