PACS Network Traffic Control

PACS Network Traffic Control

Carrison K.S. Tong (Pamela Youde Nethersole Eastern Hospital, HK) and Eric T.T. Wong (Hong Kong Polytechnic Institute, Hong Kong)
DOI: 10.4018/978-1-59904-672-3.ch013
OnDemand PDF Download:
$37.50

Abstract

Economically speaking, it is interesting to see that over the years, the question as to whether PACS is cost-justifiable has not been easier to answer. The early work at the hospital of the University of Pennsylvania, as well as at Washington University in Seattle, provided some early numbers and a framework to use, however, a clear “savings-model” is still difficult to formulate. The challenge is that one cannot just look at how much is saved by eliminating film, but that the true savings lie more in the increases in efficiency. Productivity studies by the VA in Baltimore in the early 1990’s have helped in this regard. However, one has to realize that, as Dr. Eliot Siegel from the VA in Baltimore strongly advocates, one has to re-engineer a department and its workflow to make use of the advantages of this new technology to really realize the benefits. As one can imagine, the early PACS only replaced their film-based operation with a softcopy environment without emphasizing re-engineering. That brings us to one of the big “drivers” in this technology: network standardization. In the early 1980’s, there was no one single standard. Transmission Control Protocol and the Internet Protocol (TCP/IP) was just one of the several options available. The United States government was pushing for the Open Systems Interconnection (OSI) standard.
Chapter Preview
Top

Network Standards

Economically speaking, it is interesting to see that over the years, the question as to whether PACS is cost-justifiable has not been easier to answer. The early work at the hospital of the University of Pennsylvania, as well as at Washington University in Seattle, provided some early numbers and a framework to use, however, a clear “savings-model” is still difficult to formulate. The challenge is that one cannot just look at how much is saved by eliminating film, but that the true savings lie more in the increases in efficiency. Productivity studies by the VA in Baltimore in the early 1990’s have helped in this regard. However, one has to realize that, as Dr. Eliot Siegel from the VA in Baltimore strongly advocates, one has to re-engineer a department and its workflow to make use of the advantages of this new technology to really realize the benefits.

As one can imagine, the early PACS only replaced their film-based operation with a softcopy environment without emphasizing re-engineering. That brings us to one of the big “drivers” in this technology: network standardization. In the early 1980’s, there was no one single standard. Transmission Control Protocol and the Internet Protocol (TCP/IP) was just one of the several options available. The United States government was pushing for the Open Systems Interconnection (OSI) standard. The OSI was an effort to standardize networking that was started in 1982 by the International Organization for Standardization (ISO), along with the International Telecommunication Union (ITU). The OSI reference model was a major advance in the teaching of network concepts. It promoted the idea of a common model of protocol layers, defining interoperability between network devices and software.

However, the actual OSI protocol suite that was specified as part of the project was considered by many to be too complicated and to a large extent unimplementable. Taking the “forklift upgrade” approach to networking, it specified eliminating all existing protocols and replacing them with new ones at all layers of the stack. This made implementation difficult, and was resisted by many vendors and users with significant investments in other network technologies. In addition, the OSI protocols were specified by committees filled with differing and sometimes conflicting feature requests, leading to numerous optional features; because so much was optional, many vendors' implementations simply could not interoperate, negating the whole effort. Even demands by the USA for OSI support on all government purchased hardware did not save the effort.

Major manufacturers, notably General Motors, were also trying to enforce broadband instead of Ethernet standards. As a matter of fact, the first PACS by Philips used broadband technology. There were also “ad-hoc” developments using inventive solutions in the 1980’s, such as the one at Michigan State University, whereby images from three CT scanners were sent to the University diagnostic center for reading leasing bandwidth from the commercial CATV cable system; a predecessor to cable modems! The early versions of DICOM, called ACRNEMA, only specified a dedicated point-to-point connection, leaving it up to the manufacturer to exchange the data via their network of choice. It took about ten years for the network standard to emerge, something we take for granted now. Today, everyone uses the TCP/IP as the basis for network communication, making it easy for new developments at the physical level such as gigabit/sec Ethernet to be deployed.

As with all other communications protocol, TCP/IP is composed of layers (Yale, 1995):

  • IP - is responsible for moving packet of data from node to node. The Internet authorities assign ranges of numbers to different organizations. The hospital authority assign groups of their numbers to PACS departments.

  • TCP - is responsible for verifying the correct delivery of data from client to server.

  • Sockets - is a name given to the package of subroutines that provide access to TCP/IP on most systems

Complete Chapter List

Search this Book:
Reset
Table of Contents
Chapter 1
Introduction  (pages 1-27)
Carrison K.S. Tong, Eric T.T. Wong
Picture archiving and communications system (PACS) is a filmless and computerized method of communicating and storing medical image data such as... Sample PDF
Introduction
$37.50
Chapter 2
Carrison K.S. Tong, Eric T.T. Wong
The protection of information for a healthcare organization, in any form, while in storage, processing, or transport, from being available to any... Sample PDF
ISO 27000 Information Security Management System
$37.50
Chapter 3
Carrison K.S. Tong, Eric T.T. Wong
PACS disasters can, and do, appear in a variety of forms including storage hard disk failure, file corruption, network breakdown, and server... Sample PDF
High Availability Technologies for PACS
$37.50
Chapter 4
Carrison K.S. Tong, Eric T.T. Wong
Fundamental to ISO 27000 (ISO/IEC 27001:2005, 2005) is the concept of an information security management system (ISMS). The information security... Sample PDF
Implementation of Information Security Management System (ISMS)
$37.50
Chapter 5
Carrison K.S. Tong, Eric T.T. Wong
Filmless hospital is transforming at an unprecedented rate. Physicians, nurses, clinicians, pharmacists, radiologists, emergency departments, local... Sample PDF
Planning for a Filmless Hospital
$37.50
Chapter 6
Carrison K.S. Tong, Eric T.T. Wong
More rapidly than any technological advance in medical history, filmless hospital is changing the clinical and business aspects of radiology... Sample PDF
Design of a Filmless Hospital
$37.50
Chapter 7
Carrison K.S. Tong, Eric T.T. Wong
A PACS has tremendous benefits (Bryan, Weatherburn, Watkins, Buxton, 1999) and values outside of radiology as well as internally. The biggest... Sample PDF
Implementation of Filmless Hospital
$37.50
Chapter 8
Carrison K.S. Tong, Eric T.T. Wong
As PACS gains widespread use, the importance of Quality Control (QC), Quality Assurance (QA), and Business Continuity Plan (BCP) in PACS is rising.... Sample PDF
Quality Control, Quality Assurance, and Business Continuity Plan in PACS
$37.50
Chapter 9
PACS Quality Dimensions  (pages 140-153)
Carrison K.S. Tong, Eric T.T. Wong
A large number of studies have attempted to identify the factors that contribute to good PACS quality, such as that shown by Reiner et al (2003).... Sample PDF
PACS Quality Dimensions
$37.50
Chapter 10
Customer Oriented PACS  (pages 154-169)
Carrison K.S. Tong, Eric T.T. Wong
During the early development phase of PACS, its implementation was mainly a matter of the radiology department. This is changing rapidly, and PACS... Sample PDF
Customer Oriented PACS
$37.50
Chapter 11
Carrison K.S. Tong, Eric T.T. Wong
Nowadays it is hard to think of any applications in modern society in which electronic systems do not play a significant role. In aerospace and... Sample PDF
Design for PACS Reliability
$37.50
Chapter 12
Carrison K.S. Tong, Eric T.T. Wong
There are some medical errors for which preventability is rarely questioned. These include medical errors such as wrong site surgery, wrong... Sample PDF
PACS Failure Mode and Effects
$37.50
Chapter 13
Carrison K.S. Tong, Eric T.T. Wong
Economically speaking, it is interesting to see that over the years, the question as to whether PACS is cost-justifiable has not been easier to... Sample PDF
PACS Network Traffic Control
$37.50
Chapter 14
Human Factors and Culture  (pages 225-243)
Carrison K.S. Tong, Eric T.T. Wong
Human factors engineering (HFE) is the science of designing systems to fit human capabilities and limitations. These include limitations in... Sample PDF
Human Factors and Culture
$37.50
Chapter 15
PACS Monitoring  (pages 244-263)
Carrison K.S. Tong, Eric T.T. Wong
The present study advocates the application of statistical process control (SPC) as a performance monitoring tool for a PACS. The objective of... Sample PDF
PACS Monitoring
$37.50
Chapter 16
Carrison K.S. Tong, Eric T.T. Wong
To illustrate the benefits of implementing QM in PACS, a successful case based on the Six Sigma approach is given below. It involves a project... Sample PDF
Quality Management Benefits
$37.50
Chapter 17
Epilogue  (pages 288-297)
Carrison K.S. Tong, Eric T.T. Wong
Today’s filmless radiology through PACS provides greater speed and superior image quality. However, when workflow is encumbered by inefficiencies... Sample PDF
Epilogue
$37.50
Appendix A
Appendix B
Appendix C
About the Authors