Pacs - Dicom

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DICOM History

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Digital Imaging and Communications in Medicine is the accepted standard for exchanging medical images. First developed by the ACR and teh NEMA (National Electrical Manufacturers Assoc.) in 1985. It has since been updated and revised and the current version is 3.1.

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DICOM purpose

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DICOM was established to develop consistency in workflow to improve efficiency and regulate image viewing, QA, etc...for transmission of data. It creates interoperability across institutions and is used in every hospital across the world.

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What is DICOM?

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DICOM is a set of standards/guidelines for imaging equipment developed to standardize images for transmission.

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What DICOM standardizes...

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- Production
- Storage
- Display
- Processing
- Transmission and Receipt
- Query
- Printing
- Management of Work-Related Flow such as comparisons, Rad repots, patho reports, etc.. related to the image.

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Why is DICOM necessary?

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It ensures a facility's equipment can handle any workflow, work with any electronic health record system, and work with all current and future imaging modalities and related peripheral equipment regardless of vendor.

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What does DICOM assure?

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It assures that equipment will work w/ALL other equipment such as monitors, printers, etc... and allows for old images and future images to be displayed regardless of changes in technology.

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DICOM Conformance Statement

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Manufacturers will have a DICOM conformance statement so the buyer knows it meets DICOM standards.

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Filing Needs

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- works to improve storage capabilities
- decrease physical storage space
- increase efficiency of sharing files
- decrease man power (except we require more IT people networking, etc...)

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DICOM Header

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The DICOM header is a template of image descriptors that must accompany an image set. They are registered by NEMA for each modality.

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DICOM Header Requirements

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Annotation information that tells where images were acquired, when they were acquired, the image specifics, etc...

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Deidentifying DICOM Header

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The DICOM Header may also include patient information so you must deidentify all pieces. You will need software to do this is in the DICOM header as you cannot just go in and change it since it is standardized.

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Worklist Manager Purpose

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This is found in the HIS and/or RIS. It eliminates double entry of radiology information. It aids to eliminate mistakes on patient information by allowing only single entry on patient name, spelling, DOB, MR#, exam type, etc...

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ACR Teleradiology Standards

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Are the Diagnostic image transferring standards that are there to produce diagnostic quality images. There are specifications for viewing for each type of personnel (physician, technolgist, and medical physicist) and there are equipment specifications.

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Medical Physicist

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Has ACR teleradiology viewing standards because they are responsible for preventative maintenance.

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ACR Teleradiology Standards - Matrix Requirements

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Small - Tech monitors - 512 X 512
Large - Rads monitors or for diagnostics in ICU or ER - Minimum of 2.5 lp/mm spatial resolution

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ACR Teleradiology Standards - Bit Depth Requirements

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Small - Tech monitors - 8 bit depth
Large - Rads or diagnostic monitors - 10 bit depth

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ACR Teleradiology Standards - Annotation Capabilities Requirements

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The image MUST have this specific info on it:
- Patient name
- ID number
- Date/Time of acquisition
- Facility Name
- Exam type
- Anatomic part
- Orientation indicators (R, L, Superior, Inferior)
- Method and amount of compression
- Patient history record is desirable

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ACR Teleradiology Standards - Compression Requirements

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Must state the type and amount of compression to include:
- whether it is reversible or irreversible (under direction of qualified physician)
- Whether it is lossless (transferred as is) or lossy (removed redundant or irrelevant info)

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ACR Teleradiology Standards - Transmission Requirements

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Set standards for the recieving end:
If the image is being used for diagnosis, there can be no loss of clinically significant information. A 3:1 ratio is usually the maximum loss allowed.

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ACR Teleradiology Standards - Display Capabilities Requirements - Luminance

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Specific brightness capabilities are required:
Luminance for monochromal monitors must be at least 50 foot-lamberts.

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ACR Teleradiology Standards - Display Capabilities Requirements - Ambient Light

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Ambient light in a room is controlled - it must eliminate reflections on a monitor

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ACR Teleradiology Standards - Display Capabilities Requirements - Patient Demographics

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A sequence selection option must be available so you can select the series you want to view and the image must display patient demographics on it to correlate to the images.

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ACR Teleradiology Standards - Display Capabilities Requirements - Post Processing

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Must have post processing capabilities with original labeling preserved to include:
- Window/level
- Pan/Zoom
- Rotate/flip
- Measurement tools (distance, pixel values)

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ACR Teleradiology Standards - Display Capabilities Requirements - Post Processing Image Manipulations

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Must be able to demonstrate/save prior image manipulations to include:
- compression
- cropping
- processing

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ACR Teleradiology Standards - Display Information Requirements

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A Rad must be able to put images in sequence so he can identify order. So, matrix size, bit depth, number of images and sequence, and technical parameters must be displayed on all images.

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ACR Teleradiology Standards -Archiving Requirements

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Facilities at either end should adhere to facility, state, and federal regulations regarding medical record retention. Must keep minor information until at least 5 years after they are 18. Adult information is kept for 5 years. And depending on diseases processes, there may be longer times images need to be kept.

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ACR Teleradiology Standards -Retrieval Requirements

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Prior exams should be available for comparison and HIPAA regulations must be adhered to.

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ACR Teleradiology Standards -Reporting Requirements

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Physicians interpreting images should render reports in accordance to ACR regulations.

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DICOM Conformance Statement facts

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- Describes capabilities of the device
- Is voluntary
- There is no regulation on it
- Does not guarantee compatibility, just states that it meets DICOM requirements
- Used to determine interoperability