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| Thanks Peng. You are right. We need to look at other methods of receiving payments. BACS etc. I will ask William to enquire about this. |
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Interestingly, despite banks wanting to phase out the use of cheques because they are in decline, we still write more cheques in 2012 that we did in the 80's when it was for the most part the only available option.
They are portable and easy to use.
Mind you, despite having an MP3 player I also have a turntable that plays my collection of 'big black CDs'.
I have a car but choose to ride my back when appropriate.
I have a mobile but almost always use my land-line for calls.
I have the ability to fax, e-mail, text, Facebook, Twitter etc but it's so much nicer to meet and chat.
I could if I was inclined go to someone's house and play on one of those X-Wiitendo things and have a virtual round of golf with Tiger but I prefer to actually get on the course and play.
Maybe I'm just old fashioned?:-) |
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 Mick Brown
posted on Sunday, February 05, 2012 - 04:09 pm
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| As an Australian living in the US, it's just so refreshing to see people spell the word 'cheque' correctly! |
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I understand that old registration form was incorrect with the incorrect address. I do apologise for this.
Please find the correct registration form. Please let Adele/Katie know if you are interested. |
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| Parwaez Khan
posted on Tuesday, February 14, 2012 - 11:35 pm
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Hi Neelam,
Are there places available for the Spring meeting.
Pod. |
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| Neelam Dugar
posted on Thursday, February 16, 2012 - 07:51 am
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Parwaez,
Contact Adele/Katie. They know the numbers.
Neelam |
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| Updated Programme with all speakers confirmed. |
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| Slight change in a topic. |
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Can you pay other than "Cheque"?
See Mick I can spell Cheque too! |
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Richard,
Please contact Adele/Katie directly. |
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I have been preparing my presentation for 27th April--Emerging Trends. These is what I have so far:
1. Single sign-on & Active Directory use (RIS & PACS)
2. Clinical Portal--Access to integrated EPR via XDS (RIS & PACS)
3. Patient Portal--Patient centric Information held in many organizations--XDS & XCA
4. 3rd party plug-ins (PACS)
5. MDTM workflow with MDTM worklist (RIS)
6. Point to point report sharing --XDR (3 spaekers on 27th April)
7. Data Culling (dealt with in Nov 2011)
8. Exit Strategy with data ownership--?VNA (3 speakers on 27th)
9. Radiation Dose Monitoring--(4 speakers on 27th)
10. PACS specific image launch via url
11. Zero foot-print viewers--images & documents viewed on a standard browser--2 speakers
12. Mobile device use with RIS & PACS (2 speakers on this)
I think we are a covering a number of emerging PACS trends with very high profile speakers. Procurement is also covered by Malcolm Newbury & Tony Corkett. I expect the meeting to be a very interesting one. |
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| Updated Agenda for the Meeting: |
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Excellent Meeting yesterday.
We had some some speakers who are known around the world for their contribution to DICOM standards--David Clunie, Fred Behlen, & Dave Harvey.
Data Ownership is hugely important. Standards adoption & an contractually written & agreed exit strategy is key to achieving this (ensure that we do not make the mistakes of LSP contracts where Trusts do not know what is in the contract--and what is the exit strategy). Kevin is right that much of this is about the attitude/philosophy of the PACS vendor. I remain optimistic that we will see better relationship between NHS Trusts & PACS vendors in the future--with regards to an exit strategy.
I think we have reached agreement on Radiation Dose Monitoring--on how it should be done and what is needed to automate the process of dose recording.
Differences & Pros & cons of OJEU & Framework agreement was discussed. Understanding what is in the contract is key to ensuring PACS & RIS deliver the clinical requirements. Ensure the framework contracts are well written/understandable & meets Trusts needs if Trust does go down the framework route. ND comment--- Is it possible to ask the framework provider for what is included & not included in the framework contract before going down the framework route? (Trusts must ask before deciding which is a better option for them)
XDR & XDR-I are happening to support point to point transfer of reports & images. Burnbank is making IEP-- XDR/XDR-I compliant. This brings up some interesting possibilities for NHS. If our RIS becomes XDR source & recipient compliant then we could improve the workflow for automating report transfer from RIS to RIS via IEP. Michel Pawlitz talked about adapters, and if IEP had a built-in adapter we could still communicate between a modern RIS (CDA/XDR compliant) with a legacy RIS (which does not have XDR/CDA compatibility) via XDR. XDR-I adoption by IEP also raises the possibilities of removal of CDs used for medico-legal purposes. There are some real possible worklfow improvements with XDR & XDR-I adoption by IEP.
Mobile worklfow with tablets & digital pens was hotly debated & discussed. I think there is future potential here. Some comments
1. RIS vendors writing certain pages which are compatible for mobile tablet devices--based on workflow requirements (BBC news etc write pages for mobile display). Put this in requirement for RIS replacements.
2. Use of digital pens for MRI safety questionaire, consent forms, or any other patient forms we use in RIS.
Zero-Footprint Viewers (PACS images simply viewed on modern browsers--no separate software download on the client machine) are a reality indeed for PACS suppliers such as Carestream & Agfa. Viewing images from vendors own PACS archive is relatively straight-forward as stated by John Kingham(Carestream) but zero-footprint viewer with XDS-I to view PACS images from multiple Trusts/multiple vendors can be limited by speed. |
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9.15 Introduction—Emerging Trends RIS & PACS—: Dr. Neelam Dugar (Chairman)
Here is what I think will be the trends for PACS for the 2013 replacements. 9.15 Introduction—Emerging Trends RIS & PACS—: Dr. Neelam Dugar (Chairman)
EmergingTrends.pdf (6030.2 k) |
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I'd like to share some thoughts about the speed of viewers that use XDS-I. This was presented as a zero-footprint viewer issue, but a thick client is affected as well.
First, the situation is not so dire as suggested, since apart from the SOP Instance UID's, the KOSD also contains:
- the SOP Class UID's
- the division of the study into series.
Thus, from the SOP Classes the client can immediately identify which SOP Instances contain PR and KO objects (with possible rejection notes) and retrieve these. It can then retrieve the first image of each series in order to obtain the series attributes of each series and guess the layout based on the image dimensions. Then it can present a screen to the user that displays the first image of each series. Possibly later on the sort order will dictate that this image be changed, but in a great number of cases this shouldn't be necessary.
A more robust solution would involve the use of DICOM supplement 148, WADO via web services. This allows the client to retrieve only the metadata of a SOP Instance, or even a subset thereof. The catch is that this transaction is not recognised by the XDS-I.b and XCA-I profiles, so one should negotiate this as a separate item (and/or submit a Correction Proposal to the IHE Radiology committee). |
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Thanks Pim. I am reassured to hear that XDS-I display speed can be achieved through WADO (I was a little worried). I hope IHE includes WADO in the XDS-I & XCA-I. I think we need to discuss XDS-I display in the Autumn Meeting.
Going back to the presentations from the meeting.
9.30 Standards are key to concept of PACS Data Ownership—Dr. David Clunie (IHE)
We were really fortunate to have David speak at our meeting. We do need IHE create a Migration Profile.
9.30 Standards are key to concept of PACS Data Ownership—Dr. David Clunie (IHE)
Clunie_Standards.pdf (261.1 k) |
ND Comments---
Until a migration profile comes into being as a user community we need to concentrate on "what needs to be migrated"
1. images
2. annotations (if these are required/included--we do not make permanent annotations on images in our Trust--we treat them like films of the past)
A. Database metadata--should this be simply be reconstructed from the DICOM headers or directly migrated from the database?
B. Reports/Requests--should that be part of RIS/Ordercomms migration?.
Discuss in the pre-nup agreement with PACS supplier
1. proprietary compression
2. private tags
as these could make migration difficult.
David is right tag-Morphing would be minimised, if we kept clean & good quality data |
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As an overseas member I read with interest all the posts. Would you consider web casting your next meeting so that those of us in the outer limits can experience you excellent program. I am a new Pacs manager working in Breast screening in Australia and about to review the tenders for a new Pacs system keeping our own Ris . What questions would you the experts be asking the vendors at the presentations . I have 100000 + exams a year and 120000 to migrate onto the new system .
Many thanks
Sandra Evans |
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Hi Sandra
For breast screening, in my opinion the single most important (interoperability) criterion for a new PACS is full compliance with the IHE Mammo Display profile.
Depending on your workflow (and your RIS), compliance of both RIS and PACS with the IHE Mammography Acquisition Workflow (MAWF) profile may also be desirable.
Note that acquisition modalities, and any third party reading workstations and CAD systems (if you use them), also need to be compliant with both IHE MAMMO and MAWF to gain full advantage.
Migration of prior digital mammos can be a challenge, especially if they have been acquired on non-IHE MAMMO compliant modalities in the first place; if I were you, I would consider asking your migration service provider (or new PACS vendor, if they are taking on migration responsibility), to update the image headers during migration to make them IHE MAMMO profile compliant if at all possible (this can be easy or hard depending on what is in the original image headers).
Worst case, if you choose not to use IHE profiles as a means of specifying compliance, you need to test each type (vendor, software version, site) of current modality and prior (migrated) image to see what the new PACS vendor will do with it (in terms of navigation, hanging, matching with priors, equivalent size regardless of detector, measurements, windowing, etc., as itemized in the IHE MAMMO profile). You could also run the IHE MESA test set samples through the new PACS to see what it does with them.
Do not forget the need for multi-modality display (both software and hardware, e.g., some color panels to look at US enhanced MR, though that may only be needed in a diagnostic, not screening, setting, depending on your workflow).
Regardless, test your use-cases thoroughly before you buy ("trust but verify").
David
PS. I am assuming compliance with the basic stuff that is not breast-specific, like IHE SWF, PIR, PDI, etc. And I am also assuming that display performance (reading time) is adequate, given the high throughput required in a screening environment. |
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9.50 Why Data ownership is important for future PACS migrations—Mr. Fred Behlen -(Laitek)
Like David & Dave, Fred has been working with DICOM standards for many years. We are very grateful to Fred for sharing his wisdom with our group. This is an excellent presentation.
Opening statement from Fred:
"The final test of your PACS:
You’vebeenstoringdataforyears;nowitistime to get it all back.
– Images
– Current demographics
– Annotations
• Radiologist’s markings
• Measurement calipers
• Technologist’s markings (e.g., to correct laterality) • Key image notes
Annotationsandnotesmaybeinproprietary internal formats"
Very key statements is
"Physical access to your data, raw or otherwise, is your parachute
“Ownership” of data
– Possession of hardware
– Possession of resources (e.g., cloud storage)
– Access to byte streams
– Access to databases"
I think this will hit home for many regarding lack of ownership for the data in LSP data stores--where Trusts do not own the hardware or resources, do NOT have access to database or bytestreams"
Another very key statement--about ownership of the hardware on which the data sits:
"Your rights
-When you have physical possession and ownership of the data, you have all rights except those limited by contract or public policy.
• When you do not have physical possession and ownership of the data, you have no rights except those granted by contract or public policy.
• ThereforecontracttermsarecriticalinASP services. You have to check everything. But take your parachute anyway."
Those who are scaremongering about data migration, this slide from Fred says it all with the picture of Rosetta stone & paper scrolls of centuries ago.
"Data Migration is your future"
Advice from Fred for Trusts replacing PACS
"Specify outbound migration needs in your new PACS – Availability of all needed data
– Minimum transfer rates
– Availability of raw data
• Stay involved in the contracting stage
• IfyouarebuyinganewsystemorASPservice, know that you will never have more leverage than you have now."
ND Comment--There is a section in your contract documentation for functional specification. Make sure that a very well defined EXIT STRATEGY is written within your contract for PACS & VNA. Take independent expert consultancy help in writing this from a migration vendor---Laitek, Acuo, Pukka-J etc I am sure will all give you independent expert help for documentation.
Closing Remarks from Fred
"Outsourcing file storage or CPU hosting is fairly safe
– Migrating files is a pretty well-defined and well-served computer industry problem
• If you want to outsource applications software as an ASP service, make sure the box is on your premises and you have the key and the contractual rights to use it.
• If your applications vendor uses third-party cloud storage, make sure you have contractual privileges to access your data in the cloud.
• Safest is always to possess your data in hardware you control."
This is an excellent presentation from Fred & I would encourage everyone who is considering replacing PACS or buying a PACS to go through this set of slides. There are pearls of real wisdom here from someone who has been working with DICOM for many many years.
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10.10 How to specify a VNA archive for DICOM images—Mr. Kevin Wilson (Pukka-J)
Kevin brings about a wealth of experience in the DICOM world with having been involved in many data migrations.
This presentation is really worth a read for those in the process of replacing PACS. Kevin throughout the presentation makes comparisons between traditional PACS & VNA.
"Migrating PACS Data at the end of a contract can take a very long time and can be expensive. If you own an agnostic copy the problem is simply how fast can new vendor import the data."
His closing statement
"A VNA is just a PACS with the right attitude"
ND Comment--Most PACS replacements happening today are specifying VNA as part of the replacement project. I think at the end of this 1st migration, scaremongering around migrations will end. Trusts will feel free to choose the next vendor without the fear of data migration, as with VNA data migration will no longer be an issue.
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10.50 National Radiation Dose Monitoring Requirements—Mr. Niall Monaghan (Radiation Protection Advisor & IHE-Co-Chair)
There is DOH working party which is looking at standardising radiation dose collation.
Excellent presentation by Niall.
Key points for options for automated radiation dose recording--
1. Dose data sored in the DICOM header--poor
" Can lead to problems if rejected images are deleted or there are multiple reconstructions of image data, e.g. CT.
2. MPPS message from the modality to RIS or PACS--poor
Designed for workflow, not persistent archiving " Lacks complete dose details
3. DICOM Dose SR.
" This is the preferred method.
• SR Objects.
" Easily ingested (and regurgitated) by PACS
• Granularity
" Accumulated dose over image, study &
series
• Can be templated to modality requirements"
Niall recommends IHE REM Profile adoption (which is based on DICOM SR). He advices all PACS & Modality procurements MUST put in IHE REM Profile as a requirement. Thanks to Niall & his working with DOH, I do think we have a national direction for automated radiation dose monitoring.
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11.10 Automated recording of radiation dose from modalities—Dr. David Clunie (IHE)
David is renowned over the world for his work in DICOM standards. It is interesting that both Niall & David have exactly the same message for the NHS. IHE REM profile (DICOM Radiation Dose Structured Report--RDSR) is clearly the way forward.
The concluding slide is key--defining a way forward for new PACS & modality procurement/replacement & also suggesting a way of dealing with old modalities.
"Infrastructure must support RDSR
New & updated modalities: make RDSR
Older modalities (and archive): OCR dose screens to make RDSR
Ancient modalities: worth estimating from technique in image headers?
Should be no need to record manually"
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11.30 Role of PACS in radiation dose monitoring--Professor Mats Nilsson, Medical Radiation Physics Skane University Hospital, Sweden (Speaker Sponsored by Sectra)
We are grateful to Prof Mats Nilsson for sharing his experience of 7years of automatic dose monitoring. In his talk Prof Nilsson mentioned how with automated monitoring, it was easy to recognise that an old CT scanner was producing hugely excessive doses compared to the others --resulting in the leverage needed for it to be replaced.
Some'key'areas'of'use:'
– Short and long term monitoring and follow up of patient doses'
– Gives the referring physician access to the patient ́s previous dose history
– Facilitates dose benchmarking within large X-ray departments or between hospitals' –
Rapid feedback to radiologists and radiographers during optimization programs
There is likely to be some EU legislation in this regard too.
ND Comment--I do believe that radiation dose MUST be displayed somewhere. My view is that it should be displayed in PACS. REM complaint PACS should be able to store & display the radiation dose information in its database. 2013 Replacements--"Does the PACS support REM Profile? Is the PACS able to display the radiation dose information in the display area for radiologists/radiographer/clinical users to see?" I do not think this is unreasonable. |
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