Housekeeping PACS cleaners and sweepers Dr Nicola H

Housekeeping: PACS cleaners and sweepers Dr Nicola H Strickland Consultant Radiologist Hammersmith Hospitals Trust London, UK

Why this title? • • PACS is not like a fridge! It needs looking after “a PACS nursemaid” sweeper and cleaner to keep database tidy

Jobs to be done • daily housekeeping • pre- and post upgrade housekeeping

Daily housekeeping 1. 2. 3. 4. 5. 6. unspecified exams erroneously marked dictated unreported exams unverify exams on request CR / DR problems “unfetchable exams”

Unspecified exams • appear as, eg. “unspecified CR” • problem caused: historical exams of same body part and same modality not displayed automatically • action: exam needs to be merged with correct folder for that exam on PACS

Common causes of “unspecified” • RIS update DICOM modality worklist (on modality) PACS “order entry” no update to modality worklist PACS updates correctly • no DICOM modality worklist Ø typographical / demographic errors

Common causes of “unspecified” • later follow-up images added to same exam Ø eg. nuclear medicine white cell scan Ø eg. ultrasound post micturition • solution: DICOM perform procedure step (PPS) needs to be supported on the modality and on PACS. • PPS allows a “step” of the exam to be completed without closing the whole study

Common causes of “unspecified” • bizarre equipment malfunction! Ø unpredictable change of demographics eg. nuclear medicine workstation

Daily housekeeping 1. 2. 3. 4. 5. 6. unspecified exams erroneously marked dictated unreported exams unverify exams on request CR / DR problems “unfetchable exams”

Exams erroneously marked dictated Causes: • human error (by radiologist) hit the dictated key/click dictated icon by mistake • report “lost” Ø tape lost / corrupted Ø dictation system malfunction • report typed but not sent to PACS

Exams erroneously marked dictated Action: • decide date range, eg. up to 4 weeks ago • identify status “reported” but not “completed” • check no typed report exists on RIS / speech recognition system Ø if none does. . .

Exams erroneously marked dictated Action: • restore “unreported” status so exam reappears on worklist for reporting • identify and alert radiologist responsible (for specials only) • if typed report does exist on RIS / speech rec system: Ø resend to PACS Ø correct error sending to PACS

Daily housekeeping 1. 2. 3. 4. 5. 6. unspecified exams erroneously marked dictated unreported exams unverify exams on request CR / DR problems “unfetchable exams”

Unreported exams 1. very old (months ago) unreported exams ● status may change automatically: “dictated off-line” ● only a problem when you first start housekeeping ● re-instate unreported status back on worklist ● alert appropriate radiologist (for specials)

Unreported exams 2. “missed” recent unreported exams (specials) ● eg. at session handover for CT/MR ● on call (junior radiologist) – verbal report given ● ● re-instate unreported status ● alert appropriate radiologist (for specials)

Daily housekeeping 1. 2. 3. 4. 5. 6. unspecified exams erroneously marked dictated unreported exams unverify exams on request CR /DR problems “unfetchable exams”

Unverify exams on request 1. on request by radiologist ● so that post-processed images can be sent to PACS, eg. CT reformats ● needed because PACS does not yet support DICOM perform procedure step

Unverify exams on request 2. on request by radiographer ● extra image taken later eg. - IVU delayed image - further view requested by radiologist ● exam already dictated and completed by radiologist before all (CT/MR) images sent to PACS by radiographer! (viewed by radiologist on 3 D workstation)

Daily housekeeping 1. 2. 3. 4. 5. 6. unspecified exams erroneously marked dictated unreported exams unverify exams on request CR / DR problems “unfetchable exams”

CR / DR problems • wrong plate put through CR reader ® another patient’s image assigned to the exam Ø unverify exam Ø reassign image correctly • wrong processing algorithm used Ø Reapply algorithm on plate reader / DR

Daily housekeeping 1. 2. 3. 4. 5. 6. unspecified exams erroneously marked dictated unreported exams unverify exams on request CR / DR problems “unfetchable exams”

“unfetchable” exams • old exams not retrieved from long term archive • a rare problem • alert PACS engineer = a de-archiving problem

Jobs to be done • daily housekeeping • pre- and post upgrade housekeeping

Upgrades housekeeping • print film / CDs of critical key images requested by clinicians, eg. NNU • merges +++ post upgrade Ø no RIS modalities worklists Ø no RIS PACS order entry

Policies! • anything sent to PACS must have a RIS entry Ø digitization Ø CD uploading Ø out of hours exams (especially ultrasound!) • restricted digitization / CD uploading Ø requires radiologist authorization • restricted film printing / CD burning Ø requires radiologist / radiographer authorization

The “nappy changing team”!! Imaging support systems group (ISSG) • 4 radiographers (2 full time posts, one at HH, other at CX) • why 4? Ø covers annual and sick leave • why radiographers? Ø understand difference between study types and body parts

The “nappy changing team”!! Imaging support systems group (ISSG) • pattern of errors noticed early: Ø corrected, working practices changed etc. • report to the “POG” (PACS operational group) Ø team cohesion