Background
There is a growing desire by health care facilities to add panoramic dental x-ray modalities to their capabilities. The main reasons for this are a combination of the panoramic x-ray’s broad diagnostic capabilities along with it’s low cost and low radiation relative to other traditional medical imaging modalities. Here are three common applications:
1. Emergency rooms and urgent care facilities value the targeted anatomy and field of view as be an ideal modality to assess facial trauma. For example, as more of these facilities are seeing patients with severe or emergency dental ailments, the staff values the panoramic dental modalities to help determine whether the patient should be referred to a dentist or to another specialist.
2. Surgical centers used by dental surgeons that utilize the panoramic image to capture pre and post-surgery x-rays.
3. Self-contained facilities, like military bases, prisons and native american reservations, that must provide full health care to a specific population. In these scenarios, the facility values the multi-purpose modality that not only can provide dental care, but also offer the broader capabilities mentioned above.
Challenges
One of the main challenges that these facilities face is integrating these pieces of equipment with their facility PACs. The main driver behind this challenge is that most of the panoramic x-ray solution providers are more familiar with traditional dental offices and dental office workflows. Therefore, most panoramic x-rays are designed and optimized to work in this environment. Unfortunately, Imaging Centers, Health Clinics and Hospitals use very different information systems and workflow, whether it be how procedures are ordered, or how the image is scanned, reviewed and diagnosis performed. Typically, the central hub for x-ray images in these facilities is the DICOM protocol PACs system.
What is PACs?
PACs is an acronym for Picture Archiving and Communication system. This is a unified network of systems that allow many types of medical imaging data available for modern medical diagnosis (e.g. MR, CT, Ultra Sound, etc) to be effectively and efficiently collected, stored and viewed between the various practitioners involved in the care and treatment of a patient.
In a typical workflow, a primary or emergency physician will first order a particular image study. Then the patient will go to the radiology department where a radiology technician will perform the imaging procedure. The images will then be routed to a Radiologist who will perform a reading and create a report. This report may contain imaging data diagnosis and treatment recommendations, which would then be sent to the referring physician. The PACs is the part of the hospital information system (HIS) computer network that supports this activity.
What is DICOM?
DICOM is an acronym for Digital Imaging and Communications in Medicine. This is the standard protocol that PACs systems and PACs connected equipment use to work as a system. The set of DICOM standards are the common rules specifically created and targeted to storing and sending medical diagnostic imaging data that allow independently designed software and hardware to interconnect with each other. This is analogous to the internet where MACs and PCs use Chrome, Firefox or Safari browsers to access websites running on someone else’s servers. They accomplish this by implementing various web standards such as https and www.
Who controls DICOM and why was it created?
The DICOM standards are controlled by the DICOM Committee of NEMA (National Electronic Manufacturers Association), an industrial trade organization. The impetus for the creation of DICOM standards was to make cross-vendor PACs a reality. It enables the CT, MR, CR and other diagnostic image sources from different manufacturers to integrate with image archiving and display systems. Furthermore, DICOM-compliant systems can be configured to work together no matter who manufactured the equipment or developed the software.
Are there different versions of DICOM?
The current version of DICOM is Version 3.0. However, that is only part of the answer. The complete DICOM standard is very broad to cover just about anything you can find in a hospital or imaging center that is related to diagnostic imaging. The DICOM standards are regularly updated and extended to cover changing equipment (called “modalities” in DICOM-speak) and the requirements of the various specialties that comprise modern medicine.
Can DICOM image files be viewed on any computer?
Usually software created to open DICOM images are needed to view DICOM images. This is because DICOM images usually contain additional information, called “metadata” about the patient, the image capture and display instructions. This metadata is typically not visible when viewing the images on a screen.
Can a digital Dental Panoramic X-ray Scanner be installed in a PACs?
Yes, if the panoramic system is DICOM compliant.
How do I connect to the PACs?
You will typically connect to the hospital LAN with a standard ethernet cable and will need to configure settings to make connections to 2 distinct systems within the hospital PAC system:
1. A connection to the Modality Worklist Server: This is the system where the operator pulls the list of patients scheduled for procedures. This allows the details of the patient and study (such as patient name, ID, age, sex, etc.) to be automatically input to the dental panoramic system.
2. A connection to the Image Storage Server: This is the system that files and stores the images generated by the digital panoramic system so that they can be retrieved and viewed by the radiologists, referring physicians and other medical staff that have access to the system.
What information do I need to give the Hospital’s PACs administrators to connect a DICOM Compliant Panoramic X-ray to an existing PACs system?
You will need to speak with the PACs / DICOM department and will need to give them the following information about the Dental Panoramic X-ray.
- The units IP address
- The units AET or AE Title (Application entity title)
- The DICOM modality for the equipment.
What information do I need to get from the Hospital’s PACs administrators to connect a DICOM Compliant Panoramic X-ray to an existing PACs system?
You will need to speak with the PACs / DICOM department and will need to get the following information regarding the PACs.
For the Modality Worklist Server
- The Modality Worklist Server’s IP address
- The Modality Worklist Server’s Port
- The Modality Worklist Server’s AET or AE Title (Application entity title)
For the Image Storage Server
- The Image Storage Server’s IP address
- The Image Storage Server’s Port
- The Image Storage Server’s AET or AE Title (Application entity title)
What staff training will the department expect and require?
Typically, the radiological technicians on staff will be much more familiar and comfortable with computerized image system but have less experience with panoramic X-rays than staff in a general dental office. It’s important to make sure the trainer understands the unique workflow of the particular facility.
Learn more about panoramic x-rays
Learn more about cone beam systems
If you have questions about how a hospital, urgent care facility or surgical center might benefit from a Panoramic X-Ray, reach out to us, and we would happy to answer any questions you have.
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