Abstract
Mayo Clinic Scottsdale (MCS) is a busy outpatient facility (150,000 examinations per year) connected via asynchronous transfer mode (ATM; OC-3 155 MB/s) to a new Mayo Clinic Hospital (178 beds) located more than 12 miles distant. A primary care facility staffed by radiology lies roughly halfway between the hospital and clinic connected to both. Installed at each of the three locations is a high-speed star topology image network providing direct fiber connection (160 MB/s) from the local image storage unit (ISU) to the local radiology and clinical workstations. The clinic has 22 workstations in its star, the hospital has 13, and the primary care practice has two. In response to Mayo’s request for a seamless service among the three locations, the vendor (GE Medical Systems, Milwaukee, WI) provided enhanced connectivity capability in a two-step process. First, a transfer gateway (TGW) was installed, tested, and implemented to provide the needed communication of the examinations generated at the three sites. Any examinations generated at either the hospital or the primary care facility (specified as the remote stars) automatically transfer their images to the ISU at the clinic. Permanent storage (Kodak optical jukebox, Rochester, NY) is only connected to the hub (Clinic) star. Thus, the hub ISU is provided with a copy of all examinations, while the two remote ISUs maintain local exams. Prefetching from the archive is intelligently accomplished during the off hours only to the hub star, thus providing the remote stars with network dependent access to comparison images. Image transfer is possible via remote log-on. The second step was the installation of an image transfer server (ITS) to replace the slower Digital Imaging and Communications in Medicine (DICOM)-based TGW, and a central higher performance database to replace the multiple database environment. This topology provides an enterprise view of the images at the three locations, while maintaining the high-speed performance of the local star connection to what is now called the short-term storage (STS). Performance was measured and 25 chest examinations (17 MB each) transferred in just over 4 minutes. Integration of the radiology information management system (RIMS) was modified to provide location-specific report and examination interfaces, thereby allowing local filtering of the worklist to remote and near real-time consultation, and remote examination monitoring of modalities are addressed with this technologic approach. The installation of the single database ITS environment has occurred for testing prior to implementation.
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References
- 1.Hangiandreou NJ, King BF, Swenson AR, et al. Picture archive and communication, systems implementation in a community medicine practice. J Digit Imaging. 1997;10(suppl 1):36–37. doi: 10.1007/BF03168652. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Williamson B. Picture archiving and communication system activities at the Mayo Clinic Rochester. J Digit Imaging. 1998;11(suppl 2):12–15. doi: 10.1007/BF03168171. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Smith DV, Smith S, Bender GN, et al. Evaluation of the medical diagnostic imaging support system based on 2 years of clinical experience. J Digit Imaging. 1995;8:75–87. doi: 10.1007/BF03168130. [DOI] [PubMed] [Google Scholar]