The DxRAD® solution brings together high performance image review software, professional reporting choices, an integrated clinical Microsoft SQL database and a powerful PACs image archive. DxRAD® solutions provide fast image review, fast creation of reports without transcription, and fast access to all previous studies.
DxRAD® systems are DICOM compliant and work with DICOM digital and video data. Workstations operate in local area network, wide area network or Web only modes and run on Windows operating systems. Storage solutions utilize the latest high performance RAID 5 file servers, located remotely or on site. HL7 interfaces provide communication with HIS, RIS, CIS and billing systems. DxRAD® exceeds HIPAA requirements with full security, an audit trail, and electronic signature facilities
Digital Image Review
Digital images can be displayed in real time via a network, or read from optical disk (MO), CD-ROM, or DVD. DxRAD® has no study size or clip length restrictions. Images stored on a DxRAD® system can be accessed at other workstations on the network, through a web browser to any machine having web access, or sent to remote sites via DICOM push, FTP or e-mail, where any standard Pentium computer can view the reports and images.
Image review tools include a study Preview Screen for fast review of all images in the study. Dual and quad screen loops can use images from different views, different studies, and different modalities (Cath, Echo, MRI, CT, etc.). Clips may be saved as slides or AVI clips for conferences or teaching purposes. Intuitive controls allow the user to adjust the speed of playback, step through the clip frame by frame, control brightness & contrast and zoom images.
On-line Storage and Archive
Studies may be read from or stored to the network and most devices connected to the workstation. Supported formats include DICOM, JPEG, AVI, & BMP. RAID 5 file servers provide up to 10 TB of on-line storage (200,000 echo studies @ 50 MB/study or 40,000 cath studies @ 250 MB/study). Archive solutions include jukeboxes, high capacity tape (DVD, AIT), and Veritas backup software.
Reports are professional, concise (1 page), and highly configurable, with embedded images and graphics. Report titles, logos, patient/study work lists, precision of results, and measurement names may all be customized. Multiple, custom normal range tables are included. Reports can be faxed or securely transferred directly from the application. The Review option provides network wide report review.
Practice and department statistics can be immediately compiled through the Report Query option. The Search program allows the user to mine the patient database for demographic data, diagnostic statements, quantitative results, and combinations of these.
The Echo modality includes on-screen calculations for 2-D, Doppler, M-mode, and Tissue Doppler. Measurements can also be uploaded from supported ultrasound systems, or entered through forms. The Vascular modality includes reports and forms for carotid, lower extremity arterial and venous, upper extremity arterial and venous, abdominal aorta-iliac, renal, arterial bypass, arterial treadmill, and venous reflux studies. Vascular templates can be annotated or marked as desired. The Cath modality includes on screen measurements, forms for entering cath data, and coronary artery templates for documenting angiography results. All modalities, including Holter, Nuclear, and MRI incorporate specialized Findings, Report macros and report formats
The DxRAD® solution provides professional reporting and a single clinical database for multiple cardiology modalities including echo, vascular, stress, cath, and nuclear studies. DxRAD® systems provide a solid foundation for comprehensive cardiology information and imaging networks. Core DxRAD® systems include general reporting and clinical database with modality specific forms and reporting. Options include specialized reporting tools for additional modalities, a comprehensive on-screen measurements package, links to HIS and ultrasound systems, and upgrades to digital image management.
Efficient, Professional Reporting
The DxRAD™ systems provides professional, well-organized, descriptive reports. Statements appearing in the report may be customized by the user for preferred clinical terminology and specific patient population. Report macros provide templates for procedures, conclusions, and recommendations by study type. In addition, the user can also create new study types.
No longer is there a need for dictation or separate report creation. Now, the reports are available as soon as the study has been read and can be distributed directly from the DxRAD™ workstation via fax, email, or HL-7 links to hospital information systems.
The DxRAD™ database utilizes the open architecture Microsoft SQL 2005 database engine. Users may access the database directly for interfacing with other applications. The powerful SQL query structure is available for users in constructing their own reports and/or searches.
The DxRAD™ export facility includes a “flat file” export (one row per study) of database subgroups. This export, which can be set as an ASCII or Excel format, is exceptionally convenient for research purposes.
Departmental and Accreditation Reports
Practice and department reports can be immediately compiled through the DxRAD™ Query option. These reports include total cases/procedures for each physician or technician by date period selected, number of patients by referring physician, total cases by diagnosis or clinical indication, plus a variety of other summaries.
Database Search package
An optional Echo on the Go Search program allows the user to search the patient database for demographic data, diagnostic statements and quantitative results. By simply selecting the desired criteria to create the target subgroup, the user can display the data or export it to an ASCII or Excel file.
DxRAD™ storage solutions include a range of choices from file servers to PACs archives. RAID 5 file servers, jukeboxes, magneto-optical drives, DLT, and AIT tape technology have all been supplied to customers and are currently supported devices. DxRAD™ helps sites select a storage solution based on current needs and projected growth.
RAID-5 File Server
RAID-5 file servers range in capacity from 36 GB to 10 TB. In order to provide fast response time to multiple users, top end file servers are configured with dual 2.4GHz Pentium processors, 2GB of DDR SDRAM memory and a RAID-5 disk system for image cache. RAID-5 striping provides data striping at the byte level and also stripes error correction information. This results in excellent performance and good fault tolerance.
DxRAD™ provides jukeboxes based on Magneto-optical, DVD and DLT technology. These devices provide maximum expandable image storage. However the low cost and increasing capacity of file servers means that jukeboxes are sometimes not the best choice. A careful analysis of site requirements is always needed to insure the best storage choice.
Archiving can be provided through a range of devices including jukeboxes, AIT 12 slot tape library systems or DLT Robots. Sites sometimes have their own back up solutions in place and DxRAD™ networks easily fit into these strategies. When archiving software is needed, DxRAD™ normally recommends Veritas software unless a jukebox is involved. OTG Image Management software together with DxRAD™ database software provides fast and efficient data handling for archived data on jukeboxes.
Key features of archiving software include:
DxRAD™ Access image database management software allows storage and retrieval of images from the Network File Server or stand-alone DVD/CD/MO drives Device level integration (no proprietary file systems) ensures seamless integration. User selectable cache system (dedicated, system disk partition, direct read/write to optical disk) allows optimal system performance Multiple caching for files, partitions, and drives
The Electronic Medical Record (e.g. DxEMR™) or any other third party application is the platform for replacing patient paper records with a single electronic patient folder. With an EMR/EHR model, integration of patient data and images between applications and platforms is possible and departments benefit from improved patient care and lowered medical costs.
DICOM is the imaging standard for multi-modality images (echocardiography, x-ray angiography, nuclear cardiology, OB/Gyn, radiology, etc.). DxRAD™ systems are built on DICOM imaging standards both for network and media communication. Applications that utilize the DICOM standard can share images with other applications.
HL-7 interfaces provide connectivity between applications for text and data. DxRAD™ utilizes HL-7 interfaces to provide real time communication with hospital information systems. HL-7 interfaces include ADT, Order in, Results out, and Billing.
Data Links to Ultrasound Systems
DxRAD™ also provides real time communication links to all major DICOM modalities. These data links provide background transmission of patient demographic data, measurements, and comments from CTs, MRIs, PET, etc. systems to DxRAD™ servers. DxRAD™ reports are auto-populated and the database is updated after the patient data is parsed. It should be emphasized that the data links are an electronic real-time communication facility. They are not an OCR (Optical Character Recognition) technique, which is sometimes subject to errors.
Email and Internet Communication
Users may e-mail images and reports to anyone to view on any PC. For example, users can read a study (either at the hospital or at home), make a diagnosis, and e-mail the study to a surgeon or referring physician, who could view it on any standard Windows PC, with no special or additional software. See the Remote mode section for more information on this comprehensive Internet facility.
A comprehensive export facility provides both automatic and explicit export of data in a variety of formats: ASCII (formatted and delimited), rtf, and pdf. Export files can be sent to pre-determined locations, upon pre-determined events (electronic signature), using user configurable file names. Special database export facilities are provided for Excel export and ASCII export using the Echo on the Go Query function and an auto-formatting spreadsheet facility.
HIPAA Requirements for Security and Privacy
The Security and Privacy facilities within DxRAD™ products meet HIPAA requirements as well as 21CFR part 11 FDA regulations for electronic records and electronic signatures. The Security facility within DxRAD™ software provides an administrator with the tools necessary to set up passwords and user rights for all system users. With the security feature, each user is required to log on and provide a password in order to launch the program. Once logged on, the user has access to only those features included in the security level assigned to him/her.
Once the physician has completed review of a study, he selects Electronic Signature, enters his electronic signature password, and the report is electronically signed. Distribution rules can be set so that the study is automatically sent through hospital distribution channels once a report is electronically signed.
An associated Audit Trail facility provides user/date/time stamps of all changes to final reports together with a pdf version of the full revised report. The user/date/time stamps together with the changes are stored in an audit database so that query audits can be run as needed.
All user passwords are encrypted and stored in a database. All databases are secured by a password, which is required to open the database.
Log for Failed Access
The security logon feature includes logging all unsuccessful login attempts. After 3 unsuccessful tries, the log on screen is closed and a message is written to the Failed Access file. The user name, date and time are included in this file.