243 VistA Imaging - Gateways: Behind the Scenes

1. 243�VistA Imaging - Gateways: Behind the Scenes Dave Massey Greg Bosak

2. �������� Objectives References DICOM HL7 (in terms of VI) Text Gateway Image Gateway Present limitations of Vista Imaging Imaging patch 69 and Cache Questions?

3. VistA Imaging VistA Imaging Homepage: http://vaww.va.gov/imaging/default.htm VistA Imaging Training: http://vaww.vistau.med.va.gov/VistaU/VistAImaging/default.htm OI Health Systems Design and Development: http://vista.med.va.gov/ VistA Documentation Library: http://www.va.gov/vdl/ These are the websites that contain all the documentation you�ll ever need.These are the websites that contain all the documentation you�ll ever need.

4. Text Gateway Here is a what a standard Text Gateway looks like.Here is a what a standard Text Gateway looks like.

5. Image Gateway And an Image Gateway.And an Image Gateway.

6. DICOM Digital Imaging & COmmunications in Medicine DICOM � is an Acronym meaning Digital Imaging and Communications In Medicine.DICOM � is an Acronym meaning Digital Imaging and Communications In Medicine.

7. Purpose of DICOM To create a standard to allow a common set of rules and protocols between vendors in the medical field, specifically Radiology (at least initially). Originally called ACR-NEMA 1.0 (�85) and then 2.0 (�88), and finally DICOM 3.0 (�93). DICOM Standard available at: http://medical.nema.org/dicom/ In the beginning, vendor A could talk to Vendor A, but not Vendor B. So in 1985 the ACR and NEMA got together to form a standard.In the beginning, vendor A could talk to Vendor A, but not Vendor B. So in 1985 the ACR and NEMA got together to form a standard.

8. Parts of DICOM Standard 1-Introduction and Overview 2-Conformance 3-Information Object Definitions 4-Service Class Specifications 5-Data Structures and Encoding 6-Data Dictionary 7-Message Exchange 8-Network Message Support for Message Exchange 9- RETIRED* 10-Media Storage and File Format for Media Interchange 11-Media Storage Application Profiles 12-Media Formats and Physical Media for Media Interchange

9. Parts (cont.) 13- RETIRED** 14-Grayscale Standard Display Function 15-Security Profiles 16-Content Mapping Resource 17-Explanatory Information 18-Web Access to DICOM Persistent Objects (WADO) Additional Supplements continuously added to the base standard as needed. *PS 3.9: RETIRED (FORMERLY POINT-TO-POINT COMMUNICATION SUPPORT FOR MESSAGE EXCHANGE) PS 3.9 of the DICOM Standard previously specified the services and protocols used for point-to-point communications in a manner compatible with ACR-NEMA 2.0. It has been retired. **PS 3.13: RETIRED (FORMERLY PRINT MANAGEMENT POINT-TO-POINT COMMUNICATION SUPPORT) PS 3.13 previously specified the services and protocols used for point-to-point communication of print management services. It has been retired.

10. Common Buzzwords SCP-Service Class Provider SCU-Service Class User SOP-Service Object Pair UID-Unique IDentifier Object-The collection of information that represents the modality. VR-Value Representation Message-Describes Command and Data Sets. The Data Set generally contains the demographic header and the assigned image(s). Little Endian -byte Order. Least Significant Byte first. Big Endian -byte Order. Most Significant Byte first. Group/Element-Address representing each piece of information stored in the message header.

11. Buzzwords (cont.) DIMSE �DICOM Message Service Element ULS �Upper Layer Service ACR-American College of Radiology NEMA-National Electrical Manufacturers Association. ACR-NEMA-The group who maintains the DICOM Standard. AET � Application Entity Title. PACS � Picture Archiving and Communications System

12. DICOM Spans Most of Medical Imaging

13. ISO Layer Model for DICOM

14. SCU and SCP Service Class User �Client�

15. Objects An entity in DICOM representing a collection of information. Usually includes an image. CR CT MR US Any other DICOM conformant modality Structure Reports Information Model (patient/study)

16. Type of Objects Normalized Represents single entity in the DICOM Object. Usually used for command exchange. i.e. N-EVENT, N-GET

17. Service Action(s) taken upon the Object. Storage �storing an image. Print �printing an image. Move �moving an image. Find �finding patient/study information.

18. IODs IOD �Information Object Definition IOD determines what information is used to define an Object. *Part 3 of the DICOM Standard

19. Data Element Tags A Tag represents a single piece of information. Tags are unique identifiers denoted with a Group and Element number. Group and Element numbers are in Hexadecimal format. Part 6 of the DICOM Standard � Data Dictionary.

20. Data Element Tags (cont.)

21. Example of Part 6

22. Private Data Element Tags Uses Odd Group numbers. (i.e. 0009,xxxx) Not recognized or defined by the DICOM Standard. Generally used for vendor propriety information. VI cannot use any of this information.

23. Data Element Type Not all Tags belong in all Objects. This attribute determines if the Tag is part of the Object. Types:

24. SOP Class Service combines with Object to create a SOP Class. Each SOP Class has an unique UID. This UID notifies the peer what is happening.

25. Transfer Syntax Implicit VR �Data Elements do not contain VR field. Explicit VR �Data Elements contain VR field. Little Endian �Byte order. LSB first. Big Endian �Byte order. MSB first. VR = Value Representation (character string, integer, etc.).

26. 3 things needed for connections AET IP Address Port #

27. Send DICOM Message

28. Associate-Request *************************************************************** *** Connection with 127.0.0.1 on AUG 06, 2002 at 08:01:13 *** *************************************************************** Recving PDU Type: 01H (A-ASSOCIATE-RQ) PDU len=206 d:\DICOM\DATA1\LOGDCM.292\INCOMING.PDU ******************************************************************* *** Receiving A-ASSOCIATE-REQUEST on AUG 06, 2002 at 08:01:13 *** ******************************************************************* PDU Type: 01H (A-ASSOCIATE-RQ) Length=206 Version=1 Called AE: "DICOM_STORAGE" Calling AE: "DICOM_ECHO" ITEM Type: 10H (Application Context Item) Length=21 Application Context: 1.2.840.10008.3.1.1.1 (DICOM Application Context Name) ITEM Type: 20H (Presentation Context Item) Length=46 Presentation Context ID: 1 Result=0 -- Transfer Syntax(es) -- SUBITEM Type: 30H (Abstract Syntax Sub-Item) Length=17 Presentation Context: 1.2.840.10008.1.1 (Verification SOP Class) SUBITEM Type: 40H (Transfer Syntax Sub-Item) Length=17 Transfer Syntax: 1.2.840.10008.1.2 (Implicit VR Little Endian) -- End of Transfer Syntax(es) --

29. Associate-Accept ************************************************** *** Sending A-ASSOCIATE-ACCEPT to DICOM_ECHO *** ************************************************** PDU Type: 02H (A-ASSOCIATE-AC) Length=177 Version=1 Called AE: "DICOM_STORAGE" Calling AE: "DICOM_ECHO" ITEM Type: 10H (Application Context Item) Length=21 Application Context: 1.2.840.10008.3.1.1.1 (DICOM Application Context Name) ITEM Type: 21H (Presentation Context Item) Length=25 Presentation Context ID: 1 Result=0 (acceptance) -- Transfer Syntax(es) -- SUBITEM Type: 40H (Transfer Syntax Sub-Item) Length=17 Transfer Syntax: 1.2.840.10008.1.2 (Implicit VR Little Endian) -- End of Transfer Syntax(es) -- Sending PDU Type: 02H (A-ASSOCIATE-AC) Length: 177 d:\DICOM\DATA1\LOGDCM.292\OUTGOING.PDU Recving PDU Type: 04H (P-DATA-TF) PDU len=74 PDV hdr=3, pc=1, len=68 d:\DICOM\DATA1\LOGDCM.292\INCOMING.DCM Reading d:\DICOM\DATA1\LOGDCM.292\INCOMING.DCM ******************************* *** Echo Request Received *** ******************************* FILE d:\DICOM\DATA1\LOGDCM.292\OUTGOING.DCM -- VERIFICATION ECHO RESPONSE -- NO MESSAGE HANDLE YET

30. Data/Release Sending PDU Type: 04H (P-DATA-TF) Length: 90 (90) d:\DICOM\DATA1\LOGDCM.292\OUTGOING.DCM PDU len=96 PDV hdr=3, pc=1, len=90 Recving PDU Type: 05H (A-RELEASE-RQ) PDU len=4 d:\DICOM\DATA1\LOGDCM.292\INCOMING.PDU Sending PDU Type: 06H (A-RELEASE-RP) Length: 4 d:\DICOM\DATA1\LOGDCM.292\OUTGOING.PDU

31. Instance UIDs (Unique Identifiers) Every single image contains all three of these Instance UIDs. The Instance UIDs are the key to the relationship of each Image within a Series and each Series within a Study. The Study IUID should be generated by the VI Text Gateway (will contain the VI root of 1.2.840.113754) Series and Image are generated by the modality vendor (or creator of the image).

32.

33. DICOM Correct (MAGD FIX) You have 3 new messages. (Last arrival: 11/01/05@08:39) Select Systems Manager Menu Option: correct RAD-DICOM File Entries Select one of the following: P Patient L Loop thru file D Specify a Date Range Update entries by: Loop thru file **************Processing entry********** PATIENT: Patient, One SSN: 000000000 RADIOLOGY CASE #: 1110105-8401 Equipment: CEMAX Model: CT Date Processed: NOV 1,2005 Problem with: BAD CASE # Comment: Correcting file on Image gateway server ID: A D:\DICOM\IMAGE_IN\A0089914.DCM Do you want to Correct this entry? (Y/N/D/Q/P)// y Lookup by case number or patient name Enter patient or case number: 8401 PATIENT: Patient, One SSN: 000000000 Case No. Procedure Location Exam Date ________ _________ ________________ ________ +8401 CT PELVIS W/O CONT CT SCAN 11/01/05 Exam status: EXAMINED

34. DICOM Correct (Cont.) ****Please review the following: ***** Previous name: Patient, One New name: Patient, One Previous ssn: 000000000 New ssn: 000000000 Previous case #: 1110105-8401 New case #: 110105-8401 Radiology case number different. Update? (Y/N/D/Q/P)// y Will change the following: ****Please review the following: ***** Previous name: Patient, One New name: Patient, One Previous ssn: 000000000 New ssn: 000000000 Previous case #: 1110105-8401 New case #: 110105-8401 Are you sure you want to correct this entry? ? No// y (Yes) Updating the file....

35. Site-Specific Master Files  The contents of the files in this section need to be customized to reflect the actual attributes used at the site. These changes should be made to the text file dictionaries in F:\DICOM\Dict only. The software will load this information from these dictionary files into the global variables, overwriting any previously saved information. These changes should be made to the text file dictionaries in F:\DICOM\Dict only. The software will load this information from these dictionary files into the global variables, overwriting any previously saved information.

36. Text Gateway 2 Main functions DICOM Modality Worklist Modality Worklist availability controlled by the worklist.dic. DICOM N-Event Messages to a PACS Broker N-Event messages controlled by portlist.dic.

37. Text_Gateway_1_1 This is the window that processes orders, reports, and ADTs from Vista to the Text GW. In the next slide we will look at one of these filesThis is the window that processes orders, reports, and ADTs from Vista to the Text GW. In the next slide we will look at one of these files

38. Reading an HL7 message

39. Option 1-6 � short format

40. Option 1-6 � Long Format

41. Long Format (cont.)

42. Long Format (cont.)

43. Long Format (cont.)

44. ^MAGDHL7 (on VistA) Global ^MAGDHL7 -- NOTE: translation in effect ^MAGDHL7(2006.5,0)=PACS MESSAGES^2006.5D^291^30 ^MAGDHL7(2006.5,110,0)=3011123^ORM^3011123.103622^460, ^MAGDHL7(2006.5,110,1,0)=^^7^7^3011123.103622 ^MAGDHL7(2006.5,110,1,1,0)=MSH^~|\&^ORDER ENTRY^660^CONSULTS^660^20011122140408-0500^^ORM ^MAGDHL7(2006.5,110,1,2,0)=PID^^000000001^460~^^ONE,CPRSPATIENT^^19290000^M^^^^^^^^^^^853844831 ^MAGDHL7(2006.5,110,1,3,0)=PV1^^I^24~1001-7^^^^^^^^^^^^^^^^ ^MAGDHL7(2006.5,110,1,4,0)=ORC^NW^829;1~OR^^^^^~~~~~R^^200111221403-0500^126^^126^^^200111221404080500^E~ELECTRONICALLY ENTERED~99ORN~~~ ^MAGDHL7(2006.5,110,1,5,0)=OBR^^^^36~~~25~STAT ECHO~99PRC^^^^^^^^^^^^^^B^126 ^MAGDHL7(2006.5,110,1,6,0)=ZSV^~~~2~MEDICINE~99CON^ ^MAGDHL7(2006.5,110,1,7,0)=OBX^1^TX^2000.02~REASON FOR REQUEST~AS4^^Pain in the neck

45. Modifying HL7 pointer

46. PACS Interface A PACS Interface is used any time we are sending DICOM N-Event messages to a PACS Broker (Mitra, DeJarnette) which then formulates its own worklist for modalities to query. The interface is setup by using an entry in portlist.dic � this then listens for the PACS broker to connect. The status window � need only to be concerned with U and V matching up, and W and X matching as well. U and W are the messages sent to the PACS Broker � V and X are the responses back from the broker.A PACS Interface is used any time we are sending DICOM N-Event messages to a PACS Broker (Mitra, DeJarnette) which then formulates its own worklist for modalities to query. The interface is setup by using an entry in portlist.dic � this then listens for the PACS broker to connect. The status window � need only to be concerned with U and V matching up, and W and X matching as well. U and W are the messages sent to the PACS Broker � V and X are the responses back from the broker.

47. MODALITY_WORKLIST_STATUS_1_4 This status window shows those modalities that are configured in worklist.dicThis status window shows those modalities that are configured in worklist.dic

48. Sample Worklist.dic entries and field explanations. TOPCON|123|CON|OPHTH|LONG|TOPCON Eye Camera Picker_1||RAD|MRI|SHORT|Philips RF room #1 ECAM1|123|RAD|NM|LONG|Siemens Rm. 3A118 XR1CR950|123|RAD|RAD|LONG/NODASH|Kodak CR1 Field 1 � Application Entity Title of Modality (Calling AET). Field 2 � Site code or Location. Field 3 � Imaging Service (Either RAD or CON). Field 4 � Imaging Type (Do not confuse this with modality codes). RAD � General Radiology CT � Computed Tomography MRI � Magnetic Resonance Field 5 � Accession Number Format/dashes or no dashes in SSN Accession number SHORT = radiology case number only (1234) LONG = date�case number (031106-1234) Field 6 � Description

49. Update Worklist.dic Option 4-2-7

50. MODALITY_WORKLIST_STATUS_1_4

51. MODALITY_WORKLIST_STATUS_1_4

52. ^MAGDWLST (on Text GW)

53. ^MAGDWLST (cont.)

54. Purges

55. Purges (cont.)

56. Purges (cont.) Option 11 purges ^MAGDHL7 Option 12 purges ^MAGDAUDT Global ^MAGDAUDT -- NOTE: translation in effect ^MAGDAUDT(2006.5761,0)=DICOM MESSAGE STATISTISTICS^2006.5761^^0 ^MAGDAUDT(2006.5761,3030520,1,0)=^2006.57611^3^3 ^MAGDAUDT(2006.5761,3030520,1,1,0)=ORDER ENTRY^312^3030520.102056 ^MAGDAUDT(2006.5761,3030520,1,2,0)=APPROVED REPORT^47^3030520.102031 ^MAGDAUDT(2006.5761,3030520,1,3,0)=EXAM CHANGE^12^3030520.102051 ^MAGDAUDT(2006.5761,3030520,1,"B","APPROVED REPORT",2)= ^MAGDAUDT(2006.5761,3030520,1,"B","EXAM CHANGE",3)= ^MAGDAUDT(2006.5761,3030520,1,"B","ORDER ENTRY",1)= ^MAGDAUDT(2006.5761,3030711,1,0)=^2006.57611^1^1 ^MAGDAUDT(2006.5761,3030711,1,1,0)=Modality Worklist Query^1^3030711.140307 ^MAGDAUDT(2006.5761,3030711,1,"B","Modality Worklist Query",1)=

57. Image GW - Instruments

58. Instrument.dic ##Computed Radiography CR1|Kodak CR|642|RAD|60100|A CR2|Kodak CR|642|RAD|60101|A DR1|Kodak DR|642|RAD|60110|A ##DR2|Kodak DR|642|RAD|60111|A ##Ultrasound US1|Philips iu22|642|RAD|60300|A US2|ATL|642|RAD|60301|A ## CT #CT1||642|RAD|60500|A ## MR MR1||642|RAD|60600|A ## RF RF1|Philips|642|RAD|60700|C RF2|Philips|642|RAD|60701|C ## Dexa Dexa|Hologic||CON|60800|C

59. Processing Images

60. ^MAGDINPT Global ^MAGDINPT ^MAGDINPT(2006.571,0)=DICOM RAW IMAGE^2006.571^38381^567 ^MAGDINPT(2006.571,37815,0)=C:\DICOM\IMAGE_IN\C0037815.DCM^CDIMPT^1 ^MAGDINPT(2006.571,37816,0)=C:\DICOM\IMAGE_IN\C0037816.DCM^CDIMPT^1 �. ^MAGDINPT(2006.571,38379,0)=C:\DICOM\IMAGE_IN\C0038379.DCM^CDIMPT^1 ^MAGDINPT(2006.571,38380,0)=C:\DICOM\IMAGE_IN\C0038380.DCM^CDIMPT^1 ^MAGDINPT(2006.571,38381,0)=C:\DICOM\IMAGE_IN\C0038381.DCM^CDIMPT^1 ^MAGDINPT(2006.571,"ACOUNT")=37814 ^MAGDINPT(2006.5711,0)=DICOM M2MB RPC QUEUE^2006.5711^34807^0 "ACOUNT")=34807 ^MAGDINPT(2006.5712,0)=DICOM FIXED QUEUE^2006.5712P^799^0 "ACOUNT")=799

61. Undefined Modality

62. Modality.dic KODAK|KESPR|CR|b12 f0 c4095 R8/b12 f0 c4095|LONGCASE^MAGDIR3||data_cr.dic|RAD Kodak|CR|CR|b12 f0 c4095 R8/b12 f0 c4095|LONGCASE^MAGDIR3||data_cr.dic|RAD Kodak|CR950|CR|b12 f0 c4095 R8/b12 f0 c4095|LONGCASE^MAGDIR3||data_cr.dic|RAD Kodak|CR950|*|b12 f0 c4095 R8/b12 f0 c4095|LONGCASE^MAGDIR3||data_cr.dic|RAD DeJarnette Research Systems|Imageshare CR|CR|b10 f0 c1023 R8/b10 f0 c1023|LONGCASE^MAGDIR3||data_cr.dic|RAD

63. Gateways Configuration File Option 4-2-2

64. Configuration global ^MAGDICOM(2006.563) Global ^MAGDICOM(2006.563, ^MAGDICOM(2006.563,0)=DICOM GATEWAY PARAMETER^2006.563^1^1 ^MAGDICOM(2006.563,1,"ASCII DICOM TEXT")=YES "COMMERCIAL PACS")=N/A "CONFIG DATE/TIME")=3070130.081846 "CONSOLIDATED")=NO "CSTORE CONTROL PORT")=60000 "CURRENT IMAGE DESTINATION")=\\VHAWIMCLU2A\IMAGE10$\WIM0\00\03\41\3\ "CURRENT IMAGE FILE NAME")=WIM00003413825.TGA "CURRENT IMAGE POINTER")= "CURRENT IMAGE SOURCE")=C:\DICOM\IMAGE_IN\C0038381.DCM "DAILY REPORT")=60705,;;to ;250 <ET.Phone.Home@WILMINGk ^MAGDICOM(2006.563,1,"DATA PATH",0)=^2006.5631^1^1 ^MAGDICOM(2006.563,1,"DATA PATH",1,0)=C:\DICOM\DATA1 ^MAGDICOM(2006.563,1,"DICT PATH")=\\VHAWIMCLU2A\Q$\DICOM\DICT "DOMAIN")=WILMINGTON.MED.VA.GOV "EMED_C_MOVE_DELAY")=0 "FREE DISK SPACE")=15 "IMAGE GATEWAY")=YES "IMAGE INPUT PATH")=C:\DICOM\IMAGE_IN "IMAGE OUTPUT PATH")=C:\DICOM\IMAGE_OUT "INSTRUMENT PATH")=C:\DICOM\INSTRUMENT "LAST IMAGE POINTER")=3413825 MAR 16 at 14:42:58 "LAST RAD REPORT POINTER")=393484 MAR 16 at 14:42:58

65. ^MAGDICOM(2006.563) (cont.) "LOCATION")=460 "LOCATION NAME")=WILMINGTON VAMC "LOGIN PROGRAMMER ACCESS")=5007061268 "M-to-M BROKER ADDR")=hl7.wilmington.med.va.gov "M-to-M BROKER BGND ACCESS")=2dQN|vzM51 "M-to-M BROKER BGND VERIFY")='a2O*w6U5,- "M-to-M BROKER PORT")=14810 "MACHINE ID")=C "MAILGROUP")=wilmingtonpacsadministrators@med.va.gov "MESSAGE LOG")=YES "MODALITY WORKLIST")=NO "MOVE DESTINATION AE TITLE")= "MULTIFRAME COUNTER")=0 "PACS EXAM COMPLETE")=NO "POST OFFICE")=smtp.va.gov ^MAGDICOM(2006.563,1,"PROFILE",1,0)=21171^1^.(D7Myg#p=X4}72xg#p1^!3?D$%AW~E<fkD( ^MAGDICOM(2006.563,1,"ROUTING PROCESSOR")=NO "ROUTING RULES")=NO "SCRATCH")=C:\DOCUME~1\vhawimia\LOCALS~1\Temp "SEND CPT MODIFIERS")=NO "SEND PACS TEXT")=NO "SHOW PATIENT NAME & ID")=YES "SSN DASHES FOR PACS")=NO "SYSTEM TITLE")=WIM-IMGDIG3 "TEXT GATEWAY")=NO "TEXT GATEWAY SERVICE")= "UID ROOT")=1.2.840.113754 "VERSION")=VA DICOM V3.0 "WORKLIST PORT")=60010 ^MAGDICOM(2006.563,1,"WORKLIST PORT",0)=^2006.5632^1^1 ^MAGDICOM(2006.563,1,"WORKLIST PORT",1,0)=60010

66. Master File Build - ^MAGDMFB Option 4-2-8

67. Files read into appropriate Globals Ready to build all of the DICOM Master Files? YES// yes Building the DICOM Element Dictionary -- ^MAGDICOM(2006.51) Ready to read dictionary file "C:\DICOM\DICT\ELEMENT.DIC"? y// yes Building the DICOM Message Template Dictionary -- ^MAGDICOM(2006.52) Ready to read dictionary file "C:\DICOM\DICT\TEMPLATE.DIC"? y// yes *** PASS 1 STARTED *** *** PASS 2 STARTED *** - DONE - Building the DICOM UID Dictionary -- ^MAGDICOM(2006.53) Ready to read dictionary file "C:\DICOM\DICT\UID.DIC"? y// yes Updating the extended SOP negotiation table... done! Updating the PDU TYPE table... done! Building the HL7 dictionary in ^MAGDICOM(2006.57). Ready to read dictionary file "C:\DICOM\DICT\HL7.dic"? y// yes done!

68. Master File Build (cont.) Building the Instrument Dictionary -- ^MAGDICOM(2006.581) Ready to import the Instrument Table (C:\DICOM\DICT\INSTRUMENT.DIC)? YES// 1 instrument entered into database. Building the Modality Type Dictionary -- ^MAGDICOM(2006.582) Ready to import the Modality Table (C:\DICOM\DICT\MODALITY.DIC)? YES// ***Suspect conversion parameter(s): B12 F0 C4095 R8/B12 F0 4095 Difference: C4095 only in FULL Difference: 4095 only in BIG Press <Enter> to continue: ***Warning: Imaging Service "RAD " is not defined and will be ignored. 5 modality entries in database.

69. Master File Build (cont.) Building the CT CONVERSION PARAMETERS dictionary in ^MAGDICOM(2006.5821). Ready to read dictionary file "C:\DICOM\DICT\CT_PARAM.DIC"? y// yes Building the Modality Worklist Dictionary -- ^MAGDICOM(2006.583) Ready to import the Worklist Table (C:\DICOM\DICT\WORKLIST.DIC)? YES// 2 entries added to Worklist database. Building the TCP/IP Provider Port Dictionary -- ^MAGDICOM(2006.584) Ready to import the Provider Port Table (C:\DICOM\DICT\PORTLIST.DIC)? YES// 1 entry added to database. Building the User Application Dictionary -- ^MAGDICOM(2006.585) Ready to import the User Application Table (C:\DICOM\DICT\SCU_LIST.DIC)? YES// 2 SCUs entered into local database. On VistA System: 2 updated Building the Provider Application Dictionary -- ^MAGDICOM(2006.586) Ready to read dictionary file "C:\DICOM\DICT\SCP_LIST.DIC"? y// yes Ready to build the "Data Transfer" Dictionaries? y// yes -- DICOM Master File Build completed successfully --

70. Common Errors 1) The writing of image file "\\VHACANCLUC\IMAGE3$\J0\85\88\J0858809.TGA" failed" "The error message was "-53 (Unknown Error Code)"" "Imaging entry 858809 successfully removed" Resolution: Gateway was temporarily unable to access the share - probably due to some network "bobble". Site restarted DICOM Process window and image processed. Other possible causes: Permission problem � VHAxxxIA (account on gateways) is not getting access to the cluster shares. Steps: Ping share Map share using IA account.

71. Common Errors (cont.) 2) **Error: ,Z<DKFUL>SAVE+7^MAGDFCNS:::7;34:3,*** $ZE=<DKFUL>INT+14^%ET:::7:34:3 Or a similar one: $ZE+<DKRES>INT+14^%ET Meanings: <DKFUL> --- disk full message <DKRES> --- disk resource message Steps: Use D ^%SP to determine free space in dicom.msm database (norm ~ 40% or >). Run purge options 1-10, and 1-11 on Text Gateway to free up space. Site may not be performing Status tracking of patient (Examined) ---That status change causes the patient to be dropped from ^MAGDWLST ---if it is not done the ^MAGDWLST global will fill up.

72. Common Errors (cont.) DICOM IMAGE PROCESSING ERROR The writing of image file "\\VHABHSCLU2A\IMAGE1$\Q7\53\10\Q7531063.ABS" failed The error Message was "1" Imaging entry 7531063 successfully removed Please call Support Personnel Routine: ^MAGDIR2B Meaning: The error message describes a scenario in which the Image Gateway is unable to completely process the image successfully. This can be caused by numerous reasons (network, corrupt image, permission problem to the shares, etc.). The �entry removed� is actually the deletion of ^MAG(2005,IEN) initially created within Vista. Steps: CTR-C DICOM Process Window first. Restart Process_DICOM_Images_2_3

73. Common Errors (cont.) If it still fails, you may need to bump the Image Pointer value past that image. Run option 2 - Image Gateway, then 4 - Increment DICOM Image Input pointer VistA DICOM Image Gateway -- TEST MACHINE 1 Receive PACS Exam Complete Messages 2 Send PACS Request Image Transfer Messages 3 Process DICOM Images 4 Increment DICOM Image Input Pointer 5 Display Real-Time Storage Server Statistics 6 Display Cumulative Storage Server Statistics 7 Display Daily Image Processing Statistics 8 Send DICOM Images to Another Storage Server 9 Display a DICOM Image Header OPTION: 4 The last image in the "C:\DICOM\IMAGE_IN" directory is number 294. There are no images waiting to be processed. The current image processing pointer value is 293. Do you wish to increment the image processing pointer? n// y -- INCREMENTED Press <Enter> to continue... ****Use the DICOM header dump capability in Option 9 to determine Patient Name, SSN, and accession number. The image then can be resent from the modality.

74. Displaying a DICOM Image header

75. DICOM header (cont.)

76. DICOM header(cont.)

77. DICOM header(cont.)

78. DICOM header(cont.)

79. Using the Viewer to dump the header

80. Using the Viewer to dump the header

81. Limitations of VI Image Gateway Does not store �overlay data� � group 6000 in the DICOM header. Cannot display images that contain a Photometric Interpretation of �Palette Color�. Only stores .dcm images for NM, US, and OT modality codes (controlled by the element.dic). Cannot handle DICOM presentation states. Cannot handle DICOM Structured Reports (SR).

82. Limitations (cont.) Can only properly display .tga files that contain unsigned data values (no negative values). Cannot handle images that contain embedded icon sequences (thumbnail images). If they are in tag 0088,0200 they are discarded by the Image Gateway (MAGDIW3). If present in any other groups the image will not display properly or may not even process. Does not support DICOM Storage Commitment.

83. Text Gateway Does not support DICOM MPPS (Modality Performed Procedure Step � part of Modality Worklist). Limitations (cont.)

84. Changes with Cach� (Patch 69) Menus remain pretty much the same. You will use a Cache Terminal versus MSM console.

85. Cach� Cube When Cach� is inactive, this icon is grey: When Cach� is active, this icon is blue: This icon can be used to start and stop the Cach� server. Under normal circumstances, the Cach� server is started automatically when the computer is restarted, and users only need to stop and restart Cach� when this is needed for maintenance purposes.

86. Cach� changes (cont.) Gateway options will be added to the Windows Start Menu.

87. Cach� Control Panel GUI based management tools.

88. Cach� Control Panel (cont.)

89. Cach� Control Panel (cont.) Log Files

90. Q and A Thank you. Questions?