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It's not too late! Your support of the SIIM Research & Education Fund through the 4th Annual "Ride to SIIM" will help fund the SIIM Grant Program and the Samuel J. Dwyer, III, PhD, FSIIM, Memorial Lecture.
Make a per-mile contribution to the SIIM Research & Education Fund today!
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Using Microsoft Sharepoint in the Commissioning of
New Modalities in PACS
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| Authors: |
Nicholas T. Charboneau, Mayo Clinic; Alisa I. Walz-Flannigan, PhD; Kathleen J. Williams, RT(R); Todd L. French; Tim R. Daly RT(R); Steven G. Langer, PhD
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| Background: |
Connection of new, previously unknown modalities and/or software versions to our production PACS and RIS can cause unwanted risks. To reduce the danger of either workflow interruption or sub-optimal image display, our team has adopted a process for connectivity review and commissioning. New modalities and software versions are first evaluated in a non-production environment. This new modality commissioning process uses a test system which duplicates our entire production environment, including:
• Configuration of a test RIS, worklist brokers, PACS, archive and clinical viewer
• Dataflow, workflow, interface testing
• Image quality in PACS and clinical viewer
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| Evaluation: |
New modality commissioning is a collaborative effort among IT, engineering, and physics staff. We needed to establish an efficient workflow to accomplish extensive testing within a reasonable time frame in both test and production electronic environments. The best solution our team has found to facilitate this workflow has been to establish a standardized protocol within a Microsoft SharePoint Server, a web-based tool for collaboration. With this tool we provide automated notifications, a centralized knowledge base, and cooperative evaluations and documentation of testing procedures.
When a radiology director requests the evaluation of new and unknown equipment for purchase, a SharePoint workflow is initiated. A connectivity questionnaire is sent to the vendor and sample images are requested for evaluation purposes. Early review of sample images can help in troubleshooting potential image processing issues in the electronic environment display chain. These issues can be worked out ahead of time, preventing delay in clinical deployment.
Once the vendor has returned the connectivity questionnaire, a SharePoint workflow is initiated that sends a request for a review meeting with the proponent, IT, engineering and physics staff. The goal of the connectivity review meeting is to identify potential problems and to evaluate the impact of the modality on the electronic environment. At the same time, a SharePoint document library is established for gathering DICOM conformance statements, operation manuals, commissioning checklists and connectivity review information.
When equipment arrives on site, it is first evaluated in a test environment, which replicates the functionality and software versions of the production electronic environment. This test system has its own RIS, worklist broker, PACS, and an archive and clinical viewer that uses analogous hardware and equivalent software as the production environment. Thus, the test system is useful not only for modality commissioning, but also for commissioning software changes to any of the components before they are applied in production. Such a step is a key tenet of change management and risk mitigation.
The specific testing checklist continually evolves in response to new types of outputs, clinical needs, and areas of risk identified by previous difficulties. It is captured in an Excel sheet that is collectively filled out and stored on the SharePoint site. During testing the workflow is guided by hand-off cues in the checklist and facilitated by phone, SharePoint automatic notification, and emails. The important part is that everyone across the team is working on the same document and seeing the same thing. Progress can be tracked by the project manager.
Once the test environment checklist has been worked through, and questions have been resolved, and any challenges addressed, the sign-off to move the evaluation to the production environment is given by the project manager. A similar workflow and battery of tests is used for evaluation in the production environment. Once production commissioning tests have been passed, the equipment is released for clinical use by the project manager.
Additionally, our connectivity review and commissioning record provides a resource for future evaluation of purchases and installations of new equipment. If the make or model of equipment is similar to one already evaluated, a more minimal testing procedure is used. For repeat installations, connectivity between RIS, PACS, archive, and the clinical viewer is simply verified in the production environment.
Our poster will illustrate our connectivity and commissioning workflow and its SharePoint implementation. |
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| Discussion: |
One of the primary benefits of using a SharePoint Server is web-based frameworks for the connectivity review and commissioning process. It is also a means of collective editing, of documenting the testing process, of having a single centralized documentation facilitate tracking the testing progress, and of overseeing from project managers. Additional benefits of a SharePoint Server include localized administration of users, automatic email alerts when material is added or changed, automated workflows designed to facilitate hand-offs between groups, and discussion boards that can provide a topic-centric record that is easier to reference than searching through strings of emails. In fact this abstract was created in a Wiki page on a SharePoint Server facilitating easy collaboration, single document management, and automated document edit notifications.
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| Conclusion: |
While the process herein delays the release of exciting new modalities into clinical use, it has highlighted events that would, at best, have been embarrassing, and, at worst, have been dangerous to the production environment, patient safety or both. Given the extent of testing steps and criteria we’ve developed, it is important to have this effort be an established procedure and accessible to all team members.
Some issues we discovered during testing include: incorrectly stored patient information; image series structures that are incompatible with hanging protocol; missing annotations; incorrectly displayed images, which is the result of differing number of bit depths between modality and PACS; inefficient DICOM image transmissions; DICOM storage port number limitations; etc.
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