PACS In Nuclear Medicine
Practical Experience from the Cromwell Perspective
Agenda
Introduction
The Cromwell Hospital
The Nuclear Medicine Department
Making The Change
The Challenging Points
The Good Points
The Next Step
Reflections
The Cromwell Hospital
Situated close to the heart of London, the 150 bedded Hospital was opened in 1981. It is an internationally recognised Centre of Excellence. Our Aims and Objectives are “To make people better in a safe and caring environment, with state of the art equipment, highly trained staff and London’s leading doctors.”
Nuclear Medicine Department
The Nuclear Medicine Department comes under the umbrella of The Department Of Diagnostic Imaging. The dual headed ADAC Forte Gamma Camera was installed in September 1999. Bone scansMyoview scansRenal scansThyroid scansInfection ImagingPost Therapy Imaging
The Scanning Area
The Injection Room
Workload - 2004
0
20
40
60
80
100
120
140
160
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
Total BoneExaminations
Total CardiacExaminations
Total Renalexamination
Other Examinations
Total PETExaminations
Workload 2005 (YTD)
0
20
40
60
80
100
120
140
160
1stQtr
3rdQtr
TotalBoneExaminations
TotalCardiacExaminations
TotalRenalexamination
OtherExaminations
PACS
Picture Archive and Communication System
Picture: Images are available digitally rather than on film
Archive: Images are stored on a computer archive
Communication: Allows the transmission of the images to the archive, and from there to the viewing terminals
System: Manage the acquisition, storage and distribution of images and reports
Broker
InternetIntranet
Quadrat RIS
CDBurner
WardsMedical officesRemote PCs
Imaging ReceptionEnter RIS Order
Document ScannerRequisition scanned in Radiographer receives
patient
Rad. chooses examfrom worklist Exam is performed
Radiographer QC’s exam& Sends to PACS
PACS Image ServerPACS OracleDatabase
Radiologist Views Imagesand Reports Study
Webserver
DLT Backupovernight
PACS Review StationsFor Radiographers, OPD, Wards
Laser FilmPrinter
Transcription
Prefetching
Previous
Cromwell Hospital - PACS Workflow
Making The Change
The Start Printers Network Updates Training Retraining Go-Live Updating the PACS Database
Learning Issues
How to Use the DICOM Worlist
The DICOM Print Window
Sending Images To PACS
Time Management
DICOM Worklist
Dicom WorkList DatabasePatient study information available on RIS is directly transferred to the imaging modality. The records on the system corresponds to the scheduled study entered on RIS. This eliminates errors that can occur when information is manually entered on the systemWhen you select a patient from the worklist the fields in the Patient Information Form are automatically updated.
DICOM WorkList Information is embedded into the acquired image object and all image objects obtained as a result of processing the acquired image.The input of patient data is a normal you select the procedure, ID and name. The Atlas server searches the Pegasys database and the DICOM Worklist for patients that match the criteria and then shows the patient List Form. NB. Important that correct study is selected otherwise goes into an area called mismatch on PACS.
Cheat Sheets
Check QDoc against your ...log to show allexaminations performed the previous day
Are the images on PACS ?
W ere the examinations performed ended?
IMAGE TRANSFER CHECK
W ere all the examinations listed in QDoc performed?
Yes
Take no further action
No
YES If booked appts cancel via QPlanner otherwiseinform Annette, Christian, or Simone. Do notdelete the examination from inside the request
No
Send images to PACS
If there any queries contact annette, Christian or Simone
THIS IS TO BE PERFORMED DAILY
The Challenging Points
Cannot view dynamic images on PACS
NM Physicians decided that they wanted to see the majority of images displayed white on black. At present by default the images are displayed black/white and we fix this on PACS
Difficulty in getting people to change how they do things
Clinician Acceptability
The Good Points
Provide fast, simultaneous access to radiological images on computer terminals throughout the Cromwell Hospital
Multiple access to images
Reduced errors: naming errors on the modality
Patient Centred - Patient can be shown x-rays and magnification can increase understanding of problem. Increased information and comprehension of problem increases compliance with treatment
Can view previous studies easily and are if they have been archived they can be retrieved in seconds.
Addition of old films when not digital
The images can be adjusted on screen for ease of viewing
The Next Step
PET/CT 2006
In future there will be the potential for Teleradiology, i.e. sending images between hospitals in the UK and overseas.
Home Reporting for On-call or Urgent cases
Reflections
The introduction of PACS (Picture Archive and Communication System) was part of the Hospital’s ongoing commitment to invest in the latest technology, and is in line with government proposals for the implementation of a PACS system throughout the whole of the NHS by 2007.
The Past
The Present
The Future
