Radiology PACS Department of Radiology and Biomedical Imaging UCSF
Outline PACS Impact PACS Workflow PACS Infrastructure Collaborations Implementation Challenges
PACS Impact Distribution of medical images (X-Ray, CT, MRI, Ultrasound images) for the purposes of: Direct Patient Care Research Teaching Presentations Archive of about 4 million studies Over 1500 studies arrive daily from imaging devices within UCSF and devices from other medical institutions Integrated with RIS, APeX, and surgical navigation devices
Basic PACS Workflow
PACS Workflow Components Application Servers Front End Application Database Servers Primary and Backup Oracle DB Connectivity Manager Servers Interface from Radiology Information System (RIS) Modality Worklist Servers Workflow Manager and Archive Servers Image Cache and File Services (Short-term and Medium-Term) UCSF Archive Locally Developed Long Term Archive (~180TB / ~4 Million Studies) IDC Agfa Long Term Image Archive Database and Image Server Components Full Test Environment
PACS Infrastructure GTM1 GTM2 XXX-ABC D-0123VI PRI ON XXX-ABC D-0123VI PRI ON X XX -AB CD- 0123 X XX -AB CD- 0123 Clients & Other PACS Systems (DNS Based) Clients & Other PACS Systems (DNS Based) dicom.radiology.ucsf.edu 128.218.152.198 pacs.radiology.ucsf.edu 128.218.152.197 mwl.radiology.ucsf.edu 128.218.152.200 Rad Parnassus Nameserver Nameserver1 Rad CB Rad MB Nameserver Nameserver Nameserver2 dicom.radiology.ucsf.edu 128.218.152.230 pacs.radiology.ucsf.edu 128.218.152.229 Load Balancer Pair LTM1 LTM2 mwl.radiology.ucsf.edu 128.218.152.231 Load Balancer Pair Parnassus Data Center Cisco UCS Virtual Infrastructure PACS DICOM 64.54.152.254 MWL 64.54.152.252 PACS DICOM Alternate 64.54.152.253 Minnesota St. Data Center Viprion1 Viprion2 Cisco UCS Virtual Infrastructure Modalities IP Based (Non-DNS) vsphere PACS DICOM Alternate 64.54.152.254 parnos1 T4-1 Servers vsphere Modalities IP Based (Non-DNS) PACS DICOM 64.54.152.253 minnos1 MWL 64.54.152.251 parnsvr1 parnsvr2 minnsvr1 NeApp 3250 9 Disk Shelves NeApp 3250 11 Disk Shelves Drawn By Jeff Block Unit Radiology T4-1 Servers minnsvr2 Radiology IMPAX Dual Data Center Infrastructure Rev A 3/21/14
PACS Infrastructure Dual Datacenter Design Goal: Redundancy and Enhanced Performance Minnesota Street UCSF Campus Networks & Firewall UCSF Campus Load Balancers PACS Components Parnassus Radiology Networks and Firewall PACS Components
Collaboration Radiology IT Radiology PACS Support Group Configuration of ~150 Clinical Devices Configuration / Build / Deployment of ~150 Clinical PACS Workstations Customization of PACS GUI Radiology Information Systems (RIS) Support Group RIS Integration Powerscribe 360 Voice Recognition Integration Radiology Desktop Support Group Deployment of PACS Workstations Help Desk Support
Collaboration - ITS Datacenter Team Minnesota St. Datacenter Load Balancers (F5 Viprion and GTM)
Collaboration Global Traffic Managers and Load Balancers GTM1 GTM2 XXX-ABC D-0123VI PRI ON XXX-ABC D-0123VI PRI ON X XX -AB CD- 0123 X XX -AB CD- 0123 Clients & Other PACS Systems (DNS Based) Clients & Other PACS Systems (DNS Based) dicom.radiology.ucsf.edu 128.218.152.198 pacs.radiology.ucsf.edu 128.218.152.197 mwl.radiology.ucsf.edu 128.218.152.200 Rad Parnassus Nameserver Nameserver1 Rad CB Rad MB Nameserver Nameserver Nameserver2 dicom.radiology.ucsf.edu 128.218.152.230 pacs.radiology.ucsf.edu 128.218.152.229 Load Balancer Pair LTM1 LTM2 mwl.radiology.ucsf.edu 128.218.152.231 Load Balancer Pair Parnassus Data Center Cisco UCS Virtual Infrastructure PACS DICOM 64.54.152.254 MWL 64.54.152.252 PACS DICOM Alternate 64.54.152.253 Minnesota St. Data Center Viprion1 Viprion2 Cisco UCS Virtual Infrastructure Modalities IP Based (Non-DNS) vsphere PACS DICOM Alternate 64.54.152.254 parnos1 T4-1 Servers vsphere Modalities IP Based (Non-DNS) PACS DICOM 64.54.152.253 minnos1 MWL 64.54.152.251 parnsvr1 parnsvr2 minnsvr1 NeApp 3250 9 Disk Shelves NeApp 3250 11 Disk Shelves Drawn By Jeff Block Unit Radiology T4-1 Servers minnsvr2 Radiology IMPAX Dual Data Center Infrastructure Rev A 3/21/14
Collaboration - ITS Datacenter Team Minnesota St. Datacenter Load Balancers (F5 Viprion and GTM) Network Team Network Monitoring and Performance Netscout Probes
Collaboration Netscouts for Network Performance Testing and Statistics NetScout (Clinical VLAN) RAD RAD MTZ-R2 MTZ-R1 GI 1/2 GI 1/1 64.54.2.190 64.54.2.186 GI 1/2 64.54.2.158 GI 1/1 64.54.2.154 GI 1/24 GI 1/23 MTZ-Core2 GI 1/24 GI 1/23 MTZ-Core1 Campus -MB Core 3002-s251-r05 TE 1/2 169.230.251.35 TE 1/3 64.54.131.75 TE 1/1 64.54.131.74 Campus - 654M 3043-0109-r02 NetScout (Clinical VLAN) Rad CB-R1 GI 4/45 4/48 GI 4/45 4/48 Rad CB-R2 64.54.30.241 GI 2/1 64.54.30.245 GI 2/2 64.54.30.249 GI 2/1 64.54.30.253 GI 2/2 GI 1/10 GI 1/11 CB-Core-R1 GI 1/10 CB-Core-R2 GI 5/1 64.54.1.197 GI 5/1 64.54.1.193 GI 3/1 64.54.1.194 B-Core4-R1 B-Core3-R1 GI 3/15 64.54.1.34 GI 5/1 64.54.1.142 GI 3/15 64.54.1.57 PRN-Core3 GI 6/20 64.54.1.58 GI 3/4 64.54.1.141 GI 6/20 64.54.1.54 GI 2/5 64.54.1.53 GI 1/9 64.54.1.137 GI 6/18 64.54.1.138 PRN-Core4 GI 5/1 64.54.1.198 GI 6/4 GI 1/5/2 GI 2/5/2 GI 6/4 RAD LRI-R1 (VSS stack) TE 1/6/15 128.218.217.86 TE 3/6 128.218.217.85 NetScout (Clinical VLAN) TE 1/2 169.230.251.34 Campus - 654M Campus - PRN Core 2408-0c50-r05 ISG Firewall Cluster TE 2/6/15 TE 1/1 128.218.217.90 Campus - PRN Core 64.54.131.77 Campus - 654M TE 3/6 2252-00f1-r05 TE 1/1 128.218.217.89 64.54.131.76 3043-0109-r01 Campus - 654M 3043-0109-r05 Campus - 654M 3043-0109-r05 Radiology Rack 1 Radiology Rack2 Radiology Rack 3 Radiology Rack4 CB China Basin LRI Lab for Radiologic Informatics MB Mission Bay Medical Center B Mission Center Building R Router Rad Radiology AT&T NGMAN GI 2/5 64.54.1.33 MB-Core_R1 MB-Core-R2
Collaboration - ITS Datacenter Team Minnesota St. Datacenter Load Balancers (F5 Viprion and GTM) Network Team Network Monitoring and Performance Netscout Probes Firewall Policy Access New Firewall Installation with 10G Uplinks Load Balancers and /32 Routes
Collaboration Load Balancers and Complex Routing GTM1 GTM2 XXX-ABC D-0123VI PRI ON XXX-ABC D-0123VI PRI ON X XX -AB CD- 0123 X XX -AB CD- 0123 Clients & Other PACS Systems (DNS Based) Clients & Other PACS Systems (DNS Based) dicom.radiology.ucsf.edu 128.218.152.198 pacs.radiology.ucsf.edu 128.218.152.197 mwl.radiology.ucsf.edu 128.218.152.200 Rad Parnassus Nameserver Nameserver1 Rad CB Rad MB Nameserver Nameserver Nameserver2 dicom.radiology.ucsf.edu 128.218.152.230 pacs.radiology.ucsf.edu 128.218.152.229 Load Balancer Pair LTM1 LTM2 mwl.radiology.ucsf.edu 128.218.152.231 Load Balancer Pair Parnassus Data Center Cisco UCS Virtual Infrastructure PACS DICOM 64.54.152.254 MWL 64.54.152.252 PACS DICOM Alternate 64.54.152.253 Minnesota St. Data Center Viprion1 Viprion2 Cisco UCS Virtual Infrastructure Modalities IP Based (Non-DNS) vsphere PACS DICOM Alternate 64.54.152.254 parnos1 T4-1 Servers vsphere Modalities IP Based (Non-DNS) PACS DICOM 64.54.152.253 minnos1 MWL 64.54.152.251 parnsvr1 parnsvr2 minnsvr1 NeApp 3250 9 Disk Shelves NeApp 3250 11 Disk Shelves Drawn By Jeff Block Unit Radiology T4-1 Servers minnsvr2 Radiology IMPAX Dual Data Center Infrastructure Rev A 3/21/14
Collaboration - ITS Datacenter Team Minnesota St. Datacenter Load Balancers (F5 Viprion and GTM) Network Team Network Monitoring and Performance Netscout Probes Firewall Policy Access New Firewall Installation with 10G Load Balancers and /32 Routes Medical Center IT Active Directory
Collaboration - Vendors Clinical Software / Hardware Vendors AGFA Healthcare PACS Software NetApp Storage F5 Load Balancers imorgon Ultrasound Nuance Powerscribe 360 Voice Recognition Philips isite TeraRecon 3D Image Processing
Implementation 2 Year Process Not an upgrade, a complete replacement Phased Rollout Required Zero Downtime Patient care was unaffected during go-live
Challenges Design Running New and Old Systems Simultaneously Load Balancers /32 VIPs and Complex Routing Data Migration PACS Workstations System Imaging First Few Weeks: AD GPO changes Firewall changes
Acknowledgements Radiology IT Teams UCSF ITS Teams Data Center Network Medical Center Identity and Access Management Vendors AGFA Nuance NetApp F5 Philips imorgon TeraRecon