housekeeping: pacs cleaners and sweepers dr nicola h strickland consultant radiologist hammersmith...

Housekeeping:Housekeeping:PACS cleaners and sweepersPACS cleaners and sweepers

Dr Nicola H StricklandDr Nicola H Strickland

Consultant RadiologistConsultant RadiologistHammersmith Hospitals TrustHammersmith Hospitals Trust

London, UKLondon, UK

Why this title?Why this title?

• PACS is not like a fridge!PACS is not like a fridge!

• It needs looking afterIt needs looking after

• ““a PACS nursemaid”a PACS nursemaid”

• sweeper and cleaner to keep database tidysweeper and cleaner to keep database tidy

Jobs to be doneJobs to be done

• daily housekeepingdaily housekeeping

• pre- and post upgrade housekeepingpre- and post upgrade housekeeping

Daily housekeepingDaily housekeeping

1.1. unspecified examsunspecified exams

2.2. exams erroneously marked dictatedexams erroneously marked dictated

3.3. unreported examsunreported exams

4.4. unverify exams on requestunverify exams on request

5.5. CR / DR problems CR / DR problems

6.6. ““unfetchable exams”unfetchable exams”

Unspecified examsUnspecified exams

• appear as, eg. “unspecified CR”appear as, eg. “unspecified CR”

• problem caused:problem caused:

historical exams of same body part and historical exams of same body part and same modality not displayed same modality not displayed automaticallyautomatically

• action:action:

exam needs to be merged with correct exam needs to be merged with correct folder for that exam on PACSfolder for that exam on PACS

Common causes of “unspecified”Common causes of “unspecified”

• RISRIS DICOM modality worklist (on modality)DICOM modality worklist (on modality)

PACS “order entry”PACS “order entry”

• RIS updateRIS update no update to modality worklistno update to modality worklist

PACS updates correctlyPACS updates correctly• no DICOM modality worklistno DICOM modality worklist

typographical / demographic errorstypographical / demographic errors

• later follow-up images added to same examlater follow-up images added to same exam eg. nuclear medicine white cell scaneg. nuclear medicine white cell scan eg. ultrasound post micturitioneg. ultrasound post micturition• solution: DICOM perform procedure step solution: DICOM perform procedure step

(PPS) needs to be supported on the modality (PPS) needs to be supported on the modality and on PACS. and on PACS.

• PPS allows a “step” of the exam to be PPS allows a “step” of the exam to be completed without closing the whole studycompleted without closing the whole study


• bizarre equipment malfunction!bizarre equipment malfunction! unpredictable change of demographicsunpredictable change of demographics

eg. nuclear medicine workstationeg. nuclear medicine workstation


Exams erroneously marked dictatedExams erroneously marked dictated

CausesCauses::

• human errorhuman error (by radiologist) (by radiologist)

hit the dictated key/click dictated icon by mistakehit the dictated key/click dictated icon by mistake

• report “lost”report “lost” tape lost / corruptedtape lost / corrupted dictation system malfunctiondictation system malfunction

• report typed but not sent to PACSreport typed but not sent to PACS

ActionAction::

• decide date range, eg. up to 4 weeks agodecide date range, eg. up to 4 weeks ago

• identify status “reported” but not “completed”identify status “reported” but not “completed”

• check no typed report exists on RIS / speech check no typed report exists on RIS / speech recognition systemrecognition system if none does......if none does......


ActionAction::

• restore “unreported” status so exam reappears restore “unreported” status so exam reappears on worklist for reportingon worklist for reporting

• identify and alert radiologist responsible identify and alert radiologist responsible (for specials only)(for specials only)

• if typed report does exist on RIS / speech rec if typed report does exist on RIS / speech rec system: system: resend to PACSresend to PACS correct error sending to PACScorrect error sending to PACS


Unreported examsUnreported exams

1.1. very old (months ago) unreported examsvery old (months ago) unreported exams

●● status may change automatically:status may change automatically:

“ “dictated off-line”dictated off-line”

●● only a problem when you first start only a problem when you first start housekeepinghousekeeping

● ● re-instate unreported status re-instate unreported status back on worklist back on worklist

● ● alert appropriate radiologist (for specials)alert appropriate radiologist (for specials)

Unreported examsUnreported exams

2.2. “missed” recent unreported exams (specials)“missed” recent unreported exams (specials)

●● eg.eg.

●● at at session handover for CT/MRsession handover for CT/MR

●● on call (junior radiologist) – verbal report givenon call (junior radiologist) – verbal report given

● ● re-instate unreported statusre-instate unreported status

● ● alert appropriate radiologist (for specials)alert appropriate radiologist (for specials)






5.5. CR /DR problems CR /DR problems


Unverify exams on requestUnverify exams on request

1.1. on request by radiologiston request by radiologist

●● so that post-processed images can be sent so that post-processed images can be sent

to PACS, eg. CT reformatsto PACS, eg. CT reformats

● ● needed because PACS does not yet support needed because PACS does not yet support DICOM perform procedure stepDICOM perform procedure step

Unverify exams on requestUnverify exams on request

2. on request by radiographer2. on request by radiographer●● extra image taken laterextra image taken latereg. eg. - IVU delayed image- IVU delayed image

- further view requested by radiologist- further view requested by radiologist● ● exam already dictated and completed by exam already dictated and completed by radiologist before all (CT/MR) images sent to radiologist before all (CT/MR) images sent to PACS by radiographer! (viewed PACS by radiographer! (viewed by radiologist on 3D workstation)by radiologist on 3D workstation)






5.5. CR / DR problemsCR / DR problems


CR / DR problemsCR / DR problems

• wrong plate put through CR readerwrong plate put through CR reader another patient’s image assigned to the examanother patient’s image assigned to the exam

unverify examunverify exam reassign image correctlyreassign image correctly

• wrong processing algorithm usedwrong processing algorithm used Reapply algorithm on plate reader / DRReapply algorithm on plate reader / DR

““unfetchable” examsunfetchable” exams

• old exams not retrieved from long term archiveold exams not retrieved from long term archive

• a rare problema rare problem

• alert PACS engineer = a de-archiving problemalert PACS engineer = a de-archiving problem

Jobs to be doneJobs to be done

• daily housekeepingdaily housekeeping

• pre- and post upgrade housekeepingpre- and post upgrade housekeeping

Upgrades housekeepingUpgrades housekeeping

• printprint film / CDs of critical key images film / CDs of critical key images requested by clinicians, eg. NNUrequested by clinicians, eg. NNU

• merges +++merges +++ post upgrade post upgrade no RIS no RIS modalities worklists modalities worklists no RIS no RIS PACS order entry PACS order entry

Policies!Policies!

• anything sent to PACS anything sent to PACS must must have a RIS entryhave a RIS entry digitizationdigitization CD uploadingCD uploading out of hours exams (especially ultrasound!)out of hours exams (especially ultrasound!)

• restricted digitization / CD uploadingrestricted digitization / CD uploading requires radiologist authorizationrequires radiologist authorization

• restricted film printing / CD burningrestricted film printing / CD burning requires radiologist / radiographer requires radiologist / radiographer

authorization authorization

The “nappy changing team”!!The “nappy changing team”!!

Imaging support systems groupImaging support systems group (ISSG) (ISSG)

• 4 radiographers (2 full time posts, one at HH, 4 radiographers (2 full time posts, one at HH, other at CX)other at CX)

• why 4? why 4? covers annual and sick leavecovers annual and sick leave

• why radiographers?why radiographers? understand difference between study types understand difference between study types

and body partsand body parts

The “nappy changing team”!!The “nappy changing team”!!

Imaging support systems groupImaging support systems group (ISSG) (ISSG)

• pattern of errors noticed early:pattern of errors noticed early: corrected, working practices changed etc.corrected, working practices changed etc.

• report to the “POG” (PACS operational group)report to the “POG” (PACS operational group) team cohesionteam cohesion

housekeeping: pacs cleaners and sweepers dr nicola h strickland consultant radiologist hammersmith...

Documents

unreported exams status

historical exams

radiologist exam

procedure stepunverify

pacs cleaners

alert radiologist responsible

typed report

aftera pacs nursemaidsweeper