idx imagecast disk - does not contain dicom images -stentor
mlak...@yahoo.com
I wanted to report a bad experience. A patient was transfered to my
hospital from another hospital that has a IDX imagecast pacs. The
product seems to be originally a stentor pacs that they repackage.
The patient was transferred for neurosurgery. The surgeons came to me
to ask if I could print a film from the CD so they could hang it in the
OR during the surgery. However when I looked on the CD, all it had was
some proprietary compressed version of the images, readable only by the
cd based image display program. There were no dicom files on the CD.
I contacted IDX on the 802 number listed on the CD, and they contacted
Stentor and confirmed my observation. As a result we were stuck. The
patient needed to get another CT before the operation could be done.
I would like this incident reported to the "DICOM POLICE". How can this
misbehavior be addressed? If only there were "dicom police". I suspect
this usenet group is the best we have :).
Surely CD's that are distributed should be in dicom format, or at least
have a full set of dicom images so that the patients images can be
exported and utilized.
The IDX engineer said " but usually this disk is for referring
physicians and they dont need dicom format images". I pointed out that
this was as if we had no dicom standard at all...
Mitchell Laks
eric.g...@gmail.com
technology and the user interface to deliver it is superior to what
DICOM media offers.
There are alternatives which they could have used (witness IHE portable
media format which includes both DICOM part 10/12 files intermixed with
html files and jpeg images on the same media). Organizations buying an
IDX or Stentor system can choose to buy a separate DICOM media
production system. There are a number of vendors offering auxilary
systems which will accept a DICOM store and produce a DICOM compliant
media from the transferred images. Stentor and IDX systems do support
an outbound DICOM store capability. These external systems are easily
integrated with it.
One can also question whether the person(s) making the decision to
purchase and use the proprietary media format truly understood they had
a choice or the potential pitfalls of using the proprietary format. A
lot of the time these distinctions are relegated to "technical mumbo
jumbo" by the PACS purchasing decision makers, especially when the CD
display capabilities are demonstrated.
There aren't any DICOM police and even if there were, this wouldn't be
a case of a violation of the standard; instead it is just a
demonstration of how proprietary solutions will let you down. Stories
such as yours can make it easier illustrate the advantages of
standards based outputs over proprietary solutions. The IDX engineer is
correct - most refering physicians wouldn't want or need to pull the
images up in a full function DICOM viewing/visualization application.
But as your story shows, "most" is not "all" and referring physicians
aren't the only ones who need to receive images.
One thing you can do is contact the organization from which you
received the CD to let them know how their media system let you and
your patient down so they are at least aware of the limitation of that
distribution format for cases such as your patient. If you interact
with them often enough, you might also consider several options -
setting up a DICOM interface where they could do a DICOM store to one
of your local systems or convince them that they need a DICOM compliant
media production system. You could also look into film printers which
accept a standard windows print interface (rather than a dicom print).
Finally, since Philips has both purchased Stentor and has a substantial
commitment to DICOM standards in their products, I suggest you could
contact them about the situation. I suspect they would be sympathetic
to your situation and may look into adding both DICOM images and
iSyntax images to the media produced from their systems.
David Clunie
The fact that Stentor does not produce DICOM format CDs is
well known in the industry, but comes as a surprise to most
Stentor PACS owners and users.
We (RadPharm) regularly receive these extremely irritating
CDs from sites for our clinical trials and the sites get very
annoyed when we tell them that we can't use them and that
they have to find a way to burn DICOM CDs on another device;
but often they will have a non-Stentor workstation somewhere
with the necessary capability.
I personally started asking Stentor about this at SCAR
2004 (not 2005), and I was likely not the first. The ability
to burn DICOM CDs was promised for release 3.5.
Stentor users will note that release 3.5 is still not out, but
I am assured by their marketing people that it is coming real
soon now and that it will give the users the choice to burn a
DICOM Part 10 format CD or use the Stentor format (the latter
with a viewer).
This will still leave some confusion in the minds of users
sending disks (what to send by default), but at least they
will be able to respond more easily to our rejection of
their Stentor CDs.
Unfortunately, outside the context of clinical trials, when
a radiology facility gives a patient a CD to take to a
referring doctor who wants to use the viewer, and then
that same CD is taken by the patient to a new facility that
needs to import the images into their PACS (e.g. prior to
surgery), you will still have the problem that the CD will
be unimportable and a new CD will have to be obtained.
So the ability to burn DICOM CDs will be an improvement over
not being able to burn them at all, but allowing the Stentor
format as an option and only supplying a viewer when the
Stentor format is used will still remain a problem for such
scenarios.
We will never have seamless interoperability unless the only
CD format is the DICOM format and all viewers on CDs support
the DICOM format.
Amicas has the same problem in this latter regard - it provides
the ability to burn DICOM CDs (on the print station not the
user's station I understand), but it is not the default and
hence again, we get many CDs we have to reject.
The bottom line is that since the job can be performed perfectly
adequately using the DICOM Part 10 CDs, there should be no
other format - I assert that it is complete nonsense that
any proprietary format has any advantage over DICOM in this
role (viewing off CD, as opposed to live on the network),
and that any advantage in file size of proprietary compression
can be achieved using DICOM standard compression techniques.
I believe the real issue here is the engineering headache of
trying to make the viewer on the media mirror the function of
the PACS workstation on the network, and to do it with standard
DICOM files instead of the proprietary Stentor iSyntax or the
Amicas (non-DICOM) JPEG 2000.
Interoperability is being hampered purely by the cost of
justifying this engineering effort, not by any purported
benefit of the proprietary format.
The only way to overcome the inertia to change is for users
to demand interoperability.
The current form of that demand should be framed as compliance
with the IHE PDI profile.
David
PS. I have bcc'd some of the folks at the various companies
mentioned in case they want to weigh in on this issue with
more accurate information.
mlak...@yahoo.com wrote:
David Clunie
> I believe the real issue here is the engineering headache of
> trying to make the viewer on the media mirror the function of
> the PACS workstation on the network, and to do it with standard
> DICOM files instead of the proprietary Stentor iSyntax or the
> Amicas (non-DICOM) JPEG 2000.
>
> Interoperability is being hampered purely by the cost of
> justifying this engineering effort, not by any purported
> benefit of the proprietary format.
An intermediate step that is possible that I forgot to mention
would be if the proprietary viewers on the proprietary media
had the ability to convert the proprietary files on the media
and send them as DICOM images over the network.
For example, the Stentor CD viewer has the "send DICOM" menu
command grayed out, as I recall from last time I tried this.
Though this would still require a receiving site to have a
PC and run the viewer (with the attendant security risks
that many sites refuse to accept), and require them to
configure a DICOM node (or the PACS) to receive, reconcile and
import the files over the network, it would be better than
nothing.
It also might be a lot easier than converting the viewer to
make use of the DICOM part 10 files rather than the proprietary
files.
Another option of course is to include both DICOM and proprietary
files on the media, but then there are space issues.
David