Electronic data is fast replacing old-fashioned paper, film and hard copy records in the medical industry. One type of data that is very common in the medical field is image data, referred to in the industry generally as Digital Imaging and Communication in Medicine, or “DICOM,” data. Most modern medical imaging devices (referred to hereafter generally as a ‘modality’ or ‘modalities’) are now designed to generate DICOM data and send it to a medical database referred to as Picture Archiving and Communication System, or “PACS system” for short.
Modalities include such devices known as Computed Tomography (CT or “Cat”) Scanners, Magnetic Resonance Imagers (MRIs), Positron Emission Tomography (PET) devices, Nuclear Medicine (NM) devices, Ultra-Sound (US) scanners, and Computed Radiography (CR) scanners to name just a few. Modalities generate DICOM data, often with modality-specific data or transmission formats, which are transmitted to and archived on the PACS system through which medical practitioners can access the DICOM image data.
A PACS system stores medical images received from the modalities on computers called DICOM Servers. The DICOM servers provide central storage and access to the images. They are referred to as servers because they ‘serve’ up the images to radiologists and other healthcare staff for diagnostic interpretation and ongoing clinical patient care in Clinic, hospital and home settings.
A PACS network often involves hundreds of modalities that generate DICOM data, DICOM servers that store the DICOM data, and workstations that retrieve DICOM data from the archive so that it can be reviewed by medical personnel. Often each device in the PACS network uses proprietary software and hardware and generates and transmits DICOM formatted data in a device-specific format.
One common problem in PACS network administration relates to a slowdown in the transfer of images and image data on the network. Often slowdowns are not detected until a complaint is received by PACS administrator, after the slowdown has adversely impacted some user of the PACS network. The PACS administrator then must check each link in the distributed network to identify the source of the slowdown. Then the cause of the slowdown must be determined and corrected.
Slowdowns can be caused by any number of reasons including hardware failure and incompatible software on any one the devices in the PACS network. One common cause is installing a new version of software on a device, such as a modality in the network. Often it is assumed that a newer version of software will automatically work on a device because the older version works. However, because there is no universal standard, devices on the PACS network typically must be integrated into the PACS system for the device to interface properly with the rest of the PACS network. Integration is time consuming and expensive, requiring skilled technicians including the hospital's PACS administrator, the PACS system technician, and the modalities Field Service personnel. When installing a new version of software, it is often forgotten that substantial changes may have been made to the original version of the software during integration. The resulting incompatibility may cause a perceived slowdown anywhere within the entire PACS network even though the slowdown may not be discernable at the device that is the cause of the slowdown.
For example, integration of computing devices on a PACS network often involves programming the computing device to create a header of a format that the PACS network can recognize quickly and process efficiently. Often, updating software versions on computing devices will unwittingly change the Network Interface Card (NIC) settings because the PACS system-specific changes made during integration are lost or overwritten. When a DICOM image is sent to a PACS server through a NIC that has sub-optimal speed or duplex settings then it directly impacts the performance of the network.
For example, the network interface card settings of a personal computer or workstation may be unwittingly changed when installing new software from the original settings selected by the PACS administrator. Depending on the architecture of the PACS network and the computing device's location within the flow of DICOM image data, this change result in a “bottleneck” that slows data transfer throughout the PACS network. Because the change was unknown, it may take the PACS administrator a significant amount of time to identify the network interface settings as the source of the problem. This slows down the delivery of the images to healthcare providers and impacts patient care especially in critical care situations like and Emergency or Operating room environments.
In addition, these settings are often negotiated periodically such as every five minutes and can change in response to changing in the network, such as changes in the signal strength of a wireless communication.
Another problem is the false perception of a slowdown. Often, PACS network users base their perception of the network's performance on the speed at which an image is displayed on a screen after a request or the time it takes to transmit an image to the DICOM server. However, different images may differ greatly in the size of the image file, even when they are the same type of image from the same modality. Thus, users may perceive a slowdown when, in fact, the system is operating at the same speed but the user is dealing with an unexpectedly large image file. User complaints based on such false perceptions are difficult to track down by PACS administrators as they are now tasked with verifying that the system is operating appropriately.
Yet another problem is associated with handling medical data. Due to various federal and state laws regarding the confidentiality of medical data, it is important that confidential information be maintained in confidentiality by the PACS administrators and technicians tasked with maintaining the PACS network. This adds an extra layer of complexity in the administration of the PACS network because some of the medical image data on the network, particularly the patient identification information allowing DICOM images to be associated with a patient, should not be accessible by anyone looking over the shoulder of the PACS administrators.