Chapter 9- Pacs Fundamentals

Front 1

PACS consists of:

Back 1

Acquisition devices, storage, Image management system, display workstations

Front 2

Matrix

Back 2

Rectangular or square table of #’s that represents the pixel intensity to be displayed on the monitor

Front 3

Pixel

Back 3

Basic picture element on a display

Front 4

Window level controls:

Back 4

Brightness

Front 5

Window width controls:

Back 5

Contrast

Front 6

DICOM definition

Back 6

Universally accepted standard for exchanging medical images among the modality, viewing stations, & archiving

Front 7

DICOM

Back 7

Digital imaging and communications in medicine

Front 8

Primary reading stations

Back 8

For radiologists to make a primary diagnosis

Front 9

Review stations

Back 9

For referring physicians to view current & previous reports w/images

Front 10

Technologists quality control (QC)

Back 10

Station for technologists to review images after acquisition but before sending to radiologist

Front 11

Image management file room stations

Back 11

Used to look up exams for physician or to print copies of images for pt to take to an outside dr

Front 12

Relationship between pixels & resolution

Back 12

More pixels = higher resolution

Front 13

Client or Server based system

Back 13

Images sent directly to archive server, display workstation functions as client of archive server

Front 14

Distributed systems

Back 14

Known as distributed or stand alone models, acquisition modalities send images to a designated reading station

Front 15

Web-based systems

Back 15

Images & application software held centrally & load to client display, only images held at archive

Front 16

Volume Rendering Technique

Back 16

Allows user to assign colors based on tissue intensity, uses a histogram

Front 17

Multiplanar Reconstruction

Back 17

One of most commonly used 3D rendering techniques, reconstructs slices in another plane when doing CT (ex: coronal from axial)

Front 18

What is cine & how does it work?

Back 18

Stack mode of scrolling through images, means to moves through frame by frame of the series of images, most often cross-sectional imaging

Front 19

Which system architecture would use a central server?

Back 19

Web-based system

Front 20

Soft copy reporting

Back 20

Using a computer screen without hard copies to make diagnoses

Front 21

Resolution

Back 21

Process or capability of distinguishing among individual parts of an image that are adjacent

Front 22

Factors to determine the best type of monitor for each workstation

Back 22

Resolution, orientation of monitor, # of monitors used, & size of monitor

Front 23

Teleradiology

Back 23

Ability to view the same set of images in multiple locations at one time

Front 24

Stitching

Back 24

Used when multiple images need to be put together in one image

Front 25

Shaded Surface Display

Back 25

Everything below threshold of pixel intensity is removed & everything above is assigned a color & shown as 3D object

Front 26

Maximum Intensity Projection

Back 26

Used to visualize vessels after injection of contrast on CT or MRI

Front 27

Minimum Intensity Projection

Back 27

Used to visualize air-filled structures after injection of contrast on CT or MRI

Front 28

Hanging protocols

Back 28

Define how a set of images will be displayed in the monitor

Front 29

Flip & rotate

Back 29

Used to orient image in correct anatomical hanging position, usually L to R flip & 90 degree clockwise & counterclockwise icon

Front 30

Pan & zoom

Back 30

Used primarily by radiologist to increase size of area on image, zoom up as desired then pan icon activated to move around & view different areas of image

Front 31

Most interactive part of PACS

Back 31

Display workstation

Front 32

Types of PACS architecture

Back 32

Client or server based, distributed systems, web based systems

Front 33

Measurements- distance

Back 33

Size of pixel is known so structures can be measured based on this

Front 34

Measurements- angle

Back 34

Angle measurement between two structures, common with spine

Front 35

Measurements- region of interest

Back 35

Determines pixel intensity of certain area, used to determine if something is solid or fluid

Front 36

Advantages- client or server based

Back 36

Any exam in PACS available anywhere, only 1 person can open study to read it, old studies available with new one in archive

Front 37

Advantages- distributed

Back 37

Archive server down doesn’t interrupt local reading at workstation, multiple copies in various locations = less likely for PACS data to be lost, less dependent on networks for speed

Front 38

Advantages- web based

Back 38

Hardware at client can be anything that will support appropriate web browser, same application can be used onsite & at home in teleradiology situations

Front 39

Disadvantages- client or server based

Back 39

Archive goes down = entire system goes down, network dependent, bogged down, archive server handles many requests at once and can become bottlenecked

Front 40

Disadvantages- distributed

Back 40

Personnel rely heavily on system to perform correctly, each workstation has a different work list meaning one person on list at a time, have to move to different workstation for additional studies, depend on query & retrieve for nonscheduled exams, 2 radiologists can read same exam at a time & not know

Front 41

Disadvantages- web based

Back 41

Limited functionality due to software not locally installed, network is biggest obstacle

Front 42

Categories of workstation

Back 42

Primary, review stations, technologist quality control (QC), Image management

Front 43

Workstation functions

Back 43

Receives images from archive or various radiology modalities, presents images to be viewed

Front 44

Navigation

Back 44

Used to move through images, series, studies, & patients

Front 45

Image management

Back 45

Patient demographics, query or retrieve icon, CD burning option, copy & paste, print films

Front 46

Should we ever use R or L annotation?

Back 46

No

Front 47

How many monitors did radiologists first think they needed?

Back 47

4-6

Front 48

Is having the correct patient demographic information important?

Back 48

Yes

Front 49

First PACS

Back 49

Early 1980s, served one single modality

Front 50

3 functional parts of PACS

Back 50

Image acquisition, display workstations, archive servers

Front 51

Modalities using digital & PACS far longer than general radiology

Back 51

US, CT, MRI, NM

Front 52

Archive servers consist of

Back 52

Database server or image manager, short and long term storage, workflow manager

Front 53

Archive server

Back 53

Central part of PACS, houses all historic & current data

Front 54

Info generated from order entered into RIS

Back 54

Pt name, pt hospital ID #, DOB, ordering physician name, exam ordered, reason for exam, chief complaint

Front 55

System architecture

Back 55

Hardware & software infrastructure of computer system

Front 56

PACS

Back 56

Picture archiving & communications system

Front 57

RIS

Back 57

Radiology information system

Front 58

CRT

Back 58

Cathode ray tube

Front 59

LCD

Back 59

Liquid crystal display

Front 60

QC

Back 60

Quality control

Front 61

CD

Back 61

Compact disk

Front 62

ROI

Back 62

Region of interest

Front 63

HIPAA

Back 63

Health Insurance Portability & Accountability Act

Front 64

MPR

Back 64

Multiplanar Reconstruction

Front 65

MIP

Back 65

Maximum Intensity Projection

Front 66

MinIP

Back 66

Minimum Intensity Projection

Front 67

VRT

Back 67

Volume Rendering Technique

Front 68

SSD

Back 68

Shaded surface display

Front 69

IP

Back 69

Image plate

Front 70

In which type of workstation can changes not be made to the patient demographics of an image set?

Back 70

Review workstation

Front 71

Which PACS device stores the historic image data to be viewed along with current studies?

Back 71

Archive server

Front 72

In which PACS architecture is the archive the central repository for all images?

Back 72

Client/server

Front 73

T/F: In a web-based system, images are sent directly from the modality to a display workstation for image interpretation.

Back 73

False

Front 74

T/F: Monitor type and configuration are of no concern when implementing a PACS in a radiology department.

Back 74

False

Front 75

What workstation function will allow the user the ability to arrange a certain number of images per monitor per modality?

Back 75

Hanging protocols

Front 76

T/F: Digital R and L markets should be used to indicate the anatomic side imaged.

Back 76

False

Front 77

Which advanced image manipulation function will allow the radiologist to view several different anatomic planes from the original acquired sagittal images?

Back 77

Multiplanar reconstruction

Front 78

Which advanced image manipulation function will allow the technologist to join multiple images together as one?

Back 78

Stitching