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Slide 2 U-HealthCare System 5. PACS 2011. 4. 13 (biahn99@gmail.com) Mcomputing.tistory.com @LBSAHN Slide 3 U-HealthCare System Medical Imaging Tech & PACS CT MRI PET/CT PACS DICOM Slide 4 U-HealthCare System Why use different methods of imaging ? Cost Effectiveness A good guiding principle in many walks of life is Always pick the simplest solution for your problem. In many cases the cheapest solution is the best. You do not need to give every pregnant mother in the country an MRI scan. The capital cost of installation varies widely: UltrasoundX-ray CTMRIPET 20k - 100k 500k - 1M2M - 4M>5M Slide 5 U-HealthCare System What is the CT? Mathematical transform to the measured data. Reconstruct n dimension function (image) => projection data of n 1 dimension Radon Transform (1917) Two dimension and three dimension object can be reconstructed from the infinite set of projectio n data. The First CT: 1973 in the U.S. 4 minutes scan, thickness of 10mm Slide 6 U-HealthCare System Concept of CT Getting the shape by back projection of the projection data. For example, outward view is the quadrangle => it is the cylinder CT Algorithm Slide 7 U-HealthCare System CT (From Picker) (From Siemens) Slide 8 U-HealthCare System X Basic principle of CT -Reconstruction of 2 dimensional image- Simple Backprojection Projection Data Blur x y x y curvilinear integral of absorption coefficient regarding Y object X-ray tube X-ray detector array Data Acquisition field Reconstruction field X X Y Slide 9 U-HealthCare System Basic principle of CT -Reconstruction of 2 dimensional image- Filtered Backprojection Projection Data x y x Multidirectional Backprojection Reconstruction Filter or x Filtered Projection data x X Slide 10 U-HealthCare System Reconstruction process Slide 11 U-HealthCare System Reconstruction process Data acquisition at angle : 0 180 degree Obtain F(u,v) and then 2D IFFT -> reconstruction Radon Transform is equivalent to Filtered backprojection ! Slide 12 U-HealthCare System Example of Simulation Model ImageSimple Backprojection Filtered Backprojection Slide 13 U-HealthCare System Magnetic Resonance Imaging Slide 14 U-HealthCare System Magnetic Resonance Uses equipment prod ucing magnetic fields from 0.5 Tesla to 3 Te sla Earths magnetic field i s 50 microtesla Cost of equipment is approx 700k per Tes la Slide 15 U-HealthCare System Obtaining the Data All atoms have a magnetic field or orientation When placed in a strong magnetic field the atomi c nuclei align with that field Pulses of Radio Frequency aimed at area of inte rest in the body Imparts high energy state to the nuclei of those a reas Relaxation of that state produces resonance whi ch can be detected Location and intensity will translate into pixel loc ation and intensity Slide 16 U-HealthCare System Slide 17 Slices Slide 18 U-HealthCare System Slide 19 Image Processing Slide 20 U-HealthCare System Image Manipulation and Enhancement Two time frames T1 and T2 relate to perce ntages of nuclei which have resumed nor mal state T1 improves resolution T2 improves sensitivity Contrast media can be introduced fMR can monitor specific physiology Slide 21 U-HealthCare System Anatomy or Physiology? Slide 22 U-HealthCare System Using Data Manipulation Slide 23 U-HealthCare System Image Manipulation Slide 24 U-HealthCare System When Do We Use MRI? Excellent for soft tissu e imaging Resolution is good Does NOT use ionisin g radiation but does h ave some safety issu es Slide 25 U-HealthCare System MR Versus CT MR Digital manipulation Non-ionising Non-invasive Good for soft tissue Can image physiology Technique can be altered to account for data requir ed Expensive CT Digital manipulation Ionising Xrays Non-invasive Good for range of tissue t ypes, soft tissue to a less er extent Can only image physiolog y when used with other m odalities Variation in technique pos sible Relatively Cheap Slide 26 U-HealthCare System 25 PET / CT System Slide 27 U-HealthCare System PET / CT ? PET / CT (Positron Emission Tomography) (Computed Tomography) . PET / CT CT, . . Slide 28 U-HealthCare System PET / CT ?? PET , , , , , . PET/CT PET CT . PET . Slide 29 U-HealthCare System Slide 30 PET / CT PET/CT . (+) (-) 511 KeV . PET/CT . Slide 31 U-HealthCare System PET / CT CT . . . , . 40% . . Slide 32 U-HealthCare System PET / CT . , , , . 3~4 mm . Slide 33 U-HealthCare System PET / CT PET/CT . PET/CT , , , , , , . , PET/CT . Slide 34 U-HealthCare System PET / CT PET / CT PET / CT PET / CT Slide 35 U-HealthCare System PET / CT 40 CT , PET . , , , , , , , , , , , , , . Slide 36 U-HealthCare System , PET/CT . PET/CT , , Slide 37 U-HealthCare System PET / CT , , ( ) . , . . . MRI . Slide 38 U-HealthCare System Slide 39 PET / CT . . Slide 40 U-HealthCare System What is PACS ? P: Picture, Images & Reports A: Archive, Online, Near line, Offline C: Communication, Networking, Transfer Protocols S: System, Components & Architecture PACS: for storage and distribution of images and in formation when necessary Slide 41 U-HealthCare System PACS: Small or Large Web Server Distribution Slide 42 U-HealthCare System Scale of PACS No. of Beds in Hospital/ Exams per year No. of Modalities No. of Switches Considerations: System connectivity, expandability, reliability and cost-effectiveness Slide 43 U-HealthCare System Types of images 1D, 2D, 3D, 4D Different DICOM Modality type: Cardiac / PET / 4D U/ S.. Image size: Resolution and bit depth Image quality: Bit Depth and resolution Color / Monochromatic Exam. Size: image size x no. of images Structured Reports New DICOM IOD: Endoscopic & Microscopic images / ECGs / Security Prof iles.. Slide 44 U-HealthCare System 1D, 2D, 3D, 4D, fusion Slide 45 U-HealthCare System 1D, 2D, 3D, 4D, fusion Slide 46 U-HealthCare System Image Resolution/ Bit depth U/S DF CR CR Mammogram 256 x 256 8 bit 65 KBytes 1k x 1k 10 bit 1.25 MByte 2k x 2.5k 12 bit 7.5 MByte 4k x 5k 12 bit 30 MByte Slide 47 U-HealthCare System Properties of image Bit depth Bit depth Grayscale or color Grayscale or color Resolution in pixel Resolution in pixel Example image si ze of mammogra m = 4k x 5k x 12 b it = 30 MB Slide 48 U-HealthCare System PACS Architecture Slide 49 U-HealthCare System Data Base Server CR/ DR QA Workstation Computed Radiography or DR Gateway or Frame Grabber Film Digitizer Non-DICOM Modality Archive DICOM Modality Web Server RIS Diagnostic Workstations (DICOM) Image Server (RAID) Clinical Workstations (DICOM) PACS Central Architecture Diagnostic Workstation Slide 50 U-HealthCare System Central Architecture Image Server and Database Manager is th e HEART Any image, any where, any time Unique central copy Easy update of data Requires high performance servers Potential single point of failure at server Bandwidth demanding Slide 51 U-HealthCare System Data Base Server CR QA Workstation Computed Radiography Gateway or Frame Grabber Film Digitizer Non-DICOM Modality Archive DICOM Modality Web Server Diagnostic Workstation RIS Diagnostic Workstations (DICOM) Clinical Workstations (DICOM) PACS Distributed Architecture Slide 52 U-HealthCare System Distributed Architecture Exams are routed from modality to selecte d workstations Complex routing algorithms based on dep artment / user preference Difficult to support concurrent review of im ages Less destructive for failure at database ser ver Slide 53 U-HealthCare System Components of PACS HIS/ RIS Broker ePR gateway Database Server Image Server (RAID) Long Term/ Near line Archive Networks Digitizer Slide 54 U-HealthCare System Components of PACS Acquisition Gateways Non-DICOM modality gateway DICOM Print Server Media Server Reporting Server Monitor QC Server Web Server Workstations Slide 55 U-HealthCare System PACS layout 1 Slide 56 U-HealthCare System PACS layout 2 Slide 57 U-HealthCare System PACS layout 3 Slide 58 U-HealthCare System Data Base Server CR/ DR QA Workstation Computed Radiography or DR Gateway or Frame Grabber Film Digitizer Non-DICOM Modality LTS Archive SAN/NAS DICOM Modality Web Server Broker for RIS/HIS Diagnostic Workstations (DICOM) Image Server (RAID) Clinical Workstations (DICOM) PACS Components Diagnostic Workstation Media Server ePR gateway W/S QA Server Enterprise Archive Through Acq. g ateway Slide 59 U-HealthCare System CRCRCRCR USXRAY RI S RI S PCs W/S FilmDigitizer CR QA FrameGrabber HIS/RISInterface(Broker) CT R&F MR NM DG Acquisition (DICOM) Gateway Slide 60 U-HealthCare System Role of Acquisition gateway Compression/ decompression and security Check the images for integrity Convert to PACS format (header, byte-orde r, matrix size) Queue for images (priority) to database ser ver (background) Share the workload and no point of failure f or multiple Acquisition gateway Slide 61 U-HealthCare System CRCRCRCR USXRAY RI S RI S PCs W/S FilmDigitizer CR QA FrameGrabber HIS/RISInterface(Broker) CT R&F MR NM DG Database Server and Image Server DatabaseServer RAID Slide 62 U-HealthCare System Database Server (PACS controller) The Heart of the system Integration cross point between HIS/RIS and PACS (status update) Create and manages patient folders Manage reading worklists and user profiles Manage data transfer within the system Support data mining and teaching folders Slide 63 U-HealthCare System Image Server (RAID) Online (rapid access) exam storage and di stribution device Support simultaneous exam input and out put transfer operations Up to Three months of storage capacity Scalable capacity Slide 64 U-HealthCare System Redundant Array of Independent Disks Bandwidth equal to sum of disk transfer rates Highest speed disk storage available Image Disk Array 2 MB/s 1 2 3 4 5 6 7 8 16 MB/s Hot Swap Parity What is RAID Slide 65 U-HealthCare System RAID 5 configuration If disk fails, disk can be r ebuilt- fault tolerant High data transfer rate fo r read, write slower Min. 3 disks to start Array capacity is N-1 Slide 66 U-HealthCare System Bandwidth is a measure of the information (data) carrying capacity of a network 10/100/1000 MB/sec Information Flow Data Pipe (Network) Bandwidth Slide 67 U-HealthCare System Network Bottleneck The bandwidth of an information delivery system is l imited to the bandwidth of the slowest component in the system Network Bottleneck Slide 68 U-HealthCare System Data compression reduces the information rate a network must support Uncompressed Data Compressed Data Data Compression Slide 69 U-HealthCare System Decompressed image is identical to original imag e JPEG lossless compression Average compression of 2:1 for x-ray images I C D I - D = 0 Lossless Image Compression Slide 70 U-HealthCare System JPEG 2000 Compression Selected parts of the image can be defined as R egions of Interest, they can then be delivered bef ore other parts of the image, or losslessly, whilst other parts of the image that are less critical use normal lossy compression JPEG 2000 codestream can be ordered to delive r images of lower resolution before the full image can be transmitted Motion JPEG 2000 does not have any form of ex trapolation (and hence potential distortion) in the time domain. Each frame is a separate JPEG 2 000 coded image Slide 71 U-HealthCare System JPEG 2000 images Slide 72 U-HealthCare System CRCRCRCR USXRAY RI S RI S PCs W/S FilmDigitizer CR QA FrameGrabber HIS/RISInterface(Broker) CT R&F MR NM DG Storage Device (Long Term) DatabaseServer RAID MODDLT Slide 73 U-HealthCare System Types of storage media MediaDVDMODWORMDLT9840AIT2 GB3.85.2352050 Cost Less Expen. Expen.Expen.Cheap Most Expen. Load + Assess Very fast 113 sec 15 sec 45 sec Max. T rate MB/s 55.15106 Slide 74 U-HealthCare System Long Term Archive Used to store digital data for longer period s of time Storage ranges from 100 MB to 10 TB Optical disk most common media - 5 1/4 MOD - 2.6 GB and 5.2 GB Capacity DLT used for longer term storage and redu ndancy ISP module Slide 75 U-HealthCare System CRCRCRCR USXRAY RI S RI S PCs W/S FilmDigitizer CR QA FrameGrabber HIS/RISInterface(Broker) CT R&F MR NM DG Storage Device (Near line) DatabaseServer RAID MODDLT SAN/NAS Slide 76 U-HealthCare System Storage Area Network SAN is a high-speed sub-ne twork of shared storage dev ices Contains storage device (di sk) for storing data SAN's architecture works in a way that makes all storag e devices available to all ser vers Use of Fiber Channel High scalability for additiona l storage and redundant net works PCs Storage devices Slide 77 U-HealthCare System Network Area Storage NAS is a class of dedicated hard disk-based storage dev ices which provide LAN users with additional disk storag e through a standard network connection In most cases, a NAS device (or NAS server) receives a n IP address, connects to the LAN through an Ethernet c able, and resides on the LAN as an independent network device Users are not demanding the server's processing time fo r mundane storage tasks -- often improving the performa nce of local application servers NAS systems also include some onboard memory (RAM) to cache network data to or from the disks Slide 78 U-HealthCare System SAN Vs NAS Difference between NAS and SAN is subtle NAS devices are big, single purpose storage ap pliances that you plug into network NAS sits between your application server and yo ur file system As perform only 1 task, can serve files very fast NAS is network-centric SAN is a defined architecture that sits between y our file system and your underlying physical stor age SAN is data-centric Slide 79 U-HealthCare System CRCRCRCR USXRAY RI S RI S PCs W/S FilmDigitizer CR QA FrameGrabber HIS/RISInterface(Broker) CT R&F MR NM DG Display DatabaseServer RAID MODDLT SAN/NAS Diagnostic W/S Dedicate W/S Slide 80 U-HealthCare System Workstations Four Primary Categories - Advanced Analysis: Used by specialists for advanced diagnosis - 3D, volume rendering -Diagnostic: For primary diagnosis; located in reading r ooms; high-end 2K monitors -Clinical: Used by clinicians and staff to consult; ICU / ER applications; less costly than diagnostic; 1K monit ors -At Home Review: low-end; PC based; cost-effective; r eview application; lossy compressed for faster transm it Slide 81 U-HealthCare System Standalone Vs direct PACS w/s Standalone WorkstationDirect PACS Client Workstation Hard Disk StorageYes, variesMinimal Query PACS number All PACS system (CT, ACC, Angio.) Single PACS system (ACC PACS) Retrieval mechanism DICOM Q/R and association made with different vendors Direct attached, same vendor Retrieval timeSlowerFaster Diagnostic valueDepends on Monitor Grade and Modules like MPR, 3D etc Suggested usage1.for meeting/museum purpose 2.for single modality image reviewing and reporting like Radworks in U/S Rm Direct PACS workstation for reporting Slide 82 U-HealthCare System Web distribution High availability, low cost Reports / select images to referring physici an desktop Point of integration with electronic patient r ecord Lossy compression for performance Potential for TeleRadiology Security issues to be resolved Slide 83 U-HealthCare System RIS, HIS, ePR and PACS integr ation Slide 84 U-HealthCare System CRCRCRCR USXRAY RI S RI S PCs W/S FilmDigitizer CR QA FrameGrabber HIS/RISInterface(Broker) CT R&F MR NM DG Broker HIS/RIS and PACS interfac e Slide 85 U-HealthCare System Hospital Information System Support clinical and medical patient care a ctivities in the hospital Administer the hospitals daily business tra nsactions like finance, payroll etc Evaluate hospital performances and costs and make long-term forecast Slide 86 U-HealthCare System Clinical System in HA, HK Patient Administration In-Patient and Out-Patient Administration System Accident & Emergency Information System Medical Record Abstract System Medical Record Tracking System Clinical Support Laboratory Information System Radiology Information System Pharmacy Management System Dietetics Catering Management System Clinical Management Clinical Management System (In-Patient) Discharge Summary Clinical Management System (Out-Patient) Electronic Patient Records Clinical Data Analysis and Reporting System Slide 87 U-HealthCare System Non-Clinical System in HA Human Resources and Payroll Systems Hospital Based Financial System Materials Management System Patient Billing and Revenue Collection Sys tem Executive Information System Code 9 and view codes Slide 88 U-HealthCare System Radiology Information Systems Similar to HIS but of smaller scale Interfaces to PACS based on HL7 Department administrative management - Scheduling and Film tracking - Resource management and reporting - Monitor patient status Link to Hospital Information System (HIS) - Billing and Master Record Link to Clinical Management System (CMS) - Prefetch for Clinical visit - ePR integration Slide 89 U-HealthCare System Exam Order Exam Order Exam Scheduled Exam Scheduled RIS Patient Exam Is Performed Patient Exam Is Performed Modality Worklist Demographics Downloaded Database server /Archive Database server /Archive Order Event Prefetch Exams From Storage Images transferred in STS PACS Worklist Updated PACS Worklist Updated Images / Prior Reports Image migration STS to LTA Exam Transcribed Exam Transcribed Report Verified Report Verified Final report available Final report available Exam Read Exam Read Dictated status Preliminary status Images copied on web-server Web distribution to referring physicians RIS workflow Slide 90 U-HealthCare System Broker service HA HIS HA RIS HA CMS Clinical visit ADT Mitra PACS Broker interface Appt., X-ray reques t DR CR US DF Modalities: Get WORKLIST Get REPORT, Get INFO Database s erver Slide 91 U-HealthCare System Broker service A restricted access account will be created at Sy base that gives limited authority for the DICOM Broker solely for the purpose of the interfaces In general, for data flow from RIS to the Broker, t he RIS write the supported events to the table, a nd the Broker polls against the events table and calls the associated stored procedures for the co nversion to DICOM messages Slide 92 U-HealthCare System Broker service Broker main function: - Worklist generation - Reports storage Registration + Post exa m data capture (RIS) Acc # generation + ca ll broker for update Broker poll RIS event table and convert to D ICOM info Modalities query Bro ker for worklist upda te Need SOME time!! Slide 93 U-HealthCare System ePR Architecture Selected images from individual hospitals P ACS are sent make use of the ePR record indexing and b rowsing capabilities to read the radiology im ages through CMS w orkstations Slide 94 U-HealthCare System Data Flow Diagram RISePR RIS operational data RIS statistical d ata ePR Data wareh ouse Appointment Attendance Exam records Reports (15mins) Attendance Exam & workloa d units (daily) HA system CMS Non clinical syste m Web Se rver PACS Slide 95 U-HealthCare System Characteristics of ePR Near instant image review Web distribution can be within hospital, to other hospitals or even private clinics TeleRadiography possible Update of patient information Lossy Vs lossless Broken pathway 15 minutes time lag Slide 96 U-HealthCare System Guidelines for HIS, RIS, PACS interfac e Each system remain unchanged in its conf iguration and function, only data are share d Identify the subset data to be shared and s et up access rights/ authorization Convert the subset data to HL7 standard Define transfer protocol (TCP/IP or DICO M) Slide 97 U-HealthCare System Typical patient and data flow Admission: Patient registration, notify HIS (HL7) Order entry/Arrival: Schedule exam and notify RIS Broker notified and PACS database server updated (pref etch) DICOM worklist to modality Exam completed: data to DICOM gateway (MPPS) Information/images to database/image server through ga teway (DICOM store) Images stored in PACS archive Images to workstations from PACS archive Dictation, transcription etc: workstation to RIS/PACS RIS reporting and PACS updated for reports Transfer: HIS/RIS to PACS, images to other PACS Discharge: HIS/RIS to PACS, images rub out Slide 98 U-HealthCare System Mobile PACS Slide 99 U-HealthCare System What is DICOM? The standard for Digital Imaging and Communications in Medicine. Developed by the National Electrical Manufacturers Association (NEMA) in conjunction with the American College of Radiology (ACR). Covers most image formats for all of medicine. Specification for messaging and communication between imaging machines. Slide 100 U-HealthCare System A little history The first version was ACR-NEMA, released in 1985. Its goal in developing a standard was To enable users to retrieve images and associated information from digital imaging equipment in a standard format using point-to-point connection. To hide differences same across multiple image equipment manufacturers. To handle developing network and image standarts, a new standard, DICOM, was proposed in 1981. Slide 101 U-HealthCare System DICOM Application Domain MAGN ETOM Information Management System Storage, Query/Retrieve, Study Component Query/Retrieve Results Management Print Management Media Exchange LiteBox Slide 102 U-HealthCare System Summary of DICOM Features NETWORK PROTOCOL DICOM incorporates negotiation to permit peers to agree on the functions to be performed MESSAGE ENCODING DICOM defines 24 data types (V2.0 had 4) DICOM message encoding includes JPEG compression (17 varients) DICOM supports multiple character repertoires Slide 103 U-HealthCare System Summary of DICOM Features OBJECT DATA MODEL DICOM is based on a completely specified data model DICOM includes a robust UID mechanism DATA DICTIONARY DICOM includes a large number of new data elements SERVICE CLASSES DICOM defines classes of service for specific applications (e.g. image management, printing) and conformance levels Slide 104 U-HealthCare System DICOM Objects Things such as images, reports, and patients are all objects and are called information objects. Two kinds of objects in DICOM: Composite objects (Old objects inherited from NEMA). Normalized objects (New objects defined in DICOM). All objects and their format constitutes Data Dictionary. DICOM uses UIDs to identify information objects, such as the images, reports, or transfer syntaxes. The form of the UID conforms to an international standard. 1.2.840.10008 is the root and the same for every DICOM UID. Example: UID for the DICOM explicit VR little endian transfer syntax is 1.2.840.10008.1.2.1 Slide 105 U-HealthCare System DICOM Service Classes Composite Verification Storage Query/Retrieve Study Content Notification Normalized Patient Management Study Management Results Management Basic Print Management Slide 106 U-HealthCare System Image Reading: Hardcopy Reading Hardcopy DICOM Print as Seen at Modality Reporting: RIS-Based Transcription / Validation of Narrativ e Report RIS-Based Report Storage and Management Send Reports Query Prior Reports Hardcopy Image Reading + Dictation/Transcription (Use Case 1) Slide 107 U-HealthCare System Hardcopy Image Reading + Dictation/Transcription (Use Case 1) Hardcopy Interpretation & Dictation Hardcopy Interpretation & Dictation Transcription & Correction Transcription & Correction prin t Report Repository RIS Validation sen d manual network DICOM HL7/other optional Narrative Info Only Electronic Report Film Archive quer y Paper print/ Mail/ Fax/E- mail Paper print/ Mail/ Fax/E- mail Acquisition Report Storage / Mgmt. Filming Slide 108 U-HealthCare System Image Reading: Hardcopy Reading Hardcopy DICOM Print as Seen at Modality Softcopy Reading Hardcopy DICOM Print as Seen During Softcopy Reading Reporting: RIS-Based Transcription / Validation of Narrative Report RIS-Based Report Storage and Management Send Reports Query Prior Reports Hardcopy and Softcopy Image Reading + Dictation/Transcription (Use Case 2) Slide 109 U-HealthCare System Hardcopy and Softcopy Image Reading + Dictation/Transcription (Use Case 2) Hardcopy Interpretation & Dictation Hardcopy Interpretation & Dictation prin t Report Repository RIS Validation sen d manual network DICOM HL7/other optional Narrative Info Only Electronic Report Film Archive quer y Paper print/ Mail/ Fax/E- mail Paper print/ Mail/ Fax/E- mail Acquisition Softcopy Interpretation & Dictation Softcopy Interpretation & Dictation stor e Report Storage / Mgmt. Transcription & Correction Transcription & Correction Selected Images Filming Slide 110 U-HealthCare System Image Acquisition: RIS-based Acquisition Workflow Support (Modality Worklist) Image Reading: Hardcopy Reading Hardcopy DICOM Print as Seen at Modality Softcopy Reading Hardcopy DICOM Print as Seen During Softcopy Reading DICOM Store Images -> Burn CD/DVD Reporting: RIS-Based Transcription / Validation of Narrative Report RIS-Based Report Storage and Management Send Reports Query Prior Reports Optional DICOM Store Reports -> Burn CD/DVD Acquisition Workflow Support + Burn CD/DVD (Use Case 3) Slide 111 U-HealthCare System Hardcopy and Softcopy Image Reading + Dictation/Transcription (Use Case 3) Hardcopy Interpretation & Dictation Hardcopy Interpretation & Dictation prin t Report Repository RIS Validation sen d manual network DICOM HL7/other optional Narrative Info Only Electronic Report Film Archive quer y Paper print/ Mail/ Fax/E- mail Paper print/ Mail/ Fax/E- mail Acquisition Softcopy Interpretation & Dictation Softcopy Interpretation & Dictation Report Storage / Mgmt. Transcription & Correction Transcription & Correction Modality Worklist Burn CD/DVD Off-Line Archive stor e Selected Images store Filming Slide 112 U-HealthCare System Image Acquisition: RIS-based Acquisition Workflow Support (Modality Worklist) Image Reading: Hardcopy Reading Hardcopy DICOM Print as Seen at Modality Softcopy Reading Hardcopy DICOM Print as Seen During Softcopy Reading DICOM Store Images for Burning CD/DVD PACS-based Storage and Management of DICOM Persistent Objects Archive Imaging Studies Query Prior Imaging Studies Reporting: RIS-Based Transcription / Validation of Narrative Report RIS-Based Report Storage and Management Send Reports Query Prior Reports Optional DICOM Store Reports for Burning CD/DVD PACS for Management of DICOM Persistent O bjects (Use Case 4) Slide 113 U-HealthCare System Image Repository PACS PACS for Management of DICOM Persistent Objects (U se Case 4) Hardcopy Interpretation & Dictation Hardcopy Interpretation & Dictation prin t Report Repository RIS Validation sen d manual network DICOM HL7/other optional Narrative Info Only Electronic Report Electronic Report Film Archive quer y Paper print/ Mail/ Fax/E- mail Paper print/ Mail/ Fax/E- mail Acquisition Softcopy Interpretation & Dictation Softcopy Interpretation & Dictation Object Storage / Mgmt. Transcription & Correction Transcription & Correction Modality Worklist Burn CD/DVD Off-Line Archive stor e Selected Images store Filming store q/ r store