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The Vienna SMZO-PACS-project: the totally digital hospital
European Journal of Radiology, 16 (1992) 66-68 0 1992 Elsevier Scientific Publishers Ireland Ltd. All rights reserved. 0720-048X/92/$05.00
66
EURRAD 00360
The Vienna SMZO-PACS-project: the totally digital hospital W. Hruby a,H. Mosser a, M. Urban a, W. RUgerb aSocio-Medical Center East (SMZO) of the City of Vienna, Austria bSiemens Medical Group, Erlangen. Germany
Key words: PACS; Digital hospital
Abstract This paper gives an overview of the SMZO-PACS-Project in the form of a rough specification of the system architecture and the functional parameters related to it. The PACS architecture, determined by the large amount of data volume produced in the SMZO Hospital is outlined. In both radiology and trauma departments high technical requirements concerning data throughput and fault tolerance are demanded. Therefore these PACS modules are designed to miniie the workload of the network so that the performance is not degraded in the case of fault of a single component. A PACS module includes image acquisition devices of a certain modality with related reporting workstations and a distributed electronic archive. The functionality of the modules is described, special interest is posed on the integration of the diierent information management systems PACS, RIS and HIS, to achieve a complete record of data input and throughput in the hospital.
In planning a new radiology department one must not bypass the emerging technologies in Digital Radiography, PACS, HIS and RIS. Since digitally generated images claim an increasing part of total radiologic imaging, these new devices have to be considered in the planning stages [l-6]. They are intended to increase and optimize the radiology department’s performance with the final goal of improving the medical service to the patient [5,7-91. The Vienna Socio-Medical Center East (SMZO) Health policy: Vienna, with its famous medical school, is the most important supply center not only for its own inhabitants but also of all the people living in what is called the “Region east”, east of Vienna. The ideally developed social network, in which social service and health service are interlinked to form one entity, requires continuous renewal in order to be in a Correspondence to: Hans Mosser MD, SMZO Hospital, Radiology Department, Langobardenstrasse 122, A-1220 Vienna, Austria.
position to adapt to the state of the art of medicine on the one hand, and to the changing structures within the population on the other [lo]. Medical planning aspects: The objective of the planning activities for the SMZO-Hospital, which started in 1979, was to achieve the optimum medical care for the patient; with this in mind, it had to live up to the latest developments of science, and in this sense there were primarily medical aspects which determined its constructional design, its equipment and its organisation [ll]. A complex patient care system: The SMZO consists of l a nurse training center operating since 1978, l a 400 bed geriatric medical center since 1982 for geriatric and long term diseases, l housing facilities for the staff. l The last and largest part of the project is the 900 bed teaching hospital, which has been under construction since 1985 and - the majority of it - will start operation in 1992. Characteristic values for this hospital concerning the various departments and institutes as well as number of beds are displayed in Table 1.
67 TABLE
1
Departments,
beds and institutes in the SMZO hospital
Departments/Institutes
No. of Beds
1st Medical Department 2nd Medical Department Neurological Department Surgical Department Trauma Center Neurosurgical Department Orthopaedic Department Gynecological Department Internal Pediatric Department Surgical Pediatric Department Urological Department ENT-Department Dermatological Department Opthalmological Department Emergency room Internal ICU Anaesthesiology Surgery ICU Pediatric ICU Dialysis Radiotherapy
128 96 32 96 64 32 32 64 74 54 32 32 32 32 12 12 10 7 8 12
Institutes: Central Radiology Department Anaesthesiology Laboratory Nuclear Medicine Pathology Dentology Total No. of Beds
The SMZO-PACS-Project
829
From vision to decision In August 1988 the chairman of the SMZO’s radiology department (including the radiotherapy and the radiological support to the Trauma Center) was appointed. On the horizon appeared the vision to include
Fig. 1. Radiology department:
all these emerging computer technologies in medical imaging and communication (Digital Radiography, PACS, Hospital- and Radiology Information Managment Systems) into the planning concept of the radiology department and the whole hospital. After numerous informal meetings and discussions the Administration of the City of Vienna took interest in these upcoming new technologies. The financial plan of the administration also accepted cost/benefit-considerations, which had to take into account the PACSinherent medical benefits and improvements, and the inclusion of future aspects, opening up l%her benefits. Finally an agreement was reached concerning the potential advantages and the feasibility of such an implementation. In September 1989 the decision was made to plan a fully digital hospital as described above. From this point it was up to “industry” to put all resources and efforts into this field to achieve a practical approach for a routine application of these technologies, within atfordable budget considerations. On a tender basis and competitive bidding, Siemens was selected as the major PACS vendor.
PACS configuration.
PACSplanning team: A planning team was formed, consisting of radiologists, SMZO computer-specialists, engineers, and representatives of Siemens. The involvement of the radiologist within such a PACS planning team is very important, and described elsewhere in the proceedings (Mosser et al.: Eur. J. Radiol., 16: 69-73). PACS architecture: After initial conceptions, which where subject to constant change in collaboration with radiologists, in September 1990 a new PACS-architecture for the radiology department, the third PACS generation, was worked out by Siemens (Fig. 1). Addition-
Fig. 2. Network-Configuration
-
Trauma center.
68
Conclusion LAN-bridge task-task
Patient dab to PAC.9 TrrnsrV of reports to PACS Imap control by RJS hnqe admini&ation RIS enmlation in PACS Imqe mmotetion to RIS St&?tiC¶
LAN-bridge mailbox, SQL
Patieni data Exam request Pmcedures performed Report generation SbtiStiCS
In order to avoid in-built obsolescence in building a new hospital it is necessary to take into account the emerging technologies concerning the application of computer- and information-sciences in radiology. The SMZO Hospital and in particular its radiology department have emerged from the vision of an all-digital hospital to the decision of implementing it for routine operation. The fmal goal is the routine operation of hospital-wide data communications built around the patient as the center of our care and improving the radiology stalI’s performance.
Fig. 3. Data flow and communication links of the subsystems PACS-RIS-HIS.
References
ally the Trauma Center of the SMZO was included in the digital image production and communication (Fig. 2). The overall data volume to be handled will be maximally 15 GByte per day. Workstations: There are two main groups of workstations: 1, Viewing stations like DRCs and liteBoxes, and 2, primary diagnosis-related workstations with modality specific features. The DCR is primarily used for daily demonstration of images to clinical collegues. Because of the large amount of image data at this module, the images will be prefetched overnight. The liteBox is a PC-based viewing station with up to two monitors, which according to its function does not need any enhanced image processing capabilities. The workstations designed for primary diagnosis are modality-related and offer, according to the various tasks, different processing features. PACS-RZS-HIS: The radiology information system used in the SMZO radiology department will be the Simedosm (Siemens, Erlangen), which is adapted to the specific needs of the SMZO. See Fig. 3 for overview.
Huang HK. Mankovich NJ, Cho PS, Taira R, Stewart BK, Ho BK. Picture archiving and communication systems in Japan. AJR 1987; 148: 421-429. Huang HK, Kangarloo H, Cho PS, Taira RK, Ho BKT, Chars KK. Planning a total radiology department. AJR 1990; 154: 635639. Jost RG, Mankovich NJ. Digital archiving requirements and technology. Invest Radio1 1988; 23: 803-809. Len&e HU. Computer-assisted radiology. Radiologe 1988; 28: 189-194. Mezrich RS. The implications of PACS for radiology practice. AJR 1988; 151: 828. Mun SK, Benson HK, Elliot LP. Total digital department: implementation strategy. Proc SPIE 1989; 1093: 133-139. Arenson RI+ Seshradi SB, Kundel HL, Desimone, van der Voorde F, Geftev WB, Epstein DM, Miller WI, Aroncbick JM, Simson MB, Lanken PN, Khalsa S, Brikman I, Davey M, Brisbon N. Clinical evaluation of a medical image management system for chest images. AJR 1988; 150: 55-59. Tessler, FN. Computer applications in radiology education: a challenge for the 1990s. AJR 1989; 152: 1169-1172. Witte G, Bause HW, Maas R, Pothman W, Schwermer B, Nicolas V. Chest radiography in intensive care by a digital radiographic technique. Forts&r. Rontgenstr. 1990; 152: 417-420. 10 Stacher A. Health policy. Der Au&au 1987; 10: 487-490. 11 Tragl KH. The hospital in the Socio-Medical-Center east: Medical planning aspects. Der Aufbau 1987; 10: 491-493
66
EURRAD 00360
The Vienna SMZO-PACS-project: the totally digital hospital W. Hruby a,H. Mosser a, M. Urban a, W. RUgerb aSocio-Medical Center East (SMZO) of the City of Vienna, Austria bSiemens Medical Group, Erlangen. Germany
Key words: PACS; Digital hospital
Abstract This paper gives an overview of the SMZO-PACS-Project in the form of a rough specification of the system architecture and the functional parameters related to it. The PACS architecture, determined by the large amount of data volume produced in the SMZO Hospital is outlined. In both radiology and trauma departments high technical requirements concerning data throughput and fault tolerance are demanded. Therefore these PACS modules are designed to miniie the workload of the network so that the performance is not degraded in the case of fault of a single component. A PACS module includes image acquisition devices of a certain modality with related reporting workstations and a distributed electronic archive. The functionality of the modules is described, special interest is posed on the integration of the diierent information management systems PACS, RIS and HIS, to achieve a complete record of data input and throughput in the hospital.
In planning a new radiology department one must not bypass the emerging technologies in Digital Radiography, PACS, HIS and RIS. Since digitally generated images claim an increasing part of total radiologic imaging, these new devices have to be considered in the planning stages [l-6]. They are intended to increase and optimize the radiology department’s performance with the final goal of improving the medical service to the patient [5,7-91. The Vienna Socio-Medical Center East (SMZO) Health policy: Vienna, with its famous medical school, is the most important supply center not only for its own inhabitants but also of all the people living in what is called the “Region east”, east of Vienna. The ideally developed social network, in which social service and health service are interlinked to form one entity, requires continuous renewal in order to be in a Correspondence to: Hans Mosser MD, SMZO Hospital, Radiology Department, Langobardenstrasse 122, A-1220 Vienna, Austria.
position to adapt to the state of the art of medicine on the one hand, and to the changing structures within the population on the other [lo]. Medical planning aspects: The objective of the planning activities for the SMZO-Hospital, which started in 1979, was to achieve the optimum medical care for the patient; with this in mind, it had to live up to the latest developments of science, and in this sense there were primarily medical aspects which determined its constructional design, its equipment and its organisation [ll]. A complex patient care system: The SMZO consists of l a nurse training center operating since 1978, l a 400 bed geriatric medical center since 1982 for geriatric and long term diseases, l housing facilities for the staff. l The last and largest part of the project is the 900 bed teaching hospital, which has been under construction since 1985 and - the majority of it - will start operation in 1992. Characteristic values for this hospital concerning the various departments and institutes as well as number of beds are displayed in Table 1.
67 TABLE
1
Departments,
beds and institutes in the SMZO hospital
Departments/Institutes
No. of Beds
1st Medical Department 2nd Medical Department Neurological Department Surgical Department Trauma Center Neurosurgical Department Orthopaedic Department Gynecological Department Internal Pediatric Department Surgical Pediatric Department Urological Department ENT-Department Dermatological Department Opthalmological Department Emergency room Internal ICU Anaesthesiology Surgery ICU Pediatric ICU Dialysis Radiotherapy
128 96 32 96 64 32 32 64 74 54 32 32 32 32 12 12 10 7 8 12
Institutes: Central Radiology Department Anaesthesiology Laboratory Nuclear Medicine Pathology Dentology Total No. of Beds
The SMZO-PACS-Project
829
From vision to decision In August 1988 the chairman of the SMZO’s radiology department (including the radiotherapy and the radiological support to the Trauma Center) was appointed. On the horizon appeared the vision to include
Fig. 1. Radiology department:
all these emerging computer technologies in medical imaging and communication (Digital Radiography, PACS, Hospital- and Radiology Information Managment Systems) into the planning concept of the radiology department and the whole hospital. After numerous informal meetings and discussions the Administration of the City of Vienna took interest in these upcoming new technologies. The financial plan of the administration also accepted cost/benefit-considerations, which had to take into account the PACSinherent medical benefits and improvements, and the inclusion of future aspects, opening up l%her benefits. Finally an agreement was reached concerning the potential advantages and the feasibility of such an implementation. In September 1989 the decision was made to plan a fully digital hospital as described above. From this point it was up to “industry” to put all resources and efforts into this field to achieve a practical approach for a routine application of these technologies, within atfordable budget considerations. On a tender basis and competitive bidding, Siemens was selected as the major PACS vendor.
PACS configuration.
PACSplanning team: A planning team was formed, consisting of radiologists, SMZO computer-specialists, engineers, and representatives of Siemens. The involvement of the radiologist within such a PACS planning team is very important, and described elsewhere in the proceedings (Mosser et al.: Eur. J. Radiol., 16: 69-73). PACS architecture: After initial conceptions, which where subject to constant change in collaboration with radiologists, in September 1990 a new PACS-architecture for the radiology department, the third PACS generation, was worked out by Siemens (Fig. 1). Addition-
Fig. 2. Network-Configuration
-
Trauma center.
68
Conclusion LAN-bridge task-task
Patient dab to PAC.9 TrrnsrV of reports to PACS Imap control by RJS hnqe admini&ation RIS enmlation in PACS Imqe mmotetion to RIS St&?tiC¶
LAN-bridge mailbox, SQL
Patieni data Exam request Pmcedures performed Report generation SbtiStiCS
In order to avoid in-built obsolescence in building a new hospital it is necessary to take into account the emerging technologies concerning the application of computer- and information-sciences in radiology. The SMZO Hospital and in particular its radiology department have emerged from the vision of an all-digital hospital to the decision of implementing it for routine operation. The fmal goal is the routine operation of hospital-wide data communications built around the patient as the center of our care and improving the radiology stalI’s performance.
Fig. 3. Data flow and communication links of the subsystems PACS-RIS-HIS.
References
ally the Trauma Center of the SMZO was included in the digital image production and communication (Fig. 2). The overall data volume to be handled will be maximally 15 GByte per day. Workstations: There are two main groups of workstations: 1, Viewing stations like DRCs and liteBoxes, and 2, primary diagnosis-related workstations with modality specific features. The DCR is primarily used for daily demonstration of images to clinical collegues. Because of the large amount of image data at this module, the images will be prefetched overnight. The liteBox is a PC-based viewing station with up to two monitors, which according to its function does not need any enhanced image processing capabilities. The workstations designed for primary diagnosis are modality-related and offer, according to the various tasks, different processing features. PACS-RZS-HIS: The radiology information system used in the SMZO radiology department will be the Simedosm (Siemens, Erlangen), which is adapted to the specific needs of the SMZO. See Fig. 3 for overview.
Huang HK. Mankovich NJ, Cho PS, Taira R, Stewart BK, Ho BK. Picture archiving and communication systems in Japan. AJR 1987; 148: 421-429. Huang HK, Kangarloo H, Cho PS, Taira RK, Ho BKT, Chars KK. Planning a total radiology department. AJR 1990; 154: 635639. Jost RG, Mankovich NJ. Digital archiving requirements and technology. Invest Radio1 1988; 23: 803-809. Len&e HU. Computer-assisted radiology. Radiologe 1988; 28: 189-194. Mezrich RS. The implications of PACS for radiology practice. AJR 1988; 151: 828. Mun SK, Benson HK, Elliot LP. Total digital department: implementation strategy. Proc SPIE 1989; 1093: 133-139. Arenson RI+ Seshradi SB, Kundel HL, Desimone, van der Voorde F, Geftev WB, Epstein DM, Miller WI, Aroncbick JM, Simson MB, Lanken PN, Khalsa S, Brikman I, Davey M, Brisbon N. Clinical evaluation of a medical image management system for chest images. AJR 1988; 150: 55-59. Tessler, FN. Computer applications in radiology education: a challenge for the 1990s. AJR 1989; 152: 1169-1172. Witte G, Bause HW, Maas R, Pothman W, Schwermer B, Nicolas V. Chest radiography in intensive care by a digital radiographic technique. Forts&r. Rontgenstr. 1990; 152: 417-420. 10 Stacher A. Health policy. Der Au&au 1987; 10: 487-490. 11 Tragl KH. The hospital in the Socio-Medical-Center east: Medical planning aspects. Der Aufbau 1987; 10: 491-493