One of the responsibilities of the imaging Informatics Professional is the maintenance of imaging modalities from a connectivity standpoint. When a new imaging device is purchased, the IIP is responsible for numerous things; evaluation of the DICOM conformance statement, work with the field engineer to provide the DICOM and MWL information and testing of DICOM connectivity.
However, one thing that can catch many system administrators off guard is the occurrence of modality software upgrades, device maintenance and system patches. This article will discuss some ideas on how to make these modality upgrades a seamless part of normal activity in the imaging areas.
Staff communication is a key component of being prepared for modality upgrades. You should already have a good rapport with the medical imaging staff (after all, you do get out and about the department I hope). However, it is crucial to work closely with the lead technologists in each modality. During your interaction with those tech leads, promote the need for them to communicate to you the occurrence of routine and unexpected service work on the scanner. It may also be beneficial to provide the lead techs with some of the basic DICOM info in case it is needed quickly. Provide them with the IP address, port number and AE title of the PACS and Modality Worklist so if a field engineer suddenly needs that information, there is a minimal loss of time trying to gather the configuration information.
Communication with the field engineer is also important. Be around when maintenance occurs so that you and the field engineer get to know each other. Exchange contact information so that you can contact each other directly and build a partnership. It will help each of you to know the others capabilities, strengths and weaknesses. As a team, you can better keep the modality up and running. The more the field engineer and PACS Administrator can anticipate what the other will need, the faster work on the modality can be completed. I have found in the past that most field engineers have a basic knowledge of DICOM but really depend on the PACS Administrator to ensure that connectivity is achieved and that images transfer appropriately.
Make time during scheduled software upgrades. Many times, when the software is upgraded on a modality, all of the DICOM settings will be reset. Often, the field engineer may have forgotten to export the original information or write it down. This is where planning and communication can pay off. Significant time can be wasted if, after an upgrade or maintenance, the systems administrator needs to be found to perform the DICOM configuration on the device. If you know the scheduled maintenance or upgrade time, talk with the field engineer and get a rough estimate of when connectivity testing will take place. Then, during that time, be at the modality to work with service personnel. Not only will you be able to provide the needed information right away and verify that image transfer occurred successfully but you will also be able to see error messages at the modality that may help identify the cause of any failure that may be occurring.
A common area where issues occur is after upgrades or software when DICOM settings are overwritten. Typically the DICOM configuration setting issues are quickly resolved. Sometimes an AE title is misspelled or was written in the wrong case and other times the IP address or port number was mistyped. With the modality worklist settings, things can get a bit trickier. In some instances, when the DICOM configuration is overwritten or reset, the device will be set to query for its own station name or too broad of a date range. After verifying the network and DICOM settings are correct, examine how the query is constrained. Often, if a query is too broad, the PACS will reject the query. For example of the device is query for all scheduled studies for any date and any modality, the PACS will return an error and no results. Similarly, no worklist results will be returned if the device is querying for scheduled studies assigned to a particular station name. There are not many organizations that, at the time of ordering a study, will enter the name of the device that will be used during imaging. So, when the modality queries the worklist and gets no results, check to make sure that the worklist is query for all studies scheduled for today, for that modality type. That data set will be the most likely to be returned successfully.
When modality software is upgraded or patched, disruption can occur with regards to DICOM communications. However, if prepared, such maintenance, upgrades and patches can be a quick and painless process. Ensuring that you communicate appropriately with the imaging staff, especially the lead technologists, the imaging Informatics Professional will know ahead of time when normal work will be done on the various devices throughout the imaging departments. Developing a working relationship with the various field engineers who work on the imaging equipment is also beneficial. Having an understanding of each other’s strengths and weaknesses and developing a good relationship can allow the PACS Administrator and field engineer to anticipate what may be needed next. Finally, making sure you have time scheduled to work with the field engineer during such upgrades will allow you to ensure that the equipment is down a minimal amount of time. Be prepared for system maintenance, software upgrades and patches and you will be satisfied.
John Sole BSHCA, RT (R)(CT), CPSA, CIIP
Systems Engineer at TriRivers Health Partners / Swedish American Health System