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Housekeeping: PACS cleaners and sweepers

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.

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Housekeeping: PACS cleaners and sweepers

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

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

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

  4. Daily housekeeping • unspecified exams • exams erroneously marked dictated • unreported exams • unverify exams on request • CR / DR problems • “unfetchable exams”

  5. 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

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

  7. Common causes of “unspecified” • later follow-up images added to same exam • eg. nuclear medicine white cell scan • 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

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

  9. Daily housekeeping • unspecified exams • exams erroneously marked dictated • unreported exams • unverify exams on request • CR / DR problems • “unfetchable exams”

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

  11. 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 • if none does......

  12. 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: • resend to PACS • correct error sending to PACS

  13. Daily housekeeping • unspecified exams • exams erroneously marked dictated • unreported exams • unverify exams on request • CR / DR problems • “unfetchable exams”

  14. 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)

  15. 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)

  16. Daily housekeeping • unspecified exams • exams erroneously marked dictated • unreported exams • unverify exams on request • CR /DR problems • “unfetchable exams”

  17. Unverify exams on request • 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

  18. 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 3D workstation)

  19. Daily housekeeping • unspecified exams • exams erroneously marked dictated • unreported exams • unverify exams on request • CR / DR problems • “unfetchable exams”

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

  21. Daily housekeeping • unspecified exams • exams erroneously marked dictated • unreported exams • unverify exams on request • CR / DR problems • “unfetchable exams”

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

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

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

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

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

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

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