One of the typical responsibilities of a PACS administrator
is adding a new image acquisition
With proper preparation prior to and during the actual
installation, the success rate of the install can be increased and the time to get
it up and running can be greatly reduced and frustration kept to a minimum.
This is the check list I recommend prior to the install:
1.
Do a “paper validation” between the modality and
its connections, i.e. DICOM worklist provider, DICOM destination(s) for image
Store, Storage Commitment, Modality Performed Procedure Step, and Structured
Reports. Get the DICOM conformance statements for these devices and compare
them against each other. Make sure you get the right version of these
conformance statements as functionality can differ substantially between
different releases. Specifically look for the following in these documents:
a.
Make sure that there is support for the type of
DICOM files (SOP Classes) you will be exchanging. Be aware of and look for
support of the new “enhanced” SOP Classes such as for CT, MR, Angio, RF, breast
tomosynthesis, IV-OCT and others.
b.
If you want to compress the images at the
modality, make sure there is support of the type of compression at the source
and destination(s) (JPEG lossless, lossy, Wavelet, MPEG for video, etc.)
c.
If you want to use Storage Commitment, make sure
its behavior between the SCU and SCP matches with regard to the handling of the
associations for the reply.
d.
If you want to use Modality Performed Procedure
Step (MPPS), make sure that the implementation matches your workflow, for
example, you don’t want to have MPPS report the study being complete if there
are still images to be sent, processed, or imported.
e.
Match the worklist attributes between the
modality and worklist provider and look for alternate mapping in case
attributes might be missing on the modality side. An example would be to map missing
patient weight or allergies in a Patient Comment field if that is required at
the modality but not displayed.
2.
Do a “file validation” by asking the vendor to
send you a CD with images, making sure that each type of image is on the CD. In
addition, get sample Structured Reports, such as dose reports for CT or
measurements for ultrasound and echo. Import these files on a test PACS, Voice
Recognition and Dose management system and verify proper display of the images
and measurements. Make sure that the
hanging protocols work at the workstations and if not, troubleshoot it to find
what the cause is (study descriptions, body part, etc.)
3.
Do an “install validation” by using a modality
simulator that is able to query a worklist using the same attributes as used by
the new modality and simulate Store for the various file type to the test PACS.
Simulate the Storage Commitment and MPPS. There are commercial modality
simulators available (e.g. OT-DICE)
as well as open source ones (DVTK). When
doing the simulation, use the same IP address, port and AE-Title that the new
modality would be using. It is strongly recommended to use best practices for
the AE-Titles and port numbers, i.e. use an all caps AE-Title that indicates
the institution, location and modality, and use the standard port number
(11112) as assigned by IANA to DICOM devices. Work with IT so that you get a
new, fixed IP address assigned for the new modality and make sure they
configure the VLAN and routers to allow access.
If you have taken all these precautions, you should be able
to swap out the simulator for the actual device, and the chances are that it
might be “plug-and-play” assuming you addressed all the issues during the
pre-install phase.
However, if it still does not work, you might want to do
some troubleshooting using the tools as described in part 2 of this post.
