3. PACS

Question 1

what does PACS stand for

Answer 1

picture archiving & communications system

Question 2

what were the benefits of digitising medical data and waht are some examples

Answer 2

• manage surge in patients
• interoperability
• continuity of care
• efficiency of care

examples = medical imaging, OCR, voice recognition for dictation, lab reports etc

Question 3

does a gamma camera work on a dead patient

Answer 3

no

Question 4

what is DICOM

Answer 4

standard for handling, storing & printing info in medical imaging

also a file format def & network communications protocol

Question 5

what are the PACs levels

Answer 5

dept, hospital, state

Question 6

what is CMRGlu

Answer 6

cerebral metabolic rate of glucose consumption - used for dementia

Question 7

what is EIR

Answer 7

enterprise imaging repository where patients can be searched and their imaging viewed

central repository across state-wide public hospitals

Question 8

why do we need digitisation of medical data

Answer 8

• manage the surge of patients
• collect massive amounts of data
• use data to improve standard of care
  -ageing population

Question 9

what are some structural medical images

Answer 9

xray, OCT (optical coherence tomography), US

Question 10

what are functional medical images,with examples

Answer 10

any medical image that examines changes in metabolism, blood flow, chemical consumption & absorption

cardiac MRI, functional MRI, dynamic PET

Question 11

what is the diff between PET and CT

Answer 11

CT shows the anatomical structure while PET shows the physiology of a metabolic structure e.g. the blood supply of a tumour

Question 12

what is an issue with all of the advancements in imaging

Answer 12

data explosion = multiple scans = more data
more sophisticated imaging * more patients =
PETs generate > 40TB of data a day (imagine the cost)

Question 13

what is PACS purpose

Answer 13

storage & communication of imaging data

Question 14

what does PACs integrate with

Answer 14

EMR (institute level/hospital)
also follows HL7

Question 15

what are PACS features

Answer 15

• standardisation (DICOM, HL7)
• cost-effectiveness
• fault tolerance
• connectivity (multi-disciplinary teams can access their respective modalities)
• architecture

Question 16

what are the 4 levels of dicom data

Answer 16

• patient
• study
• series (PET, CT)
• image (CT has 128 slices)

Question 17

what is PMS

Answer 17

pharmacy management system

Question 18

why are big PACS vendors less popular

Answer 18

they have restrictive software, that makes data heterogeneous, whereas smaller companies are more open source so the imaging data can be more homogenous

Question 19

why are DICOM web-based viewers popular now

Answer 19

different images require different types of visualisations e.g. there are more greys in a radiologists visualisation, which may be different to a histologist, who needs more colours

Question 20

what is a PACS thick client model

Answer 20

• stand-alone
• images automatically sent to designated diagnostic & review WS
• short term cache

Question 21

what is a PACS thin client model

Answer 21

• client server
• images centrally archived in PACS server
• each client WS can access imaging from PACS
• no local storage, images flushed after reading

Question 22

what is a PACS web based model

Answer 22

• similar to client side but only a web browser is needed
• hardware can be platform independent
• viewed anywhere
• limited functionality & performance

Question 23

describe the interaction between PACS & PHR

Answer 23

• PHR can have links to the full PACS archive
• image compression is lossless
• includes diagnostic report with key images

Question 24

what is DICOM-SR & it’s purpose

Answer 24

• DICOM structured reporting
• rules for encoding, transmitting & storing imaging diagnostic reports
• structured doc containing text and links to waveforms (ECG), spatial & temporal coordinates (pathology location), images
• purpose is for it’s coding to enable integration with EHR

Question 25

image of DICOM-SR

Question 26

what is PACS customisation

Answer 26

the same software, with tuned features for a specific specialty. based on:
- patient volume
- number of interpretation areas
- diagnostic locations
- cost

Question 27

what is a major paradigm shift in PACS

Answer 27

vendor neutral archives (VNA):
- simplifies data migration issues
- inter-departmental data exchange
- long term enterprise wide storage

Question 28

Questions for Review

1. A hospital has an existing EHR system and several other HISes. They wish to
   establish an on-site PACS for their radiology department that integrates
   with the existing infrastructure. Explain how this establishment and
   integration can be achieved?
2. With the use of an example provide two benefits of Cloud PACS.
3. You have been asked to design a new PACS solution for your hospital.
   Select your preferred solution (standalone or cloud), justifying your
   selection by contrasting the limitations of standalone PACS and Cloud
   PACS.