Proper preparation ensures PACS potential
SEATTLE—An imaging informatics enterprise is a dynamic environment. New modalities are added to expand patient care possibilities, while existing technology is periodically refreshed with new software applications, updates, and upgrades in order to enhance reliability, security, and clinical capabilities.

“Imaging informatics professionals (IIPs) who serve as system administrators should be actively engaged with the installation and support of DICOM devices in their facility,” said Herman J. Oosterwijk, president of Denton, Texas-based healthcare IT education firm OTech. “They are ultimately responsible for data and image integrity.”

According to Oosterwijk, who shared his expertise on DICOM implementation during the 2008 Society for Imaging Informatics in Medicine (SIIM) annual meeting, the first step to a successful implementation is performing the necessary DICOM due diligence prior to an installation.

“The IIP needs to review the DICOM conformance statement of the new device; in particular, he or she needs to look for any service-object pair (SOP) classes that might not be supported by their PACS,” Oosterwijk said. Examples of SOP classes that are not supported by some systems include mammography (MG) and intra-oral (IO) image types, he noted.

The next step a system administrator should perform is to evaluate the attributes that are used for the modality worklist. These attributes are used to ensure that one can filter worklist responses from the device on the basis of its modality workstation name and application entity (AE) title.

“This will prevent getting very long worklists that are not really applicable to the particular device,” Oosterwijk said. “If you really want to replace the paper requisition, make sure all attributes from the requisition form are present on the worklist such as pregnancy status for x-ray, patient weight for MR, and contrast allergies for CT and MR.”

The next step is for the IIP to ensure that the infrastructure is ready for the new technology; such as the proper network configuration, the assignment of a static IP address, and the allocation of an AE title.

 “The third step takes place when the system is installed—never allow a new modality, software application, or upgrade to be connected to a production system without proper verification and validation; not doing so could potentially impact the data integrity of your PACS,” Oosterwijk cautioned.

He advocated that a test environment be created that is a digital virtual replica of the production PACS. Oosterwijk noted that such an environment can be setup by an IIP using open-source and free components, such as the OFFIS modality worklist provider and Conquest as a test archive.

“Never allow a service entity to leave a test system before acceptance testing is completed against a checklist,” Oosterwijk advised.

The same procedures should be followed whenever a modality is upgraded. Although many upgrades may appear to be innocuous, downstream effects in specific PACS configurations are unknown and have the potential to compromise the quality of patient care.

“By taking the proper precautions when installing or upgrading a new modality, one can minimize the potential impact to the data integrity of a PACS,” Oosterwijk stated.