PACS Operation

PACS Operation
Q.1 Suggest two different ways to archive the DR image into the PACS.

– In DR after we finished examining the patient and adjusting the image contrast resolution, we click on end the exam button, the image will be directly sent to the destination by default to the Addresses that have been saved in the system. This way will facilitate the work if the PACS (IP) address is already saved in the system, does not require the radiographer to put the IP address every time he/she finishes from an exam which will take time.
– If there is any communication problem regarding sending the image, it will show up as (×) symbol found under the store result column on past exam interface, we need to do it manually after the problem got solved. Click to the past exam button, then click on the case we need to send from the study list and then we click on send image icon and choose the destination and press send exam button. This need to be happened as soon as the exam finished in order to not delay the diagnostic report.
Q.2 Suggest a way to use the DR system to check the DR image archival status.
By looking at store result column found on past exam interface, we might see:
? “ a green tick icon “means the image is successfully sent to the selected destination.
× “a red cross icon “means, there is a communication problem, the image has not been sent to the saved destination.
– “a dash symbol “ means the routing destination not selected, so no image has been sent.
Double arrows mean (sending)
Double dashes mean the image is not sending to any PACS, this in case we do not want the radiologist to see the image. For example, If the image is unreadable or hard to diagnose because the examination was inappropriate.
We might see on the statues (Tick and cross) this mean the image has sent to one PACS but there is a communicating problem to the other one such as wrong IP address. The purpose of checking the Archiving status is to make sure the image has been sent to radiologist for diagnosis, if not this will lead the diagnostic report to delay.
Q.3 Describe the key steps involved in the ‘Send and Receive’ process for the DR image?
Image receiving:
1- Association which is the identity check. Modality need to ask the PACS for potential communication. The PACS then will check the modality identity and try to look at the Application entity (AE) title list, if the PACS can see the name of the modality within the AE title list, it will provide the communication service. If not, the association will delay and no further communication will occur.

2- After the PACS has checked the modality identity and found the DR modality is compatible with the PACS, C- store service will be provided.
3- Image stacking which the PACS will form very special four levels of structures within the hard disk. After the PACS has saved the file, will extract the details from the file, such patient name/patient ID. The PACS then will pass all the details to the PACS database to form the Images record (Indexing). The details will be put in multiple database tables. For example, patient name will be stored under patient name table.
4- The final step after the image stacking is the PACS database update. when we move an image from short term archive to long term archive we need update the index in order to the PACS server to know the image storage location.
Q.4 Suggest five ways to use the PACS server to check the DR image archival status?

To check whether the file has been saved into the PACS successfully:

1- By looking at the PACS sever log and check if the file is written in the system (Patient name/ ID), this means the PACS has saved the file successfully.
2- Go to the PACS database and check if there is image record (Patient name/ ID), this means the PACS has already saved the file and then extract the details information from the file and put the information as new record ,so if you can see the image record this mean the image has been saved into the PACS successfully.
3- Each PACS, it has a specific default DICOM file storage location. We just go the default DICOM file storage location and find the file, if we can find it, this mean it has been saved successfully.
4- Go to PACS server program and then to files database record, if we can see the record, this mean the file has been put into the PACS.
5- Use the Query/move function of the PACS and we can search for the file by using patient name or patient ID and press to search button , if we can see the record of the image, this mean it has been saved.
The reason we have five methods to check the DR image archival status three of them (1,3,&4) are related to the PACS server and one (2) is related to the database server that if there is any issue in the PACS server we can go to the database server to check the image archival status. The last method which by using the Query and move functions is to facilitate the workflow as the easiest way to check the archival status just by putting the patient name or patient ID. It is also easier for the radiographers who do not have enough experience about the PACS in details.

Q.5 Suggest the function(s) of the PACS database?

The main function of PACS database is to manage the patients’ details and form the image index. When the PACS server receive an image from the modality, it will extract all its details , such as patient name, study level and put it as new record in the database server. The database contains multiple database tables, so it works to organize the details. For example, patient name will be stored under patients table and the study information under the study table. This will facilitates the information structure for query and retrieves process. If we do not have the PACS database, it will be hard for us to find a particular file.

The other function, it can store diagnostic report from the RIS as well as receive information about the patients such as admission/discharge/transfer from the HIS. However, this will require the database system to interface with HIS and RIS in order to allow the PACS database to receive more information about the patient from those databases. When the RIS passed information to the PACS database that patient will have a test in the coming future, the database will give the PACS sever order for prefetching the patient old exam. In addition, give the PACS server to move the image from short term archive to long term archive when the patient is discharged from the hospital.
Q.6 Suggest the steps to use the display workstation to query and retrieve the DR image from PACS?

We use the workstation software to query and retrieve the DR image. We need to provide the search criteria, such as patient ID and then select the proper PACS (PACS Curtise). After we click the search button, the workstation program initiates the C-FIND request. The PACS then will find the matching record from the PACS database and send it back to the workstation (C-FIND). The workstation will identify the appropriate record of image that wants to retrieve. The PACS goes to the file directory to get the image, here where (C-MOVE) initiated. The retrieved image has sent to the workstation. Finally, the PACS will ask the workstation to provide the (C-STORE) by storing the image.

 

Q.7 Suggest the steps to use the display workstation to retrieve the diagnostic report from RIS?

When we finish from Q/R process, we will have the image displayed; we can press on report icon at the bottom of the image in order to get the report from the RIS. For retrieving the report from the RIS which will be in HL7 format and we need it in DICOM format in order to be read by the workstation. The request from the workstation will be first sent to database gateway (PACS broker) to change the request language from DICOM to HL7 format in order for the RIS to understand the language (HL7). When the RIS got the request will send the report to the workstation through the database gateway to change the language from HL7 to DICOM format in order to be encoded in the PACS.

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