- Email: [email protected]
Integration of a voice processor machine in a PACS
Compurerized Medical Imaging and Graphics. Vol. 17, No. Printed in the U.S.A. All rights reserved.
INTEGRATION
I, pp.13-19,
I
I993 Copyright
OF A VOICE
PROCESSOR
MACHINE
0895-61 l/93 $6.00 + .OO 0 1993 Pergamon Press Ltd.
IN A PACS
Claudine M. Breant,* Ricky K. Taira, and H. K. Huang Department of Radiological Sciences, Medical Imaging Division, University of California, Los Angeles, CA 90024- 172 1 (Received 4 June 1992; Revised 16 November 1992) Abstract-The final stage of development of a clinical picture archiving and communication system (PACS) at the University of California at Los Angeles (UCLA) department of radiological sciences consists of building a dwumentation package of a complete radiological consultation. In this paper, we present the technological aspect of the integration of a digital voice server in our PACS environment. This component improves the timely delivery of the dllostic report with the images. The interface of this voice system is integrated into the PACS display station. It offers the user the capablllty to easily dictate and/or listen to radiological reports, while viewing and/or performing image processing operations at the display station. Key Words: Picture archiving and communication
system (PACS), Voice system integration, Radiological documentation, PACS radiological workstation design, Radiological diagnosis
INTRODUCTION
Typically, radiological reports are archived and transmitted independently from the image files. They are recorded on a simple audio cassette recorder from which a textual form is transcribed and inserted into the radiological information system (RIS, MAXFILE, Dimensional Medicine, Inc., Minneapolis, MN) several hours later. The interface between the RIS and the PACS is then responsible for sending and inserting the reports into the PACS data base. Subsequent to these steps, reports can be displayed at the PACS display station when requested by the user. The main inconvenience of this process is that the textual format of the report does not reach the referring physician in a timely manner because of the delay imposed by the transcription process. In this paper, we present the integration of a voice server into a clinically operating PACS as an intermediate step before the typed report is ready. This work is part of our effort in designing a comprehensive radiological documentation tool integrated in the PACS display station. Some implementation issues of the integration of a voice system into a workstation environment have been described previously (6-8).
Current film-based systems typically do not provide radiologists and referring physicians with the ability to access patient images and reports in a timely manner. Immediate availability of patient radiographs is important because it has been shown to lead to faster medical action in an intensive care unit (ICU) setting (e.g., tube placement, drug therapy) (1, 2). During the last several years, an enormous amount of research and development work has been devoted to the building of picture archiving and communication systems (PACS). A PACS has been developed in the department of radiology at the University of California at Los Angeles (UCLA) that satisfies the timely requirement to access the digital images. The present PACS is able to acquire, store, display, and communicate patient images that originate from different imaging acquisition systems such as computed radiography (CR), magnetic resonance (MR), and computed tomography (CT) (3). The implementation of the PACS system at UCLA and its performances have been presented elsewhere (4, 5). Most efforts in the past have been in image acquisition, management, display, and evaluation (5). Very little research has been done on the communication of a complete and appropriate radiological consultation report (image, graphic annotation and pointers, and the radiologist’s study interpretation) to the referring physician in a timely fashion.
MATERIAL
AND
METHODS
System configuration The integration of a voice processor machine to a PACS requires interfaces between a commercially available digital Dictaphone system and two components of the PACS: Display stations, and the PACS data base server. The detail of the PACS in our department has been described elsewhere (3-5); here, we
* Correspondence should be addressed to Claudine M. Breant, Department of Radiological Sciences, Medical Imaging Division, University of California, Los Angeles, CA 90024- 172 1. 13
14
Computerized
Medical Imaging
and Graphics
briefly summarize the display station and the data base server for completeness. The PACS display station. The PACS display station used for the interface is based on the SUN SPARCserver 470 computer (SUN Microsystems, Mountain View, CA), a text monitor, and two 17”diagonal 2K portrait mode images monitors (UHR4820P MegaScan display system, AVP, Littleton, MA). It has a parallel transfer disk with 2.6 GByte formatted storage, which can display a 2048 X 2048 X 12-bit image in 1.5 s (Storage Concepts, Irvine, CA). All software programs were written in C programming language. (UNIX operating system, and X-window user interface.) PACS data base server. The PACS uses the Sybase, a relational data base management system, (Sybase Inc., Emeryville, CA) to manage the images. Images are archived in two optical disk libraries ADL 6800, (Kodak, Rochester, NY) using the UCLA format, which is compatible with the American College of Radiology/ National Electrical Manufacturers Association (ACR/ NEMA) format (9). The PACS data base is interfaced with the RIS, which, in turn, is interfaced with the hospital information system, (HIS, IBM, Yorktown, NY). The HIS transmits patient admission, transfer, and discharge information to the RIS and the PACS. The RIS sends procedure-complete and approved report data to the PACS. Diagnostic reports are appended to the patient directory in the PACS data base once they are available in the RIS. At the PACS display station, images as well as reports can be recalled. The dictaphone. A Dictaphone Digital ExpressTM DX 7000 system (Dictaphone Corporation, Stratford, CT) is used as the master digital recording system and data base manager for voice file creation (10). The Dictaphone host computer system and the supervisor terminal are used for voice management operations, and display of text information about the voice files. The Dictaphone server is accessible through regular phone lines by using a phone station. The configuration for the server used in this implementation includes a CPU with a 32-bit 80386 microprocessor (INTEL Corp., Santa Clara, CA), and a disk capacity of 74 1MB for 40 h of dictation. Figure 1 presents the interconnection of the various PACS components with the voice server and the associated dictated and transcription station. There is one voice server for the whole system, and one dictate/ listen station per PACS display station. The PACS data base server is connected to the voice message server with an RS-232 line. Each PACS display station is connected to a dictate/listen station, with an RS-232 line.
January-February/
1993, Volume
17, Number
I
Two workstations were used in this figure to illustrate the principle. Figure 1 also shows the RIS terminals, the RIS network, the RIS data base server, and the RIS connection to the PACS network. System integration Two special modules. We used two special modules of the Dictaphone system, the management information system (MISTM), and the Digital ConnexionsTM in our implementation. The MISTM allows voice file information from the Dictaphone voice message server to be transmitted to the PACS data base server. The Digital ConnexionsTM module facilitates easier DX 7000 access from a general purpose computer; it includes a hand microphone and an external speaker. One module is used for each display station. Figure 2 shows the hardware connections. Znterjke software. The software commands to the Digital ConnexionsTM issued from the PACS display station program consist of a subset of the Hayes (Hayes Microcomputer Products Inc., Atlanta, GA) ( 11) command set, and are sent and received in the ASCII format. After a command is sent to the Digital ConnexionsTM, a response code is returned in ASCII that indicates the status of the execution of this command (0, if the command has been correctly executed, other numbers if an error occurs). The communication between a PACS display station and the Digital ConnexionsTM IS . asynchronous, follows the protocol depicted in Fig. 3, and is transparent to a user. We developed the interface software between the PACS data base and the Dictaphone DX 7000 voice message server using the MISTM module, which automatically pulls data from the Dictaphone internal data base through the RS-232 line each time a data update occurs in the Dictaphone data base (12). The software creates a process that reads the data and triggers the proper PACS data base server operations. The PACS stores the replicated information about the voice reports (but not the voice). The software also establishes a link between the report and the patient image and text data. User interface. We developed two additional icons in the display station for the user to interface with the Dictaphone. ??The icon dictate triggers the Dictaphone system into
the dictation mode. The voice file created when a report is recorded is automatically correlated to the patient study by the workstation interface program. 0 The icon listen triggers the Dictaphone system into the playback mode. The voice file retrieved during this operation corresponds to the patient study
Integration of a voice processor machine in a PACS ??C. M. BREANT, R. K. TAIRA, and H. K. HUANG
15
Public Phone SystemNetwork
I RIS Terminals R.I.S. Network
Transcription Station
I Communication Channel Management
Voice Message Server
Information
I
PACS Network
PACS workstation
PACS workstation
Computer
Dictate/Listen Station
yFy*
Computer
Dictate/Listen Station ??
:::: ..I. Communication Channel
I
J ?? Communication Channel
%
I
Public Phone SystemNetwork Fig. 1. System configuration of the PACS and the Digital Dictaphone System. Two display stations are used to illustrate the concept. There are two connections between the two systems: PACS data base server with the voice message server, and the PACS display station with the dictate/listen station.
whose images itors.
are being
displayed
on the 2K mon-
The integrated PACS display station with the digital voice server is shown in Fig. 4. Figure 5 shows the windows and icons at a 2K imaging monitor. OPERATION
MODES
At the display station, the user can either dictate or listen to reports. Dictate
a report
User action. To dictate a report, the radiologist selects the patient, displays the images, and activates the dictate icon. The hand microphone, which is similar to a standard dictate phone, provides the usual functions (record, pause, fast forward, rewind, stop, and done) to record a report. The function done is used to
terminate the dictation process, and the report is automatically saved by the Dictaphone voice server system. &stem action. When the dictate icon is selected, the display station interface program automatically sends the dictation mode commands to the Dictaphone system. As soon as a report is saved, the PACS display station generates a voice report identifier which correlates the image, image description, study description, and the voice report identifier provided by the Dictaphone system. All this information is stored in the PACS data base. In addition, reports are simultaneously queued in the voice server and saved for future access by the transcriptionist to produce text reports through the RIS. The RIS sends the reports, in a textual format, to the PACS display station upon approval by the radiologist. The corresponding voice reports are then automatically discarded.
16
Computerized Medical Imaging and Graphics
January_February/l993,
Volume 17, Number 1
Radiology Display Station
Dictate/Listen Station
hand mic Connexions
PACS
Database Server
SUN 41490 SPARC SYBASE server ’
Dictaphone Machine Database Interface
Digital Express DX 7000 Dictaphone
phone line
PACS network
Fig. 2. Hardware connections between the PACS display stations and the Dictaphone directions),
and between the Dictaphone
management information (one direction).
Listen to a report User action. From a display station, an attending physician displays the images and textual information for a patient case of interest. If the written report is not yet available, he/she can listen to the corresponding voice reports by selecting the listen icon. It only takes about 2-4 s for the system to start to replay the voice report. System action. The system retrieves the voice file information from the PACS data base associated with the case being displayed. If several voice reports are available, a list is displayed on the text monitor from which the desired report can be chosen. The corresponding commands, and the identifier of the voice report are sent to the Dictaphone voice server. There, it retrieves the voice report, and activates the play back.
Digital ConnexionsTM (two system (MISTM) and the PACS database server
RESULTS
AND DISCUSSION
A Dictaphone DX 7000 Digital ExpressTM has been successfully integrated in the clinical pediatric radiology PACS system designed and implemented in our department ( 13). A dictate/listen station was added to the PACS display station. The information about the voice reports in the Dictaphone data base was replicated into the PACS data base for an optimal use of the information related to the voice reports. The integrated system is under clinical evaluation, and data is not yet available about its acceptance by the physicians. In our clinical environment, a typed report is generally only available a couple of days after it is dictated. The integration of the voice as a temporary media before the typed report is available should improve the patient care significantly, because the system provides immediate access to images as well as to the corresponding voice reports.
Integration of a voice processor machine in a PACS
C. M. BREANT,R. K. TAIRA,and H. K. HUANC
Digital Connexions (Dictaphone)
PACS Display Station Computer SUN 4/470
[ Send Command to Dictaphone: send_msg(command) .I
ASCII message
Ex: Listen to Report no. 999 1 send_msg (ATDT 12999;) I send_msg : Send the Hayes command to Digital Connexions ATDT : Hayes command dialing the following numbers: I 1 : go IO Dictaphone mode 2 : go to listen mode I 999 : report identifier I [W+TING
,L~~,
17
??
Receive Command
Execute Command Ex: Report no. 999 is played
v
LOOP]
Send Acknowledgement:
Acknowledgement
7’
send_msg(ack)
1
&: send_msg (0)
- 1 : error of transmission 0 : no error - command executed other : error in command Fig. 3. Communication
protocol between a PACS workstation and a Dictaphone Digital ConnexionsTM module. An example is used to illustrate the decoding process.
This integrated system has met the following operational requirements: 1) Immediate access, creation, deletion, edition, and playback of voice reports from
interactive commands issued at the PACS display station, which can simultaneously execute image display and image processing operations; 2) use of a powerful,
Fig. 4. The integrated PACS display station with the patient text monitor (T), two 2K imaging monitors (I), a dial box (D), a mouse (M), and the dictate station (DS).
18
Computerized Medical Imaging and Graphics
January_February/l993,
Volume 17, Number
Fig. 5. Dictate and listen icons on the PACS display station. A set of CT images are also shown. pointing to the listen icon.
reliable voice processor dedicated to the voice digitization and the management of voice files on disk. This voice server is easily accessible through regular phone lines by transcriptionists from RIS transcription terminals; 3) immediate access to information about the dictated reports, and automatic integration of this information into the global PACS relational data base; and 4) automatic association of the voice report files with the corresponding digital image files in the PACS data base. SUMMARY
A clinical PACS has been developed at the UCLA department of radiological sciences, to acquire, store, manage, and display images on 2K X 2K monitors along with text information about patients. The final stage consists of building a documentation package which will provide complete radiological consultation at the PACS display station. Typically, radiological reports are archived and transmitted independently from the image files. They are recorded on a simple audio cassette recorder from which a textual form is transcribed and inserted into the RIS several hours later. In this paper, we present a component of this package in the integration of a digital voice server in our PACS environment. This component improves the timely delivery of the diagnostic report with the images. The interface of this voice system is integrated into the PACS display station. It offers the user the capability to easily dictate and/or listen to radiological reports,
The arrow is
while viewing and/or performing image processing operations at the display station. This paper presents the technological aspect of the system integration of a commercially available voice processor system, Dictaphone Digital ExpressTM DX 7000, in our PACS environment. We describe the interfaces required between the Dictaphone system, and two components of the PACS; the display stations and the PACS data base server. We used two special modules of the Dictaphone system, the management information system (MISTM) and the Digital ConnexionsTM in our implementation. The Digital ConnexionsTM module facilitates easier DX 7000 access from a general purpose computer because it includes a hand microphone and an external speaker. One module is used for each display station. The software commands to the Digital ConnexionsTM issued from the PACS display station program consist of a subset of the Hayes command set, and are sent and received in the ASCII format. The MISTM allows voice file information from the Dictaphone voice message server to be transmitted to the PACS data base server. We developed the interface software between the PACS data base and the Dictaphone DX 7000 voice message server using the MISTM module, which automatically pulls data from the Dictaphone internal data base through the RS-232 line each time a data update occurs in the Dictaphone data base. Two icons have been added at the PACS display station for the user to interface with the Dictaphone.
Integration of a voice processor machine in a PACS
0 The icon dictate triggers the Dictaphone system into
the dictation mode. The voice file created when a report is recorded is automatically correlated to the patient study. 0 The icon listen triggers the Dictaphone system into the playback mode. The voice file retrieved during this operation corresponds to the patient study whose images are being displayed on the 2K monitors.
C. M. BREANT,R. K. TAIRA, and H. K. HUANG
??
‘. Nicholson, R.T. Usage patterns in an integrated voice and data 8. 9.
IO.
11.
A Dictaphone has been successfully integrated in the clinical pediatric radiology PACS system designed and implemented in our department. The integration of the voice as a temporary media before the typed report is available, improves the patient care significantly, because the system provides immediate access to images as well as to the corresponding voice reports.
Acknowledgment-This work was partially supported by Public Health Service Grant No. ROl CA 39063 and PO1 CA 5 I 198, awarded by the National Cancer Institute, Department of Health and Human Services.
REFERENCES 1. Arenson, R.L.; Seshadri, S.B.; Kundel, H.L.; et al. Clinical evaluation of a medical image management system for chest images. AJR 150:55-59; 1988. 2. Cho, P.S.; Huang, H.K.; Tillisch, J.; Kangarloo, H. Clinical evaluation of a radiologic picture archiving & communication system for a coronary care unit. AJR 151:823-827; 1988. 3. Wong, W.K.; Taira, R.K.; Huang, H.K. Digital archive center: Implementation for a radiology department. AJR 159:1IOl1105: 1992. 4. Huang, H.K.; Taira, R.K. PACS Infrastructure design. AJR 158: 743-749; 1992. 5. Huang, H.K.; Kangarloo, H.; Cho, P.S.; et al. Planning a totally digital radiology department. AJR 154:635-639; 1990. 6. Nicholson, R.T. Integrating voice in the office world. Byte 8( 12): 177-184: 1983.
19
12.
13.
communications system. ACM Trans. Off. Inf. Syst. 3(3):307314; 1985. Loyolan, M.; Taira, R.K.; Hayrapetian, A.; Huang, H.K.; Razavi, R. Voice recording module for PACS. SPIE 123468 l-685: 1990. ACR-NEMA Digital Imaging and Communication Standards Committee. Digital imaging and communications ACR-NEMA. Washington, D.C.: National Electrical Manufacturers Association; 1988. Bergeron, L.E. The evolution of the digital expressTM7000 system: A primer on voice processing. Stratford, CT; Dictaphone Corp.; 1991. Black, U. Physical level interfaces and protocols. The Computer Society of the IEEE. IEEE Catalog Number EH0275-9: 1988: 167-174. Breant. CM.; Taira, R.K.; Sinha, U.; Huang, H.K. Documentation and playback of a radiological diagnosis in a PACS environment. Radiology 181(P):283; 1991. Taira, R.K.; Mankovich, N.J.; Boechat, MI.; Kangarloo. H.; Huang, H.K. Design and implementation of a picture archiving and communication system (PACS) for pediatric radiology. AJR 150:1117-l 121: 1988.
About the Author-CLAUDINE M. BREANTreceived her Ph.D. degree
in Computer Science from the University of Paris in 1988. She is presently a postdoctoral fellow at the University of California, Los Angeles (UCLA) in the department of radiological sciences. Her major interest is in the area of multimedia and distributed medical data base systems. About the Author-RICKY K. TAIRA,Ph.D., graduated with a Bachelor of Science in electrical engineering from the University of California, Los Angeles (UCLA). He received his Ph.D. in biomedical physics from UCLA, where he is now Assistant Professor in the department of radiological sciences. His research interests are in Biomedical Image Processing, knowledge-based multimedia data base systems, and picture archiving and communication systems. About the Author-H. K. HUANGis Professor, Vice chairman, and Director of Radiological Informatics Laboratory, department of radiology, University of California, San Francisco campus. Dr. Huang spent 10 years at UCLA, where he designed and implemented the PACS system which is now in daily clinical operation. He transferred to UCSF in October 1992. At UCSF, he will develop the Radiological Informatics Laboratory (RIL). Two primary functions in the RIL are PACS and multimedia radiological data base.
INTEGRATION
I, pp.13-19,
I
I993 Copyright
OF A VOICE
PROCESSOR
MACHINE
0895-61 l/93 $6.00 + .OO 0 1993 Pergamon Press Ltd.
IN A PACS
Claudine M. Breant,* Ricky K. Taira, and H. K. Huang Department of Radiological Sciences, Medical Imaging Division, University of California, Los Angeles, CA 90024- 172 1 (Received 4 June 1992; Revised 16 November 1992) Abstract-The final stage of development of a clinical picture archiving and communication system (PACS) at the University of California at Los Angeles (UCLA) department of radiological sciences consists of building a dwumentation package of a complete radiological consultation. In this paper, we present the technological aspect of the integration of a digital voice server in our PACS environment. This component improves the timely delivery of the dllostic report with the images. The interface of this voice system is integrated into the PACS display station. It offers the user the capablllty to easily dictate and/or listen to radiological reports, while viewing and/or performing image processing operations at the display station. Key Words: Picture archiving and communication
system (PACS), Voice system integration, Radiological documentation, PACS radiological workstation design, Radiological diagnosis
INTRODUCTION
Typically, radiological reports are archived and transmitted independently from the image files. They are recorded on a simple audio cassette recorder from which a textual form is transcribed and inserted into the radiological information system (RIS, MAXFILE, Dimensional Medicine, Inc., Minneapolis, MN) several hours later. The interface between the RIS and the PACS is then responsible for sending and inserting the reports into the PACS data base. Subsequent to these steps, reports can be displayed at the PACS display station when requested by the user. The main inconvenience of this process is that the textual format of the report does not reach the referring physician in a timely manner because of the delay imposed by the transcription process. In this paper, we present the integration of a voice server into a clinically operating PACS as an intermediate step before the typed report is ready. This work is part of our effort in designing a comprehensive radiological documentation tool integrated in the PACS display station. Some implementation issues of the integration of a voice system into a workstation environment have been described previously (6-8).
Current film-based systems typically do not provide radiologists and referring physicians with the ability to access patient images and reports in a timely manner. Immediate availability of patient radiographs is important because it has been shown to lead to faster medical action in an intensive care unit (ICU) setting (e.g., tube placement, drug therapy) (1, 2). During the last several years, an enormous amount of research and development work has been devoted to the building of picture archiving and communication systems (PACS). A PACS has been developed in the department of radiology at the University of California at Los Angeles (UCLA) that satisfies the timely requirement to access the digital images. The present PACS is able to acquire, store, display, and communicate patient images that originate from different imaging acquisition systems such as computed radiography (CR), magnetic resonance (MR), and computed tomography (CT) (3). The implementation of the PACS system at UCLA and its performances have been presented elsewhere (4, 5). Most efforts in the past have been in image acquisition, management, display, and evaluation (5). Very little research has been done on the communication of a complete and appropriate radiological consultation report (image, graphic annotation and pointers, and the radiologist’s study interpretation) to the referring physician in a timely fashion.
MATERIAL
AND
METHODS
System configuration The integration of a voice processor machine to a PACS requires interfaces between a commercially available digital Dictaphone system and two components of the PACS: Display stations, and the PACS data base server. The detail of the PACS in our department has been described elsewhere (3-5); here, we
* Correspondence should be addressed to Claudine M. Breant, Department of Radiological Sciences, Medical Imaging Division, University of California, Los Angeles, CA 90024- 172 1. 13
14
Computerized
Medical Imaging
and Graphics
briefly summarize the display station and the data base server for completeness. The PACS display station. The PACS display station used for the interface is based on the SUN SPARCserver 470 computer (SUN Microsystems, Mountain View, CA), a text monitor, and two 17”diagonal 2K portrait mode images monitors (UHR4820P MegaScan display system, AVP, Littleton, MA). It has a parallel transfer disk with 2.6 GByte formatted storage, which can display a 2048 X 2048 X 12-bit image in 1.5 s (Storage Concepts, Irvine, CA). All software programs were written in C programming language. (UNIX operating system, and X-window user interface.) PACS data base server. The PACS uses the Sybase, a relational data base management system, (Sybase Inc., Emeryville, CA) to manage the images. Images are archived in two optical disk libraries ADL 6800, (Kodak, Rochester, NY) using the UCLA format, which is compatible with the American College of Radiology/ National Electrical Manufacturers Association (ACR/ NEMA) format (9). The PACS data base is interfaced with the RIS, which, in turn, is interfaced with the hospital information system, (HIS, IBM, Yorktown, NY). The HIS transmits patient admission, transfer, and discharge information to the RIS and the PACS. The RIS sends procedure-complete and approved report data to the PACS. Diagnostic reports are appended to the patient directory in the PACS data base once they are available in the RIS. At the PACS display station, images as well as reports can be recalled. The dictaphone. A Dictaphone Digital ExpressTM DX 7000 system (Dictaphone Corporation, Stratford, CT) is used as the master digital recording system and data base manager for voice file creation (10). The Dictaphone host computer system and the supervisor terminal are used for voice management operations, and display of text information about the voice files. The Dictaphone server is accessible through regular phone lines by using a phone station. The configuration for the server used in this implementation includes a CPU with a 32-bit 80386 microprocessor (INTEL Corp., Santa Clara, CA), and a disk capacity of 74 1MB for 40 h of dictation. Figure 1 presents the interconnection of the various PACS components with the voice server and the associated dictated and transcription station. There is one voice server for the whole system, and one dictate/ listen station per PACS display station. The PACS data base server is connected to the voice message server with an RS-232 line. Each PACS display station is connected to a dictate/listen station, with an RS-232 line.
January-February/
1993, Volume
17, Number
I
Two workstations were used in this figure to illustrate the principle. Figure 1 also shows the RIS terminals, the RIS network, the RIS data base server, and the RIS connection to the PACS network. System integration Two special modules. We used two special modules of the Dictaphone system, the management information system (MISTM), and the Digital ConnexionsTM in our implementation. The MISTM allows voice file information from the Dictaphone voice message server to be transmitted to the PACS data base server. The Digital ConnexionsTM module facilitates easier DX 7000 access from a general purpose computer; it includes a hand microphone and an external speaker. One module is used for each display station. Figure 2 shows the hardware connections. Znterjke software. The software commands to the Digital ConnexionsTM issued from the PACS display station program consist of a subset of the Hayes (Hayes Microcomputer Products Inc., Atlanta, GA) ( 11) command set, and are sent and received in the ASCII format. After a command is sent to the Digital ConnexionsTM, a response code is returned in ASCII that indicates the status of the execution of this command (0, if the command has been correctly executed, other numbers if an error occurs). The communication between a PACS display station and the Digital ConnexionsTM IS . asynchronous, follows the protocol depicted in Fig. 3, and is transparent to a user. We developed the interface software between the PACS data base and the Dictaphone DX 7000 voice message server using the MISTM module, which automatically pulls data from the Dictaphone internal data base through the RS-232 line each time a data update occurs in the Dictaphone data base (12). The software creates a process that reads the data and triggers the proper PACS data base server operations. The PACS stores the replicated information about the voice reports (but not the voice). The software also establishes a link between the report and the patient image and text data. User interface. We developed two additional icons in the display station for the user to interface with the Dictaphone. ??The icon dictate triggers the Dictaphone system into
the dictation mode. The voice file created when a report is recorded is automatically correlated to the patient study by the workstation interface program. 0 The icon listen triggers the Dictaphone system into the playback mode. The voice file retrieved during this operation corresponds to the patient study
Integration of a voice processor machine in a PACS ??C. M. BREANT, R. K. TAIRA, and H. K. HUANG
15
Public Phone SystemNetwork
I RIS Terminals R.I.S. Network
Transcription Station
I Communication Channel Management
Voice Message Server
Information
I
PACS Network
PACS workstation
PACS workstation
Computer
Dictate/Listen Station
yFy*
Computer
Dictate/Listen Station ??
:::: ..I. Communication Channel
I
J ?? Communication Channel
%
I
Public Phone SystemNetwork Fig. 1. System configuration of the PACS and the Digital Dictaphone System. Two display stations are used to illustrate the concept. There are two connections between the two systems: PACS data base server with the voice message server, and the PACS display station with the dictate/listen station.
whose images itors.
are being
displayed
on the 2K mon-
The integrated PACS display station with the digital voice server is shown in Fig. 4. Figure 5 shows the windows and icons at a 2K imaging monitor. OPERATION
MODES
At the display station, the user can either dictate or listen to reports. Dictate
a report
User action. To dictate a report, the radiologist selects the patient, displays the images, and activates the dictate icon. The hand microphone, which is similar to a standard dictate phone, provides the usual functions (record, pause, fast forward, rewind, stop, and done) to record a report. The function done is used to
terminate the dictation process, and the report is automatically saved by the Dictaphone voice server system. &stem action. When the dictate icon is selected, the display station interface program automatically sends the dictation mode commands to the Dictaphone system. As soon as a report is saved, the PACS display station generates a voice report identifier which correlates the image, image description, study description, and the voice report identifier provided by the Dictaphone system. All this information is stored in the PACS data base. In addition, reports are simultaneously queued in the voice server and saved for future access by the transcriptionist to produce text reports through the RIS. The RIS sends the reports, in a textual format, to the PACS display station upon approval by the radiologist. The corresponding voice reports are then automatically discarded.
16
Computerized Medical Imaging and Graphics
January_February/l993,
Volume 17, Number 1
Radiology Display Station
Dictate/Listen Station
hand mic Connexions
PACS
Database Server
SUN 41490 SPARC SYBASE server ’
Dictaphone Machine Database Interface
Digital Express DX 7000 Dictaphone
phone line
PACS network
Fig. 2. Hardware connections between the PACS display stations and the Dictaphone directions),
and between the Dictaphone
management information (one direction).
Listen to a report User action. From a display station, an attending physician displays the images and textual information for a patient case of interest. If the written report is not yet available, he/she can listen to the corresponding voice reports by selecting the listen icon. It only takes about 2-4 s for the system to start to replay the voice report. System action. The system retrieves the voice file information from the PACS data base associated with the case being displayed. If several voice reports are available, a list is displayed on the text monitor from which the desired report can be chosen. The corresponding commands, and the identifier of the voice report are sent to the Dictaphone voice server. There, it retrieves the voice report, and activates the play back.
Digital ConnexionsTM (two system (MISTM) and the PACS database server
RESULTS
AND DISCUSSION
A Dictaphone DX 7000 Digital ExpressTM has been successfully integrated in the clinical pediatric radiology PACS system designed and implemented in our department ( 13). A dictate/listen station was added to the PACS display station. The information about the voice reports in the Dictaphone data base was replicated into the PACS data base for an optimal use of the information related to the voice reports. The integrated system is under clinical evaluation, and data is not yet available about its acceptance by the physicians. In our clinical environment, a typed report is generally only available a couple of days after it is dictated. The integration of the voice as a temporary media before the typed report is available should improve the patient care significantly, because the system provides immediate access to images as well as to the corresponding voice reports.
Integration of a voice processor machine in a PACS
C. M. BREANT,R. K. TAIRA,and H. K. HUANC
Digital Connexions (Dictaphone)
PACS Display Station Computer SUN 4/470
[ Send Command to Dictaphone: send_msg(command) .I
ASCII message
Ex: Listen to Report no. 999 1 send_msg (ATDT 12999;) I send_msg : Send the Hayes command to Digital Connexions ATDT : Hayes command dialing the following numbers: I 1 : go IO Dictaphone mode 2 : go to listen mode I 999 : report identifier I [W+TING
,L~~,
17
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Receive Command
Execute Command Ex: Report no. 999 is played
v
LOOP]
Send Acknowledgement:
Acknowledgement
7’
send_msg(ack)
1
&: send_msg (0)
- 1 : error of transmission 0 : no error - command executed other : error in command Fig. 3. Communication
protocol between a PACS workstation and a Dictaphone Digital ConnexionsTM module. An example is used to illustrate the decoding process.
This integrated system has met the following operational requirements: 1) Immediate access, creation, deletion, edition, and playback of voice reports from
interactive commands issued at the PACS display station, which can simultaneously execute image display and image processing operations; 2) use of a powerful,
Fig. 4. The integrated PACS display station with the patient text monitor (T), two 2K imaging monitors (I), a dial box (D), a mouse (M), and the dictate station (DS).
18
Computerized Medical Imaging and Graphics
January_February/l993,
Volume 17, Number
Fig. 5. Dictate and listen icons on the PACS display station. A set of CT images are also shown. pointing to the listen icon.
reliable voice processor dedicated to the voice digitization and the management of voice files on disk. This voice server is easily accessible through regular phone lines by transcriptionists from RIS transcription terminals; 3) immediate access to information about the dictated reports, and automatic integration of this information into the global PACS relational data base; and 4) automatic association of the voice report files with the corresponding digital image files in the PACS data base. SUMMARY
A clinical PACS has been developed at the UCLA department of radiological sciences, to acquire, store, manage, and display images on 2K X 2K monitors along with text information about patients. The final stage consists of building a documentation package which will provide complete radiological consultation at the PACS display station. Typically, radiological reports are archived and transmitted independently from the image files. They are recorded on a simple audio cassette recorder from which a textual form is transcribed and inserted into the RIS several hours later. In this paper, we present a component of this package in the integration of a digital voice server in our PACS environment. This component improves the timely delivery of the diagnostic report with the images. The interface of this voice system is integrated into the PACS display station. It offers the user the capability to easily dictate and/or listen to radiological reports,
The arrow is
while viewing and/or performing image processing operations at the display station. This paper presents the technological aspect of the system integration of a commercially available voice processor system, Dictaphone Digital ExpressTM DX 7000, in our PACS environment. We describe the interfaces required between the Dictaphone system, and two components of the PACS; the display stations and the PACS data base server. We used two special modules of the Dictaphone system, the management information system (MISTM) and the Digital ConnexionsTM in our implementation. The Digital ConnexionsTM module facilitates easier DX 7000 access from a general purpose computer because it includes a hand microphone and an external speaker. One module is used for each display station. The software commands to the Digital ConnexionsTM issued from the PACS display station program consist of a subset of the Hayes command set, and are sent and received in the ASCII format. The MISTM allows voice file information from the Dictaphone voice message server to be transmitted to the PACS data base server. We developed the interface software between the PACS data base and the Dictaphone DX 7000 voice message server using the MISTM module, which automatically pulls data from the Dictaphone internal data base through the RS-232 line each time a data update occurs in the Dictaphone data base. Two icons have been added at the PACS display station for the user to interface with the Dictaphone.
Integration of a voice processor machine in a PACS
0 The icon dictate triggers the Dictaphone system into
the dictation mode. The voice file created when a report is recorded is automatically correlated to the patient study. 0 The icon listen triggers the Dictaphone system into the playback mode. The voice file retrieved during this operation corresponds to the patient study whose images are being displayed on the 2K monitors.
C. M. BREANT,R. K. TAIRA, and H. K. HUANG
??
‘. Nicholson, R.T. Usage patterns in an integrated voice and data 8. 9.
IO.
11.
A Dictaphone has been successfully integrated in the clinical pediatric radiology PACS system designed and implemented in our department. The integration of the voice as a temporary media before the typed report is available, improves the patient care significantly, because the system provides immediate access to images as well as to the corresponding voice reports.
Acknowledgment-This work was partially supported by Public Health Service Grant No. ROl CA 39063 and PO1 CA 5 I 198, awarded by the National Cancer Institute, Department of Health and Human Services.
REFERENCES 1. Arenson, R.L.; Seshadri, S.B.; Kundel, H.L.; et al. Clinical evaluation of a medical image management system for chest images. AJR 150:55-59; 1988. 2. Cho, P.S.; Huang, H.K.; Tillisch, J.; Kangarloo, H. Clinical evaluation of a radiologic picture archiving & communication system for a coronary care unit. AJR 151:823-827; 1988. 3. Wong, W.K.; Taira, R.K.; Huang, H.K. Digital archive center: Implementation for a radiology department. AJR 159:1IOl1105: 1992. 4. Huang, H.K.; Taira, R.K. PACS Infrastructure design. AJR 158: 743-749; 1992. 5. Huang, H.K.; Kangarloo, H.; Cho, P.S.; et al. Planning a totally digital radiology department. AJR 154:635-639; 1990. 6. Nicholson, R.T. Integrating voice in the office world. Byte 8( 12): 177-184: 1983.
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12.
13.
communications system. ACM Trans. Off. Inf. Syst. 3(3):307314; 1985. Loyolan, M.; Taira, R.K.; Hayrapetian, A.; Huang, H.K.; Razavi, R. Voice recording module for PACS. SPIE 123468 l-685: 1990. ACR-NEMA Digital Imaging and Communication Standards Committee. Digital imaging and communications ACR-NEMA. Washington, D.C.: National Electrical Manufacturers Association; 1988. Bergeron, L.E. The evolution of the digital expressTM7000 system: A primer on voice processing. Stratford, CT; Dictaphone Corp.; 1991. Black, U. Physical level interfaces and protocols. The Computer Society of the IEEE. IEEE Catalog Number EH0275-9: 1988: 167-174. Breant. CM.; Taira, R.K.; Sinha, U.; Huang, H.K. Documentation and playback of a radiological diagnosis in a PACS environment. Radiology 181(P):283; 1991. Taira, R.K.; Mankovich, N.J.; Boechat, MI.; Kangarloo. H.; Huang, H.K. Design and implementation of a picture archiving and communication system (PACS) for pediatric radiology. AJR 150:1117-l 121: 1988.
About the Author-CLAUDINE M. BREANTreceived her Ph.D. degree
in Computer Science from the University of Paris in 1988. She is presently a postdoctoral fellow at the University of California, Los Angeles (UCLA) in the department of radiological sciences. Her major interest is in the area of multimedia and distributed medical data base systems. About the Author-RICKY K. TAIRA,Ph.D., graduated with a Bachelor of Science in electrical engineering from the University of California, Los Angeles (UCLA). He received his Ph.D. in biomedical physics from UCLA, where he is now Assistant Professor in the department of radiological sciences. His research interests are in Biomedical Image Processing, knowledge-based multimedia data base systems, and picture archiving and communication systems. About the Author-H. K. HUANGis Professor, Vice chairman, and Director of Radiological Informatics Laboratory, department of radiology, University of California, San Francisco campus. Dr. Huang spent 10 years at UCLA, where he designed and implemented the PACS system which is now in daily clinical operation. He transferred to UCSF in October 1992. At UCSF, he will develop the Radiological Informatics Laboratory (RIL). Two primary functions in the RIL are PACS and multimedia radiological data base.