Planning and implementing image delivery to outpatient specialty clinical practices in a large medical center.

Softcopy image viewing using web-based technologies has been deployed to 3 specialty outpatient practices - Lung Center, Neurosurgery, Orthopedic Surgery - where films remain available. Physicians and staff use Philips Easyweb (a web-based image browser) and BJC HealthCare ClinDesk (a Java-based electronic patient record) clients in patient examination rooms and physician workrooms to retrieve images from a Mitra image server. Practice-specific planning and training preceded deployment; on-site training and support came with deployment; on-site and telephone support are available as needed. Softcopy viewing generally is accepted although a few physicians continue to use films. The unavailability of studies performed before the introduction of the image server remains an issue until the server builds a suitable archive. Softcopy-based clinical-image viewing can be supported with web-based technologies, but effective practice-specific planning, training, and technical support are crucial to successful deployment to those accepting softcopy image viewing.

Enhanced interfaces for web-based enterprise-wide image distribution.

Modern Web browsers support image distribution with two shortcomings: (1) image grayscale presentation at client workstations is often sub-optimal and generally inconsistent with the presentation state on diagnostic workstations and (2) an Electronic Patient Record (EPR) application usually cannot directly access images with an integrated viewer. We have modified our EPR and our Web-based image-distribution system to allow access to images from within the EPR. In addition, at the client workstation, a grayscale transformation is performed that consists of two components: a client-display-specific component based on the characteristic display function of the class of display system, and a modality-specific transformation that is downloaded with every image. The described techniques have been implemented in our institution and currently support enterprise-wide clinical image distribution. The effectiveness of the techniques is reviewed.

Challenges in image acquisition and distribution for clinical image service.

We have developed a centralized application for acquiring images from multiple picture archiving and communication systems (PACS) and distributing images to a clinical image web server and other repositories. Our flexible strategy addresses a number of administrative challenges associated with delivering images into clinical, research, and test environments. DICOM images flow from PACSs and modalities to a UNIX-based "distributor" application, which relays them to one or more destinations. Image volume and transmission times were collected and analyzed. Three distributors receive an average of 34 gigabytes of image data per day. Images are sent concurrently to two web-based image servers, one used clinically by physicians and one used for testing. Transmission of certain classes of studies is prioritized for key physician groups. Delivery to research systems is also supported. Acquiring images from multi-vendor PACS for distribution to a web server for clinical image viewing is a challenging task. Centralizing the acquisition and distribution process reduces both the administrative effort and the impact on clinical operations associated with maintaining dynamic clinical, testing, and research environments.