4. PACS Fundamentals Flashcards by Dana Athena Augusto | Brainscape

Q

-electronic version of the radiologist reading room and the file room.

A

PACS (Picture Archiving and Communication System)

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-consists of a digital acquisition, display workstation and storage devices interconnected through an intricate network.

A

PACS (Picture Archiving and Communication System)

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

year of the First PACS

A

1980s

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

PACS generally served a single modality which is

A

Ultrasound

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Modalities

A

Ultrasound, MRI, CT scan and more…

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-first completed in 1985, this standard laid the groundwork for the future development of the integrated PACS.

A

DICOM (Digital Imaging and Communications in Medicine)

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-is a universally accepted standard for exchanging medical images among the modality, viewing stations, and the archive.

A

DICOM (Digital Imaging and Communications in Medicine)

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-each modality and PACS communicates via _____, and it continues to be refined every year.

A

DICOM (Digital Imaging and Communications in Medicine)

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

3 FUNDAMENTAL PARTS OF PACS

A

Image Acquisition
Display Workstations
Archive Servers

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-most images are acquired in a digital format, meaning that the images are inherently digital and can be transferred via a computer network.

A

Image Acquisition

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-Ultrasound (UTZ), computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine have been digital for many years and have been taking advantage of PACS far longer than general radiography has.

A

Image Acquisition

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-any computer that a health care worker uses to view a digital image.

A

Display Workstations

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

It is the most interactive part of a PACS, and these workstations are used inside and outside of radiology.

A

Display Workstations

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-has a PACS application software that allows the user to perform minor image-manipulation techniques to optimize the image being viewed.

A

Display Workstations

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Archive Servers are composed of

A

Database Server or Image Manager,
Short-term and Long-term Storage,
computer that controls the PACS workflow know as: Workflow Manager

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

computer that controls the PACS workflow

A

Workflow Manager

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-a term that can be used in any industry or in any organization.

A

Workflow

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-It simply means how a process is done, step by step.

A

Workflow

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-In radiology, this term is used to describe how we complete an examination from order entry to transcribed report.

A

Workflow

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-Most departments were designed years ago for film and chemical processing.

A

Film-based Workflow

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-The hardware and software infrastructure of a computer system

A

System Architecture

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

System Architecture consists of:

A

Acquisition devices,
Storage,
Display Workstation, and
Image Management System

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-The technologist may get the order via an electronic worklist or a paper requisition, but after that, things begin to change

A

Generic PACS Workflow

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Types of System Architecture

A

Client/server-based system,
Distributed or stand-alone system,
Web-based system

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Client “display workstation” (thin-client)

A

Client/server-based system (thin-client)

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-images are sent directly to the archive server after acquisition and are centrally located

A

Client/server-based system (thin-client)

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-The display workstation functions as a client of the archive server and accesses images based on a centralized worklist that is generated at the archive server

A

Client/server-based system (thin-client)

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-The health care worker at the display workstation chooses a name from the central list, and the archive server sends the image data to display station. After the “client” is finished, the image data are flushed from its memory.

A

Client/server-based system (thin-client)

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-Most systems allow basic image manipulation at the display workstation or “client,” and the changes are saved on the archive server.

A

Client/server-based system (thin-client)

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-the acquisition modalities send the images to a designated reading station and possibly to review stations, depending on where the order originated (i.e., ICU or ER)

A

Distributed or stand-alone system (thick-client)

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-is very similar to a client/server system in how data flow.

A

Web-based system

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-The significant difference is that both the images and the application software for the client display are held centrally

A

Web-based system

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

is a term used to describe the reading of images from outside of the hospitals walls.

A

Teleradiology

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

uses large multi viewer lightboxes to display the images

A

conventional film/screen radiography

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

DISPLAY WORKSTATION CONSISTS OF:

A

monitor,

a computer with a mouse and keyboard.

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

monitor used in cross sectional images (ct san)

A

1k monitor

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

monitor used in cr/dr projection

A

2k monitor

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

highest resolution monitors (mammography)

A

5k monitor

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

basic picture element on a display

A

Pixel

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

number of pixels contained on a display

A

Resolution

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

rectangular or square table of numbers that represents the pixel intensity to be displayed inn a monitor

A

Matrix

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Display stations can be categorized by their primary use:

A

primary reading stations for radiologists,
review stations for referring physicians,
technologist quality control (QC) stations

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

-used by a radiologist when making a primary diagnosis.

A

Reading stations- radiologist

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

The reading station has the ________ hardware, including the _____ monitor

A

highest quality,

best,

Q

-is a step-down model of the radiologist reading station.

A

Review station- referring physicians

Q

-use the same level of software with the reading station but may eliminate some of the more advanced functions.

A

Review station- referring physicians

Q

One of the most important features on a physician review station is

A

the ability to view current and previous reports along with the images

Q

One of the greatest advantages of a PACS

A

is the ability to view the same set of images in multiple locations at one time.

Q

-used to review images after acquisition but before sending them to the radiologist.

A

Technologist quality work station

Q

may be used to improve or adjust image quality characteristics

A

Technologist quality work station

Q

-it may be used to verify patient demographic information

A

Technologist quality work station

Q

Before PACS, the file room was a

A

large open room with endless rows of shelves full of film jackets/envelopes

Q

Today a file room in a PACS environment may be simple as

A

a couple of computers and a dry laser to make copies for outside needs.

Q

-may be used to look up examinations for a physician or to print copies of images for the patient to take to an outside physician

A

File Room Workstation

Q

-are used to move through images, series, studies, and patients.

A

Navigation functions

Q

Commonly used functions in General Radiology

A

Navigation functions,
Image manipulation and enhancement functions,
Image management functions

Q

Most modern PACS software conforms to the look and feel of the

A

Windows (Microsoft, Redmond, WA)

Q

how a set of images will be displayed on the monitor

A

Hanging Protocols

Q

current or previous examination being viewed

A

Study Navigation

Q

may comprise two or three single images such as the case with CR and DR (projection radiography), or it may contain several series of images such as the case with MRI.

A

Study Navigation

Q

In studying function, Images can paged through either:

A

Scroll wheel (mouse)
Arrows on keyboard
Cine

Q

stack mode of scrolling

A

Cine

Q

Cine comes from the word

A

Cinematic

Q

it means to move through frame by frame of the series of images

A

Cinematic

Q

Navigation tool that is commonly found is

A

close patient or close study icon

Q

this icon closes the active patient or study and either pulls up the worklist or moves to the next unread patient in the worklist.

A

Close patient or close study icon

Q

-default function of the left mouse when an image is actively displayed in the software

A

Window/level

Q

-this function should NOT be used to label left or right to indicate the patient’s side because digital R and L will not hold up in court

A

Annotations

Q

-can indicate prone or supine, 30 minutes, upright or flat plate

A

Annotations

Q

-These functions are used to orient the image in the anatomical hanging position

A

Flip and rotate

Q

This function makes it very important that lead markers are used to ensure that the radiologist reads the correct side.

A

Flip and rotate

Q

These functions are used primarily by the radiologist to increase the size of an area on the image.

A

Pan, zoom, and magnify

Q

-Usually used together

A

Pan, and zoom

Q

will usually enlarge a square area of the image, and the square can be moved around the image to quickly see various areas enlarged.

A

Magnify

Q

most common measurements

A

Distance measurement

Q

size of the pixel

A

the known measurement

Q

another common measurement which measures the angle between two structures

A

Angle measurement

Q

it is commonly used in spine studies

A

Angle measurement

Q

Common measurement for radiologist

A

ROI (region of interest)

Q

It will determine the pixel intensity of a certain area.

A

ROI (region of interest)

Q

used to retrieve studies from the archive

A

Query/retrieve function

Q

allows the user to query a study on multiple fields such as the patient’s name or ID, date of service, or modality

A

Query/retrieve function

Q

most commonly used three-dimensional (3D) rendering techniques.

A

Multiplanar reconstruction (MPR)

Q

most common application is producing coronal images from the axial set to reduce radiation to the patient and scan time at the modality

A

Multiplanar reconstruction (MPR)

Q

used to visualize vessels

A

Maximum Intensity Projection (MIP)

Q

air-filled structures

A

Minimum Intensity Projection (MinIp)

Q

Similar to MIP but allows the user to assign colors based on the intensity of the tissue so that bone, contrast agent, and organs can be seen in different colors

A

Volume rendering technique (VRT)

Q

The technique uses a histogram-type graph to differentiate the various structures

A

Volume rendering technique (VRT)

Q

-Using a threshold of pixel intensity values, everything below the threshold will be removed, and everything above will be assigned a color and shown as a 3D object.

A

Shaded surface display (SSD)

Q

Used when multiple images need to be put together into one image

A

Stitching

Q

Stitching is commonly used for

A

full-spine x-rays or
scoliosis series,
long bones (extremities)

Q

advanced function of the workstation, such as edge enhancement, smoothing, and contrast enhancements

A

Image postprocessing

Q

examples of image post processing

A

edge enhancement, smoothing,

contrast enhancements

Q

4 CATEGORIES OF COMMON FUNCTIONS ON A PACS WORKSTATION

A

Navigation functions,
Image manipulation and enhancement functions,
Image management functions,
Advanced workstation functions

Q

Navigation functions

A

Hanging Protocols

Study Navigation

Q

Image manipulation and enhancement functions

A

Window width
Annotations
Flip and rotate
Pan, zoom and magnify
Measurements

Q

Advanced workstation functions

A

Reading station advanced functions,

Technologist QC station advanced functions

Q

Reading station advanced functions

A

Multiplanar reconstruction (MPR)
Maximum intensity projection (MIP) and Minimum intensity projection (MinIp)
Volume rendering technique (VRT)
Shaded surface display (SSD)

Q

Technologist QC station advanced functions

A

Stitching

Image postprocessing

Q

Cardiothoracic ratio

A

(0.42-0.50)

Q

Carina distance – endotrachealtube ETP (distance measurements)

A

(2.5 cm) (4 cm/3-5 cm)

Q

represents the range of gray values that are being viewed

A

Window

Q

represents the center value of the range

A

Level

Q

ADVANTAGES OF CLIENT/SERVER-BASED SYSTEM

A

Any examination sent to the PACS is available anywhere without other interventions.
Only one person can open the study and others that open it will receive a message that the study is open and being read.
There is no need to pull or send historic images because the old studies are available with the new on the archive.

Q

DISADVANTAGES OF CLIENT/SERVER-BASED SYSTEM

A

The archive server is seen as a single point of failure. If the archive goes down, the entire system is down, and no image movement can take place. All newly acquired images must remain at the modality until the archive is up and can again receive the images.
The system is very network dependent. The images are flying back and forth between the archive and the workstations, and the network can become bogged down because of the large volume of data being moved.
The archive server is handling many requests at once and can become bottlenecked because of the high volume of requests

Q

ADVANTAGES OF DISTRIBUTED OR STAND-ALONE SYSTEM

A

If the archive server goes down, local reading at the workstations is not interrupted, other than not being able to get historic images. After the archive comes back up, the images that have been changed and signed off by the radiologist will automatically be forwarded to the archive to be saved.
Copies of an examination exist at various locations because the images can be distributed to many locations at once. Therefore it is less likely that PACS data will be lost.
The system is less dependent on the network for its speed. The user can be working on one examination while the workstation is pulling and getting the next examination ready to be read. The workstation can fetch historic images according to rules the user sets up.

Q

DISADVANTAGES OF DISTRIBUTED OR STAND-ALONE SYSTEM

A

There is heavy reliance on the assumption that the distribution of images is being done correctly. If the distribution is wrong, the prefetching of historic examinations will not be correct either.
Each workstation has a different worklist, and therefore only one person can be working on that list at a time.
It can be inconvenient to read additional studies; the radiologist would have to move to another workstation to read the images designated for that workstation.
The users must depend on the query-and-retrieve function when nonscheduled examinations arrive at the workstation to be read.

Q

ADVANTAGES OF WEB-BASED SYSTEM

A

The hardware at the client can be anything that will support an appropriate web browser. This allows for greater flexibility with hardware but can also be a disadvantage because image displays (monitors) may not be able to support diagnostic quality.
The same application can be used on site and at home in teleradiology situations.

Q

DISADVANTAGES OF WEB-BASED SYSTEM

A

The system’s functionality may be limited because the software is not installed locally. The bandwidth of the network connection limits the amount of data that can be transmitted for download, and some programs are too large to be transmitted over the network that is installed.
As with client/server systems, the network is the biggest obstacle to performance