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 Link to this message James Wafula  posted on Friday, September 19, 2008 - 05:30 pm Edit Post Delete Post Print Post
I suspect this has been discussed before but I have not been able to find the thread in the archive.

Does anyone use a DICOM viewer such as Dicomworks on a PC connected to PACS to project and view images at an MDM? We have Agfa IMPAX 5.2 and currently project JPEG images from the web browser but would like to project DICOM images for better quality and also easier manipulation.
 Link to this message Neelam Dugar  posted on Saturday, September 20, 2008 - 11:14 am Edit Post Delete Post Print Post

If you wish to view Dicom images at MDTM with a Agfa PACS implementation you have the following options:
1. Install a Agfa PACS workstation in your MDTM room (this is what we have done)
2. Upgrade to Impax 6.x (as the with Imapx 6.x is a toatlly web-based system--so your client on PC and workstation can both display Dicom images. Quality of images displayed will depend on the Monitor quality used)
3. PC/workstation with a 3rd party PACS application is a more clinically cumbersome option. You could install a free Dicom application on a PC in the MDTM room. However,
a. you will need to set-up a Dicom Query retrieve between Agfa PACS server and your PC/workstation.
b. Dicom Q/R can be very slow and therefore may be cumbersome for clinical MDTMs.

My advice would be to look at options 1 and 2.
 Link to this message Marco Crispini  posted on Monday, September 22, 2008 - 10:50 am Edit Post Delete Post Print Post
Note also that in Impax 5.2, workstations can be configured to use a local cache on the PC itself, as well as sourcing imaging from the PACS system.

This may complement Neelam's option 1 suggestion, where you may want to keep foreign imaging 'off-PACS', if some of the MDT patients are not from your Trust.
 Link to this message James Wafula  posted on Monday, September 22, 2008 - 01:38 pm Edit Post Delete Post Print Post

Thanks and I agree.

We already use option 1 with CS5000 Agfa WS in our seminar room except that we cannot fit all MDMs plus teaching in the one room. There are 3 or 4 other seminar rooms in the hospital where effective display of images is required and we cannot justify the cost of a diagnostic WS for that purpose alone.

As far as option 2 is concerned we expect to upgrade to 6.x next financial year hence the search for an inexpensive interim solution.

I agree that DICOM Query/Retrieve can be slow and frustrating except that we would do this in good time before the MDM just like we do now for a number of our other Q/R e.g. for priors and worklists.

Well, all in all, we may have to go for the upgrade as soon as the financial year starts.


If your solution is commercial pleas feel free to send me details privately.
 Link to this message John Coe  posted on Monday, September 22, 2008 - 01:44 pm Edit Post Delete Post Print Post
One possible solution is to burn the images for a meeting to CD or memory stick - then use the built in viewer. You only need a PC and projector in each meeting room.
 Link to this message Richard Mann  posted on Monday, September 22, 2008 - 01:56 pm Edit Post Delete Post Print Post
As far as image quality goes, when we looked at this, the main factor seemed to be the level of blackout that the mdm team could live with!

Some seperate lighting for those typing minutes etc is helpful.
 Link to this message James Wafula  posted on Monday, September 22, 2008 - 02:02 pm Edit Post Delete Post Print Post
John Coe
We have tried this but it is not practical as the CD will only take 1-2 cancer patients with all their CTs, MRIs etc and the prospect of burning up to 10-15 CDs for an MDM is not appealing.
 Link to this message John Coe  posted on Monday, September 22, 2008 - 02:08 pm Edit Post Delete Post Print Post
These must be very big studies! You can use DVD's. Alternatively you could use a Laptop with a DICOMviewer loaded, then preload the relevant patients for a meeting. Or use the same as a portable workstation and Q/R whatever you require.
 Link to this message Andrew Bell  posted on Monday, September 22, 2008 - 02:14 pm Edit Post Delete Post Print Post
I'm with Richard - have you done any tests to see how much better = quality you're going to be getting with DICOM images ? Are you changing = projector ? How dark is the room / white is the screen ? How much = diagnosing is required in the meeting ?

Or are the jpegs you're looking at THAT BAD ?

Things to think about before shelling out for =A3X K worth of gear.
 Link to this message Marco Crispini  posted on Monday, September 22, 2008 - 02:16 pm Edit Post Delete Post Print Post
Hi James,
It's nothing commercial from us, just letting you know a setting/setup that's possible on Agfa 5.2 - you'd need to get your local engineer to make the change. I'm not sure if it's done at install-time or can be switched on later.

For cheap interim solutions, I'm aware of sites trying to use K-Pacs, but without much success as it doesn't run easily as a service, so a user needs to be logged in all the time. So I would suggest a 1-year eFilm licence.

Just IMHO...I have no connection or commerical interest in eFilm.
 Link to this message Marco Crispini  posted on Monday, September 22, 2008 - 02:21 pm Edit Post Delete Post Print Post
Actually, as you're suggesting to pull (ie query/retrieve) from the workstation, that service thing doesn't matter. It's only relevant if you want to push/DICOM send from your service tools for example.
 Link to this message Nicola Strickland  posted on Monday, September 22, 2008 - 02:55 pm Edit Post Delete Post Print Post
How much time do you guys have to do all this uploading prior to MDTMs? It takes long enough to review all the imaging in advance! What do you do with the reports?
 Link to this message Ian Inglis  posted on Monday, September 22, 2008 - 03:06 pm Edit Post Delete Post Print Post
As far as the image quality is concerned you will normally find that DICOM grey scale calibration and projector resolution are the most important factors.

DICOM part 14 Grey scale calibration on the actual projected image compensates for the ambient light conditions within the room (within reason) as well as the projectors light output and the reflectivity of the projection screen.

Calibration can be performed on the graphics card in the PC or a simpler solution is to use a projector with DICOM grey scale calibration built into the firmware.

 Link to this message Neelam Dugar  posted on Tuesday, September 23, 2008 - 08:51 am Edit Post Delete Post Print Post
I agree with Nicola's comments. Presence of reports are vitally important. Most radiologists I know, are very uncomfortable reviewing images on the hoof in MDT without a report (this particularly applies to CT, MRIs PET-CT etc). The radiologist who provides a report always spends more time looking at images than a MDT radiologist (and quite rightly so).

Hence, the system used for MDT should have not only display images, but reports as well.

Another issue to consider: if you are burning images onto CDs/USB sticks, there is now a national requirement to encrpt them. Hence, this is cumbersome and not a useful option for MDTs.

Keeping radiology/imaging reports and images synchronised is a very vital issue and should not be under-estimated. This should not be taken lightly. When sharing images across organizations via Dicom push every attempt should be made to send reports as well. NHS e-mail is an option to consider, which can then be copied and pasted on RIS. (I understand on Agfa PACS it is not possible to push reports alongwith images via Dicom push--whereas it is possible to do this on GE PACS). I do think we need ability to automate the report sharing process. Any help from PACS vendors?

I personally think that keeping images and reports together is a national patient safety issue, and should form part of national guidance from the national patient safety agency (NPSA). National guidance should also include the requirement for documenting any second opinions provided by radiologists which may differ from the original opinion (as radiology reporting/opinions is a dynamic process). I am concerned about the potential trend the Breast screening is likely to create where images and reports/opinions will not be available together/synchronized.
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