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 Link to this message Roy Burnett  posted on Monday, October 14, 2013 - 07:03 pm Edit Post Delete Post Print Post
Hi Everyone

We are trying to connect our Image Intensifiers (II's) to PACS.

However, IP Addresses here are partitioned, so it is not possible, as far as i am aware, to plug them into any network point and download MWL, then upload to the pt folder, as happened at my last hospital, and, i suspect, many others.

Our II suppliers say they need a static, fixed IP Address. Our IT Dept say they can't give a fixed, static IP Address and connect the II from anywhere (different floors, different sites). Our IT say we can use DHCP to get a floating IP Address. Our II suppliers say their II's need a fixed IP Address.

Alternative is for radiographers to manually input all theatre cases (except in nearby theatres where the points are connected to the same switch, and therefore can work in the way we want them to).

I can colour code the II's and points i suppose, so that radiographers can easily identify which II's work in which theatre, but its not very satisfactory.

Has anybody been in a similar situation? What did you do?
 Link to this message Simon Waddington  posted on Monday, October 14, 2013 - 08:01 pm Edit Post Delete Post Print Post
That should be relatively easy to deal with.
Use static IP addresses on the IIs and integrate per normal modality.
Identify the port(s) in each theatre they will use and mark them for PACS / II use only.
Get IT to patch the ports to the switch and the switch ports to be static on your PACS VLAN.
Try also using a short patch lead with two-way connector on the Identified network ports. Use cable ties to secure the patch cable. That way, if the II pulls away it only breaks the 50p two-way connector and not the wall port.
 Link to this message Roy Burnett  posted on Monday, October 14, 2013 - 08:57 pm Edit Post Delete Post Print Post
Thanks. We could do this, but the trouble is that if we have to move an II from another part of the hospital (we have theatres on different floors, and different buildings where the network points are not connected to the same switches), then it will not be able to download the MWL and upload to the patients' folder. Images will go to PACS, but only as unspecified/unverified, and then the PACS team will have to manually merge.
 Link to this message Simon Waddington  posted on Monday, October 14, 2013 - 09:07 pm Edit Post Delete Post Print Post
If the II has a fixed IP then whatever port it connects to will be okay, wherever this is. MWL / SC will work.
This is provided the switch ports are all configured on the PACS VLAN to support fixed IP and not DHCP.
It does work. I'm sure your IT network people will understand the above okay. That's how other sites are setup (unless they're wireless).
 Link to this message Yinka Onifade  posted on Monday, October 14, 2013 - 09:27 pm Edit Post Delete Post Print Post
You definitely need static IPs to connect to PACS. You can have dedicated IIs with dedicated network points for different areas (theatres)and get your radiographers to download MWL prior to image acquisition and send images to PACS from the same network points afterwards.
 Link to this message Farouk Nassim  posted on Monday, October 14, 2013 - 09:37 pm Edit Post Delete Post Print Post
II's definitely need to be on a static IP address and ideally there should be a dedicated PACS port on the imaging VLAN in each theatre so you can download a MWL and export studies to PACS.
 Link to this message Brandon Bertolli  posted on Monday, October 14, 2013 - 11:22 pm Edit Post Delete Post Print Post
I think it will be difficult in some circumstances to ask a radiographer to power up an II in one room, just to get a worklist and then power it down and take the II to another room to do the case.

Depending on your PACS and RIS setup you may be able to book in the case on RIS and note down the PACS accession number which you may be able to enter on the II when you power it up.

Of course the manually entered demographics and accession number on the II need to be accurate otherwise the images will be in an unspecified/mismatched/failed verification on PACS.
 Link to this message John Parker  posted on Tuesday, October 15, 2013 - 09:24 am Edit Post Delete Post Print Post
Its probably worth clarifying if a fixed IP is a network requirement and/or a PACS requirement.
I have previously connected modalities using dynamic addressing to Agfa PACS, and it worked fine... the only issue might be if you have problems and are trying to troubleshoot.....(we didn't!)

maybe the wireless option is worth exploring or securing a specific NP for PACS modalities only. I recall in some theatres we didn't have enough NP's and rather than go to all the cost/ trouble/ inconvenience of running new cables, IT came up with a little network gismo, that plugged into an exisitng NP but had 4 separate NP's, which could be configured (sorry can't rememeber all the details of this thing but it was great)

top tip re Simons short patch leads - saves much pain!!
 Link to this message Victoria Freemantle  posted on Tuesday, October 15, 2013 - 05:44 pm Edit Post Delete Post Print Post
We have the same issue....our hospital network has "meshing" (bear with me....I lose it when it comes to networks!) so we're never left with no connectivity in a room/theatre if one hub room was to fail...

Our radiographers have an area where the IIs are stored which is where the imaging is pushed back to PACS from. That hub rooms also feeds selected ports in the main theatres where IIs are used, so they can also send to PACS whilst in theatre if available. They don't use the MWL as half the time the requestors don't put the II requests on order comms before the op and the radiographers have to do it (and then the RIS bit) retrospectively :-(. Leaves me with a whole load of fixing up and chasing as sometimes the order comms/RIS bit can be rather too retrospective for my liking!!!! :-(
 Link to this message Victoria Freemantle  posted on Tuesday, October 15, 2013 - 05:45 pm Edit Post Delete Post Print Post
Oh.... and our IIs have static IPs as per the rest of our medical devices connected to PACS.
 Link to this message Simon Seal  posted on Wednesday, October 16, 2013 - 11:54 am Edit Post Delete Post Print Post
We have several modalities out on DHCP, the trick is, if your DHCP servers are able, to reserve a particular IP address against the MAC address of the network adapter on the modality. Then both sides are happy, IT can continue with DHCP and not have to set up a separate VLAN, and PACS sees the same IP address every time.
 Link to this message Ed McDonagh  posted on Wednesday, October 16, 2013 - 01:36 pm Edit Post Delete Post Print Post
The problem with the DHCP with reserved IP against MAC address is when you have IP subnets that are restricted to particular physical locations (departments, buildings, floors etc).

This can be very useful from a network maintenance point of view as you can tell where rogue devices are likely to be relatively quickly and shut them off from the rest of the network.

Therefore when you want to plug your II in in different departments, you would have to have a different IP.

If you have a VLAN that is allowed to cross these boundries with its own IP subnet, then you may be able to operate. As long as you have dedicated wall ports.
 Link to this message Simon Waddington  posted on Wednesday, October 16, 2013 - 02:05 pm Edit Post Delete Post Print Post
This scenario (DHCP always assigning same IP on particular port) only works with some PACS.
Some PACS only use IP address and ports so different mobile IIs can use the same port and whilst using it be assigned the same static IP address. As only 1 machine can use the port at a time all well and good.
Others use IP, AET and port, in which case you can't use this setup as they'll get the same IP on that port but have different AETs. They need to have different AETs of course because they could be used concurrently in another theatre on a different port assigning through DHCP a static IP.
Much easier to have ports identified in each area / theatre on a PACS VLAN for Radiology use only allowing static IP and each II to have its own address details.
 Link to this message Roy Burnett  posted on Wednesday, October 16, 2013 - 04:04 pm Edit Post Delete Post Print Post
Thanks to everyone for their comments. Keep 'em rolling in!

I am aware of the vlan, dhcp issues etc., but unfortunately we do not have a pacs vlan. Needless to say, i was very surpised to learn that when i started here.

Ed has summarised the situation perfectly. We do have subnets. Great for IT, not so great for people like us.
 Link to this message Nick Gibson  posted on Wednesday, October 16, 2013 - 04:10 pm Edit Post Delete Post Print Post
we have one or two modalities which move locations and have to be DHCP to work as different locations are in different IP address range; a different IP is reserved in each location (via MAC address, nothing to to with Port). Think we got this to work by putting both in the PACS config i.e. putting the modality in twice.

Seems to work, though you might have issues with Storage Commitment depending on how your PACS derives which IP address to send the Response back to.
 Link to this message Marco Crispini  posted on Friday, October 18, 2013 - 07:02 am Edit Post Delete Post Print Post
This is pretty much covered across a few of the posts above but an option may be for IT to set up the DHCP server so it gives the IIs the same IP address in each range each time it's connected.

Extending that a little further, assuming the network partitioning means a different IP address ranges, then you should be able to set up each II on PACS under multiple IP addresses. PACS will probably consider each IP a separate device but at least it avoids radiographers manually inputting each theatre case.

For example, if partitioning is such that 192.168.1.x is assigned to devices on 1st floor and 192.168.2.x on 2nd floor, etc, then DHCP can be configured to handle that.

Then on PACS, you have II.a with same AE and 192.168.1.x and II.b with same AE and 192.168.2.x and so on, but of course it's actually the same II.
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