PACS strategic plan and needs assessment, technical Issues, PACS architecture.

PACS strategic plan and needs
assessment, technical Issues, PACS architecture.

1. Medical Image Processing Medical Image Processing
Server using DICOM.Server using DICOM.
Barberis, Sebastián (1), Graffigna, Juan Pablo
(2), Isoardi, Roberto (1)
1 – Escuela de Medicina Nuclear. Mendoza. Argentina.
2 – Universidad Nacional de San Juan. San Juan. Argentina.
[email protected]

2. Problematic Situation

Algorithms developed by research groups Algorithms developed by research groups
present inconvenients that make difficult their present inconvenients that make difficult their
validation and clinical implementation.validation and clinical implementation.

Highly trained medical and technical staff Highly trained medical and technical staff
usually work in very demanding usually work in very demanding
environments and cannot employ the environments and cannot employ the
developed tools.developed tools.

For the validation, a selection of studies and For the validation, a selection of studies and
its later processing is required. Actually, its later processing is required. Actually,
validations are performed manually.validations are performed manually.

3. Objetive
–The implementation of a centralized The implementation of a centralized
processing server processing server that allows solving that allows solving
different needs in diagnosis and researchdifferent needs in diagnosis and research. .
–The development of a DICOM system The development of a DICOM system
interact within a PACSinteract within a PACS..
–Quickly associate research processing Quickly associate research processing
algorithms to clinical implementation, algorithms to clinical implementation,
allowing their validationallowing their validation..

4. WorkstationWorkstation
Network ServiceNetwork Service
ModalitiesModalities
Diagnostic Diagnostic
WorkstationWorkstation
Storage Storage
ServerServer
DICOM PrintersDICOM Printers
PACS PACS
ManagerManager
HIS / RISHIS / RIS
Processing Processing
ServerServer
Connecting to a PACS system

5. Features

Communication of studies in clinical environments (DICOM).Communication of studies in clinical environments (DICOM).

Different algorithms of processing:Different algorithms of processing:
• Intermodality/intrapatient registration for radiotherapy.Intermodality/intrapatient registration for radiotherapy.
• Intramodality/intrapatient registration for treatment Intramodality/intrapatient registration for treatment
monitoring.monitoring.
• Processing of single studies for diagnosis. Processing of single studies for diagnosis.
• Others.Others.

Easy administration and set-upEasy administration and set-up

Automatic Function.Automatic Function.

Multi-thread.Multi-thread.

Stability against failures.Stability against failures.

Development with GPL tools.Development with GPL tools.

6. Tools used

Support tools for design:Support tools for design:
•Notation diagrams in Unified Modeling Language UML.Notation diagrams in Unified Modeling Language UML.
•Tool box BOUML® release 2.32Tool box BOUML® release 2.32

Develop Enviroment and compiler: Develop Enviroment and compiler:
•Code::Blocks 8.02Code::Blocks 8.02
•Compiler MinGW 3.4.5Compiler MinGW 3.4.5

DICOM facilities: DICOM facilities:
•CTN of Mallincrodt Institute of Radiology. CTN of Mallincrodt Institute of Radiology.

Database facilities.Database facilities.
• MySQL 5.0 API for C.MySQL 5.0 API for C.

Processing AlgorithmsProcessing Algorithms

Research project.Research project.

7. Implementation model - Application Data Flow

8. Implementation of the DICOM standard

The whole communication and transfer of images with The whole communication and transfer of images with
remote application entities is carried out using the DICOM remote application entities is carried out using the DICOM
network protocol using the TCP/IP protocol. The functions network protocol using the TCP/IP protocol. The functions
supported by the entities of the system are:supported by the entities of the system are:

UL services supported are: A-ASSOCIATE, A-RELEASE, A-UL services supported are: A-ASSOCIATE, A-RELEASE, A-
ABORT, A-P-ABORT and P-DATAABORT, A-P-ABORT and P-DATA
SCU
(Application Entitys ‘Send’)
SCP
(Application Entitys 1 to N)
Storage. Storage.
Verification.

9. Implementation of the DICOM standard

The reception Applications Entity in this system The reception Applications Entity in this system
support a great number of storage service class support a great number of storage service class
(listed in its Conformance Statement) and the (listed in its Conformance Statement) and the
verification service class.verification service class.

As the communication module only supports the As the communication module only supports the
storage and verification, the response to other storage and verification, the response to other
request (as posts C-FIND or C-GET) is reject whit request (as posts C-FIND or C-GET) is reject whit
the corresponding response messages.the corresponding response messages.

10. Features database

1) Contains the configuration parameters (available 1) Contains the configuration parameters (available
processing algorithms, conditions for them, processing algorithms, conditions for them,
assigned port, etc).assigned port, etc).

2) Served for recording studies information 2) Served for recording studies information
(general and specific data).(general and specific data).

Both sets of data are used to making decisions.Both sets of data are used to making decisions.

Decision-making system: SQL QueryDecision-making system: SQL Query

11. Thread use

Allows opening a listening port for each different Allows opening a listening port for each different
processing algorithm (including their capacity of processing algorithm (including their capacity of
solve one o more association request).solve one o more association request).

Allows the separation of tasks and avoid problems Allows the separation of tasks and avoid problems
that can halt its overall performance. The latter is that can halt its overall performance. The latter is
important because the imaging techniques can be important because the imaging techniques can be
used in a development phase, causing instability in used in a development phase, causing instability in
the processthe process

12. Test and application

This tool has been implemented in a Medical This tool has been implemented in a Medical
Imaging and Radiotherapy center, “Escuela de Imaging and Radiotherapy center, “Escuela de
Medicina Nuclear, Mendoza, Argentina” including Medicina Nuclear, Mendoza, Argentina” including
three image processing algorithms. three image processing algorithms.
•Quality control in computed tomography. Quality control in computed tomography.
•Flip process to prepare PET studies for Flip process to prepare PET studies for
Radiotherapy Planning. Radiotherapy Planning.
•Cropping and segmentation of MRI brain Cropping and segmentation of MRI brain
studies.studies.

13. Test and application
Quality control in computed tomographyQuality control in computed tomography
Cropping and segmentation Cropping and segmentation
of MRI brain studiesof MRI brain studies..
Flip process to prepare PET Flip process to prepare PET
studies for Radiotherapy studies for Radiotherapy
Planning.Planning.

14. This work has allowed the development of a
Processing Server in accordance with DICOM
standard.
It is possible to integrate new processing
algorithms to clinical environments.
The application allows an automatic management
of studies. The decision made determines which
operation must be executed, which studies take
part, and to whom the results must be sent.
The system can receive several studies, execute
algorithms, or send results simultaneously using
different processing threads. Operations, ports,
conditions, etc., can be quickly modified by means
of a SQL database.
Conclusions

15. For the design and the development of the server,
GPL software tools have exclusively been used.
A weakness of the system is the necessity of
employing automatic algorithms that require no
user intervention. Even though there is a tendency
to this kind of techniques, there is no possibility to
interact with the user during processing tasks.
Regarding the implementation of the system in a
clinical environment, it is necessary to execute it
for a prolonged time in order to evaluate the system
and algorithms. It will allow to analyze the
organizational changes.
Conclusions