LSUHSC GE PACS System Overview

Picture Archiving and Communications System

Overview | Resources | FAQ

Chronology | Installed Hardware | Resolution Issues | Issues | Ortho Clinic | Web-based Version

CHRONOLOGY:

• Originally designed for the ER only (not the entire hospital and medical school), then Clinical Review Stations were given to the Department's of Medicine, Neurology, Surgery and Orthopaedic Surgery. Other departments wanted them, too.
• More users and image types were quickly added to the system.
• Usage increased dramatically because it was so useful.
• Workstation location was an issue.
• First version had limited short term memory...almost everything had to be fetched. The new upgrade has enough short term memory for 3 months worth of images.
• Originally had single server, now have 2 plus a storage unit.
• New system designed to last 5 years ($500,000 / yr). This is not a big budget for a PACS system.
• This is not a Dept. of Radiology system; it did secure the bids (GE bid was $1M lower and system had many more capabilities).

INSTALLED HARDWARE:

• Due to cost constraints, workstations were reduced from 7 diagnostc quad-head and 16 clinical dual-head workstations to 12 diagnostc dual-head (Radiology) and 6 clinical workstations (2 in ER, 1 each in ortho Clinic, MICU, SICU and PICU). These workstations cost ~$65,000. The difference between the diagnostic and clinical workstations is the resolution of the monitors (see below).
• An additional 10 still in use (one is in 3-335) that use the web version, but are not part of the GE service contract any longer (when these monitors go out (in about 1 year), the departments will have to replace them). The recommendation is to buy a new cpu and 20" flat panel monitor (~$3500).
• Minimum hardware requirments to run the web version and Windows XP: Pentium 4 and 512MB RAM.

RESOLUTION (dpi):
Monitor	Flatpanels			Clinical Workstations	Diagnostic Workstations	CRT
	15"	17-19"	20-21"
Resolution	1024 x 768	1280 x 1024	1600 x 1200	1600 x 1200	2000 x 2000	Progressive Wavelet
MR (512x512)
CT (512x512)
Ultrasound (512x512)
CR (2Kx2K)	*	*	*	*		*
NucMed (?x?)
Mammography (4Kx4K)	There are only 2 Mammography workstations capable of displying these images
Can display complete image without loss. * To see complete image, you either have to use general magnification (2x for clinical workstation, but will have to pan around because the image will be too big for the screen), or the magnifying glass to enlarge specific areas of the image.

• Diagnostic and clinical workstation monitors are fixed gray scale (no color). They use look-up tables for calibration.
• Flatpanels are fixed pixel/less distortion; always run at native resolution.
• Web browser version will display whatever your monitor is capable of.
  • Progressive wavelet (displays best possible image)
  • To select this, look at the bottom Left of the Web Viewer screen (under the thumbnail navigation bar) for the drop down box (typically named "Default Compression"). Click on it and then select Progressive Wavelet.
• Click to download Bill Gregg's Display Characteristics PowerPoint presentation.
• Sites that explain resolution, etc.:
  • Pixels, Dots and Resolution
  • About megapix, resolution and file size

ISSUES:

• Capabilities of monitor (see Resolution above).
• Type of video card
  • Set it to maximum color depth (24 or 32 bit) to allow for greatest number of shades of gray.
  • A separate video card (as opposed to an 'integrated' card) is recommended - preferably one with a DVI interface to go along with a DVI connection on a flat panel monitor (but not all video cards or flat panels have a DVI connection, however).
• Speed of ethernet connection (dial-in; old shared 10MB; switched 100MB; gigabyte).
• HIPAA violations ("minimum & necessary"; "reasonable & appropriate").
  • Need to logoff every time (each image accessed is part of an audit trail).
  • Required to keep log recording every access to an image over a 6 year period.
  • Don't use web browser in conferences -- download 1st w/o patient info and save as jpeg.
• Maximum of 50 concurrent users.
  • Therefore, it is important (not only because of HIPAA) to logout when you are done using the system.
• Forced password change every 30 days.
  • Passwords can be changed at any time (the login dialog box has "Change Password" and "Login" buttons). You won't be locked out unless you don't use the system for sevral months.
• Dial-in access from off campus.

ORTHO CLINIC:

• 8 PCs being installed for doctor/patient interaction (15" flat panels & adequate CPUs - Pentium 4s with 512MB RAM).
  • There will be a difference in the image resolution on the 15" monitors (which run the web version) and the clinical workstation (may not see the same thing). Magnify the image to see the same level of detail.
• Make diagnosis from the Clinical workstation.
• Applications will be locked down (maybe Envision and Word) by Computer Services with Fortress software.
• Network drops are to the 100MB network (dictated by the type of network cards in the computers).
• Physicians should kill initial dead time, while logging on, with patient interaction.

WEB-BASED VERSION (Centricity Web 2.0 Server):

• Use Internet Explorer version 5.5 SP2 or later.
• Drawbacks:
  • no Worklists
• Inactivity default is 15 min.

Connecting On-Campus | Connecting Off-Campus | Downloading Images

Connecting to the PACS Web Server (Web Access Installation) On-Campus

LSUHSC-S HIPAA policies require that Identifiable Healthcare Information not be accessible to unauthorized personnel. Be sure that you can ensure privacy when accessing images via the web, and always be sure to close out the application when you are through viewing images.

The following is a brief set of instruction on how to connect to the Centricity Web 2.0 server with Microsoft Internet Explorer (version 5.5 SP 2 or later). You must have the ability to install software on the pc you are trying to use (on some pc's this may require logging on as the user 'administrator'). Once you are connected to the server, you will have the ability to go into a help screen that will provide more detail if necessary. The minimum requirements for the pc are a Pentium III or 4 and 128Mb of memory.

1. In your browser, type '10.1.204.17/ami' in your address line and hit enter (without the '').

2. The Centricity Web 2.0 home page will appear, and will indicate if your browser is supported.

3. Click on 'Test' to start the plug in downloads. The first will be 'msxml4.cab' from Microsoft. The second is 'AMI WebViewer Controls' from Applicare Medical Imaging BV.

4. A 'Security Warning' dialog box will pop up asking if you want to install each one of these. Click 'Yes'.

5. At the top left of the screen you will see 'You may now start Centricity Web'. Click on 'Centricity Web'.

6. You will see a security alert regarding a 'security certificate'. Click on 'View Certificate', then 'Install Certificate'. Click 'Next' or 'OK' to keep the process going until it is completed so that the certificate is installed. You will still need to click 'Yes' to proceed from the original alert dialog box, but the certificate should now be installed so you won't have to do this again.

7. You will be asked to install and run "Login Page Control". Click 'Yes'.

8. The GE Centricity Web logo appears, and then the login dialog box. You can create a Favorite entry by clicking on Favorites/Add to Favorites, and a desktop shortcut by clicking File/Send To/Shortcut to Desktop.

9. Enter your login ID and password. Remember you must be in all caps. (Note that you can change your password from this login dialog box).

You must fill out a PACS Access request form to get a login ID and password. This form is available on our web site at www.sh.lsuhsc.edu/radiology. Click on 'PACS' in the main menu bar, then click 'Downloads', and then click on 'PACS Access Request Form'. Instructions are at the top of the form.

Once you have logged in you will be able to find and select patients and exams, and display the exam. There are tools to window and level, flip, invert, cine, magnify, zoom and pan, measure and copy the image to a bitmap or the clipboard. You can get to these by right clicking on the image to pop up a menu, or using the toolbars at the top and side of the screen. You can also put multiple images up at a time, and navigate much more efficiently through the images. It also allows you to do comparisons by selecting two procedures at the same time. There is help available on the page as well.

Connecting to the PACS Web Server Off-Campus: New Dial-in VPN (Virtual Public Network) Capability

Previously, the only way that PACS was accessible off-campus was if you had an LSUHSC dial-in account. The user name and password connection dialog box was used to verufy that you were an employee. Since connection speed is always an issue, especially when dealing with images like those available from the PACS, and since many employees have accounts with other ISPs, an alternative VPN connection from off-campus was then made available for broadband users. To make this type of connection, you needed to install the VPN software on your home computer.

Now, all you have to do is login through the LSUHSC-S Home page. Go to:

• Education
  • Other Educational Resources
    • Computer Services
      • User Applications
        • VPN Access (http://vpn.lsuhsc-s.edu/dana-na/auth/url_default/welcome.cgi)

Hardware:

-wireless connection is problematic

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