Cloud Storage and Medical Image Management RESPONDING TO THE INCREASING FILESIZES OF ADVANCED IMAGING TECHNOLOGIES

Speaker Bio

20+ years healthcare IT

Software development, network design, management, storage network design

Computerworld Honors Laureate for Visionary Use of Information Technology in Medicine - 2002

Network World Enterprise All-Star Award for use of free space optics - 2005

Computerworld Best Practices in Storage - Finalist, Data Lifecycle Management – 2006

ITIL Foundation Certified

ARA Diagnostic Imaging

17 outpatient imaging centers

20+ area hospitals

90+ radiologists

1.3 million exams read or performed annually

900,000 exams digitally stored annually

ARA – Department of Information Technology

Chief Information Officer

Director, Service Delivery

Manager, Service Delivery

Service Delivery Group

Server/Network Administration

Director, Imaging Informatics

Application Managers

Software Engineering Manager

Development Group

Security Administrator

ICT Group

Administrative Assistant

ARA Image Management Through The Years

2001

ARA – Department of Information Technology

• 6 TB usable • Growth rate was 3 TB annually

ARA Image Management Through The Years

2003

ARA – Department of Information Technology

• 24 TB usable • Secondary datacenter for replication

ARA Image Management Through The Years

2004 – content addressable storage

ARA – Department of Information Technology

• 2006: 58 TB of usable space

ARA Image Management Through The Years

2010– clustered storage

ARA – Department of Information Technology

• 2011: 235 TB of usable space

ARA – Department of Information Technology

Image Management Today

As Image Quality Goes Up, So Do Filesizes

16 slice CT: 18MB

64 slice CT: 23MB

1.5T MRI: 29MB

3T MRI: 71MB

US: cine loops, color flow

Digital Mammography By The Numbers

Average file size for a standard mammography image: 19MB

Average file size for a 3D tomography image: 392MB

Average ingest rate: 25G/day

6.60 13.40

27.20

55.21

112.08

227.52

461.87

937.60

1,903.32

3,863.74

7,843.40

0

1000

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3000

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7000

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2014 2016 2018 2020 2022 2024 2026

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AB

YTES

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Projected Storage Consumption of Digital Mammography: 2D, 3D

Sum

The Challenge

Migration Migration

Image Management At Scale

Image retention requirements

Increasing file sizes

Hardware refreshes Maintenance costs

Data migrations 10 months to migrate 150Tb off CAS

Alternatives to the “Classic” Storage Arrays

Managed vendor neutral archive (VNA)

Software-defined storage

Storage-as-a-service/cloud

Managed VNA

Hardware, software, off-site replication

Possible to have no capital outlay

Dell, Deepwell

Software-defined Storage

Your hardware, their software

Multi-protocol support SAN + NAS = Unified

Act as basis for scale-out storage architectures

Atlantis, SwiftStack, Elastifile, Datacore

Cloud Storage Attractive

Let someone else worry about capacity planning

True pay-as-you-grow

Considerations Data protection

Privacy laws

Compliance with Health Insurance Portability and Accountability Act of 1996

Pricing models

Performance

“The future for PACS is in the cloud,” - Steven Tolle, chief product officer for Merge Healthcare, at the 2013 annual meeting of the Radiological Society of North America (RSNA).

Nasuni – Storage-as-a-Service

Onsite cache married with cloud storage Your hardware appliance or theirs.

Encryption in flight, encryption on disk

Business-associate under HIPAA

Simplified pricing: one vendor, one price, one check.

Performance Testing

Old-school: stopwatch

Time to first image <= 3 seconds

3 trials for each study, per modality, using different settings Over 3,000 time trials

Compared to baseline established by incumbent

Performance Findings - On premise

Time to first image from the cache – on average – performed 21% faster.

For a complete study coming from the cache – on average – 7% faster than the incumbent.

Performance Findings – Cloud Retrieval

80MB Internet link

No bandwidth restrictions

Time to first image from the cloud – on average – was 49% slower than the 3-second baseline

A complete study from the cloud downloaded 8.5% slower than local storage

Nasuni Today

Upon implementation, all new mammography studies were written directly to Nasuni.

Have migrated 98% of all historical mammography studies (2d,3d) to the cloud

Performance has not been a concern due to the radiologists’ workflow for mammography images

We’re Not Done Yet

Deployment of a VNA bring some compelling image lifecycle tools to the environment

Multi-protocol support and storage-agnostic

Reduces the need for high-speed links to cloud

DATACENTER 2

Imaging Storage Architecture v4.1

1

2

1. Images ingested into VNA

2. VNA writes two concurrent copies

3. Nasuni writes images to out to the cloud

3

Cost Considerations

1. Primary array acquisition and maintenance

2. StAAS appliance

3. Cloud costs

4. Telecom

5. Port speed connection charge for a direct connection

6. VNA acquisition and maintenance

In Summary

Filesizes are continuing to increase as modalities provide higher resolutions.

Storage-as-a-service is a viable model for long-term study retention. Hybrid deployments even more so

Choose your cloud partner carefully.

Ensure compliance with HIPAA/HITECH/Omnibus from your partner vendor

THANK YOU

R Todd Thomas Chief Information Officer Austin Radiological Association Email: thomast@ausrad.com LinkedIn: www.LinkedIn.com/in/rtoddthomas www.ausrad.com