Electronic archive of Diagnostic Images

It is impossible to imagine modern medicine with no diagnostic equipment that produces diagnostic images. No wonder that the tasks of developing an electronic archive of such images, its integration with equipment and providing access to such diagnostic data for medical facilities are of current interest. CIR company developers created a system called CIR.Radiology to tackle these tasks. The system is designed for upgrading the quality and efficiency of diagnostic processes at medical facilities and providing a foundation for implementing resource-saving filmless and paperless work technologies.

In order to understand the tasks the system can solve, let’s consider its evolution by a stereotype example. For instance, a medical facility purchased a diagnostic device – a computerized tomographic scanner. This is a self-sufficient device which can be used for examining patients. However, its potential is not realized to the full extent: it can examine a patient each 10-15 minutes, but a doctor needs several times more time to analyze obtained data. While the doctor is analyzing, the patients are waiting in line.

A special diagnostic station is connected to the device to increase its patient capacity. Another doctor can work at the station simultaneously. Usually a small archive of images is created at the diagnostic station and a simple local area network is used for transferring the images. It is the first stage.

In course of time several diagnostic devices and diagnostic stations are integrated into a united network. There is such an opportunity thanks to the international standard of diagnostic equipment interoperation DICOM (Digital Imaging and Communications in Medicine). It gives a diagnostician an opportunity to see a pathology using different examination methods (ultrasound, X-ray, endoscopy, computerized tomography) and make a more accurate diagnostic decision. It is the second stage.


Illustration 1

Examination data is placed at different stations which function as temporary archives. This might be inconvenient for data search. The station which is situated in the other unit might be switched off, which means you cannot receive the images stored there, or another doctor might consider them unnecessary and delete them.

These problems are solved by connecting a special server with a large memory space (usually 1000 gigabytes) to the network. The server becomes a central archive. It can store millions of images, search for them, and transfer to a doctor in a matter of seconds. Such systems are called PACS (Picture Archiving and Communication System — система архивирования и передачи изображений). It is the third stage. At this stage images are transferred to clinical units as films.

At the next, fourth stage inexpensive browsing stations are set up at clinical departments of medical facilities. Usually it is one-two stations – in the department chief’s room and in the staff lounge. It provides doctors with immediate access to all images of a patient without loss of quality, directly from their workplaces equipped with necessary processing tools. It is important for surgeons who plan operations. It also helps clinician doctors to consider an objective view of the disease.

It must be mentioned that at this stage the medical facility can switch to film-saving or filmless modes.

At the fifth stage all diagnostic devices, including laboratory equipment connected to the subsystems, are integrated into the medical facility’s united information space. Then the system is able to provide the staff with all necessary information about a patient at required time and place.

The system CIR.Radiology maintains work of a medical facility up to the fifth stage. It automates the complex of a medical facility treatment and diagnostic processes which are characterized by intensive information exchange between its subjects – the clinical information system (CIS), medical diagnostic equipment, electronic archive of images, and staff of diagnostic tool, clinical and surgery departments. Information exchange involves constant communication between programs. The CIS supplies information about patients, schedules of diagnostic rooms and prescribed examinations; it is a resource of unique patient and examination identifiers. These identifiers enable all interoperating systems to determine who exactly conducted certain examinations. The archive of diagnostic images ensures long-term storage of different objects and access to stored data for browsing and analyzing. Medical equipment is a user of passport data and patients’ identifiers and also a source of graphic diagnostic data. Lack of connections causes chaos.

Those who neglected the rules of patient and examination identification ended up with a big electronic “trash bin” instead of a well-ordered archive. It is the most commonly made mistake in the process of exploiting such systems and it might discredit the whole system.

In order to avoid this mistake, four conditions must be fulfilled.

  1. 1. A hospital must have an information system which registers all patients who have undergone a tool examination.
  2. 2. The system must have a DICOM-WorkList-server – a software and hardware complex which is designed for transmitting passport data and unique identifiers from the CIS to medical equipment in accordance with the DICOM standard. It can transliterate information from a Russian text into an English text, as not all devices support the Cyrillic characters.
  3. 3. Medical equipment must support the DICOM standard, including data received from DICOM-WorkList-server (usually this option is not included in the standard set and it should be discussed with the supplier when purchasing).
  4. f the device doesn’t have the DICOM-WorkList option, an operator or a doctor must request identifiers from the CIS and correctly input them manually.

At first it seems to be additional load on personnel. But at a later stage it turns out to be a significantly beneficial in relation to an examination duration and quality.

The following effects and new opportunities can be pointed out based on the experience of implementing such systems:

  • increase in productivity of the instrumental diagnostics department;
  • speeding up the instrumental diagnostics cycle from an application to the result in hands of an attending physician;
  • upgrading quality of diagnostics thanks to accessibility of visual data from different types of equipment (multimodal analysis);
  • more accurate assessment of a diseases dynamics by means of comparing a patient’s archive data with the current data;
  • an opportunity of conducting internal audit of quality, setting and controlling diagnostics standards;
  • reducing labor input in research work;
  • decrease of an examination primary cost by means of saving expensive consumables;
  • refusing to use outdated technology of recording an examination to a video tape and switch to CD in DICOM format.
  • an opportunity to connect stereotaxis equipment and systems of planning radiation therapy 3 to the system.
  • during clinical discussions a doctor doesn’t have to waste time on preparing diagnostic images: direct access to the images archive and cineloops can be used from a speaker’s place equipped with a projector

Software and hardware basis of the system

The following are necessary to maintain functioning of the system: well-developed local area network of a medical facility, serves and large-capacity electronic storages. A high-performance server (one or a cluster) and external SATA-disc arrays which support RAID 6 technology are used in developing an electronic archive of images. Such storage system is defined by high fail-safety (it functions even if two dick drives fail simultaneously), high scalability when the archive capacity grows from 10 to 50 Tb, lower cost of keeping and at the price comparable to hierarchical archiving on DVD or tape. All the examination data in the archive complies with the international standard DICOM.

The CIR.Radiology system is a set of self-sufficient modules which can be used for developing various applicable solutions based on functionality of clinical information system implemented at a medical facility. The module of browsing images doesn’t need to be installed on a doctor’s automated work station and operates via the Internet browser.

The graphical shell for browsing diagnostic images (Web-client)

The graphical shell for browsing diagnostic images (Web-client)


In addition, the archive web-portal as a module can operate with any PACS-system using the DICOM standard. The module of virtual print is able to grip data from any medicine program functioning under Windows 2000/XP. This feature makes the system universal and adaptable.

One of successful examples of CIR.Radiology implementation is the project which was realized in the Regional Consultation and Diagnostics Center of Rostov-on-Don city. It is a leading medical facility of the region which has modern equipment for delivering qualified medical care.
Using high technologies changed doctors’ working schedule which is habitual at some medical facilities. The number of patients increased manifold, doctors work from 8 a.m. to 8 p.m. All of them are high-profile specialists, members of professional associations who are involved not only in clinical work, but also in research. At present the Regional Consultation and Diagnostics Center functions as the leading institution of the region. It coordinates work of such kind of facilities in such fields as material and technical supply, human resourcing, information support, and optimization of diagnostic processes.

The Rostov-on-Don Regional Consultation and Diagnostics Center has already used the CIS. It covered almost all fields of the medical facility’s operation with the exception of graphic data exchange, integration with diagnostic equipment and the electronic archive. It was decided to purchase a complete hardware and software complex. First of all, the institution management got familiarized with the same kind of work that the potential executor accomplished at the Tatarstan Inter-regional Clinical and Diagnostic Center. After the project started, the mechanism of integration between the clinical information system and CIR.Radiology was coordinated. Integration was narrowed down to adding several fields, which are necessary for the DICOM format compliance, to the CIS database, writing a SQL query to the clinical system to ensure WorkList-server receives the schedule, and embedding a mechanism of operating with URLs to images and other objects in the electronic archive.


HIS-PACS Integration

HIS-PACS Integration

Afterwards digital diagnostic equipment (for instance, a tomography scanner, seven ultrasound devices, an X-ray unit, four diagnostics stations) was enabled over five days and a training course for diagnostician doctors, who learnt to work on devices using the CIR-Radiology system, was held. Specialists of the medical facility’s automated control system enabled the hardware which does not support DICOM and doesn’t require involvement of medical equipment engineers.

Fully-fledged software complex provided the attending staff with means of making more well-grounded decisions, and executives – with means of conducting immediate control of quality and correcting the diagnostics and treatment process immediately as it is carried out. Information entered by various subdivisions (reception, admissions department, consultation department, clinical-expert department, statistics department, etc.) is available for all specialists who work with the CIS; it is subsequently used for tackling different tasks. The Regional Consultation and Diagnostics Center’s IT department heads believe this solution does not yield to expensive international analogues in the respect of its functionality; at the same time most Russian medical facilities can afford it.


March 2009


Published in PC Week Doctor №1 (5), March 2009