The storage of research results by the method of radiology

Many of us have been in a situation when an x-ray or x-ray is taken at the clinic, and then we need to carry these large and inconvenient pictures to the doctor on our own. And how many kilograms of nerves we spend, standing in queues at the registry, to get our medical records, which often do not turn out to be in place or are completely lost. How many man-days do we spend telling doctors the histories of our illnesses and ailments, forgetting important details and exaggerating insignificant ones?



We can cite the following incident from the life of one of our employees: in his youth he had been ill with pneumonia, as a result of which all subsequent years a blackout was recorded in the fluorogram. The local doctor knew about it perfectly. But once the hero of this story had to do a fluorography in another clinic. And there, seeing the spot, he was almost hospitalized forcibly, suspecting of tuberculosis. No stories about pneumonia helped, I had to go to my clinic, ask for my old pictures and carry them as evidence. But even after that, they looked askance at him and tried to force him to take control shots weekly. But all these inconveniences and hassles could have been avoided if our country had a well-developed system of medical data storage of regional and city levels. A doctor could go in there and reveal the entire patient history from birth. Many questions would be removed and a lot of time saved.



The lack of storage systems that aggregate medical information is not only characteristic of cities and regions. Many polyclinic networks, as well as large hospitals, clinics and medical centers that have several buildings, still do not have their own unified storage systems. And the doctor, taking the patient in one building, is forced to request physical records from doctors from other buildings, if required by the procedure of diagnosis and treatment.

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There is another problem arising from the lack of unified storage systems. It is not so obvious. All sorts of pictures and research results are “deposited” in the local storages of the devices and instruments on which they were obtained. And due to the limited available memory, the oldest records are periodically deleted. Therefore, if you were examined several years ago and you needed to get these results, then there is a risk that they have already been deleted.

Vendor-independent medical image archives

Modern medicine operates with all sorts of data obtained during the study of patients by the method of radiology: radiographic images, ultrasound, MRI and computed tomography, echocardiograms, and many others. Most often, the results of the study are presented in graphical form. And the traditional way to share this data is to print it out on a printer and then send it. With all the inconveniences arising from this.



Most (if not all) of these devices support the DICOM (Digital Imaging and Communications in Medicine) industrial medical standard. This is the industry standard for creating, storing, transmitting and visualizing medical images and documents of the examined patients. TCP / IP is used to transfer information from medical equipment to a PACS — system (Picture Archiving and Communication System) and for communication between PACS — systems.



Most manufacturers of medical equipment supply with their products also PACS and workstations for the processing of research by medical diagnosticians. But the possibilities of such solutions are limited, since equipment manufacturers, as a rule, do not set themselves the task of building global research storage systems. And besides, they want to protect their interests in the supply of workstations (rather expensive). For example, manufacturers of medical equipment “tie” consumers to their workstations, using so-called, while maintaining the processed research. “Proprietary” DICOM tags that do not allow working with these studies from workstations from other manufacturers. The problem becomes even more acute if the clinic (or the network of clinics, or even the region) decides to change the supplier of PACS / workstations. Migration projects can take months, and in some cases, fail.



As you understand, such a problem could not remain without a solution. Today, for the construction of centralized archives of medical images, so-called Vendor independent archives (VNA - Vendor Neutral Archive) from companies that are not suppliers of medical equipment. These archives also work on the DICOM protocol, and in the DICOM network, naturally, they are present as PACS. Vendorondependence is provided by converting proprietary tags into public ones at the time of recording the study into the archive. Naturally, each VNA provider claims full vendor independence. But since manufacturers of medical equipment do not publish, for obvious reasons, information about the use of proprietary tags, the real degree of vendor independence depends only on the experience of a particular VNA supplier. The more projects implemented, the larger they are, the more different PACS from different suppliers are integrated into the archive, the more the supplier has experience and information on the use of proprietary tags. And the faster his reaction in the case of a change in the use of these most proprietary tags by any medical equipment manufacturer.



In addition, when building global archives at the level of a region or even a country, the experience of a VNA provider in managing very large amounts of information, including in infrastructure distributed across several data centers, is also important. After all, the size of a single DICOM study, for example, MRI, can reach 4.5 GB. The risks are obvious - the VNA provider may declare that his decision is ready to work with any amount of information, and in fact it may turn out that the response time of the archive increases from the first few terabytes. It even happens that there is a loss of information.



To solve the problem of dependence on end (expensive) workstations, VNA providers offer, as part of solutions, a means to view medical research. For some suppliers, this is just a lightweight viewer, for some, a full-fledged (often web-based) workplace for a doctor-diagnostician.



In our country, such archives at the regional level began to be built during the period of the massive introduction of the IIA (Medical Information System) as part of the healthcare modernization program. Some regions have successfully built such archives and exploited, although, as a rule, not all clinics in the region are connected to the archive, and not all studies of even connected clinics fall into the central archive. Now the Ministry of Health of the Russian Federation has breathed new life into these projects, including the creation of regional archives in the roadmap until 2018.

EMC Solution

The typical architecture of a venon-independent medical image archive offered by EMC is as follows:

• LPU - medical and preventive institution: hospital, clinic, medical center, etc.
• Modality - a device for medical research: radiography, computerized tomography, ultrasound, etc.
• The research viewer is the primary tool for physicians to work with data. It is a web-application written in HTML5, which allows it to work even on weak "thin clients". In this viewer has all the capabilities of the workstation. In Europe, it is licensed as a diagnostic tool and can be fully used in diagnosis.

Medical devices — modalities — generate research data that goes to a local caching server (DICOM — gateway). This is necessary to ensure uninterrupted operation in case of lack of communication with the central repository. If the connection is stable, then the data is automatically sent from the gateway to the repository, if the connection is unstable, then the data is sent on a schedule or as the connection appears. On a caching server, data is stored for some time, which depends on the storage capacity of the server. And all requests from “thin clients” are processed first by the caching server, and if there is no necessary information on it, then it is requested in the data center.



Ensuring vendor independence and confirming the ability to build global archives is based on EMC's vast experience. The specificity of our products is the management of huge amounts of information both on the hardware and software levels. Our portfolio has a large number of implemented solutions, including country level projects (for example, Finland).