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Introduction
History of PACS
PACS Function
PACS UNIT and
services
Q&A
• Hospital Selayang
• Hospital Putrajaya
• Hospital Serdang
• Hospital Ampang
• Hospital Sg. Buloh
• Hospital Alor Setar
• Hospital Sg. Petani
• Pusat Perubatan UKM
• Hospital USM
• Pusat Perubatan UM
Built: 2nd November 1993.
Operation: 1st July 1997.
Official Opening: 14th July 1998.
Teaching hospital.
1054 bedded.
23 operation room.
A collaboration project of PPUKM IT
Centre with Department of Radiology
Services
Started since 2001, on implementing:
› Integrated Radiology Information System
(IRIS)
› Picture Archiving and Communications
Systems (PACS)
Starting with Nuclear Medicine Unit.
2005 : Reporting facilities in the
Department of Radiology Services
11 computers with diagnostic monitors
having high resolutions of 3 and 5
Megapixel.
2006 : Expanded to other modalities
› MRI
› CT Scan
› Ultrasound
2006 : 2 Kodak CR reader
2006 : 2 Philips DR
2008 : DR Mamography
2009 : CBCT/ Digital OPG
2012 : 1 Konika CR reader
2013 : 1 Siemens DR
Modality Unit
Digital Radiography 3
Computed Radiography 2
Mobile Radiography 3
Digital Mobile C-Arm 4
Digital Fluroscopi 2
Angiography 2
CT Scanner 3
Bone Densitometer 2
Mammography 1
Mammography Biopsy 1
Magnetic Resonance Imaging 2
Ultrasound 8
CR Scanner 3
CBCT 1
Clinical monitors (PACS VIEWER) 12
Issue Explanation
Reengineering Vendor and clinician engagement
Workflow design Integrated work process and information
management
Physical design Interoperability in Ward, Clinic, Critical Care and
Operation Theater.
System design Workflow design, user interface and department
requirement.
Equipment interface Different vendor and image properties
Image management Work process and policy is not properly establish
– printing film policy.
Network band width not enough
High cost – modalities, high resolution image
viewer and compatibility issues.
Project management Training, operation, support and maintenance.
Modality
PACS
router
PACS
Server
Viewer
Backup
Server
Image
Server
PACS
Workstation
1. Acquisition
2. Storage
3. Viewing
4. Sharing of images
DIGITAL
RADIOGRAPHY
MOBILE
RADIOGRAPHY
ULTROSOUND
MAGNETIC
RESONANCE
IMAGING
CT SCAN
SPECT/ PET
SCAN
MAMMOGRAPHY
DIGITAL
FLUROSCOPY
CONE BEAM CT
ANGIOGRAPHY
1 2
3 4
5 6 7
RAID STORAGE
MEDWEB SERVER
SERVER RACK
Modality Matrix Size File Size (MB)
CT 512 X 512 0.5
MRI 512 X 512 0.5
CR/DR 2048 X 2494 10
Nuclear Medicine 256 X 256 0.128
Mammography 4096 X 3328 26.6
PET/CT 128 X 128 0.032
Ultrasound 640 X 480 0.3
*File sizes based on 2 bytes/pixel
0.5
0.5
10
0.128
26.6
0.032
0.3
0 5 10 15 20 25 30
CT
MRI
CR/DR
NUCLEAR MED
MAMMOGRAPHY
PET/CT
ULTRASOUND
Modality Image size Volume Requirement
CT Small High Very High
MRI Small High High
CR/DR Large High High
Nuclear Medicine Very small Low Low
Mammography Very Large Low Very High
PET/CT Very small Low Low
Ultrasound Very small High Medium
• Changes in storage requirements due to
› Additional modalities
› Additional equipment
› Changes in technology
› Protocol changes
› Increase volume
• PACS Storage requirement calculation
› http://www.pacscalculator.com/
HIGH RESOLUTION VIEWER
(3 or 5 Megapixel)
DICOM Support
• DICOM Storage SCU/SCP
• DICOM Query/Retrieve SCU
• Import/Export Capabilities for Various Image
Formats (DICOM, TIFF, JPEG, PDF, AVI, MPEG, and
QuickTime)
• CD/ DVD burning
• Film printing
• USB device support
Basic Image Manipulation
• Contrast addjustment
• Image measurement
• Image inversion
• Image magnification
• Polygon tools
• Annotation
• HU
• The digital images can be viewed from all the
computers in UKM Medical Centre that are
connected to the network.
• Internet explorer with MEDWEB plug-in
Advance Image Manipulation
• 3D Volume Rendering
• 4D Viewer for Cardiac-CT and other Temporal Series
• 5D Viewer for Cardiac-PET-CT and other Temporal Series
• Image Fusion with Adjustable Blending Percentage
• MPR (Multi Planar Reconstruction) with Thick Slab
• Curved-MPR
• Surface Rendering
• Volume Rendering
• MIP (Maximum Intensity Projection)
1. FILM
PRINTING
2. IMAGE
COPY TO CD/
DVD/ USB
3. FILM
DIGITIZER
4. TELE-
RADIOLOGY
Abbreviation Full name System function
1 IRIS
Intergrated
Radiology
Information System
Radiology system to register patient, reports
and image merger in RadiologyDepartment.
2 C-HETsCaring Health Enterprise System
Hospital Information System (HIS) for UKMmedical center.
• Integrated Radiology Information System
• Company from Australia - Integrated Medical
Systems Pty. Ltd.
• Radiology system on
• Patient registration
• Reporting
• Images
Function› Registration
› Patient Tracking
› Order confirmation and reporting work-lists
› Diagnostic Reporting
› Modality specific details
› Integrated Scheduling and appointments
› PACS Integration
› Workflow Rules Engine
› HL7 and DICOM support
› Management Reporting
C-HETs – Caring Hospital Enterprise System
Hospital Information System
In house development
Web base interface
Module › ADT & Appointment
› Patient accounting
› Order entry
› Electronic Medical Record
› Research
PACS UNIT
RADIOLOGI DEPARTMENT
HCTM PPUKM
Establish on: 14 August 2007
Objective:
Provide service on supporting PACS implementation in UKM Medical Centre.
KETUA JABATAN RADIOLOGI
PROF MADYA DR HAMZAINI ABDUL HAMID
PAKAR RADIOLOGI UNIT PACS
PROF MADYA DR ROZMAN ZAKARIA
KETUA JURU X-RAY
EN HISHAMUDDIN MALEK
KETUA BAHAGIAN PACS
EN MOHAMAD NORMAN BIN MOHD NORDIN
PENYELIA UNIT PACS
EN MOHD SAFWAN HASHIM
JURU X-RAY PACS (U29)
PN NOOR ADILA ZOLKIFLEE
JURU X-RAY PACS (U29)
EN NORAZHA AZIZ
JURU X-RAY PACS (U29)
PN SHUHADA SHAHNAN
JURU X-RAY PACS (U29)
EN MUHD NIZAM MUHD SOBRI
UNIT PACS
Equipment Total
Digitizer Filem 1
CD Burner 1
Workstation Syngo 1
Workstation Mac Osirix 3
Workstation Windows 1
PACS UNIT
COUNTER
CD
BU
RN
ER
DIG
ITIZER
DOOR
SY
NG
OW
OR
KSTA
TION
SERVER
WORKSTATION WORKSTATION WORKSTATION
Service
› Film printing
› Image copy to CD/ DVD/ USB
› Film scanning/ digitized
› Image searching
› Image reconstruction and manipulation
› Image storage and backup
• Free› Image Guided Surgery› Research (with supported
letter)• Charges› Patient need images for
seccond opinion.› Transfer patient to other
hospital.› Charge CD – RM 30.00 Film - RM 40.00 per sheet.
START
User had problem
with the system
Step 1
User reported problem to PACS staff.
END
Step 2
PACS staff will identify the problem.
Step 3
Problem with PACS System
Step 3
Problem with computer or networking
Problem solved.
User informed.
Step 4
User has to inform to IT Department
• Wrong MRN
• Image not transfered to server
• Examination has not been done
• To many image in queue / server busy
• Patient has two MRN
• Network problem
• Computer virus / Internet explorer problem
• Old images / not in the system (before July
2007)
• Managing the increasing volume of imaging data
(multidimensional imaging)
• Dedicated 24 X 7 uptime service
• CAD (Computer-Assisted Diagnosis)
• Data sharing across a wide range of healthcare
communities
• Potential new ways of delivering diagnostic
imaging services
• Holographic media and GRID computing
Issues Solution
Wrong data input RIS must be integrated with HIS
Worklist down Worklist backup server
Missing imagesAutomated image cross-check
with RIS via MPPS
System backup Duplication of server
Storage backup Duplication of storage
Network failure Backup network ports
Power failure UPS
Infrastructure
System/ server duplication
Storage duplication
Uninterruptible power supply
Automatic fire suppression system
Personnel
Trained/ drill
Standby/ on call
Procedure
Downtime task-card
Disaster plan (Fire/ flood/
earthquake/ volcano/ thypoon)
Plan
Modality
PACS
router
PACS
Server 3
Viewer
Backup
Server 1
Backup
router
PACS
Server 2
PACS
Server 1
Backup
Server 2PACS
Server 4
…in May 2018…
• Implementing PACS is a complex and difficult
multimodelity effort that will stretch an
organisation’s skills and capacity change
• It will be a challenging and ‘stressful’ continuous
learning experience.
• However seeing the systematic benefits of PACS in
improving patient care is a gratifying experience.
• Towards improving patient care and enhancing
overall productivity.
NOW !!!
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