An open-source PACS model for university hospitals

Abstract

Managing the increasing amount of data that is produced in healthcare centers is a challenging problem. Picture Archiving Communication System (PACS) helps healthcare managers to transmit, store, archive, and access medical imaging data. However, PACS are not readily affordable for all hospitals, especially those in developing countries. Using an open-source PACS could be a viable solution but selecting one and integrating it with other hospital information systems is a challenging problem for hospitals. Open-source PACS are different from each other in terms of software design, internal architecture, interoperability, support, and user functionality. Thus, in order to have a better understanding of available open-source and be able to select one, it is critical to have good selection criteria. In this research, firstly, four criteria are defined as the required characteristics of an open source PACS to be used in a university hospital, which are following: - criteria 1: community activities; - criteria 2: licensing models; - criteria 3: activity, support, and documentation; - criteria 4: enterprise functions and software characteristics. These criteria are used to assess sixteen open-source PACS, such as available support from the software creator, future development and distribution possibility, and implemented and developed functions. To achieve this assessment, PACS project source code repositories, PACS websites and research papers are used to collect data for this evaluation. The result of the assessment shows that: Orthanc, DCM4CHE, DCMTK, Dicoogle, and MRIdb are the topranked open-source PACS using these criteria. Orthanc is then selected in this research to conduct an interoperability case study for the Donka university hospital in Guinea, Africa. The main components of a modern hospital information systems for radiology are the hospital information system (HIS), the radiology information system (RIS), a PACS, and a radiology image viewer. The Donka hospital management has already acquired an HIS named eHospital which includes all the modern hospital functionality, including an RIS. But the hospital administration did not plan the acquisition of a commercial PACS required to store, archive and access the many imaging files of the hospital. In this research, the case study looks at the use of a middleware between the HIS/RIS and the open source PACS Orthanc. The middleware chosen for the case study, named Mirth Connect, is a mature open-source project which facilitates interoperability and data exchange of heterogeneous IT systems to allow them to exchange messages between each other using different exchange format, like FIHR/HL7 which is very popular in the healthcare industry. A seamlessly extensible interoperability model is proposed to interconnect the SIH/RIS eHospital and the open source PACS Orthanc. The main components involved in the exchange of data are: the HIS/RIS, Mirth Connect, the PACS Orthanc, and image viewer, and other future interfaces. In this model, different scenarios are defined as routine and required data transactions between mentioned components. The six data transactions scenarios experimented are: 1. HIS and PACS (two scenarios); 2. Modality and PACS (two scenarios); 3. PACS interface and Mirth Connect; 4. Dashboard and Mirth Connect; 5. Image viewer and PACS; 6. TensorFlow model and PACS. Each of these transactions is explained and implemented with the assistance of Mirth Connect for the Donka university hospital. Each of the transactions going through the Mirth Connect SOA communication bus is explained and implemented to demonstrate how to integrate Orthanc PACS at the Donka University Hospital as well as the use of the FIHR / HL7 communication protocol allowing the future interoperability of any future component.

Date	3 Jan 2021
Original language	American English
Awarding Institution	École de technologie supérieure
Supervisor	Alain April (Supervisor)