Monday, September 14, 2015


Universal Improvements

I have referenced some of our trials and tribulations with the new GE Universal Viewer, which is technically version 5.x of Centricity.

We've found that some of our problems were of our own making, with the help of some unusual programming on GE's part. The disappearing measurements, for example, didn't really disappear. Rather, my hanging protocol created a clone of the main window, and if things are measured there, they won't show up, although they do live on as the Saved Presentation. Lesson learned. Various other "glitches" were due to our lack of understanding of something esoteric. Well, if they all worked the same, no one would buy the expensive PACS, now would they?

However, one problem has not yet been fixed, that of skipped images. We thought at first this was also due to the clone window handling, but apparently it is a coding error. Which is to be fixed. IN THE RELEASE AFTER NEXT!!  Um.....GE....a glitch that hides patients' image data is a VERY SERIOUS PROBLEM! This is the sort of thing that calls for emergency hot-fixes and mea culpas to the FDA. I do have to admit that the problem is not as bad as what we saw with Centricity 2.x, wherein scrolling would simply jump over images; UV 5.x tells us when it's skipping images by flashing "0% Loaded" in the missing frame. This is a definite improvement, can do better!

Anyway, a team from GE came by the other day to show us how things will improve.

The two apps people who came to visit were well-known to me, one having demoed Centricity to us about 12 years ago, and the other having shown me the Universal Viewer for the first time at RSNA 2012. They brought a laptop-based workstation and server, and a cargo-load of monitors. Given the fact that we just redid all the workstations, couldn't we have simply, temporarily downloaded UV 6.x on our station, saving a LOT of time and effort? Oh well, I guess that's why I'm not in sales.

The team showed us a few things we already had that we didn't know about. For example, two CT series can be synchronized by "Image Registration" as well as position or slice number. The modifier was there all along under the Sync menu, but I never thought to look there. Perhaps theres also a "Sync by Phase of the Moon when Study Acquired" or "Sync by State of Consciousness" in there, too. I'm sure there are other little Easter Eggs hidden in the somewhat scattered GUI I haven't found as yet.

UV 6.x apparently plays nicer with Windows than 5.x. We had complained about the Navigator pane disappearing behind the Patient Folder; resizing the latter will solve this temporarily, but the windows all revert back to where they were upon opening the next study. Ah, Windows. Some problems scrolling through old reports after clicking somewhere else supposedly will be improved in the next release as well.

One of the main deficiencies in UV to date has been the lack of the promised ability to read PET/CT without adding the Advantage Workstation Server. We were shown the AW functionality, which is FINALLY tightly integrated into UV about 12 years after it was supposed to happen. It does appear to work as I would expect it to, with all windows, planes, 3D renderings, cartoons, and other stuff linked. Adjust one, the others all follow, whether on UV or AW. Very nice. This gives us the full PET/CT reading capability, matching that of the old AW upon which we now depend. Works for me. There's also a nice OncoQuant module which we may or may not get that will allow serial lesion measurements. That is, after all, what we do in oncologic imaging. Having a table of what was there before could certainly help us to be certain we measure all the lesions seen last time. Each. And. Every. Single. One.

I took a few moments to rant about the control layout of UV, which is not terribly logical, and can get worse depending on what buttons are pressed, and what the state of the viewer might be. For example, when using measurements (obviously the bane of our existence), the buttons for linear measurement, ROI, etc., are placed to the right of the "Study Dictated" button, which is otherwise nicely placed at the end of the line. Yes, said GE, you are not the first to complain about that. Well, gee, GE, how about trying these things out with real users before deploying them? Little problems could be caught before they become big problems. That would be nice, and few companies do it. My services are available for a very reasonable fee!

Having heard of our difficulties with another PACS, the reps approached me after the demo and wondered if this might be the time to present their wares to the troubled site. Since the problems there might not be the fault of the PACS itself, I urged patience. A LOT of patience. Like wait until I've fully retired patience... Some of my former partners have told me quite clearly that they would really rather not have to use UV anywhere else. To them, I urge patience as well; UV represents tremendous progress over its predecessors, and you never know how much better it might get...

Thursday, September 03, 2015

Another Question

Hypothetical question:

Which vendor/product out there is capable of (rapidly) overlaying an existing PACS?

So far, Merge, Intelerad, and Visage seem to be able to do so. Any others? Any experience in doing this?

And how well will they work if your networks aren't in good shape?

Thank you for sharing your thoughts.

Wednesday, September 02, 2015

A Question For You...

A very simple question...

Has this blog been helpful to you? Has the description of our trials, tribulations, and occasional successes with PACS led you astray or in the right direction?

Just wondering...

Tuesday, September 01, 2015

Connectivity Deja Vu

Tonight, there was semi-emergent IMPAX downtime to allow for the updating of the Connectivity Manager. The 6-8 hour anticipated impact on PACS was planned about 8 hours before it happened, and is necessitated by our imminent move to IMPAX 6.6.1. The system is due back up in less than one hour, and we'll see if we fare any better than last time. You see, this is all quite familiar. Here is a regurgitation of my post, "Connectivity Banisher" from January, 2009:


In the world of Agfa Impax, a "Connectivity Manager" is:
. . . a middleware component in the integration between HIS, RIS, modalities, and PACS systems, linking patient and study data with images. To display the information available from a non-Agfa RIS in the Text area of IMPAX, connect to the Connectivity Manager. . .

The main purpose of the Connectivity Manager is to take data from one system, such as a HIS, and translate it into a format that another system, such as a modality, can understand. Connectivity Manager accomplishes this translation with mappings. The mappings tell Connectivity Manager how to translate incoming and outgoing messages to external systems. The following mappings must be configured so that Connectivity Manager knows which report source to go to for each study, and how to translate messages sent from IMPAX. . .

Map a reporting name into the Data Store by identifying the sending facility in the Connectivity Manager database. Identifying this value means it will work regardless of whether the sending facility sends their name along with the message or not. Also, if the sending facility changes their name at some point, mapping or configuration changes will not be necessary. The Default Assigning Authority identified in this mapping is the name of the report source entered in the Business Services Configuration Tool.

The sending facility is required to view reports in IMPAX. Connectivity Manager uses the Entering_organization and Requesting_Service mappings to populate the sending facility field. These mappings should include the Default Assigning Authority so that every report contains a sending facility.
Our Connectivity Manager was upgraded last night. And again this morning. From the rad's point of view, this means:
During this time Modality Worklists will not be available and Technologists will have to manually input ALL Patient Information. Studies sent to IMPAX will Fail Verification, and will not update with Reports until the downtime is ended.
I drew the short straw, and experienced the joys of the upgrade. Fortunately, the downtime lasted less than one hour, and not two. Of course, only a few of the techs got around to manually inputting ANY Patient Information. Still, we were OK. Until this morning, when this information (including the accession number by which we dictate) was suddenly absent once again. The culprit was, of course, the Connectivity Manager, which seemed to be confused by "multiple" inputs for the same patient. Now that's a problem, which we hope will be fixed by the experts before too much longer.

As usual, Dalai's Laws of PACS apply. In particular, the First and Third Laws are applicable:
I. PACS IS the Radiology Department.
III. Once PACS, never back.
When PACS malfunctions, the department malfunctions, and don't even consider asking anyone to go back to a manual process. It ain't gonna happen.

So, in the ideal land of Dalai-wood (Hooray for Dalai-wood!), PACS should never break. Since that isn't achievable, these thing need to be created with an eye toward simplicity and functionality. Based on what the "Connectivity Manager" is supposed to accomplish, I'm not really certain why it has to be a separate program or computer or whatever it is. Shouldn't the simple, basic, core PACS be able to talk to others? OK, provide a look-up table (user-configurable, of course), but do we have to have a big, separate, grandiose module that manages to bollux up the works when we upgrade it?

Yes, I know..."simple" and "basic" aren't in the vocabulary of a lot of PACS vendors. Neither is "easy". And "uptime" can be defined to the preferences of those making the definition. But as far as I'm concerned, if it isn't totally "up," then it's "down." (Which happens to be true for many things in life.) So, today, we were "down," courtesy of our dear Connectivity Manager.


A party close to the 2009 update had this closing comment:

Please understand this is not normal hospital type workflow, and with the hundreds of other mappings to get right is an easy oversight, the missing "Cerner ID" should have been noticed during your sites testing and identified prior to the go live.

But once again an easy oversight by all involved.

This also was not a standard upgrade, Yes your CM software was upgraded to the latest version, But behind the scenes each and every interface was recreated from scratch, including the HL7 Feeds, all the modality’s (100’s) and each and every Impax device and client, There was months of work evolved with this upgrade.

On a different note, I truly enjoyed reading your blog, And can fully understand the frustration these upgrades cause the people working with the software. I do try my best to ensure as little impact to your job as possible.

I have yet to understand what, beyond me, makes our system any different than any other. And I'm not sure how we were able to squeeze "months" of work into 14 hours. Perhaps the process has been perfected in the last 6.5 years. Right.



Initially, the update seemed to have gone well, and I even sent an email congratulating those involved. WRONG.

It apparently did NOT go well. In the middle of it things went completely down for about 30 minutes. No PACS, no nuthin'. Did we have adequate communications on this? Did we share the responsibility properly?

And our 6.6.x upgrade has been inexplicably delayed.

Not good. Not good at all.