From a patients perspective make sure you make the right decisions regarding Mammography PACS. A. When reporting a screening mammogram it is vital that the previous mammogram appears as relevant prior automatically (even if was a symtomatic mammogram) B. When reporting a symptomatic mammogram it is vital that previous mammogram appears as an relevant prior automatically (even if was a screening mammogram).
To be able to deliver the above screening and symptomatic mammograms must be stored and displayed in the same mammogram PACS.
NBSS is used for scheduling screening mammograms whilst RIS is used for scheduling symptomatic mammograms.
When choosing your Mammogram PACS supplier make sure that they understand the above concepts. a. DTI with NBSS b. DTI with RIS must be clearly specified. Access to radiology PACS is also key. Access to radiology PACS when reporting symtomatic mammograms could be achieved through existing DTI with RIS. Context linking servers-from Sentillion/Carefx are alternatives.
Royal Cornwall Hospital's breast imaging unit has just finished implementing a digital mammography service, ahead of the national screening age range extension. This was a collaborative piece of work between the Trust, Siemens, CSC (our LSP), HSS (RIS) GE (PACS) and NBSS. The imaging staff are delighted with the results which also saw replacement of the existing fixed and mobile mammography machines. We decided to go off piste with Siemens Mammo Workstations which, after some initial reluctance from the LSP, has integrated beautifully at desktop level with both CRIS and NBSS. Images from the modalities (vans included) are sent to an image shuttle (server) at the base hospital before being pushed on to the (GE) PACS store and several Siemens reporting work stations. These work stations cache the images for rapid image review & reporting. There are minor niggles with unspecified images on PACS arising from incompatibility of NBSS and RIS/PACS demographics but these are easily idenitified and sorted by the PACS Team (under 5% of the screened images). We hope to resolve this issue in due course.
It just goes to show what can be achieved by good team work, even when not necessarily choosing a product provided by the LSP!
That is really encouraging to hear Nick - interoperability at work. Would be interested to hear more of the detail at some stage - a future meeting maybe?! A down side when discussing a possible implementation model close to yours a while ago was inability to Query/retrieve non mammo historical images from the GE PACS onto the Mammo reporting station; say, a previous MRI of breast. Is that the case at Royal Cornwall? (Of course the requirement would be rare and the workaround isn't difficult.)
posted on Thursday, August 05, 2010 - 08:01 am
Not sure that requirement for previous non-mammo imaging is "rare" at least not in a radiological/surgical MDT context. The requirement would seem quite common and is an extra task for either the operators or the PACS team to develop a work-around.
I meant rare when sitting at the Mammography reporting workstation (normally in the breast screening unit) banging through the screening work. Problem arises with the symptomatic work - MDTs would use the 'mainstream' PACS workstations (5 MP?) - GE in this case. I.e. workaround would be to have a GE PACS workstation in the breast screening unit to cover the occasions when Query/retrieve from local PACS archive is required. But this is why I'd be interested to know if you can call from PACS store to the Siemens Mammo workstations at Royal Cornwall, Nick.
And another question to ask of you... has the Trust had to pay extra for the Mammo images to be stored in LSP PACS archive?
Dorset Breast Screening went fully digital 6 months ago with a non LSP PACS. Our PACS supplier Carestream also provided a RIS for the assessment worklists that NBSS can be used for at the moment. We are still working on an auto prefetch with our symptomatic PACS sites but the system we have put in place in the mean time works well.
In response to Margaret's 2 Qs -=20 1. Yes, the Siemens WSs automatically prefetch any related body part exam = (e.g. breast MRI etc) from the (GE) PACS server. (There is Q/R functionalit= y as well.) 2. No, we didn't cough up extra to store the mammo images.
It is encouraging to hear that Trusts like Nick's & Elspeth's are moving out from the commercial clutches of the LSPs. Well done!
We have had years of all the PACS suppliers (there are no exceptions here) trying to create data silos 1. not allowing the clinical users to view other applications on the workstation hardware---this is improving with time--Fujifilm, Agfa Impax 6 etc 2. Not allowing users to view images & documents which maybe stored in other vendors archives
A true Electronic Health Record of a patient should display all documents & images which maybe stored in multiple different vendors archives. Adoption of XDS & XDS-I will do just this. XDS-I publishing by your radiology/mammography PACS vendor will allow for these images to be viewed in an EPR/EHR viewer alongwith other images and documents.
I would be interested to know whether Siemens and Carestream are XDS-I compliant as a image document source.
I agree with Margaret. Whist reporting mammograms radiologists should have "easy-1 mouse click" access to CXR, bone scans etc which maybe relevant to a particular patients. We all know that technically this IS possible. However, the battle is commercial interests from PACS companies vs. clinical users/patients interests. I do hope that patients are the winners. Autumn Meeting will try to move this debate further.
To clarify my response to the Q about cost of storing extra mammo images on the PACS server: no, there was no additional cost for this (although it will clearly impact on our on-site archive). However, there was an additional PACS 'license pack' fee payable, to accommodate the additional 20,000 mammo images; cost £30k. (Covers 25,000 exams). Something to remember to budget for - we didn't...!
1. You have bought just the Siemens workstations (not their PACS)--so the long term archiving of mammography images is into the Radiology PACS from GE? 2. Modalities send Mammography CR/DR images directly to Siemens workstations & also to GE PACS.--Is that correct? 3. When reporting screening mammograms, --there is DTI with NBSS & Siemens image display software on workstations. Is that correct? 4. If there is a previous mammogram done 1 year ago,--is there an automatic display of relevent prior on the Siemens display (although images may lie on the GE PACS), without any manual efforts by a reporting radiologist? 5. If the radiologist want to look at a breast MRI/Nuc Med/CXR/CT do they have to Query Retrieve this --and does this display within 3 secs on Siemens software (although images are stored in GE PACS store)? 6. Are symtomatic mammograms reported on Siemems software with DTI with RIS? 7. Is the DICOM Modality Worklist provided by Siemens or by GE (the DMWL information has to come for both RIS & NBSS--and will be queried by Mammography CR/DR)? 8. The 30K ---is that the fee to store mammography images into the LSP CDS per annum?
Neelam - 1. correct, long term archive of mammograms is to (LSP)GE PACS. 2. Mammo Modalities (DR & US) send to GE Shuttle. This then sends all images to GE PACS, 6 (non-LSP) Siemens Mammo WSs & 2 QA WSs. 3. correct, there is DTI btw NBSS and the Siemens WSs. 4. Previous mammograms (i.e. relevant priors) are loaded automatically on to the (Siemens) WSs as all breast exams have a breast body part code added on the (GE)PACS. 5. If an exam is not mapped to BREAST body part, e.g. CXR etc., radiologists do have to pull these from PACS via Q/R. Times not tested but no complaints. 6. correct, there is DTI btw (C)RIS and the Siemens WSs. 7. DMWLs are provided by a GE ConnectR broker. This has both NBSS & (C)RIS feeds. 8. no, the £30k charge is a one off license fee payable for the increased number of exams the Trust now stores per year, it's not specific to mammos. (So if we suddenly doubled our CT workload for example, the fee wd also be payable.) Needless to say there is an annual maintenance charge!
Hope this helps. (Thanks to Alan Brimacombe, RCHT PACS Manager for help with these answers.)
Excellent Nick. 1. Scheduling info from both RIS(HSS) & NBSS (Temenos) feeding DMWL provider via HL7 messages 2. DMWL provider- GE ConnectR Broker 3. Modalities (different vendor) 4. DICOM archive --GE Shuttle 5. DICOM display (hardware & software)--Siemens 6. DTI between RIS & NBSS with Siemens DICOM display 7. Siemens prefetch from GE archive (rules based DICOM)
There is a truly multivendor environment. Hl7 & DICOM standards @ every step (except DTI). this is truly a display of the power of Standards like DICOM.
Well done vendors--Siemens, GE, HSS & Temenos. Well done Nick & your team for showing the community what can be done, if you have an intelligent buying team in the NHS. Do we really need costly middle men like LSPs or CFH? You are an example to all of us!
Please may I make mammo purchasers aware of our exoPACS with Breast Module please, which I think would be of interest to this thread.
This provides region-wide pre-fetch that Elspeth refers to, as well as local pre-fetch and auto-routing that is done by the shuttle/part-manually in Nick's scenario.
You don't have to buy exoPACS' archive component. I could say more but am hopefully finding balance between awareness which contributes to the group vs just ads. Please refer to link or contact me directly if you want more info/reference sites.
Peng, it is important to remember VNA is also supplied by a vendor. Key thing to understand is surrounding interoperability standards. We could have different PACS systems for 1. Radiology 2. Cardiology 3. Ophthalmology 4. Pathology 5. You may wish to separate mammography PACS from rest of radiology Etc However, if all your PACS systems are XDS-i source & consumer compliant, & you have a backbone of XDS registry in your Trust,then you can view ALL the images from ANY PACS system on ANY PACS display.
XDS-i source & consumer specification is key to future proofing.