Interface CR Fuji en un Ambiente de Red DICOM

Abstract
CR technology, especially that manufactured by Fuji Medical Systems, Inc., is now well established and
accepted in
clinical environments. It has become clinically desirable to use CR digital image acquisition as a primary
image input into
PACS and teleradiology systems. The techniques and technology useful in interfacing Fuji CR to PACS and
teleradiology
systems will be discussed. Interfacing of Fuji laser imagers to PACS will also be discussed.
Introduction
Figure 1 shows a typical CR configuration as delivered by Fuji Medical Systems, Inc. Many such systems
have been
installed worldwide. The configuration consists of a Fuji CR, a Fuji Workstation (HI-C654) and a Fuji Laser
Imager. The
CR is used to digitize the CR phosphor plate. The raw image data is then processed for printing and sent to
the Fuji Laser
Imager. The raw image data is also transmitted to the Fuji Workstation for viewing, reprocessing and
potentially
reprinting.
Most installed Fuji CRs are in non-PACS environments and as a consequence, the acquired images are
distributed by
means of film only. Interfacing of the Fuji CR systems to non-proprietary PACS was not a design requirement
for these
early systems. The only provision made for interfacing beyond this local system is of a proprietary nature.
The question
then arises as to how does one interface a Fuji CR system to a non-proprietary DICOM based PACS or
teleradiology
system, in a clinically useful fashion.
Figure 1
In order to answer this question, one must consider the workflow model which is used in acquiring CR
images. A
technologist will take one or more x-ray plates for a given patient. The plates must then be identified, by some
means, of
belonging to that patient, and then digitized by the CR plate reader. The digitized x-ray image can then have
QC (quality
control) performed on it or not, depending on radiology departmental policies and preferences. In a PACS or
teleradiology
environment, one would then like to distribute the acquired images for softcopy review and in some instances
printing.
The standard Fuji CR configuration as represented in figure 1, only addresses some of this workflow model.
The standard
configuration with HI-C654 Workstation does an excellent job of providing QC capability for the system.
Unfortunately,
the proprietary nature of its external digital interfaces makes the device less useful in a DICOM network
environment, for
distributing those images. The standard configuration also is sub-optimal in terms of associating patients with
images.
Until recently, the only process was a totally manual process. To make best use of a Fuji CR in a DICOM
network
environment, one must address these two issues.
The Fuji Laser Imager in the configuration can only print images from the CR and not other modalities. When
viewed in
Fuji HIC-654
Fuji CR w/ IDT
Fuji Printer
Image Data and
Limited Demographics
Fuji LP Proprietary Fuji DMS Proprietary Fuji Proprietary Protocol
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the light of a DICOM network environment, this is an obvious waste of resource. It is not a requirement that
this issue be
addressed in making use of a Fuji CR in a DICOM PACS, however, there are improvements which can be
made in such an
environment.
In the remainder of this paper, I will address each of these issues:
- getting Fuji CR images into a DICOM network (Image Interface)
- correlation of Fuji CR produced images with patient information (Demographic Interface)
- making use of an existing Fuji Laser Imager in a DICOM network environment. (Network Printing)
I will also provide a set of guidelines and a decision matrix which will help purchasers of CR interfacing
technology assess
their needs.
Image Interface
There are two types of digital image interfaces available in the standard Fuji CR configuration. One is a
proprietary parallel
interface, known as DMS, and the other is a proprietary ethernet interface available on the HI-C654. The
DMS interface
hardware is capable of supporting a number of application specific proprietary protocols, such as printing and
the delivery
of raw data images to an external device. Fuji has licensed this technology, in the past few years, to a small
number of
companies. Until recently, the only product which could be used, by someone other than Fuji, to interface to
the Fuji CR
system DMS port, was a Fuji DASM. Fuji would provide these DASM units to end users and other
manufacturers in order
to accomplish image interfaces. The author knows of no instance of Fuji making available its proprietary
ethernet
interface to any other party.
The Fuji DASM is not a high value added product. The DASM allows one to acquire raw image data from
either the CR
itself or the HI-C654. It is not possible to acquire Fuji processed images, suitable for printing, via this
interface. The
DASM simply converts from Fujis proprietary DMS and associated protocols to a SCSI interface, which can
be treated
like a disk drive. The DASM is currently used by all vendors, other than Fuji and DeJarnette, to interface to
the DMS port.
Fuji products make use of Fuji proprietary interface boards in their products like the HIC. DeJarnette showed
its DIB
(DeJarnette Interface Board) at RSNA 1997 and will release this board as a component of the companys new
line of Fuji
CR QC Workstations in early 1998.
Any system level product, which is meant to provide DICOM image network connectivity, must also address
the issue of
whether and how to provide image processing of the raw image data. Again, Fuji has licensed a small number
of
companies to make use of Fujis image processing algorithms. These algorithms and the generally used (Fuji
recommended) processing parameters have been optimized for printing on Fuji film. They are not necessarily
optimal for
other manufacturers film or softcopy display stations of any manufacturer (including Fuji). It is the authors
experience
however, that this processing and the recommended processing parameters give very good results on other
manufacturers
film and on most softcopy display stations. Future clinical experience will most probably result in more
optimal processing
parameters being found for use on softcopy display stations.
Early PACS implementors, like Dr. Eliot Siegel at the Baltimore VA, have discovered that it is possible to
read raw data
(unprocessed) images produced by the Fuji CR. This is accomplished by window and level adjustments on a
softcopy
display station. Such reading is however thought to be more time consuming and less desirable than reading
an image,
which has been processed using the Fuji algorithms. Reading of raw data images also requires some
adjustment and
training on the part of the radiologist.
Today there are a number of DICOM image network interfaces available on the market. Asking the following
questions
can differentiate these products:
- Is QC display capability provided?
- If QC capability is available, is a high brightness monitor available?
- If QC capability is available, what is the monitor size and resolution?
- If QC capability is available, what image manipulation and processing controls are available?
- Is a Fuji DASM required? (note some manufacturers place the DASM inside their product)
- Are DICOM Print and DICOM Query/Retrieve supported as well as DICOM Storage?
- Does the product produce processed images?
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- Does the product support Fujis HQ?
- Is advanced processing available? (DRC, TAS)
- Are both processed and raw data images available from the product?
- Is it possible to simultaneously acquire, process and transmit images?
- Does the interface device support transmission to multiple network destinations? How many?
- Are other common PACS network protocols supported? (such as PACSnet which is used preferentially by
both the
Siemens and the GE PACS product offerings)
- How many Fuji CR readers can be interfaced to the network by a single interface device?
- What is the interface device throughput? (How many images an hour can be acquired, processed and
transmitted over
the network?)
- What does it cost?
By asking these questions one can determine whether the image interface device is suitable for your
application. It should
be noted that these interface devices are divided into two major classes, those, which provide QC capability,
and those,
which function as black boxes. Generally the black box or pass box interfaces are less costly than the
QC
Workstation variety. The black box interface is only suitable if you have no requirement for technologist
QC or if you
have suitable QC capability on a network display station. It is the authors experience that doing QC on a
general purpose
network display station is sub-optimal and that the dedicated QC Workstation is better suited to the QC task
and more cost
effective in the end.
A second consideration will further delineate product offerings: are processed images available for network
transmission
from the device. If an interface product does not supply Fuji processed images, you will have to process these
images
somewhere else in your PACS or teleradiology system before reading them or printing them. Generally this
would be done
on another workstation.
Demographic Interface
The Fuji CR requires that it be supplied with certain demographic information. This information is used to
associate the
patient with the exposed phosphor plate. In the standard Fuji CR configuration, it is required that this
information be
entered either by means of manual entry, barcode scanning or magnetic card scanning. Only limited
demographic data is
available for use in this standard configuration. Patient name, patient sex, patient birthdate, patient number
and acquisition
date are the only data of interest to the CR reader. This is sufficient information if you are only printing the
image. This is
far from sufficient if one is making use of the produced image in a PACS environment.
Early PACS implementors who have used Fuji CR devices in their systems have found that workflow is
greatly improved if
a HIS or RIS is available and interfaced to the CR reader. Through the use of such an interface it is possible to
have the
patient information which is input to the HIS or RIS made available to the CR reader. This eliminates the step
of having
the radiology technologist generate a barcode or magnetic card. Apart from the time saved in not performing
this function,
the incidence of inconsistent patient information between the HIS/RIS and the PACS is greatly reduced. Such
inconsistency was found to be a significant problem in early PACS implementations.
Today Fuji supplies the FCR Information Manager to interface its readers to HIS and RIS systems. It should
be noted that
the FCR Information Manager requires the existence of a DICOM Worklist Management Gateway to the HIS
or RIS in
order to provide this functionality. One such gateway will support many Fuji CRs as well as other modalities
in the
radiology department. DICOM Worklist Management Gateways are available today from two sources,
DeJarnette and
Mitra.
State of the Art Interfacing - 1997
Figures 2 and 3 illustrate the state of the art configurations, at the end of 1997, for interfacing Fuji CR to
DICOM PACS
and teleradiology systems. Figure 2 illustrates a Fuji CR with IDT (AC3 like) interfaced to a HIS/RIS system
and a PACS.
This figure illustrates the use of a black box interface with no QC capability. The HIS/RIS makes available
a worklist to
the FCR Information Manager, by means of a DICOM Worklist Management Gateway (not shown
embedded in
HIS/RIS). The technologist, after exposing the CR plate, places the plate in the reader and selects the
appropriate patient
registration from the worklist displayed by the FCR Information Manager. The patient demographic
information