Cross-site imaging and diagnosis using PergamonMED

Introduction

Modern digital medical imaging systems (such as CR / DR / CT / MR / MG) spurred manufacturers of medical software to meet the increasing demands of the market of diagnostic imaging. Automatic transfer of  images between systems or providing access to them from different locations becomes more and more popular. The solutions must vary depending on available resources (management and image storage) and keep appropriate access rights to individual images and appliances, as well as to be configurable on client site.

Basic approach

PergamonMED supports various PACS clustering concepts. It is possible to use a centralized or decentralized structures.

Central database structures...

...centralize the data storeage, but allow the retention of backup time in the local archives for faster image loading. In this way, Doctors get faster access to most recent data. These archives can also be synchronized with physicians in different locations, providing quick access to the same examinations.

Decentral database structures...

...are composed of independent locations and at least one archive. Synchronization is done using DICOM both heterogeneous (each archive has a direct connection with another), or is controlled from a central location. Speed of synchronization is dependent on the quality and performance of the internet connections between those systems.

One database – many locations

The main advantage of having one database for several sites is that all data entered into the database are immediately available in all systems simultaneously.

PergamonMED has the ability to assign individual stocks locally, which allows you to keep a clear workflow and eliminate possible errors, e.g. by sending a request to a device by mistake.

Images acquired in one place are at first stored locally, then, when it is convenient, they are physically synchronized with other clinics to allow faster access to research in other branches. This solution enables you to perform synchronization, e.g. at night, when there is less bandwidth use on the connection.

If the user wishes to access data stored physically in a different location, the system automatically will send a query to the external archives and instantly synchronize all the desired studies.

 

Requirements:

10 MBIT – Upstream in database lacation

> 10 MBIT – Downstream in other lacations

ZOSU- Center for Orthpedics and sports medicine

The starting point: three cities (Mainz, Taunusstein and Bodenheim) located approximately 30 km apart from each other were using two different PACS and imaging systems from two different manufacturers.

At all three places, the complete data from the old PACS was transferred to PergamonMED and synchronized between schools. Two already existing CR readers (Konica and Agfa) were integrated into the system, as well as one new Konica CR system. On the occasion of the installation, a few ultrasound devices and bone densitometer were integrated as well - with the help of our own interfaces. At every location, all the data is available synchronously for all three systems, and for each unique patient there is only one record in the database.

Many locations / Many databases - DICOM-Sync Clustering

Cross-site imaging and diagnosis using PergamonMED from different POV

Clustering via DICOM-sync allows you to preserve the independence of each location using the on-demand synchronization. Disorders of the network, VPN, or crowded links do not interfere with the daily operations of your PACS.

Each location operates independently!

At a convenient time (e.g. at night) PergamonMED synchronizes with other PACS. If synchronization at night is insufficient and some studies are needed elsewhere (e.g. to add further diagnostic opinions) they may be sent in advance.

Data synchronization strategies can be designes in a a star or a ring topology.

When using star topology,  we make sure that central server do not return data back to the source (so no unnecessary transfers are done)

Project: Herten

Star topology, DICOM-Sync synchronization

A total of six locations has been merged. This network had prior two different PACS systems. Due to this reason, and due to be extended to additional locations there were many ranges of patient numbers and the data was often duplicated. In accordance with the requirements of system adminstrators, each patient had to have a number of this specific range. These informations were included during conversion. A large part of the data was stored without patient numbers- it has also been complemented by conversion. 

Due to the fact that the client software – MedicalOffice -  works with multiple databases, our solution had to ensure a maximum of reliability of connections and be able to work independently, even when disconnected from the network. So we implemented stand-alone solutions by synchronizing automatically when internet connection is available. Star topology has been preserved due to the existing VPN network topology.

Project: Kronshagen

Ring topology clustering through DICOM-Sync

In total, five branches have been networked / digitalized. Software for managing patient data is triggered by remote desktop. PergamonMED initiates connections on the local workplace so the flow of image data is carried out locally (only patient data is called from a remote system). 

Transferring images to other sites is spread over time, shifted to night hours, in order to maximize the use of bandwidth. Each system transmits its data to another location.

Local patient registration systems use several patient number ranges. Implementation of these systems helped to preserve the integrity of patient data. Now it's possible to call all studies for the selected patient (from different institutions). There is also the possibility to sort the data according to standard parameters.