To store DICOM data into the PACS,

To store DICOM data into the PACS, a commercially available software tool is used (DICOM Open LiteBox; ETIAM, Rennes, France). This software supports the two DICOM functionalities required: DICOM Modality Work List (DMWL) query and DICOM Storage. DMWL is used to facilitate patient reconciliation, which replaces the patient ID and name by valid ones. The whole procedure comprises six steps1,2 (Fig 1) as follows:

Patient is entered, if needed, into the hospital information system (HIS) to obtain a locally valid patient number.
The patient is planned into the radiological information system (RIS) to obtain a valid accession number.
The CD-ROM is loaded into the drive and the DICOM Open LiteBox software is started.
The CD-ROM is selected in the DICOM Open LiteBox software.
Reconciliation is defined for required fields (patient name, patient number, accession number) by using the DMWL entry that is automatically generated after step (1).
Relevant data are selected and transferred. Reconciliation is performed on-the-fly during the transfer to PACS or institutional web server.
Fig 1
Fig 1
Schematic overview of the steps in the upload of DICOM data from CD onto PACS and/or EPR.
The first step is performed by the administration of the requesting department. If this is not done before the request is sent to the radiology department, the request will not be processed and the CD will be returned.

The second step is performed by the radiology patient administration, which receives the request form, or by the dedicated PACS employees. To enter the studies into the RIS, two new radiological examinations are defined: EXTERNAL DATA and SECOND OPINION.

The other steps are performed by dedicated PACS employees. Currently, 2 fte are assigned to PACS-related tasks: besides the upload of CDs, this also includes, e.g., the helpdesk for PACS-related issues, quality control, and CD publication.

All data are read from the CD-ROM, and patient ID and accession number are replaced on-the-fly during transfer to either the PACS or the web server by using DMWL.

Data marked as EXTERNAL DATA are only stored into the institutional web server to provide access to the data through the electronic patient record, which is accessible everywhere in the hospital. These data are only stored for the life cycle of the data on the web server, currently 2 years, and are hereafter deleted. No report is added to this data and they are only used for referral. An example is the use of data acquired elsewhere during a surgical procedure.

The SECOND OPINION data are permanently stored into the PACS and, from there, automatically forwarded to the web server. For these studies, a radiological report is required.

The process described above was monitored for a year (July 2004–July 2005) at the radiology department. The number of images and series stored at the PACS both for EXTERNAL DATA and SECOND OPINION were determined by using queries on the PACS. Based on the results of these queries, the amount of storage required was calculated by using an average size per image. The average image size was determined for each modality.

After 1 year, a questionnaire was distributed to all departments that had been using this facility, to evaluate whether the procedure was satisfying.

The questionnaire contained the following questions:

At which department are you employed?
Who is handling the CDs within your department?
How many CDs do you send on average per week?
How do you grade the time between submitting the CD and availability of the data for viewing?
How do you grade the possibility to request to upload to both PACS and web server compared to viewing the CD-R on your own PC and storing it locally?
How do you grade the possibility to request to upload to the web server only compared to viewing the CD-R on your own PC?
How do you grade the procedure compared to viewing the CDs on your own PC using the viewer included on the CD?
Do you have any remarks or suggestions?
Questions 4 to 6 were to be graded on a 5-point scale (1 = bad, 2 = not so good, 3 = reasonable, 4 = good, 5 = excellent), and median and mean values were calculated.

The questionnaires were distributed by e-mail to the different departments, so an exact number of the number of questionnaires issued is not known.

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