In the NHS we have already paid a huge amount for workstation hardware replacement as per LSP contract. 1. Has any Trust had their hardware refreshed? 2. Have you specified the hardware to the current standards of hardware (rather than what was considered adequate 10years ago) 3. What have people specified for hardware a. Monitors--3MP diagnostic colour or is it monochrome still b. RAM--Is it 2GB minimum
I think the entire community will benefit from responses to this.
posted on Thursday, April 21, 2011 - 02:37 pm
We have spoken about this at various PACS Managers meetings.
In particular, we were very keen to have the option to reassess our needs, rather than just have a straight like for like swap, and I think that we now have that agreed.
The refresh has been delayed for several reasons, including:
1. Discussions with sub contractors about software version (especially Windows XP/ Windows 7, and server s/w versions.
2. Initially the plan was to deploy Impax 6.5 with the tech refresh, but that doesn't now look like it will happen.
3. With so many Trusts to refresh, the logistics take some planning.
As for the spec of machines, that details isn't quite there yet (or hasn't been released) but I think the intention is to go with 'current spec' hardware (whatever that is).
There is also (still) some discussion about what is and isn't included in the refresh...whats the expression, the devil is in the detail .....
Windows 7 offers significant performance benefits over previous Windows OS - but can/ will your trust support it?
Don't forget Windows 7 comes with Internet Explorer 8 as well?
I've been involved in a hardware refresh and a software upgrade (IMPAX 5.2 to 6.4) recently.
I have to say this this wasn't a particularly easy upgrade since documentation was not in order and an internal supplier was particularly difficult to manage.
I left the project just before go-live (due to illness requiring treatment) but as far as I'm aware all went well.
All I can suggest to others is to ensure that your documentation is in order (and in particular contractual documentation)and easily accessible to the project manager. Try not to chop and change project team members too often to maintain continuity and make sure everyone is aware of their role on the project team (and what is expected of them).
Don't pluck go-live dates from the air then try to retrofit tasks and activities to fit; assess what activities need to happen, when, how long they will take (allowing contingency) THEN arrive at a projected go-live date for further discussion/ approval.
The refresh in London has not started yet but is about to. The spec is 6G= B RAM, 1GB graphics card, monochrome monitors. If I was specifying I woul= d have gone for a 2GB graphics card and colour monitors. BT did up the gr= aphics card to 1GB after we complained but I suspect we will not win the = battle for colour monitors. The really important point is that whatever i= s offered it must be ready to run windows 7 64-bit. Whatever PACS you are= currently running you will not survive until contract end with a 32-bit = PACS application. The graphics card is also of critical importance; do no= t overlook this.
Thanks for this. Very helpful indeed. I think NHS has paid a lot of money for hardware refresh over the years on the LSP contract--including the interest on the prepaid hardware refresh charges. The cost of old spec of hardware including monochrome monitors has reduced (but we have paid a high price for refresh based on old costs). Requirements for PACS hardware have altered ---with VR on workstation increasing the RAM requirements, PET-CT/NM/MPR/3D inclusion into PACS now a norm---thus need for diagnostic colour monitors. I think it is unacceptable for LSPs to provide outdated hardware refresh to Trusts considering the price NHS & taxpayers have paid for this.
Brian provides sensible advice 1. 3MP diagnostic colour monitors 2. 2GB graphics cards 3. 6GB RAM I think this is the minimum specification we should accept for diagnostic display hardware.
posted on Tuesday, April 26, 2011 - 08:15 pm
> > Thanks for the intersting message, Brian. >
If I may ask, what are the reasons for choosing those particular specifications? In particular, do they provide a provable benefit of appropriate value?
I too have seen the LSPs provide very strangely specified machines. E.g. I saw an impax 6 installation supplied with 1 GB RAM, quad-core CPU and SAS 15k RAID and old 512 MB graphics.
Despite the dated and low-power graphics card, the performance was excellent on 64 slice CT, for all practical purposes (apart from real-time interactive complex volume renderings, which are of limited diagnostic value). Do you have any figures that suggest using high end graphics capability would be useful? The real benefit of the more powerful graphics cards (the RAM is merely a surrogate marker of a more powerful graphics processor) is in running high-end 3D software. This is only useful if you plan on licensing high-end diagnostic 3D software for every machine (or using a floating license arrangement). There is quite a lot of competition in this market, and I can see some users opting for a server-side 3D system (e.g. Terarecon iNtuition, Vital images Vitrea core) which obviates the need for advanced graphics capability on the client hardware.
The quad-core CPU was excessive, as the PACS software and 3D software were both single-core only, the CPU demands of the RIS/dictation were negligible. In testing, I could never get the CPU demand to more than about 30% under anything resembling normal reporting practice. In essence, it's all well and good having numerous cores, but unless the software is multi-core capable, the extra cores just sit their using electricity and generating heat. As it is, quad core is now commodity level hardware, so should be the minimum specifiation. However, I would caution on the purchase of more expensive 6-8 core systems, as unless the software is multi-core capable, they won't be used. Instead, it may be better concentrate on the CPU frequency, and get the highest frequency CPU that is appropriately priced, as this will result in all software benefiting.
The SAS drives were largely unused, as impax doesn't cache data on local hard drives. This was simply a waste of extremely expensive drives.
The 1GB RAM was grossly inadequate leading to appalling performance. 4 GB would be much better. 6 GB may be better, but subject to certain technical limitations.
I'll expand further on this point, for the benefit of others, as there are complex issues regarding this.
32 bit versions of Windows are limited to approximately GB of RAM total. If more ram is installed, and windows XP, Vista or WIndows 7 32 bit are installed, all extra RAM is ignored. WIndows XP becomes orphaned by microsoft in August 2014. At present, microsoft no longer provides updates for defects in XP, unless they are security critical. From Aug 2014, all updates will cease. This is highly undesirable for a PACS system, as it may become unprotectable from malicious software, hacking, etc.
To receive any benefit from RAM > 3 GB, you require a 64 bit version of Windows. Ideally, this should be windows 7, in order to ensure optimal use of modern hardware, which contains numerous refinements that XP and vista may not be able to take advantage of. However, that is not the whole story. Not only must the operating system be 64 bit, so must the software. 32 bit software is inherently limited to 2 GB in Windows. Unfortunately, not all PACS software is 64 bit. I have examined Impax 6.2, and it is 32 bit only, so unable to take advantage of a 64 bit machine and windows system (this also means that it won't be able to take full advantage of a 2 GB graphics card).
As for colour monitors, they are desirable. However, I'm not convinced that there is a genuine need for displays with the high contrast/resolution needed for diagnostic work, together with colour - particularly given the higher cost, and higher maintenance (more complex calibrations due to colour difts, etc.) Unfortunately, colour would be an expensive upgrade, and most colour radiology images are of relatively low resolution (e.g. post-processed CT or MRI and NM). Similarly, most PACS systems have appallingly bad support for functional or quantitative data, so do you really forsee analysing such data on PACS workstations?
As I see it, I would specify the following: 1. Windows 7 (64 bit only) 2. PACS client software (must be 64 bit, or guaranteed upgrade path to a 64 bit software version) 3. 3D visualisation software (must be 64 bit or guaranteed upgrade path to a 64 bit version) [There may be reasons why not all PACS workstations have 3D visualisation e.g. licensing costs] 4. Graphics card 1GB if 3D software installed (2GB if specialist work is to be performed on the PACS workstation, e.g. virtual colonscopy, cardiac CT). 512 MB or less if no 3D software. 5. RAM 6 GB with ECC 6. Quad-core CPU of at least 3 GHz.
A few points to remember that we are not simply doing hardware refresh for Impax.
1. In 2013, many Trusts will change their PACS suppliers. However, if we have refreshed workstation hardware in 2012, we would hope to reuse it (this provides cost savings to Trusts). Most PACS suppliers now allow customers to source their hardware if they wish. So we must not get hung up about what we have today and make sure we future proof. Always remember we have paid a lot of money for this & currently priced 3MP colour monitor workstation hardware can be accomodated within refresh charges already paid by Trusts. 2. Radiologists in Trusts can make a choice whether they think colour monitors are fit for reporting CR or not. Colour monitors do have an advantage of versatility for use---CR, 3D, NM, PET-CT, cardiac CT, virtual colonoscopy 3. As commneted by Sven Boule on this forum---most PACS suppliers now include 3D, PET-CT display, Cardiac CT, as a standard rather than an optional extra. Good display hardware specification for workstation refresh now will future proof for 2013 PACS replacements.
DISPLAY HARDWARE REFRESH SPECIFICATION---If what we have paid in refresh charges allows then we should specify high enough 1. Windows 7 (64 bit only) 2. Graphics 2GB 3. RAM 6 GB with ECC 4. Quad-core CPU of at least 3 GHz. 5. 3MP colour diagnostic monitors (local radiologists to assess for adequacy)
In 2013 we would need to specify for PACS display client 1. PACS client software must be 64 bit, 2. 3D visualisation software must be 64 bit
This is based on my own observations and opinions. Of course requirements will vary from site to site and user to user, the point is that, with the exception of Breast Imaging, we have become used to being able to safely review and report anything on any workstation (at least in LSP land anyway). We could move to a model where each workstation was specified for the task it was to perform so, for example, we could specify 2MP colour monitors for CT, MR and NM reporting and this might save a few pounds but we would have lost the ability to review a PET CT alongside a chest x-ray. Similarly, we could specify 512MB graphics cards for plain film workstations but we would have lost the capability to do on the fly MPR on a CT scan. I personally do not think that this is the direction we should be heading.
I accept (just) that you may be able to review a 64-slice CT with a relatively low spec machine but how long will we keep the hardware that is being refreshed now and how long will it be before 128 and 256-slice CT are the norm? When the PACS workstations we have now were installed we only had one 64-slice scanner and the rest were 16, 8 and 4-slice; by the time the hardware has been refreshed we will have three 256s, two 128's and three 64s (even the PET CT and RT planning scanners are 64-slice).=20
Current contracts expire in 2013 (2015 in London). Leaving aside that many of us are anticipating a PACS software upgrade in the interim it is almost inevitable that our post contract PACS will also be running on the hardware we are refreshing now and that it will be storing more than just diagnostic imaging. It is my view that the specification of these refresh workstations should reflect this.
posted on Thursday, April 28, 2011 - 11:29 pm
Intel i5,Windows 7 running 64bit OS with a hybrid drive, 8GB RAM and 1 or 2GB graphics card should be a common spec. PACS viewing technology has moved on and with the use of a thin client application the power of the PC become the thing of the past with the exception of the viewing quality. The problem is that none of the major PACS suppliers have such technology. The large Barco monitors present exceptional quality in a single unit. This is why a splitting of the archive and viewer gives a lot more flexibility. Remember the time to decide if you are going to change when 2013 comes, plans must be made over the next 6 months or the contract will may be extended what ever.
I agree with all the points Brian makes here. I think workstation hardware refresh MUST be future proofed for POST 2013/2015. So Trusts can specify for software only solutions in 2013.
I agree we need to make workstations capable of performing ALL reporting tasks. PACS software has already moved in that direction with majority of vendors--PET-CT, NM, MPR/3D. Thus 3MP colour monitors preferred to 3MP mono-chrome (provided diagnostic quality for CR remains)
One significant point to remember that NHS Trusts have already paid for workstations refresh. We are wasting our/taxpayers money if we do not get this refresh. The spec Brian & Mark have come up with will be affordable within what we have paid with our LSP refresh changes, I think. It would be worth getting in touch with Eizo, Barco or other vendors & get an independent cost from them for this spec.