"Digital Imaging and Archiving in a Radiological Department The"
IAGS 2000 Proceedings VIRTUAL REALITY, TELEMEDICINE, DISTANCE CARE AND EDUCATION Digital Imaging and Archiving in a Radiological Department: The 2nd Radiology Department’s Experience at the University of Athens Dimitrios A. Kelekis, MD, E.P. Efstathopoulos, MD, E. Brountzos, MD, A.D. Kelekis, MD Present problems with film-based procedures. data processing equipment and communications, show Many aspects of the current organization and proce- impressive progress. Now technology is offering new dures in a radiology department are still based on means with which to organize the imaging department. film and paper documents for storage, display and These new means are not only compatible with the communication. These methods are slow and less new digital imaging modalities, but promise great effective and they are incompatible with the methods improvements. used with the increasing number of digital modalities Some years ago, the main problem of archiving digi- (CT, MR, DSI, Digital Radiology, etc.) which have tal images from any modality of a radiology department been developed and tend to abolish conventional in a common database was the incompatibility of digital imaging techniques. image formats between different modalities and manu- Film storage and retrieval in a conventional radiolo- facturers. This problem was recently solved when man- gy department present many problems. The more seri- ufacturers adopted a common protocol to manage ous of these problems are: slow access; loss of images medical images, named Digital Imaging and Communi- due to misfiling or unrecorded loans; difficulty in find- cation in Medicine (DICOM). The DICOM standard is ing a specific image at a needed time; no possibility of a set of rules that allow medical images to be interacting with the recorded information; requirement exchanged between instruments, computers, and hospi- for a large amount of space; and the need for a great tals. It establishes a common language, guaranteeing deal of physical effort in order to create and maintain that a medical image produced on one vendor’s an image database. These are some of the reasons that machine will be displayable on the workstation from created the need for the Picture Archiving and Commu- another vendor.5 nication Systems (PACS) some years ago.1,2 The Picture Archiving and Communication System Digital image management. The introduction of the (PACS) in Evgenidion University Hospital of Athens. first digital imaging systems has led to the concept of a In order to find a solution to all the above stated difficul- totally digital imaging department — the “filmless” ties in storing and managing conventional medical images department.3,4 This concept has now been grasped by printed on film, a PACS system has been developed in the clinicians, researchers and manufacturers. Develop- 2nd Radiology Department of the University of Athens in ments in key technologies, such as semiconductors, Evgenidion University Hospital. The main problem was that most of the medical equip- ment of the department did not dispose the DICOM stan- From the 2nd Department of Radiology, Evgenidion University dard. The digital modalities of the department are: a Hospital, University of Athens, Greece. Originally presented at the Sixth Biennial International Andreas Philips Tomoscan LX/C CT system, a Philips Diagnost Gruentzig Society Meeting in Crete, Greece. ARC digital subtraction angiography system, a Philips Address reprint requests to: D.A. Kelekis, Professor and Director Diagnost 96 digital radiology system, and a Philips of Radiology, 2nd Department of Radiology, University of Athens, Gyroscan ACS NT 1.5T MR system. From all these Evgenidion University Hospital, 20 Papadiamantopoulou St., 115 28, Athens, Greece. modalities, only the MR adopts the DICOM standard. 422 The Journal of Invasive Cardiology Digital Imaging and Archiving in a Radiological Department Table 1. Advantages of the Picture Archiving and Commu- MG, the signals are digitized and sent simultaneously nications system (PACS). to the laser imager and to the PACS server. At the same time, with the use of specially designed software Archiving Films Using PACS which performs an optical character recognition (OCR) Much physical effort need- No physical effort needed to procedure, all the identity data of the patient that were ed to maintain the archive maintain the archive written on the image are stored in another file. There Loss of images due to many No loss of images at this time are thus two files at the end of the procedure, one reasons including the identity data of the patient and another including the image in a digital format. This transfor- Need to print twice every Need to print every image image (one for patient use only once (for patient use) mation results in a patient file containing both the and one for the archive) patient data and the examinations performed on the patient (usually, there is more than one examination of 10–30 minutes average 3 minutes average image a patient from either the same modality or from differ- image retrieval time retrieval time ent modalities). In this way, all patient data are stored Very difficult to produce Not difficult to produce slides in a DICOM format. When selecting a patient, all slides for educational purposes for educational purposes examinations are displayed and when any one of them is selected, all the images can be viewed for diagnosis, processing, printing on film, or any other purpose. The PACS server consists of an Oracle database To overcome this problem, the video output from server together with limited image storage facilities. each non-DICOM modality was used. The video sig- This server is connected with a jukebox that can nals are sent to a laser film imager (Agfa LR3300) house 52 optical disks (OD) of 2.3 GB capacity each passing through a special purpose computer (Agfa for image storage, and each of them has a unique MG) which manages the printing procedure. With the label that tells the system which images are included use of an analog-to-digital converter placed into the on the disk. When all 52 ODs are full of data, the Archive Server + Workflow manager + Oracle Database Server M.O.D. Data Aquisition Jukebox 129 GB on line Philips CT Tomoscan LX/C Non DICOM modalities (video) Running on the same hardware M.G. Philips x-rays DSI (Digital S8PI) Provider Any Philips x- DICOM rays DVI modality (video) Hardcopy Figure 1. The picture archiving and communication system in the 2nd Radiology Department of the University of Athens: The scheduled situation. Vol. 13, No. 5, May 2001 423 KELEKIS, et al. system requires the replacement of the disks. If access to their patients’ images. The final scheduled someone requires images stored in a replaced disk, step of the expansion is to install a web server, which the system asks for the specific disk to be placed into will allow clinicians to retrieve images while away the jukebox. from the hospital (e.g., at their office or home). The A number of workstations (up to 50) can be connect- scheduled situation is shown schematically in Figure 1. ed on the server. Therefore, patient files can be distrib- Security aspects are now under consideration. uted in any work place in the department. The workstation is a common personal computer executing C o n c l u s i o n . The operation of the PACS system special software developed by Agfa Medical Company solved many problems that had arisen with the use of con- named IMPAX, which allows the user to find and dis- ventional films for archiving patients. The time required play any image of any patient stored. The software has to find important images has been shortened dramatically, all the common capabilities of a database, such as find- no images are missing, and the production of educational ing a patient by name, examination date, type of exami- materials is very easy — a very important feature consid- nation, etc. It also provides the possibility to extract ering the duties of a University Department. images outside the system in common image formats (.tiff, .bmp or DICOM), print images on film, perform common image processing, etc. REFERENCES This system has been operating since January 2000, 1. Lehr JL. Impact of manual and computer-assisted PACS for and the examinations of all patients are stored. The use automated PACS. Radiol Manage 1983;5:2–10. of the system has resulted in the easy location of any 2. Cadenhead G. PACs — What they are and what they do. Miss patient. The average time for displaying a specific image RN 1983;45:16–17. of a certain patient is 3 minutes, as compared to 10–30 3. Osteaux M. Radiology is digitally headed. Eur J Radiol minutes when conventional films were stored in a room. 2000;34:1–2. Other advantages of this system are shown in Table 1. 4. Strickland NH. PACS (picture archiving and communication sy st ems): F ilml ess rad i o lo g y. Ar ch Dis Child 2000;83:82–86. Future targets. The next step of the system expan- 5. Digital Imaging and Communications in Medicine. National sion is to install workstations in all departments of the Electrical Manufacturers Association (website). URL: hospital, allowing clinicians to have easy and prompt http://medical.nema.org/dicom.html 424 The Journal of Invasive Cardiology