Home

Vista Imaging Routing User's Manual

1. e Images at receiving site purged at end of retention period Imaging dest only 78 VistA Imaging V 3 0 Patch 18 April 2006 Appendix B Using MAG_Decompressor This section explains how to install and configure the Automatic Decompression Service MAG_Decompressor MAG_Decompressor can be installed on a VistARad workstation or on any other system that is receiving compressed images via automatic or on demand routing Note that MAG_Decompressor should NOT be installed on a DICOM Gateway Once it is configured MAG_Decompressor runs in the background and will de compress routed images as they are received by the destination system This service does not need to be installed on systems that only receive uncompressed routed images Licensing A toolkit license is needed for each system that is sending or receiving compressed images For more information contact VistA Imaging Customer Support MAG_Decompressor Setup Distribution The decompression software is distributed as a part of Patch 51 The installation file MAG_Decompressor_Setup exe is available on the Imaging FTP site under Software Released Software Mag3_0pSIIMAG_Decompressor Installation 1 Log in as an administrator on to the system that will be receiving compressed images via automatic or on demand routing 2 Install the MAG_Decompressor_Setup exe file as follows a Locate the distribution directory for MAG_Decompressor_Setup exe and double click the
2. d b e c local not routed 74 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Appendix A List conditions that will trigger the execution of the rule fill any all that apply a Exam modality of b Off hours holiday coverage specify hours days c Other Rule Impact Review to be completed by Imaging Coordinator Estimated amount of storage needed at each destination for this rule Bandwidth available between sending and receiving sites Total number of exams expected to be transmitted per month Rule adheres to routing policies established by sending site circle one Yes No Rule adheres to routing policies established by receiving site circle one Yes No Rule Implementation to be completed by staff responsible for Routing G W Rule as entered into the Route dic file sample rules listed below Route dic imported to Routing Gateway circle one Yes No Rule tested and found to be functional circle one Yes No Date April 2006 VistA Imaging V 3 0 Patch 18 75 Appendix A Routing User Guide Sample Rules The following sample rules use the fictional destinations listed below Imaging destinations entered in the Network Location File 2005 2 Archive COntrRactor_ CONE Tractor CONC racor ContractingReader LocalJukeBox LogBook DICOM destinations entered in the DICOM Transmit Destination File 2005 587 via SCU_List dic E FilmApplication LaserShare Example 1 a
3. Review log files for error messages Re queue all failed entries in the As needed transmission queue based on routing volume Purge completed and expired entries in Monthly 3 7 the transmission queue Remove obsolete entries from Monthly 3 9 transmission queue Monitor available free space in Imaging As Needed N A destinations this can be done using the Background Processor s Network Location Manager Confirm access to routing destinations As Needed Using Routing Log Files A log file 1s created for each evaluation and transmission processor session These log files can be used to review routing processes and to ensure that no errors have occurred gt A DICOM Gateway retains the 20 most recently generated log files Additional files will be retained if they are still open Older log files are deleted Displaying log files 1 Open a terminal window and log into the Routing Gateway 2 Enter 4 at the prompt to select System Maintenance from the DICOM Gateway Menu MAGDMENU 3 Enter 1 to select System Operation 4 Enter 2 to select Display DICOM Message Log The most recent log files will be displayed 5 Enter the number of the log file you wish to display April 2006 VistA Imaging V 3 0 Patch 18 53 Using the Routing Gateway Routing User Guide Disabling Routing Short Term Routing Shutdown If routing needs to be disabled for a short period of time the easiest thing to do is to stop the tr
4. question is used for routing Physical The computer and The name used should be meaningful to Reference 1 share name at the both the sending and receiving sites receiving site Cannot exceed 63 characters in length Site 25 Destination as Used in the RC column of VistARad s reported to exam lists VistARad users The value used should contain the nationally assigned 3 character site code 26 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Configuring Routing When an Imaging destination is established all the above values should be related in some way The following example illustrates destination names for a fictional routing system In this system the sending site uses autorouting to meet two sets of needs MRI images are routed to an off site specialist for interpretation Urgent exams acquired in the evening are routed to an affiliated hospital for after hours interpretation Jonesville Offsite location MRI Interp enor a VistARad tion WON ELLE MRI_RC Image Archive Maryvale off hours coverage IZ VistA HIS Ane dos ation VistARad MRVVWONESVILLE_ RC Network location file entries for destinations NETWORK LOCATION File Entries at Jonesville Name field for Destination 1 OFFSITE MRI_READ Phys Ref field for Destination 1 WWONESVILLE MRI RC Site field for Destination 1 JVL_MRI Name field for Destination 2 MARYVALE_RC Phys Ref field for Destination 1 MRV
5. the transmission processor locates the image and identifies the destination For Imaging destinations the transmission processor is responsible for copying the image to the destination For DICOM destinations the transmission processor passes the image and destination information to the Transmit DICOM Images to a DICOM SCP function of the DICOM Gateway and waits for the function to report the status of the transfer back to the routing software After the image is copied the appropriate entry in the transmission queue is updated with the status of the image transfer Transmission queue entries are retained for tracking and troubleshooting purposes Entries can be deleted as described on page 57 Remote Reading with VistARad A properly configured VistARad workstation can be used to display and interpret exams routed from another site Radiologists performing remote reading can use VistARad to log into the site that sent the routed exams and then use the contents of the RC Remote Cache exam list column to determine which exams have been routed to them For additional information about working with routed exams refer to page 59 Exporting DICOM Images In general terms any DICOM Storage SCP Service Class Provider can serve as a DICOM destination Apart from transmission logs images routed to a DICOM destination are not tracked by the Imaging system Retention management and deletion of routed images is the responsibility of the
6. Activating Routing The steps below explain how to start the Routing Gateway s evaluation processor and transmission processor Before performing the following steps verify that Image Gateways in the routing system are processing images If images are not being processed no new entries will be added to the rule evaluation queue Starting the Evaluation Processor 1 Verify that the MSM server is running on the Routing Gateway If it is not double click the MSM Console icon to start the MSM server Eda MSM Console 2 Open a terminal window and log into the DICOM Gateway software 3 Enter 3 to select Routing Gateway from the DICOM Gateway Menu MAGDMENU 4 Enter 3 to select Start Evaluation Processor from the Routing Gateway Menu April 2006 VistA Imaging V 3 0 Patch 18 51 Using the Routing Gateway Routing User Guide 5 Position and size the terminal window for subsequent monitoring Note that no new information will be shown in the terminal window until the evaluation processor encounters entries in the rule evaluation queue Starting the Transmission Processor 1 Open a new terminal window and log into the DICOM Gateway software 2 Enter 3 to select Routing Gateway from the DICOM Gateway Menu MAGDMENU 3 Enter 1 to select Start the Transmission Processor 4 A list of destinations will be displayed To select all possible destinations enter an asterisk To enter a partial list follow t
7. SITE The value of this field is a code used by VistARad to identify the source of routed exams The value of this field can be any text string In the VistARad software the value for this field will be shown in the RC Remote Cache exam list column ROUTER The value of this field indicates whether or not the shared folder defined in the PHYSICAL REFERENCE field is being used as a routing destination For routing the value of this field must be Yes TIME OFFLINE The value of this field will be filled in by the transmission processor 1f 1t marks a destination as off line For more information see MAX RETRY ON CONNECT MUSE SITE This field 1s not used for routing For MUSE EKG network locations this field contains the MUSE site number assigned by a GE Marquette field engineer during MUSE server installation MUSE VERSION This field is not used for routing For MUSE EKG network locations this field contains the MUSE software version number 36 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Configuring Routing Defining DICOM Destinations In general terms defining a DICOM destination breaks down into the following steps 1 Determine the names that will be used to identify the destination and gather information about the receiving application 2 Edit the SCU_List dic file a dictionary file used by the DICOM Gateway s 3 Use the DICOM Gateway to load the contents of SCU_List dic into the MUMPS databases on
8. a film printer or external PACS or any other DICOM Storage Service Class Provider DICOM TRANSMIT DESTINATION File 2006 587 The FileMan file where information about DICOM destinations is stored This file should not be edited directly to update the contents of this file use the DICOM Gateway to update the SCU_List dic file evaluation processor The process responsible for handling entries in the rule evaluation queue This process is started or stopped from the Routing Gateway and executes from the VistA Host IMAGE BACKGROUND QUEUE File 2006 03 The FileMan file where rule evaluation queue entries are stored The IMAGE BACKGROUND QUEUE File contains entries used by various processes to move copy or delete images The IMAGE BACKGROUND QUEUE File is populated by Image Gateways and is used by both the Background Processor and the evaluation processor locks Used on a VistARad workstation prevent more than one radiologist from interpreting the same exam If a radiologist opens a locked exam they will be notified that the exam is locked and while they can display the exam they will be unable to update its status NETWORK LOCATION File 2005 2 The FileMan file where routing destinations are defined The NETWORK LOCATION File contains entries for all physical storage devices in the Imaging system on demand routing The transmission of manually selected exams to one or more destinations Images are selected using the VistARad diagn
9. and Hedy Towan who provided valuable background information and feedback for initial drafts of this document vi VistA Imaging V 3 0 Patch 18 Apr 2006 Routing User Guide Introduction Revision Table 25 Jun 2002 20 Mar 2003 Draft Based on 23 Sep 1999 Autorouting Tutorial Updated for Patch 9 test 2 distribution Final version for p9 release A McFarren E deMoel 30 Jul 2005 Updates for patches 11 and 51 Change bars in margins indicate updated content A McFarren E deMoel 03 Apr 2006 Updates minor updates for patch 18 Change bars in margins indicate updated content A McFarren J Christensen Related Documents The following documents contain additional information about routing 22 Sep 2003 1 1 Minor p22 updates in VistARad chapter Added info about routing rules and priority that was not included in original rev Minor clarifications and corrections throughout A McFarren J Christensen Patch Descriptions for patches 9 11 and 51 Routing Guidance Document The following documents contain additional information about components in the routing system DICOM Gateway User Guide DICOM Gateway Installation Guide VistARad User Guide The following documents contain information about the VistA Imaging system in general VistA Imaging System Installation Guide VistA Imaging System Technical Manual VistA Imaging System Planning Document amp Approved Equipment List Copies of th
10. based on date time of day or type of day such as weekday holiday and so on A rule to send all CR images to a destination on certain days would look like Send CR images to Kansas City on Mon Wed Fri send KANSASCITY when MODALITY CR NOW MON 00 01AM to 11 59PM WED 00 01AM to 11 59PM FRI 00 01AM to 11 59PM The Now condition is described along with other date time conditions on page 21 April 2006 VistA Imaging V 3 0 Patch 18 11 Defining Routing Rules Routing User Guide Rule Destinations The first parameter in a routing rule contains either the send command or the balance command and contains one or more destination names The send and balance commands are described in detail below Destination names are described on pages 26 and 37 The SEND Command Typically the send command is used to specify a single destination as in the example below send KANSASCITY when MODALITY CR NOW MON 00 01AM to 11 59PM WED OOSOLAM to 1L1 lt 59B2M gt FRI 00 01AM to 11 59PM To send similar exams to multiple destinations multiple rules would be used as shown below send KANSASCITY when MODALITY CR send BACKUP when MODALITY CR The BALANCE Command Use the balance command when you want to divide a pool of exams between multiple destinations When using the balance command you must specify what percentage of exams should be sent to each destination In the sample rule
11. below 25 of the exams are sent to KANSASCITY and 35 of the exams are sent to KANSASCITY2 The remaining exams are not routed at all as indicated by the lt local gt 40 portion of the command balance KANSASCITY 25 KANSASCITY2 35 lt local gt 40 when MODALITY CR gt The total value of the percentages specified in the command must equal 100 12 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Defining Routing Rules How Load Balancing Works When a rule incorporates the balance command the routing software uses two things to determine which destination receives a given exam the percentages specified in the rule and internal counters set by the routing software When a rule including a balance command is first applied the routing software begins distributing exams the same way a deck of cards is dealt the first destination receives one exam the second destination receives the next exam and so on Exams are evenly distributed until the destination with the lowest value specified in the balance command has received its allotted percentage of exams Then that destination is skipped until the counter resets Since load balancing is based on percentages the counter is reset each time 100 exams have been sent For example if a rule specifies balance DEST1 10 DEST2 40 DEST3 503 when MODALITY CR The first 30 CR exams will be distributed evenly with each destination receivi
12. destination Deletion of Routed Images For Imaging destinations the amount of time routed images are retained is based on the value of the RETENTION PERIOD field in the NETWORK LOCATION File 2005 2 When connecting to a destination for the first time on a given day the transmission processor April 2006 VistA Imaging V 3 0 Patch 18 5 Routing Overview Routing User Guide determines if images at the destination are older than the number of days specified in RETENTION PERIOD Images older than the specified number of days are deleted from the destination s storage location For DICOM destinations routed images are retained until they are deleted locally The routing software will not delete images sent to DICOM destinations Routed images are copies The original image files are retained at the site where they were acquired The age of a routed image is based on the transmission queue entry for that image not on the date of the image file itself Changes made to the date of the image file such as those made by some anti virus packages will not affect when the image is deleted 6 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Routing Overview How On Demand Routing Works On demand routing uses the same infrastructure as autorouting However in on demand routing exams to be routed are manually selected by a VistARad user rather than being identified automatically by a Routing Gateway With the proper
13. entries in the transmission queue have the same priority value entries are processed on a First In First Out FIFO basis Because the transmission processor works on an image by image basis it is possible for the images in a lower priority exam to be interrupted mid stream by the images in a higher priority exam If this happens transmission of all lower priority images will resume after transmission of all higher priority images is complete 8 VistA Imaging V 3 0 Patch 18 April 2006 Defining Routing Rules This chapter explains how to define the rules used for autorouting This chapter covers the following topics Routing Rules Explained Rule Destinations Rule Conditions Routing Rule Priority Routing Rule Tips Routing rules can be defined before the configuration of the routing system is complete but cannot be tested until the setup of the routing system is finished Routing Rules Explained The Routing Gateway uses routing rules to determine which images are to be automatically routed and where the images are to be sent Routing rules need to be established as a part of configuring the routing software and will need to be adjusted if there is a change of staff availability or workflow The definition of routing rules involves 1 Determining the needs of the staff at the sending and receiving sites 2 Determining what resources will be used at the receiving site 3 Translating the resulting informati
14. equal to J2K JPEG 2000 compression will be applied before the file is transmitted When the value of this field is empty or equal to None no compression will take place All images that are sent to the destination will be treated in the same fashion that is either compressed or uncompressed Note If compressed images are to be sent to a VistARad workstation the MAG_Decompressor software will need to be installed on the workstation See Appendix B for more information Note A toolkit license is needed for each system that is sending or receiving compressed images For more information contact VistA Imaging Customer Support If some images need to be sent compressed and some not compressed set up two destinations that are almost the same one with a name like WhereEver with this field set to lt blank gt and one with a name like WhereEver_Compressed with this field set to the appropriate type of compression All other fields in the two records could have the same value most specifically the field named Physical Location Then the following routing rules could be set up Send WhereFver when MODALITY MR and Send WhereEver_Compressed when MODALITY MR This will allow both compressed and uncompressed images to be sent to the same destination 34 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Configuring Routing USER NAME The value of this field is the username that the rou
15. mode FALSE CacheLocationID DEMO 5 Save and close the file Making Multiple Destinations Accessible to VistARad A VistARad workstation can be used to display images from multiple local destinations This is possible because partial matching is used when the CacheLocationID is compared to the names of routing destinations defined in the NETWORK LOCATION File 2005 2 For example if a site is sending images to the destinations shown below a VistARad workstation with its CacheLocationID set to Telerad would be able to access both destinations TeleradMain TeleradBackup Note that the partial matching used is based on leading characters Continuing the above example a destination named NewTelerad would not be treated as a match for workstations using Telerad as their CacheLocationID April 2006 VistA Imaging V 3 0 Patch 18 49 Configuring Routing Routing User Guide Changes Affecting Routing System Configuration The following table lists situations that will require a change in routing configuration and outlines the changes that will need to be made Routing System Change Related Configuration Change Alteration of location permissions Update NETWORK LOCATION File 2005 2 entry for the etc of a Imaging destination applicable destination folder New destination or name change Update NETWORK LOCATION File entry for the of existing destination applicable destination Update routing rules Stop and restart tr
16. priors logic for Enter to see a list of CPT codes and descriptions Select MAG RAD PRIOR EXAMS LOGIC CURRENT CASE CPT GROUP 5 Atthe Select MATCHING CPT GROUP prompt enter a CPT code that has been previously entered as being a match for the current exam or enter a new CPT code to match to the current exam Note Altering the settings for this prompt will affect both VistARad s prefetch function as well as the auto route priors capability April 2006 VistA Imaging V 3 0 Patch 18 41 Configuring Routing Routing User Guide 6 Set the following three prompts as desired for autorouting priors Details follow AUTO DISPLAY YES VERSION LIMIT AUTO DISPLAY 1 DAYS LIMIT AUTO DISPLAY 1800 AUTO DISPLAY The value of this field should be set to YES for entries that should cause autorouting of prior studies DAYS LIMIT AUTO DISPLAY The value of this field should be set to an integer number Studies that precede the current image by more than this number of days will not be candidates for auto routed transmission Only studies that are less than the number of specified days will be included VERSION LIMIT AUTO DISPLAY The value of this field should be set to an integer number This number indicates the maximum number of prior studies that will be auto routed for the current image Note The names of fields will be changed in a future patch 7 Select additional fields to edit or exit FileMan DICO
17. route a lower volume of exams may only need to run this option once a week 9 Remove obsolete entries from Transmission Queue Use this option when there is a large backlog of outdated entries in the transmission queue When this option is executed you will be prompted to enter a cutoff date the date can be entered using FileMan conventions After the date is entered all unprocessed queue entries older than the specified date will be removed This option should be run once a month as part of a Routing Gateway s periodic maintenance cycle 10 Display Current Set of Routing Rules Use this option to display the current set of routing rules This option is especially useful immediately after using option 5 to import a new set of rules April 2006 VistA Imaging V 3 0 Patch 18 57 Using the Routing Gateway Routing User Guide This page is intentionally blank 58 VistA Imaging V 3 0 Patch 18 April 2006 Using VistARad in a Routing System This chapter explains how to use the VistARad diagnostic workstation software at sites that are part of a routing system This chapter covers the following topics Displaying Routed Exams VistARad amp On Demand Routing Displaying Routed Exams In VistA Imaging the VistARad diagnostic workstation is used to display routed exams A routed exam is available for display when the RC Remote Cache column in a VistARad exam list contains the destination name established for your site R
18. routing rules by the evaluation processor Entries that meet the criteria in routing rules are added to the transmission queue SCU_List dic A dictionary file used by the DICOM Gateway that contains information about each DICOM Storage SCP that can receive DICOM images from VistA Imaging DICOM Storage SCPs in this file can receive DICOM images sent automatically as a function of routing or sent manually using a menu option on the DICOM Gateway SEND QUEUE 2006 035 The FileMan file where transmission queue entries are stored sending site The site where routed images are produced The Routing Gateway resides at and is maintained by the sending site storage folder The physical storage location provided by an Imaging destination A storage folder must be referenced in a destination entry in the NETWORK LOCATION File transmission background processor The original name of the transmission processor in test versions of the routing software There is no relationship between the transmission background processor and the Background Processor transmission processor The Routing Gateway process responsible for processing entries in the transmission queue and for purging obsolete routed image files from routing destinations transmission queue The queue used by the transmission processor to send routable images to their destinations Each entry in this queue represents a single image file Entries are added to this queue by the evaluation process
19. security keys on demand routing is available to any VistARad user in the routing system The following figure illustrates the transfer of images between a local and remote VistARad workstation using on demand routing On demand routing can also be used to transfer images to a DICOM destination such as a film printer or an external PACS Exams available VistARad used to Routing G W Images in VistARad queue exams for copies images gt reviewed exam lists on demand routing to destination at destination Se e login gt VistA Remote VistARad _ HIS Sending Site Destination Site Route _ Request Ta a ange site Routing Gateway a sao site Trans Processor Local image copies SY S id Archive Remote Storage Destination Selecting Images for On Demand Routing VistARad s Route Request dialog 1s used to select the exams to be routed on demand and to indicate where exams are to be sent When a user accepts the settings in the Route Request dialog the exams are checked by VistARad to see if they can be routed images present available in short term storage etc Then entries for each image in the selected exams are added to the transmission queue Once an exam has been added to the transmission queue on demand routing functions in the same way as autorouting This figure illustrates on demand routing being initiated from the site with a local Routing Gateway On demand rout
20. user logs into VistARad the locally defined CacheLocationID is compared to the SITE CODE IMAGING SITE PARAMETERS File 2006 1 of the site being logged into If the two values are different the VistARad software assumes that it will be used to display routed images When a routed exam is selected for display VistARad will check the local storage location for routed images The storage location checked is specified in the applicable NETWORK LOCATION File 2005 2 entry at the sending site The following steps must be performed for each VistARad workstation that will be used to display routed images To set the CacheLocationID in MAGJ INI 1 Log into the VistARad workstation as an administrator 2 Use Explorer or the Start Run menu option to open C Programs Vista Imaging MAG VistaRad MAGJ INI 3 Locate the CacheLocationID line under Workstation Settings near the beginning of the file 4 For CacheLocationID enter the destination name that contains local copies of routed images The value you enter must match a routing destination name as defined in the sending site s NETWORK LOCATION File 48 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Configuring Routing Partial matching can be used to allow VistARad to access images from multiple destinations For more information see the next section Workstation Settings WorkStation TimeOut minutes 0 ID UNKnown Location UNKnown VistaRad test
21. 40 Remedy Help Desk 65 Remote Cache RC column 36 59 67 remote storage see storage folders representative images 67 retention period 5 36 60 Route Request dialog 7 61 Route dic 44 46 56 83 routed exams compression 34 79 deleting 5 36 60 displaying 5 59 dividing between destinations 12 priority of 8 22 routing activating 51 configuration 25 49 50 78 described 1 7 66 67 84 destinations 26 39 disabling 54 Image Gateway config options 42 log files 53 maintaining 53 menu options for 55 57 on demand 61 63 Routing Gateway config options 43 rules 9 23 44 46 terms of use v troubleshooting 65 88 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide routing cont VistARad configuration 47 49 Routing Gateway 55 configuring 43 described 2 84 importing rules for 44 46 log files 53 menu options for 55 57 using 51 54 rule evaluation queue 4 51 84 rules routing comments in 23 conditions in 14 22 date time in 21 described 9 84 destinations in 12 displaying 45 57 examples of 10 11 formatting 23 importing 44 46 56 load balancing with 12 multiple sets of 46 Operators 20 priority 8 22 wildcards 20 worksheet 74 S SCU_List dic 37 39 84 security keys 61 send command routing rules 12 SEND QUEUE File 2006 035 4 84 see also transmission queue sending sites configuration tasks for 25 described 84 displaying routed exams at 60 VistARad configuration for 47 shutdown routing 54 speed
22. 8 April 2006 Routing User Guide Configuring Routing Note Altering the settings used to identify a prior will affect both VistARad s prefetch function as well as the auto route priors capability However the settings that determine the number and age of priors to be auto routed can be set independently from the similar settings used for prefetch To change route priors logic 1 Log into the VistA Hospital Information System 2 Use FileMan to select the MAG RAD PRIOR EXAMS LOGIC File 2006 65 for editing Select OPTION E ENTER OR EDIT FILE ENTRIES INPUT TO WHAT FILE 2006 65 MAG RAD PRIOR EXAMS LOGIC 288 entries 3 Select the following fields for editing EDIT WHICH FIELD ALL 01 lt Enter gt CURRENT CASE CPT GROUP THEN EDIT FIELD 1 lt Enter gt PRIOR CASE MATCHING CPT GROUP multiple EDIT WHICH PRIOR CASE MATCHING CPT GROUP SUB FIELD ALL 01 lt Enter gt MATCHING CPT GROUP THEN EDIT PRIOR CASE MATCHING CPT GROUP SUB FIELD 1 lt Enter gt AUTO DISPLAY THEN EDIT PRIOR CASE MATCHING CPT GROUP SUB FIELD 2 lt Enter gt DAYS LIMIT AUTO DISPLAY THEN EDIT PRIOR CASE MATCHING CPT GROUP SUB FIELD 3 lt Enter gt VERSION LIMIT AUTO DISPLAY THEN EDIT PRIOR CASE MATCHING CPT GROUP SUB FIELD lt Enter gt THEN EDIT FIELD lt Enter gt STORE THESE FIELDS IN TEMPLATE lt Enter gt 4 At the following prompt enter the CPT code or description for the types current exams you want to alter the route
23. AGPATIENT1201 11201 4 Rout CHEST 2 VIEWS PA amp LAT 11 24 2003 17 07 EXAMIN 2 Y Route CR 112403 175 IMAGPATIENT1201 11201 4 Rout CT THORAX WICONT 11 25 2003 009 43 EXAMIN 66 Y Routel CT 112403 179 IMAGPATIENT1202 11202 4 Rout CHEST 2 VIEWS PARLAT 11 25 20036010 30 EXAMIN 2 Y CR 112403 180 IMAGPATIENT1203 11203 4 Rout SHOULDER 2 OR MORE 11 25 2003 10 40 EXAMIN 6 Y CR 112403 181 IMAGPATIENT1203 11203 4 Rout MAGNETIC IMAGE UPPE 11 25 2003 10 53 EXAMIN 93 Y MR 112403 183 IMAGPATIENT1204 11204 4 Rout ABDOMEN 3 OR MORE 11 25 2003 11 08 EXAMIN 4 Y CR 112403 182 IMAGPATIENT1204 11204 4 Rout CHEST 2 VIEWS PA amp LAT 11 25 2003 11 19 EXAMIN 2 Y CR 112403 184 IMAGPATIENT1204 11204 4 Rout CT ABDOMEN W CONT 11 25 2003 11 27 EXAMIN 113 Y CT AAA AAP UE SAAT era AA MAMI a Me SSA ds Ie AA MAI AAA ERA A IA reas Ae ates no as oT gt You can view all exams routed and non routed by clearing the checkbox in the Remote Read Filter area near the top of the Manager window 3 Double click the exam or select the exam and click Open If a non routed exam an exam without a value in the RC column is selected for display there will be a delay while the images are retrieved gt A routed exam can be locked and marked as interpreted in the same manner as any other exam For more information refer to VistARad User Guide gt You can use ReadList to successively display all routed exams in an exam list For more inform
24. E This field is retained for backward compatibility For sites using the patch 32 VistARad client this field when set to YES will show only the exams that have been routed to their site For sites using the patch 18 client this setting is a filter that can be set as desired by each user For more information refer to the VistARad Quick Start Guide SITE SENDS TO REMOTE CACHE Setting this field to YES turns on extra processing that is needed to manage routed exams properly One of the results of setting this field to YES is the addition of the RC column to VistARad s exam lists The RC column is described on page 59 April 2006 VistA Imaging V 3 0 Patch 18 47 Configuring Routing Routing User Guide receiving sites see the next section for details It is recommended that the SITE CODE be set to your standard 3 digit site code Select OPTION E ENTER OR EDIT FILE ENTRIES INPUT TO WHAT FILE 2006 1 IMAGING SITE PARAMETERS 1 entry EDIT WHICH FIELD ALL 09 SITE CODE THEN EDIT FIELD lt enter gt Select IMAGING SITE PARAMETERS NAME 1 TEST SITE SITE CODE TST VistARad Configuration Receiving Sites VistARad workstations at receiving sites will need to be configured to check the appropriate local storage location for the presence of routed exams This is done by setting the CacheLocationID in the MAGJ INI file for each VistARad workstation Setting the CacheLocationID affects VistARad in the following ways When a
25. E URGENT and STAT The value for this field is determined by the Radiology Package April 2006 VistA Imaging V 3 0 Patch 18 19 Defining Routing Rules Routing User Guide WORM_REF The network location of the jukebox platter where the image is stored provided there is a jukebox in the Imaging system Operators The following operators can be used in routing rule conditions Operator Image property must Match value in rule NOS Not match value in rule Be less than a numeric value in rule For date time values this operator can be used for earlier than Be greater than a numeric value in rule For date time values this operator can be used for later than lt Be less than or equal to a numeric or date time value in rule gt Be greater than or equal to a numeric or date time value in rule Values Values are the user supplied part of a routing rule condition Most values are text strings Values are typically enclosed in quotation marks If a value contains both upper and lowercase characters or if 1t contains punctuation marks or spaces quotation marks are required Two types of wildcard characters can be used in routing rules the asterisk and the question mark The question mark allows one single character in a value to be any character The asterisk allows one or more characters to be any character The following examples demonstrate how wildcards can be used in text bas
26. For detailed information about specific fields see page 39 User Application List Format e H MERGE EFILM VistA_Storage VistA_Send_Image 111 222 33 44 4006 Appendix A line 1 App Name Called AE Calling AE Destination IP Address Socket line 2 Presentation Context Name Transfer Syntax Name line 3 Transfer Syntax Name if there are more than one Modality Worklist Information Model FIND Implicit VR Little Endian Verification SOP Class Implicit VR Little Endian Specified as the Application in the SCU_List dic file and referenced in routing rules Route dic April 2006 VistA Imaging V 3 0 Patch 18 73 Appendix A Routing User Guide Routing Rule Definition Worksheet Rule Request fo be completed by Radiology staff or supervisor Identify the purpose of the rule circle one a Routine workload sharing Rapid access for clinic facility After hours or holiday coverage Second opinions consults Transfer of images to a non local specialist support for a new modality or imaging type Other o a oO TS h List each destination that this rule will serve a d b e c Will prior exams be included with this rule circle one Yes No Will prior exams be included with this rule circle one Yes No Will all exams for this rule be sent to all listed destinations circle one Yes No If the answer to the above is NO specify the of exams each destination should receive total must 100 a
27. M Gateway Configuration A site that is the source of auto routed images will need to set the configuration file for all Image and Routing Gateways as described in the following sections No configuration changes are needed for Text Gateways in a routing system Image Gateway Configuration Image Gateways at a site using autorouting will need to have their configuration file set as described below The following steps cover only routing related configuration parameters For information about other configuration parameters refer to the DICOM Gateway Installation Guide To configure Image Gateways 1 Open a terminal window and log into the DICOM Gateway software 2 Enter 4 to select System Maintenance from the DICOM Gateway Menu MAGDMENU 42 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Configuring Routing 3 Enter 2 to select Gateway Configuration and DICOM Master Files 4 Enter 1 to select Update Gateway Configuration files 5 Set the prompts indicated in bold below to Yes computer be a DICOM Image Gateway YES YES computer be a DICOM Text Gateway NO NO computer be a Routing Gateway NO NO computer be part of a system where autorouting is active NO Yes to a commercial PACS Mitra Broker et cetera NO NO 6 Press lt Enter gt to cycle though the rest of the prompts and to exit the program Routing Gateway Configuration The workstation serving as a
28. P function of the DICOM Gateway The value for this field may be up to 16 characters in length is case insensitive and punctuation can be used Destination IP The TCP IP address of the machine that will be receiving the DICOM transmission The IP address can be numeric 123 46 57 89 symbolic xxx yyy med va gov or a name stored in the local hosts file Socket The TCP IP port number on which the system that will be receiving the DICOM transmission expects to be called Presentation Context The name of a presentation context expected by the system that will be receiving the DICOM transmission Refer to the current DICOM standard for a complete list of possible values Transfer Syntax The name of a transfer syntax expected by the system that will be receiving the DICOM transmission There are four possible transfer syntaxes Implicit VR Little Endian Implicit VR Big Endian Explicit VR Little Endian Explicit VR Big Endian April 2006 VistA Imaging V 3 0 Patch 18 39 Configuring Routing Routing User Guide Defining Route Priors Logic Verifying that Prefetch is Enabled The capability to route priors assumes that prefetch is enabled Prefetch is generally enabled at sites using VistARad You can verify that prefetch 1s enabled by checking the following settings In the Protocol File 101 use FileMan to verify that MAGJ PREFETCH SEND ORM is defined as a Subscriber to the RA REG protocol Inthe APPLICA
29. Patch 18 lil Routing User Guide Contents Troubleshooting ROUINO iii sssccscciccccnsidenincceacewacieaseiecncdencdseseweniencsdewusewesasuaeswawews 65 BASIC TOMO ESOO O str een 65 GETTING AD sio td dio ada 65 Additional ROUTING Consideration S essa naaa 66 APPENA Aci 69 Imaging Destination WoONSIee lacras 71 DI COM Destination WoOrSnee Eurasia 73 Routing Rule Definition Worksheet rsinirar ai A ida 74 ROUTING Setup CNECKIIS sida ico dalas 78 Appendix B Using MAG_DecompresSOF cococcoconococooronononronononrnnnnnnrnrnnnrnrnsnnnrnss 79 A A O A E A 79 MAG DCCOMpPICSSON Sei els indicios 79 MAG Decompre sor LO OQIING a as da 81 GIOSSANY nn ciales aaa Ria 83 gt suavinvisaedencassavescsapancaasaaaneusawaudarueudusaeteusuaesvescsaacncucscaameansanusawdesdususteucucusdeucas 87 IV VistA Imaging V 3 0 Patch 18 Apr 2006 Introduction This manual explains how to configure and use the routing capability of the VistA DICOM Gateway This manual also explains how to use the on demand routing capability of the VistARad diagnostic workstation software This manual is intended for Staff at VA Medical Centers who are responsible for setting up and maintaining Routing Gateways Clinical staff who need to use VistARad for on demand routing For technical staff this manual assumes familiarity with the VistA system MUMPS and Windows networking For clinical staff this manual assumes familiarity with the Windows environment and the VistA
30. RK LOCATION File 2005 2 for editing Select OPTION E ENTER OR EDIT FILE ENTRIES INPUT TO WHAT FILE 2005 2 NETWORK LOCATION 7 entries EDIT WHICH FIELD ALL lt Enter gt 3 When you are prompted to select a network location enter the name that you want used for the destination Select NETWORK LOCATION TESTDEST Are you adding TESTDEST as a new NETWORK LOCATION the 11TH No YES The name must be entered in upper case cannot contain punctuation or spaces and cannot match the name of a DICOM destination 4 At the next prompt enter the computer name and share name of the storage location you want used for this destination This name references a folder defined as described on page 28 PHYSICAL REFERENCE VHAxxxxxx images 5 At each new prompt enter the desired values for each field Be sure to enter Y at the ROUTER prompt Typical values for a routing destination are shown below For more detailed information about a particular field enter at the prompt or refer to the next section STORAGE TYPE MAG MAGNETIC TOTAL SPACE lt blank gt SPACE USED lt blank gt FREE SPACE lt blank gt April 2006 VistA Imaging V 3 0 Patch 18 31 Configuring Routing Routing User Guide OPERATIONAL STATUS 1 On Line HASH SUBDIRECTORY lt set as appropriate for your site gt ABSTRACT N No FULL Y Yes BIG Y Yes TEXT Y Yes DICOM N No COMPRESSION lt blank or J2K gt USER NAME lt Use t
31. Rad diagnostic workstation software Terms of Use In compliance with FDA and VA policies authorization to use the software described in this document is contingent on the execution of a Site Agreement between the VistA Imaging HSD amp D group and the site where this software is installed Once a routing system is enabled at a site an updated Site Agreement must be filed before significantly altering the configuration of a routing system In addition to any restrictions noted in the Site Agreement the following restrictions apply Caution Federal law restricts this device to use by or on the order of either a licensed practitioner or persons lawfully engaged in the manufacture or distribution of the product No modifications may be made to this software without the express written consent of the VistA Imaging National Project Manager The Food and Drug Administration classifies this software as a medical device Modifications to the computer where this software is installed such as the installation of unapproved hardware or software will adulterate the medical device The use of an adulterated medical device violates US Federal Law 21CFR820 US Federal regulations and VA internal policy prohibit unencrypted transmission of patient information outside the VA s intranet April 2006 VistA Imaging V 3 0 Patch 18 V Introduction Routing User Guide About this Manual Using this Manual This document contains material of interes
32. Routing Gateway will need to have its configuration file set as described below Completing these steps will make the Routing Gateway menu option and its submenus available in the main DICOM Gateway Menu MAGDMENU The following steps cover only routing related configuration parameters For information about other configuration parameters refer to the DICOM Gateway Installation Guide To configure the Routing Gateway 1 Open a terminal window and log into the DICOM Gateway software 2 Enter 4 to select System Maintenance from the DICOM Gateway Menu 3 Enter 2 to select Gateway Configuration and DICOM Master Files 4 Enter 1 to select Update Gateway Configuration files 5 Set the prompts indicated in bold below to Yes computer be a DICOM Image Gateway YES NO computer be a DICOM Text Gateway NO NO computer be a Routing Gateway NO Yes computer be part of a system where autorouting is active NO Yes to a commercial PACS Mitra Broker et cetera NO NO April 2006 VistA Imaging V 3 0 Patch 18 43 Configuring Routing Routing User Guide 6 Press lt Enter gt to cycle though the rest of the prompts and to exit the program Importing Routing Rules Route dic This section covers the following topics Creating and Importing a Routing Rules File Verifying Imported Rules Re Importing Routing Rules Routing Rules amp Multiple Routing Gateways This section assumes that you have prepar
33. SITE CODE IMAGING SITE PARAMETERS File 2006 1 must be set to a non null value that will identify the sending site To set routing related VistA Rad site parameters 1 Open a terminal window and log into the VistA Hospital Information System 2 Access the VistARad System Options menu MAGJ MAIN and run the E E VistARad Site Parameters option MAGJ VISTARAD SITE PARAMETERS 3 Set the routing related fields shown in bold below to YES Select MAG VISTARAD SITE PARAMETERS VISTARAD SITE NAME DEMO VISTARAD SITE NAME DEMO ENABLE STATUS UPDATE YES RECENT EXAMS DAYS LIMIT 9999 UNREAD EXAMS DAYS LIMIT 9999 PREFETCH ACTIVE YES LIST ONLY EXAMS HAVING IMAGES NO ENABLE SERIES DISPLAY YES BACKGROUND COMPILE EXAM LISTS NO UNREAD BKGND COMPILE INTERVAL 2 RECENT BKGND COMPILE INTERVAL 30 REMOTE LIST ONLY REMOTE CACHE NO YES lt obsolete gt SITE SENDS TO REMOTE CACHE NO YES lt required gt PATIENT LIST LIMIT YEARS 10 PATIENT LIST LIMIT EXAMS 15 UNREAD LIST PRIORITY SEQ S U P R These steps assume that other fields in MAG VISTARAD SITE PARAMETERS are already set as desired For information about other site parameters refer to chapter 3 in the VistA Imaging Installation Guide 4 Use FileMan to check the value of your site s SITE CODE field 2006 1 09 The value entered must not match any of the CacheLocationID values defined at REMOTE LIST ONLY REMOTE CACH
34. TION PARAMETER File 771 verify that MAGJ CLIENT is set to Active Note The PREFETCH ACTIVE setting in the VistARad Site Parameters File 2006 69 does not affect the automatic routing of priors For more information refer to chapter 3 in the Imaging System Installation Guide How Prior Exam Routing Works The logic for automatically routing prior exams is triggered when a prior study statement is used in a routing rule The baseline logic for routing priors is For each exam being automatically routed also route up to one matching prior exam up to 1800 days about five years old This logic is stored in the MAG RAD PRIOR EXAMS LOGIC File 2006 65 Ina nutshell this file is used for three things 1 Itis used to identify based on procedure name CPT code what qualifies as a prior exam 2 Itis used to determine the maximum number and age of exams to automatically route as priors 3 Itis used to determine the maximum number and age of exams to retrieve from the jukebox for VistARad prefetch Note Numbers 1 and 3 above are pre existing functions Number 2 is a new function introduced in Patch 51 Altering Route Priors Logic To alter the logic used for automatic routing of prior exams you will first need to identify the procedure name CPT code of the current exams in question Then you will need to edit the MAG RAD PRIOR EXAMS LOGIC File 2006 65 as described below 40 VistA Imaging V 3 0 Patch 1
35. _RC1 JONESVILLE_RC Site field for Destination 2 MRV Storage Location Names for offsite MRI specialist Folder name Exams_from_Jonesville Computer and share name MWJONESVILLE MRI_RC VistARad CacheLocationID JVL_MRI_RC Storage Location Names at for after hours coverage at Maryvale Folder name Exams_from_Jonesville Computer and share name MRV_RC1 JONESVILLE_RC VistARad CacheLocationID MARYVALE_RC April 2006 VistA Imaging V 3 0 Patch 18 27 Configuring Routing Routing User Guide Storage Folders for Imaging Destinations This section explains how to create and verify a folder for an Imaging destination on a Windows based server The folder will be used as the storage location for routed images at a receiving site The resulting folder will be referenced in the NETWORK LOCATION File 2005 2 Folder Prerequisites Before creating the folder A username and password to be used by the routing software to copy images to the folder will need to be established by the receiving site The username password must be provided to the sending site Note Unannounced password changes are a major cause of routing problems To avoid future problems the sending and receiving sites need to establish a procedure by which username password changes can be implemented without adversely affecting routing The sending site and the receiving site must establish naming conventions to use for the various elements that describe an Imaging d
36. a rule contains more than one condition all of the conditions must be met for an image to be routed Send CR images produced in Wichita to Kansas City send KANSASCITY when MODALITY CR SOURCE WICHITA Tip When defining multiple conditions for a rule list the most restrictive condition first Listing the most restrictive condition first will minimize the amount of time needed by the routing software to process the rule 10 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Defining Routing Rules Rules using Wildcards Wildcards can be used when you want a condition to be valid for more than one value In the example below all images regardless of modality will be routed Send all images to Kansas City send KANSASCITY when MODALITY Wildcards are described in detail on page 20 Rules using the does not match Operator A condition can use different types of operators The previous examples used as an operator indicating that the specified image property must match a particular value for a condition to be met The following example uses as an operator indicating the image property in question can be any value except the listed value Send non CR images to Kansas City send KANSASCITY when MODALITY CR Operators are described in detail on page 20 Rules using Date Time Conditions A rule using date time conditions can be used to route images
37. account does not have any of the security keys for on demand routing assigned 4 When the Route Request dialog opens make sure all the exams you selected are shown gt If a selected exam is not online not available in short term storage a message will appear at the bottom of the Route Request window indicating that exam has been requested from the jukebox long term storage Once the exam is available in short term storage you can select it for on demand routing Route Request Image Date Time Status Route To Priority 080504 255 IMAGPATIENT1011 TIBIA amp FIBULA 2 VIEWS AUG 5 2004 13 51 EXAMINED ROUTESITE1 Medium 080504 256 IMAGPATIENT1011 KNEE 2 VIEWS AUG 5 2004 13 51 EXAMINED Do Not Route Medium Default Route To Do Not Route Default Priority Medium mes 5 For each exam click the Route To field to select where you want to send the exam In the Route To field the first destinations listed are Imaging destinations such as remote VistARad workstations If there are any DICOM destinations such as film printers defined they will appear at the bottom of the Route To field and will be preceded by dem Use the Default Route To box near the bottom of the Route Request window to choose a single destination for all listed exams 6 For each exam use the Priority field to select the priority used to send the exam Use the Default Priority box near the bottom of t
38. ansmission processor if one processor serves all destinations or start a new instance of the transmission processor for the new destination Update VistARad workstation MAGJ INI at receiving site New Image Gateway imaging Configure Image Gateway modality Review and update routing rules if needed Change of radiology staff at Review and update routing rules if needed sending or receiving site Review NETWORK LOCATION File entry for destination and adjust if needed Determine if new staff members need on demand routing privileges Addition of new VistARad Update VistARad workstation MAGJ INI workstation 50 VistA Imaging V 3 0 Patch 18 April 2006 Using the Routing Gateway This chapter explains how to use the Routing Gateway This chapter covers the following topics Activating Routing Maintaining Routing Disabling Routing Routing Gateway Menu Options This chapter assumes that the Routing Gateway has been properly installed and configured US Federal regulations and VA internal policy prohibit unencrypted transmission of patient information outside the VA s intranet A Routing can have a significant impact on network traffic It is the responsibility of sites using routing to properly manage network demands related to routing Before activating the routing software notify your network administrator that there will be an increase often a significant one in network traffic to routing destinations
39. ansmission processor s When this is done images will still be evaluated and queued but they will not be transmitted until the transmission processor is restarted Before restarting the transmission processor use option 9 Remove Obsolete Entries from Transmission Queue to remove any entries that may have been created while the routing system was disabled For more information see page 57 Long Term Routing Shutdown If routing needs to be disabled for an extended period of time perform the following Stop the evaluation processor Stop all transmission processors Alter the configuration files for all Image Gateways to indicate that they are NOT part of a routing system see page 37 for more information All images processed when routing is disabled as described above cannot be autorouted even after routing has been restarted Such images will need to be routed on demand using VistA Rad 54 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Using the Routing Gateway Routing Gateway Menu Options This section describes the menu options associated with the Routing Gateway Routing Gateway menu options are accessed by entering 3 Routing Gateway from the DICOM Gateway main menu Start the Transmission Processor Stop the Transmission Processor Start the Evaluation Processor Stop the Evaluation Processor Import Routing Rules Purge all completed entries in the Transmission Queue Purge completed and expired entr
40. at they are are being routed incorrectly processing images Attempt to re send images by running the Re Queue all failed entries in the Transmission Queue option Routing Gateway menu shortcut 3 8 Review the routing log files to determine if the images were transmitted successfully if you have just used the re queue failed entries option wait 15 20 minutes before opening the log files 4 Review the contents of the routing rules file Route dic The routing software cannot Verify that the network connection being used is available connect to the destination and set up properly If the destination is an Imaging destination refer to the steps for testing folders on page 29 The log files indicate an invalid Contact the receiving site and verify that the correct user username or password name and password is being used by the routing software Getting Help If additional assistance is needed contact your Imaging Coordinator or local support staff If the problem cannot be resolved locally open a help desk ticket or contact the National Help Desk between 8 00AM and 6 00PM Eastern time Monday through Friday at 1 888 596 4357 Urgent after hours service requests can be directed to the Expertise Center at 1 800 299 7282 April 2006 VistA Imaging V 3 0 Patch 18 65 Troubleshooting Routing Routing User Guide Additional Routing Considerations Transmission Processors and Drive Mapping For each Imaging destination t
41. atch the PHYSICAL REFERENCE field value 2005 2 1 defined at the site that will be sending images to this folder It is recommended that you make the folder a hidden share by adding a dollar sign to the end of the share name A hidden share will be accessible by the routing software but will not be visible to users browsing your network 6 After typing the share name click Permissions 7 Inthe Permissions dialog click Add then select the user group user name that the routing software will use to access this folder The username and password for the user you choose will need to be included in the NETWORK LOCATION File entry that references this folder Use the domain name as well as the username Example VHAIS VHAKANIU note the absence of leading backslashes 8 After adding the routing user set the access type for the routing user to Full 9 In the list of users allowed to access the folder click the Everyone user group then click Remove 10 When you are finished click OK to apply your changes and to close the Properties dialog Folder Verification After the receiving site has created the folder the sending site will need to verify that the folder can be remotely accessed and that files can be copied to and deleted from the folder To complete the following steps you will need the username and password that the routing software will use to access the folder Testing folders from the sen
42. ation refer to VistARad User Guide Local copies of routed exams are stored for a certain period of time typically several days and then deleted automatically by a process initiated from the sending site The original exam remains available at the sending site after routed copies are deleted 60 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Using VistARad in a Routing System VistARad amp On Demand Routing This section describes on demand routing prerequisites and explains how to use VistARad s on demand routing capability US Federal regulations and VA internal policy prohibit unencrypted transmission of patient information outside the VA s intranet Like autorouting on demand routing can have a significant impact on network traffic It is the responsibility of sites using routing to properly manage network demands related to routing On Demand Routing Requirements For on demand routing to function A VistARad user must be logged into an Imaging system that includes a Routing Gateway At the site being logged into the VistA Imaging host the Routing Gateway and storage folders must be set up as described in this manual The Routing Gateway s transmission processor must be running To route images to other non DICOM destinations within the VistA system such as VistARad at a remote site a VistARad user must have the MAGJ DEMAND ROUTE security key assigned to their account To route images t
43. ation Processor When this option is executed the evaluation processor will begin examining routing specific entries in the rule evaluation queue This file is populated by Image Gateways provided that Image Gateways are configured as part of a routing system The evaluation processor uses the rule evaluation queue and site specific routing rules to determine which images are to be routed and where they are to be routed Entries for images to be autorouted are added to the transmission queue Typically a single instance of the evaluation processor can manage all images produced at the sending site For consolidated sites an instance of the evaluation processor should be started for each location In this situation a location equates to an entry in the IMAGING SITE PARAMETERS File 2006 1 4 Stop the Evaluation Processor Use this option to stop the evaluation processor When this option is executed a flag is set that the evaluation processor will recognize as stop evaluating The evaluation processor checks this flag after analyzing each image file against the routing rules 5 Import Routing Rules When this option is executed the rules in DICOM Dict Route dic will be loaded into the Routing Gateway s local MUMPS environment For detailed steps about importing routing rules see page 44 6 Purge all completed entries in the Transmission Queue Use this option to reduce the size of the transmission queue in test ins
44. context holidays are those days that are marked as such in the sending site s HOLIDAY File 40 5 A rule to send images on holidays only could be specified as Send CR images to Kansas on Holidays send KANSAS when MODALITY CR NOW HOL 00 01AM to 23 59PM Date time ranges use a 24 hour clock While the use of AM or PM indicators is not required they can be useful when the hours specified are 0 00 AM midnight and 12 00 PM noon Date time ranges can be used to express date values from any century as well as time values for any second in the day When the routing software compares a date time property in an image entry to a specified value the date time value is broken into components Day of week Hour Day of month Minute Month Second Year Which of these components will be used in the actual comparison will depend on the specified value l The actual value of NOW is the moment when the rule is evaluated April 2006 VistA Imaging V 3 0 Patch 18 21 Defining Routing Rules Routing User Guide Routing Rule Priority Automatically routed exams are assigned a default priority of Medium This priority can be changed by adding a priority statement after the conditions for the rule Prioritize images based on destination send KANSAS when MODALITY CT priority HIGH send BACKUP when MODALITY CT priority LOW In addition to the priority that is derived from routing rules the routing softwa
45. ding site Explorer 1 On the computer you will be using to test the folder log in as an Administrator Under Windows NT the option name is Share As Under Windows 2000 it is Sharing Under Windows XP and 2003 it is Sharing and Security April 2006 VistA Imaging V 3 0 Patch 18 29 Configuring Routing Routing User Guide Start Windows Explorer choose Start Run then type Explorer then click Tools Map Network drive In the Map Network Drive dialog enter the drive letter path and username including domain name that the routing software will be using Then click OK If desired you can map a drive to the folder to make troubleshooting easier However be aware that the transmission processor will map certain drives as it sends exams to Imaging destinations For more information see page 66 When prompted enter the password that will be used by the routing software then click OK If you cannot map the folder use the next set of steps below Testing folders from the sending site Command Line to provide more detailed information about the problem you are encountering Select the folder you just mapped to copy a test file into the folder and then delete the file If the file is successfully copied and deleted the routing software should be able to use the folder Disconnect the mapped drive Testing folders from the sending site Command Line 1 2 30 Log in as an Administrator
46. e Importing Routing Rules To be change routing rules Route dic will need to be modified and then re imported When routing rules are re imported The existing routing table will be replaced Retaining the original set of rules in a backup file allows you to restore the routing table 1f necessary If you are using load balancing importing routing rules will cause internal counters that control load balancing to be reset For more information see page 13 If multiple Routing Gateways are present the steps for importing the modified rules file must be performed for all Routing Gateways so that Gateways will all use the same set of rules Routing Rules amp Multiple Routing Gateways If multiple evaluation processors need to be active as could be the case at a consolidated site each Routing Gateway can use its own local set of rules However it is usually better for all Routing Gateways to use a single set of rules stored in a shared directory Using the same set of rules will make maintenance easier changes to rules need to be made in only one Route dic file rather than several and allows each gateway in the pool to function as a backup for any other gateway 46 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Configuring Routing VistARad Configuration Sending Sites For sites that will be sending autorouted images The MAG VISTARAD SITE PARAMETERS File 2006 69 needs to be edited A sSite s
47. e procedure date time of the image at hand to the provided value PROCEDURE_TIME_FIRST can be used to compare the procedure date time of the earliest oldest image in the exam to the provided value PROCEDURE_TIME_LAST can be used to compare the procedure date time of the latest newest image in the exam to the provided value RADIOLOGY_REPORT The name of the Radiology Report associated with the image SAVED_BY The name of the person who logged in to capture the image SHORT _DESCRIPTION A one line description of the image or object record SPECIALTY The specialty or sub specialty for which the image was acquired as stored in the SPEC SUBSPEC INDEX field 2005 44 SPECIMEN The specimen number of the slide given in the LAB DATA File 63 SPECIMEN _ DESCRIPTION The description given to the specimen in the LAB DATA File 63 STAIN Free text description of the Histological Stain SUMMARY A flag that indicates whether or not the image functions as a summary for a group The value of this property is either empty or equal to 0 NO or 1 YES TRACKING ID An identifier for the package that performed the Import value looks like package name semi colon ID code TYPE The type of image as stored in the TYPE INDEX field 2005 42 Typical types are IMAGE DIAGRAM CONSENT etc URGENCY A code that indicates the clinical urgency of the exam for which the image was produced Possible values are ROUTIN
48. ed values PATIENT CRAY To meet this condition the patient name for an image must contain the characters CRAY Any characters may precede or trail these characters Names like CRAY MCCRAY and CRAYNE will meet this condition but CREY will not PATIENT SMIT To meet this condition the patient name for an image must start with the characters SMIT after which exactly one character may follow Names like SMITH and SMITT will meet this condition but SMITHSON will not PATIENT PETERS N To meet this condition the patient name for an image must start with the characters PETERS then contain one arbitrary character then end with N Names like PETERSON and PETERSEN will match this comparison but PETERSSEN will not 20 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Defining Routing Rules Values for Date Time Properties When condition based on date and time is used the supplied value must adhere to VA FileMan conventions Values for date time conditions are presented as a range enclosed in braces The most frequently used date time property is NOW NOW can be used to select the times that a staff member will be present by specifying certain workdays and times of day Send CR images to Kansas on Mon Wed Fri send KANSAS when MODALITY CR NOW MON 08 00AM to 17 00PM WED 08 00AM to 15 30PM FRI 08 00AM to 17 00PM Date time properties can also be used to specify holidays In this
49. ed your routing rules as described in the previous chapter Creating and Importing a Routing Rules File Routing rules are initially defined in the DICOM Dict Route dic file which is stored on the Routing Gateway This file can be created and modified using any text editing program Routing rules take effect after Route dic has been imported into a local MUMPS table used by the Routing Gateway To create and import routing rules 1 On the Routing Gateway use a text editor to open x DICOM Dict Route dic where x is the name of the drive used by the Routing Gateway to store dictionary files The first time routing rules are defined this file will need to be created If you are modifying an existing file it is recommended that you create a backup copy of the file 2 Enter your rules gt Route dic must end with a line feed To ensure proper termination of the last meaningful line add a comment line after the last routing rule such as last update on 1 April 2003 end of file 3 Save the file into the directory noted in Step 1 When using programs such as Microsoft Word make sure that the file is saved in text only mode Confirm that the file extension is not changed by the text editor The file will only be imported if it is named Route dic and if it is stored in the proper directory 4400 VisthImagingV 3 0 Patch18 April 2006 Routing User Guide Configuring Routing 4 Open a terminal
50. emote Cache Indicator Manager In Use by IMAGPROVIDER8 8 on vhaiswimgs1 File View Help Exam List Refresh Exams Patient Lookup O Remote Read Filter i Route Exams Patient Exams Unread Exams Custom Exam History All Active Exams fo UNREAD EXAMS All Examined by Priority Date Time y 040600 28 IMAGPATIENT1011 CHEST SINGLE VIEW ary 2000 10 58 EXAMIN Y 092602 123 IMAGPATIENT1011 11011 4 Rout CT ABDOMEN W CONT 09 26 2002 018 03 EXAMIN 12 Y CT 112403 176 IMAGPATIENT1201 11201 4 Rout CHEST 2 VIEWS PA amp LAT 11 24 2003 17 07 EXAMIN 2 Y Routel CR 112403 175 IMAGPATIENT1201 11201 4 Rout CT THORAX WICONT 11 25 2003 009 43 EXAMIN 66 Y Route CT 112403 179 IMAGPATIENT1202 11202 4 Rout CHEST 2 VIEWS PARLAT 11 25 2003 010 30 EXAMIN 2 Y CR 112403 180 IMAGPATIENT1203 11203 4 Rout SHOULDER 2 OR MORE 11 25 2003 10 40 EXAMIN 6 Y CR 112403 181 IMAGPATIENT1203 11203 4 Rout MAGNETIC IMAGE UPPE 11 25 2003 10 53 EXAMIN 93 Y MR 112403 183 IMAGPATIENT1204 11204 4 Rout ABDOMEN 3 OR MORE 11 25 2003 11 08 EXAMIN 4 Y CR 112403 182 IMAGPATIENT1204 11204 4 Rout CHEST 2 VIEWS PA amp LAT 11 25 2003 11 19 EXAMIN 2 Y CR 112403 184 IMAGPATIENT1204 11204 4 Rout CT ABDOMEN W CONT 11 25 2003 11 27 EXAMIN 113 Y CT AAA ANA AOE IBAA Aes ITA MINI LAI a PR or TIP PAS ads I A A IAI IAA ERA A A ras Ae ate nw ar oT Values in the RC column are based on the SITE field in the sending site s NETWORK LOCATION F
51. ese documents are available at http vaww va gov imaging Apr 2006 VistA Imaging V 3 0 Patch 18 vil Introduction Routing User Guide This page is intentionally blank viii VistA Imaging V 3 0 Patch 18 Apr 2006 Routing Overview This chapter explains how routing functions within the VistA Imaging system It covers the following topics Routing Explained How Autorouting Works How On Demand Routing Works How Routing Priority Works Routing Explained In VistA Imaging routing is the combination of methods and software used to identify and transmit exams produced at one site to a storage location at another site Routing takes two forms autorouting and on demand routing In autorouting automatically selected images are transmitted to one or more destinations Images are selected based on a predefined set of routing rules Autorouting functions are managed using the Routing Gateway In on demand routing manually selected exams are transmitted to one or more destinations Exams are selected using the VistARad diagnostic workstation and are transmitted by the Routing Gateway Destinations of routed images fall into two broad groups Imaging destinations are defined to support remote reading using a VistARad workstation Images sent to these destinations are in VistA Imaging s internal file format DICOM destinations are defined to support transmission of DICOM images to a Storage SCP Service Class Provider s
52. estination For more information refer to the previous section The sending site should work with the receiving site to estimate the amount of storage space needed based on the anticipated volume of transmitted images and the planned retention period Folder Creation When the folder to be used as an Imaging destination is established by the receiving site the receiving site will need to choose a logical folder name and share name The share name will ultimately be referenced in the sending site s NETWORK LOCATION File Creating amp sharing a folder to be used in an Imaging destination 1 Log in as an Administrator to the computer where you will be creating the folder and start Windows Explorer choose Start Run then type Explorer 2 Select the drive or folder that you want to create the new folder in 3 Click File New Folder After the new folder appears in the right side of the Explorer window type the name of the new folder and press Enter 4 Right click the new folder then click Sharing 28 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Configuring Routing 5 In the Sharing tab click the option that allows for sharing the folder then enter the share name you want used for the folder The share name cannot contain punctuation marks or spaces and the combined string identifying the computer and the shared folder cannot be more than 63 characters long The share name you enter must m
53. ets that can be used while setting up a routing system They can also be used for record keeping purposes The following worksheets are provided Imaging Destination Worksheet DICOM Destination Worksheet Routing Rule Definition Worksheet Routing Setup Checklist April 2006 VistA Imaging V 3 0 Patch 18 69 Appendix A Routing User Guide This page is intentionally blank 70 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Appendix A Imaging Destination Worksheet Use this worksheet to record information about a specific Imaging destination A sample Network Location File definition is provided on the next page Destination name Site served by destination General purpose of this destination Alternate backup destination Storage folder name Destination computer share name Username password for destination Associated user group if any File types transmitted to destination circle those that apply Abstract Full Text Big Retention period in days Specified in the 01 field in the NETWORK LOCATION file Referenced in routing rules Route dic and in the CacheLocationID parameter for VistARad workstations at receiving sites Specified by receiving sites when creating a storage folder Referenced sending site s NETWORK LOCATION file Specified in sending site s NETWORK LOCATION file April 2006 VistA Imaging V 3 0 Patch 18 71 Appendix A NETWORK LOCATION File Sa
54. file b As the InstallShield script is executed click on Next OK and Finish as appropriate The software will be installed into its own folder under C Program Files VistA Imaging 3 Set up system variables for the decompression service as follows a Open the Windows Control Panel click Start Settings then double click on System April 2006 VistA Imaging V 3 0 Patch 18 79 Appendix B Using MAG_Decompressor Routing User Guide b Inthe System Properties dialog click the Advanced tab then click Environment Variables In the System Variables list at the bottom of the dialog locate the following variables and adjust the values if needed DECOMP_LOG_FSPEC the path and file name of the decompression service log file The administrative user must have write permission for this file The format of this name must follow the usual pattern lt drive gt lt path gt lt filename gt lt ext gt neither lt filename gt nor lt ext gt may contain a period DECOMP_LOG_FILE_MBYTES the maximum size permitted for the decompression service log file default is IMB when this limit is reached the old log file is renamed and a new one is created The last 10 files are retained DECOMP_WATCH_DIR the root directory of the directory tree that will be monitored by the decompression service default is c This value should be changed to reflect the folder that is receiving compressed images The format of this name must follow the
55. hat it sends exams to the transmission processor will map a drive using the following progression of drive letters Q Z then G P If a drive letter Q for example is not available it will move to the next letter R for example and so on When all entries for a particular destination have been processed the applicable drive is unmapped This logic is not used for DICOM destinations Factors Affecting Routing Speed Given a T1 connection and a light to moderate amount of network traffic the first images in a routed exam will typically begin arriving at a destination within minutes However any of the following can impact the delivery of routed exams A backlog of images at the Image Gateway which is responsible for adding entries to the rule evaluation queue A backlog of entries in the transmission queue If numerous large exams are flagged for routing in a brief period of time there will be a delay while all the images in the exam are transmitted In situations where multiple destinations are being used additional transmission processors may be used to alleviate delays For more information see page 51 Problems connecting to destinations For Imaging destinations the routing software will attempt to re connect or retransmit the number of times specified for each destination in the NETWORK LOCATION File 2005 2 For DICOM destinations retry attempts are part of the DICOM transmission protocol Failed connection or t
56. he routing username here gt PASSWORD lt Use the routing password here gt MAINTAINCONNECTION lt blank gt MAX RETRY ON CONNECT 3 MAX RETRY ON TRANSMIT 5 SYNTAX U UNC SUBDIRECTORY lt blank gt Select USER lt blank gt RETENTION PERIOD 5 LAST PURGE DATE lt set by routing software gt SITE lt set as appropriate for your site gt ROUTER Y YES TIME OFFLINE lt blank gt MUSE SITE lt blank gt MUSE VERSION lt blank gt Imaging Destination Definition using the Background Processor The Background Processor software can also be used to define an Imaging destination in the NETWORK LOCATION File 2005 2 In the Background Processor choose Edit Network Location Manager A destination definition worksheet is also located on page 71 Imaging Destination Values Fields used in the NETWORK LOCATION File are described below These fields are listed in the order that they are defined in the file and their descriptions assume that a routing destination is being defined NETWORK LOCATION The value of this field will serve as the destination name for the location where image files will be sent The routing software will accept uppercase alphanumeric characters and dashes but will not accept values that use lowercase characters or other punctuation marks The value for this field is used in the routing rules file described on page 44 The value for this field can be different fro
57. he dialog to choose a single priority for all listed exams 62 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Using VistARad in a Routing System The priority assigned to exams for on demand routing is not related to the exam priority indicated in VistARad s exam lists 7 Confirm that the settings in the Route Request dialog are correct gt You can choose not to route a listed exam by selecting the Route To box for that exam and choosing the Do Not Route option You can click Cancel to close the Route Request dialog without routing any exams 8 Click OK to route the exams When the exam is received by the receiving site the RC column entry for that exam will show the name of the receiving site April 2006 VistA Imaging V 3 0 Patch 18 63 Using VistARad in a Routing System Routing User Guide This page is intentionally blank 64 VistA Imaging V 3 0 Patch 18 April 2006 Troubleshooting Routing This chapter covers the following topics Basic Troubleshooting Getting Help Additional Routing Considerations Basic Troubleshooting If images are not arriving as expected at a routing destination perform the following Steps This is the first time that routing Verify that all configuration steps described in this document software is being used have been completed Configuration checklists are available in Appendix A Exams are not being routed or 1 Check the Image Gateways and verify th
58. he instructions at the prompt Possible destinations are 125 KANSAS at TELERAD3 wichita 152 ST LOUIS CR at whaestivistarad 164 IMAGPROVIDER1 at C REMOTE IMAG1 166 LEAVENWORTH KS at C REMOTE LVW 167 IMAGPROVIDER2 HOME at C REMOTE IMAG2 168 ST LOUIS MO at C REMOTE STL Select destinations by gt Enter their number s separated by commas gt Enter an asterisk to select all possible destinations Prefixing an entry with a dash deselects the listed destinations Enter a period when the selection is complete o gt 5 The destinations you selected will be displayed Enter a period when you are finished 6 Position and size the terminal window for subsequent monitoring As the transmission processor sends exams to Imaging destinations it will map and un map certain drives For more information see page 66 7 To start additional transmission processors repeat steps 1 6 in a new terminal window 52 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Using the Routing Gateway Maintaining Routing This section provides a summary of maintenance tasks for a routing system and explains how to access Routing Gateway log files Periodic Maintenance The following tasks should be performed periodically to control the size of the transmission queue and to detect potential routing problems Task Interval Check terminal windows for evaluation 2 3 times daily and transmission processors
59. hen the routing software deletes the local copy of the exam The addition or removal of the indicator is dependent on a specific representative image in the routed exam A representative image is the last image processed by an Image Gateway for a given exam Typically the representative image is also the last image in an exam s clinical sequence Image Gateways process images in the order that they are received from a modality Some modalities may send images to Image Gateways in an order other than the expected clinical sequence If this occurs and if such an exam is routed the RC column may be populated before transmission of all the exam s images has completed A user opening such an exam may experience a delay while part of the exam is retrieved from the sending site Preventing Transmission of Duplicate Exams For Imaging destinations the transmission processor will check the destination to see if the image to be routed is already present If a duplicate of the image is found the transmission processor removes the redundant entry from the transmission queue and moves on to the next entry in the queue For DICOM destinations image management and duplicate checking is the responsibility of the destination system April 2006 VistA Imaging V 3 0 Patch 18 67 Troubleshooting Routing Routing User Guide This page is intentionally blank 68 VistA Imaging V 3 0 Patch 18 April 2006 Appendix A This appendix contains workshe
60. ies in Transmission Queue Re Queue all Failed Entries in the Transmission Queue Remove Obsolete Entries from Transmission Queue Display Routing Rules 1 2 3 4 5 6 7 8 9 O 1 1 Start the Transmission Processor Use this option to start the transmission processor Once started the transmission processor will begin processing entries in the transmission queue As the transmission processor sends exams to Imaging destinations it will map and un map certain drives For more information see page 66 If a single transmission processor cannot manage a site s routing workload additional transmission processors each sending images to a subset of destinations can be started using this option For detailed steps see page 51 2 Stop the Transmission Processor Use this option to stop all running instances of the transmission processor When this option is executed a flag is set that the transmission processor will recognize as stop processing The transmission processor checks this flag after transmitting each image file Stopping the transmission processor can result in an incomplete exam being sent to a destination If this occurs the remainder of the exam will be transmitted when the transmission processor is re started provided that the applicable entries in the transmission queue are still present April 2006 VistA Imaging V 3 0 Patch 18 55 Using the Routing Gateway Routing User Guide 3 Start the Evalu
61. ile 2005 2 When VistARad is used at a site that is the source of routed exams the RC column can be used to determine which exams have been routed and where they have been routed to When VistARad is used at a site that is the destination of routed exams users will need to log into the sending site s VistA system After logging in VistARad will automatically filter exam lists to include only routed exams this filter can be removed if desired see the next page for details Detailed steps for displaying routed exams are on the next page April 2006 VistA Imaging V 3 0 Patch 18 59 Using VistARad in a Routing System Routing User Guide To display a routed exam 1 Log into the site or division that the routed exam was sent from 2 Use an exam list to locate the routed exam you want to open By default exam lists are filtered to show only exams that have been routed from the site or division you are performing remote reading for Remote Cache Indicator Manager In Use by IMAGPROVIDER8 8 on vhaiswimgs1 tia File View Help Exam List Refresh Exams Patient Lookup O Remote Read Filter fj Route Exams NE Patient Exams Unread Exams Custom Exam History All Active Exams fo UNREAD EXAMS All Examined by Priority Date Time y 040600 28 IMAGPATIENT1011 CHEST SINGLE VIEVY arr 17200010 58 EXAMIN Y 092602 123 IMAGPATIENT1011 11011 4 Rout CT ABDOMEN W CONT 09 26 2002 18 03 EXAMIN 12 Y CT 112403 176 IM
62. ing can also be initiated from a destination site as long as the destination site is logged into the location division where the exams to be routed were acquired April 2006 VistA Imaging V 3 0 Patch 18 7 Routing Overview Routing User Guide How Routing Priority Works The following factors are used to determine the priority of a routed exam Assigned priority Clinical urgency autorouting only Time in transmission queue Priority and Autorouting For automatically routed exams the routing software uses the priority assigned in a routing rule and the clinical urgency of the exam to calculate a numeric value Images with the highest priority value are transmitted first Assigned priority Low 250 Priority is set in routing rules as described Medium 500 On page 9 High 750 If not explicitly set a default value of Medium is used Clinical urgency Routine 0 Values are based on the clinical urgency Urgent 10 defined for the exam in the VistA system STAT 20 Priority and On demand Routing When an exam is routed on demand VistARad s Route Request dialog can be used to assign a priority of Low Medium or High The clinical urgency of the exam is not used The Route Request dialog is described on page 61 If a user selects an exam to be routed on demand that is already in the transmission queue the higher priority of the two instances will be used Other Priority Factors If two or more
63. jma Routing User Guide DRAFT VistA Imaging V 3 0 Patch 18 April 2006 VistA Imaging Software Design amp Development Veterans Health Administration Department of Veterans Affairs Routing User Guide DRAFT Patch 18 April 2006 Property of the US Government No permission to copy or redistribute the software described in this document is given Use of unreleased versions of this software requires the user to execute a written test agreement with the VistA Imaging Development Office This is a controlled document No changes to this document may be made without the express written consent of VistA Imaging Development Office While every effort has been made to assure the accuracy of the information provided this document may include technical inaccuracies and or typographical errors Changes are periodically made to the information herein and are incorporated into new editions of this document Product names mentioned in this document may be trademarks or registered trademarks of their respective companies and are hereby acknowledged VistA Imaging Software Design amp Development Department of Veterans Affairs 1335 East West Highway 3 Floor Silver Spring MD 20910 301 734 0100 April 2006 VistA Imaging V 3 0 Patch 18 ii Contents Introdu iria V Termsion Usan sd V PDO ds vi Related Document aani inanes a tits vil ROUTING OVINA AAA 1 ROUTING EXP Claras 1 FRO WEG Prerrequisito a 2 HOW AUCOTOUCNO WOKS erra ta
64. last resort the KERNEL SITE PARAMETER field for the number of the institution will be used April 2006 VistA Imaging V 3 0 Patch 18 15 Defining Routing Rules Routing User Guide Other Properties ABSTRACT REF The network storage location of the image abstract ACQUISITION_DEVICE The name of the device that generated the image as defined in the ACQUISITION DEVICE File 2006 04 BIG JUKEBOX_PATH Full file path on jukebox for BIG images This field indicates whether this file is located on the jukebox BIG MAGNETIC PATH Full file path for BIG images This field indicates on which magnetic server this file resides CLASS The class of the image as stored in the CLASS INDEX field 2005 41 Typical values are CLIN ADMIN CLIN ADMIN and ADMIN CLIN CLINIC If an image is associated with a patient encounter visit the value of this parameter is the name of the clinic where the appointment occurred DESCRIPTIVE_CATEGORY This is mainly for Document Imaging it further describes the type of document image EXAM TIME The date time of the procedure or the examination For more information see page 21 EXAM_TIME can be used to compare the exam date time of the image at hand to the provided value EXAM_TIME_FIRST can be used to compare the exam date time of the earliest oldest image in the exam to the provided value EXAM_TIME_LAST can be used to compare the exam date time of the latest newest image in the exam
65. ll sites in the routing system and filed with the VistA Imaging HSD amp D group The contingency plan must contain procedures to be followed should the routing system be unavailable General hardware and operational requirements for routing are summarized below For detailed information contact your VistA Imaging Implementation Manager Infrastructure Requirements Routing relies on the following infrastructure If remote interpretation is being performed one or more VistARad diagnostic workstations for the display of routed exams An operational VistA Hospital Information System an operational Image Gateway and an operational Routing Gateway configured as described in this document An operational Local Area Network LAN An operational Wide Area Network WAN with sufficient bandwidth to manage the anticipated volume of routed exams Windows based servers to provide exam storage at each routing destination configured as described in this document 2 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Routing Overview Operational Requirements The medical and IT management at a site implementing the routing system will need to develop policies establishing Locations to which the exams may and may not be routed Reporting transcription requirements for routed exams Bandwidth utilization guidelines and priorities Storage of routed exams at receiving sites Management of patient confide
66. m the actual directory name or share name used for physical network location being referenced 32 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Configuring Routing PHYSICAL REFERENCE The value of this field identifies the physical network location where routed images will be stored This value must contain the computer name and the share name of the directory where routed images will be stored ISWIMGO1 IMAGE1 TeleRad Wichitas This value must be entered using UNC Universal Naming Convention standards This field is limited to 63 characters in length must end in a backslash 1 and the part of the name that identifies the computer cannot contain punctuation TOTAL SPACE SPACE USED FREE SPACE These fields are not used for routing The Background Processor uses these fields and will set values as needed OPERATIONAL STATUS The value for this field can be 0 off line or 1 on line The routing software will set this value appropriately as it is operating When no connection can be established the routing software will set this field to 0 off line Once this field is set to 0 the routing software will not attempt to reach the storage location referenced in this entry for 15 minutes After 15 minutes have passed the routing software will reset this field to 1 and then try to connect again STORAGE TYPE The value of this field describes the media type for the storage location identified above For r
67. mple For detailed information about specific fields see page 32 Select NETWORK LOCATION TESTDEST Are you adding TESTDEST as a new NETWORK LOCATION the 11TH No Y PHYSICAL REFERENCE VHAxxxxxx images STORAGE TYPE MAG MAGNETIC TOTAL SPACE lt blank gt SPACE USED lt blank gt FREE SPACE lt blank gt OPERATIONAL STATUS 1 On Line HASH SUBDIRECTORY lt set as appropriate for your site gt ABSTRACT N No FULL Y Yes BIG Y Yes TEXT Y Yes DICOM N No COMPRESSION lt blank or J2K gt USER NAME lt Use the routing username here gt PASSWORD lt Use the routing password here gt MAINTAINCONNECTION lt blank gt MAX RETRY ON CONNECT 3 MAX RETRY ON TRANSMIT 5 SYNTAX U UNC SUBDIRECTORY lt blank gt Select USER lt blank gt RETENTION PERIOD 5 LAST PURGE DATE SITE lt set as appropriate for your site gt ROUTER Y YES TIME OFFLINE lt blank gt MUSE SITE lt blank gt MUSE VERSION lt blank gt 72 VistA Imaging V 3 0 Patch 18 Routing User Guide April 2006 Routing User Guide DICOM Destination Worksheet Use this worksheet to record information about a specific DICOM destination Destination name Site served by destination General purpose of this destination Alternate backup destination Calling AE Title Called AE Title IP address hostname Socket port Presentation Context Transfer Syntax list all used DICOM Destination Sample
68. ng 10 exams Once DEST1 has received 10 of the exams the routing software will skip DEST1 until the counter resets The next 60 CR exams are split evenly between DEST2 and DEST3 After this point DEST2 and DEST3 each have a total of 40 exams DEST2 now has its allotment of 40 exams and will be skipped until the counter resets The remaining 10 CR exams are sent to DEST3 giving that destination a total of 50 exams Once 100 CR exams have been sent the routing software resets its counters to zero and starts distributing exams to all three destinations again Note that a destination receiving a comparatively smaller percentage of exams will become idle more often than destinations that receive a greater percentage of exams Resetting the Load Balancing Counter When routing rules are imported the counters used for load balancing are all reset to zero You can take advantage of this trait if you need to fine tune or troubleshoot situations where load balancing is used Note that it is not necessary to change routing rules to achieve this you only need to re import them April 2006 VistA Imaging V 3 0 Patch 18 13 Defining Routing Rules Routing User Guide Rule Conditions In routing rules a condition is a comparison between a particular property of an image and a user supplied value The results of the comparison determine if the rule will be applied to an image or not A routing rule can contain multiple conditions A si
69. ng Convention 1s accepted SUBDIRECTORY Typically this field is left blank The value of this field determines if a subdirectory under the directory specified in PHYSICAL REFERENCE should be used to store files for this destination If hashing 1s turned off all transmitted files will be stored in the subdirectory specified in this field if hashing is turned on all transmitted files will be stored in subdirectories of this subdirectory Select USER lt Future use gt The values that may be entered for this multiple valued field are e mail addresses that will be used by a future version of the routing software to notify people about significant events related to routing activities April 2006 VistA Imaging V 3 0 Patch 18 35 Configuring Routing Routing User Guide RETENTION PERIOD The value of this field determines the number of days routed image files are stored at this destination A typical value is five days Whenever a transmission processor connects to a destination it checks whether or not it has executed a purge for that destination on that day If the connection in question is the first of the day and no purge has been executed yet a purge will be initiated During a purge any image files older than the number of days specified by RETENTION PERIOD are deleted note that files are always retained at the sending site LAST PURGE DATE The value of this field 1s set by the transmission processor when it executes a purge
70. ng an Imaging destination breaks down into the following steps 1 Establish naming conventions that are agreed on by the sending and receiving sites 2 Define storage folders for routed images at the receiving site and verify that the sending site can access those folders 3 Create routing specific entries in the NETWORK LOCATION File 2005 2 at the sending site A destination definition worksheet is located on page 71 Note Imaging destinations are defined to support remote reading using VistARad For information about defining a DICOM destination see page 37 Naming Conventions for Imaging Destinations Before an Imaging destination is established the sending and receiving sites should decide how to identify themselves to routing users The values that identify an Imaging destination are stored in the NETWORK LOCATION File 2005 2 at the site where the Routing Gateway is installed The values defined for the following should be related in some way Fed Descripon Nowe Network The official Used by routing rules and the Routing Location destination name Gateway at the sending site Referenced 01 in VistARad CacheLocationID at appropriate receiving site Cannot match any other name in the NETWORK LOCATION File or in the DICOM TRANSMIT DESTINATION File 2006 587 30 max no spaces or punctuation The value used should contain the nationally assigned 3 character site code and should indicate that the entry in
71. ngas uw ciel AA A tae es 4 How On D emang ROUTING WOrKS uns ld 7 ROW ROUNO PO IAN RS aaa dds 8 Defining ROUTING RUNS iiwinicivcssscsccccareciecscatevativeivanesticseessesecantavarcacuetesescsassaeredcss 9 ROUTING RUNES EXI Nina aio 9 RUIG Destacar nico 12 RUS COMICIOS antracita bebidas 14 ROUUNO RUS PO ins 22 ROUTING Images fom Pror EXAMS aaa 22 ROUTING RULE TIPS aaa tdt datos 23 CONMGUFING ROUTING essa tira cai AR ica 25 Defining imaging Destinatarios 26 DeTINITNADICOMDESIISIONS carnada 37 Defining ROUTE PROFS LOGIC miira a EA 40 DICOM Gateway COntQUratlO Niwisnissira tira luarnarta dna rnd marta been pean 42 Importing Routing Rules ROUTE CIC pal 44 VistARad Configuration Sending SIteS ccccccceceececeeeeeeeeeeeeeeeeeeeeeeeeeeeeeaeeeeaeseeneseeeeantgeags 47 VistARad Configuration Recelving Sites oococccconoconnococnonononnncnnnncnnnoronnnnonnnnornnnnrnnnorennonens 48 Changes Affecting Routing System Configuration ocoococcccconocnnccnnnnnncnnrnnnnnoncnnnnnnoronrnanannoss 50 Using the Routing Gateway visiiccecscccccsscsesesescsescrencnesersusescutseccssascseccncscsssvaseverencn 51 PCV GUI ROUND ela biblas 51 Math Cail ROUTING i cwizews iia 53 VIS SII ROUN aer dado ano 54 Routing Gateway Menu ODUONS ciutat iaii 55 Using VistARad in a Routing SySteM cococcconononononononononnnnnnnnnnnnnnrnrnenennnnnnnnnnananas 59 DISPO ROUTO EX Sa idos 59 VistARad amp On Demand OUT dina aa 61 April 2006 VistA Imaging V 3 0
72. ngle when statement precedes all conditions in a rule se a RANSASCITY when MODALITY CR SOURCE WICHITA The parts of a condition are property operator value A property 1s one of the known attributes of an image Properties that can be used in a condition are listed the following section An operator 1s a code for a type of comparison Operators are described on page 20 A value 1s a text or date string supplied by the user A value specifies what 1s being tested in the condition Values are described on page 21 Properties The properties listed in this section can be used in routing rule conditions Property names are not case sensitive However properties are typically rendered in uppercase Frequently Used Properties MODALITY Abbreviation for the type of modality Possible values are listed below Retired values are indicated by ret AS Angioscopy MA Magnetic Resonance Angiography AU Audio MG Mammography BI Biomagnetic Imaging MR Magnetic Resonance CD Color Flow Doppler MS Magnetic Resonance Spectroscopy CF Cinefluorography NM Nuclear Medicine CP Colposcopy OP Ophthalmic Photography CR Computed Radiography OT Other CS Cystoscopy PR Presentation State CT Computed Tomography PT Positron Emission Tomography PET 14 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide continued DD Duplex Doppler DF Digital Fluoroscopy ret DG Diaphanography DM Digi
73. ns 26 on demand routing to 61 passwords for 28 29 storage folders for 28 30 user names for 28 29 worksheet 71 importing routing rules 44 46 56 J L JPEG 2000 34 79 keys security 61 lists see exam lists load balancing 12 locks exam 60 83 log files 53 M N MAG RAD PRIOR EXAMS LOGIC File 40 MAG VISTARAD SITE PARAMETERS File 47 MAG_Decompressor 79 MAGJ DEMAND ROUTE DICOM key 61 MAGJ DEMAND ROUTE key 61 MAGJ INI 48 maintaining routing 53 manual routing see on demand routing mapped drives transmission processor and 66 modality routing rules and 14 MSM server 51 multiple conditions in routing rules 10 23 multiple evaluation processors 46 naming conventions DICOM destinations 37 Imaging destinations 26 NETWORK LOCATION FILE 2005 2 described 83 field descriptions 32 39 Imaging destinations in 31 sample values for 31 72 Routing User Guide O P obsolete trans queue entries purging 57 on demand routing described 1 7 83 requirements for 61 using 61 see also routing operators routing rule 11 20 passwords 28 29 patient information transmission of v prior exams routing 5 22 40 priority routing 8 22 procedures see exams purging the transmission queue 56 57 R RC Remote Cache column 36 59 67 receiving sites configuration tasks for 25 described 83 displaying routed exams at 60 exam list filtering for 47 VistARad configuration for 48 see also destinations related exams routing 5 22
74. ntiality and privacy issues related to routed exams Methods for addressing performance issues and or misuse of the routing system April 2006 VistA Imaging V 3 0 Patch 18 3 Routing Overview Routing User Guide How Autorouting Works The following figure illustrates the transfer of automatically routed images to a VistARad workstation for remote reading The processes outlined in this figure are explained in more detail below Apart from the destination the same processes are used when autorouting images to a DICOM Storage SCP Image G W Routing G W Routing G W Images Images _ processes compares copies le wad acquired images then image data routable images d ei ei archives images to routing rules 1 to destination 2 Patient E VistARad 1N Sending Site Destination Site gt O O O O VistARad fade e Gateway S 2 dl Gateway Eval Processor nae Processor 3 E Ca A Local image copies Image Archive Remote Storage Destination Identifying Images to be Autorouted Autorouting begins with an Image Gateway As it is processing newly acquired images a properly configured Image Gateway will add routing specific entries to the rule evaluation queue This queue is continually checked by the evaluation processor which resides on the VistA Host and is started from the Routing Gateway If the Image Gateway is not configured to add entries to the rule evaluation queue the images being processed by the gate
75. o a DICOM Storage SCP destination the MAGJ DEMAND ROUTE DICOM key must be assigned to their account Using On Demand Routing On demand routing lets you use VistARad to manually select exams and transmit them to existing routing destinations On demand routing is intended for situations where you need to route exams that do not satisfy existing routing rules or where autorouting is not used If you are frequently using on demand routing for the same sorts of exams contact your Imaging Coordinator and request that a change or addition be made to the rules used for autorouting Any exam that appears in a VistARad exam list can be routed on demand Newly acquired exams should not be routed until they have been case edited by a technologist using the Radiology package Such exams have a status of examined in VistARad s exam lists April 2006 VistA Imaging V 3 0 Patch 18 61 Using VistARad in a Routing System Routing User Guide To use on demand routing 1 Log into VistARad The VistARad workstation used for on demand routing must be logged into a VistA system that includes a Routing Gateway If you have access to more than one division log into the division where the exams to be routed originate from 2 Use the exam lists in the VistARad Manager to select the exams you want to send 3 Click the Route Exams button located in the upper right corner of the exam list If the Route Exams button is not present your user
76. on into a rule that can be executed by the routing software gt A rules definition worksheet is located in Appendix A How Routing Rules Work Routing rules are defined in a text file and are implemented when the text file 1s imported into a local table on the Routing Gateway A basic routing rule looks like send destination when condition A condition Bess April 2006 VistA Imaging V 3 0 Patch 18 9 Defining Routing Rules Routing User Guide Each routing rule must contain at least one destination and one condition When the conditions in a rule are met the image is sent to the specified destination The destination specified in a rule must match an entry in either the NETWORK LOCATION File 2005 2 or the DICOM TRANSMIT DESTINATION File 2006 587 Routing rule destinations are described in detail on page 12 A condition is a comparison between a general image property and the specific value associated with a particular image Conditions are described in detail on page 14 Sample Routing Rules The following pages contain examples of routing rules as they would be entered into the Route dic file For more information about the Route dic file see page 44 A Simple Routing Rule A common routing scenario is the transmission of images from a particular modality for remote interpretation Send CR images to Kansas City send KANSASCITY when MODALITY CR Rules using Multiple Conditions If
77. or for autorouting or by VistARad for on demand routing Processed entries can be purged from this queue using a Routing Gateway menu option 84 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Glossary VistARad In VistA Imaging the software used to display diagnostic quality radiologic exams VistARad is the primary tool used to display routed exams and to route exams on demand April 2006 VistA Imaging V 3 0 Patch 18 85 Glossary Routing User Guide This page is intentionally blank 86 VistA Imaging V 3 0 Patch 18 April 2006 Index A C after hours coverage 11 21 autorouting defining rules for 9 23 described 1 4 6 83 prior exams 5 22 40 see also routing Background Processor 32 balance command 12 cache remote see RC column storage folders CacheLocationID 48 comments in routing rules 23 completed trans queue entries purging 57 compression 34 79 conditions routing rule defining 14 22 described 14 examples of 10 11 configuration destination 26 39 general information 78 Image Gateway 42 Routing Gateway 43 routing rules 9 23 VistARad 47 49 configuration files MAG INI 48 Route dic 44 46 56 83 SCU_List dic 37 39 84 coverage after hours 11 21 customer support 65 D date time conditions 11 21 deleting routed exams 5 36 60 destinations described 1 83 DICOM 37 39 Imaging 26 36 routing rules and 9 12 13 VistARad and 48 49 DICOM destinations config
78. or more information see page 21 LAST_ACCESS can be used to compare the last access date of the image at hand to the provided value LAST_ACCESS_FIRST can be used to compare the last access date of the earliest oldest image in the exam to the provided value LAST_ACCESS_LAST can be used to compare the last access date of the latest newest image in the exam to the provided value MAGNETIC _REF The path for the network location of the stored image MICROSCOPIC _ OBJECTIVE Free text description of the Microscopic Objective selected by the pathologist It identifies the power of the microscope objective used when capturing an image of a slide OBJECT_NAME The natural language name for the image usually consisting of the patient name social security number and image description April 2006 VistA Imaging V 3 0 Patch 18 17 Defining Routing Rules Routing User Guide OBJECT _TYPE The object type such as still image black amp white image x ray as described in the OBJECT TYPE File 2005 02 PACKAGE An abbreviation for the name of the package that the image is attached to as defined in the PACKAGE INDEX field 2005 40 Possible values are RAD LAB MED NOTE CP SUR PHOTOID NONE or CONS PACS PROCEDURE The name in the radiology reports file that identifies the procedure PACS UID The unique 26 character image identifier of the PACS image PARENT DATA The name of the file that contains the Pa
79. ostic workstation and are transmitted by the Routing Gateway receiving site The recipient of routed images The receiving site provides either a storage folder for Imaging destinations or a DICOM Storage SCP for DICOM destinations for images to be routed to Route dic The DICOM Gateway dictionary file used to store routing rules April 2006 VistA Imaging V 3 0 Patch 18 83 Glossary Routing User Guide routing Inthe VistA system the process responsible for sending images across a WAN to one or more remote locations Routing can be performed automatically autorouting or on demand Routing Gateway A computer running the DICOM Gateway software that is configured to manage the routing of images in the VistA system A Routing Gateway is typically run on a dedicated computer Also the set of menu options in the DICOM Gateway software specific to routing routing rules The information used by the Routing Gateway to select images for autorouting Routing rules are defined in a text file and are imported into a MUMPS table used by the Routing Gateway routing system All of the software and hardware components related but not necessarily limited to routing Parts of the routing system include the Routing Gateway Image Gateways and VistARad workstations rule evaluation queue The queue used to determine if newly acquired images will be autorouted or not This queue is populated by Image Gateways Entries in this queue are compared to
80. outing destinations the value will be MAGNETIC HASH SUBDIRECTORY The value of this field determines if routed image files are stored in one single directory value is No or empty or in a hierarchy of directories value is Yes This value should be set based on the needs of your site ABSTRACT The value of this field indicates whether or not abstract files should be transmitted to this destination Abstract files also known as thumbnail or icon files are used by Clinical Display workstations FULL The value of this field indicates whether or not full files should be transmitted to this destination Full files contain the complete image potentially at a reduced resolution For routing this field should be set to Yes April 2006 VistA Imaging V 3 0 Patch 18 33 Configuring Routing Routing User Guide BIG The value of this field indicates whether or not big files should be transmitted to this destination Big files contain the complete image always at the original resolution For routing this field should be set to Yes TEXT The value of this field indicates whether or not text files should be transmitted to this destination Text files contain the header information from the original DICOM file For routing this field should be set to Yes DICOM Do not use COMPRESSION The value of this field is a code that indicates which type of compression will be used for routed images When the value of this field is
81. ransmission attempts are logged by the Routing Gateway The routing priority of a particular exam For more information see page 67 Routed Images vs Routed Exams The Routing Gateway evaluates and transmits data on an image by image basis If the transmission processor is disabled when an exam is partially transmitted the exam is usually treated as unrouted until the transmission processor is re started and the transmission of the exam is completed In some situations such as the presence of multiple Image Gateways or the use of on demand routing images from one exam will interrupt the transmission of images of an exam that is partially routed This can occur because entries are added to the rule evaluation and transmission queues for each image rather than for each exam Usually this behavior is invisible to the end user If a partially routed exam is opened from VistARad the VistARad software will first attempt to retrieve images from the local storage location identified in the MAGJ INI file 66 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Troubleshooting Routing for that workstation Images not found in local storage will be retrieved from their originating site How the RC Column is Populated The RC Remote Cache column in VistARad s exam lists is populated with a destination specific indicator when a routed exam is received by a destination The same indicator is removed from the RC column w
82. re takes the clinical urgency of an exam into account For more information see page 8 Routing Images from Prior Exams Images from prior exams can be automatically routed by adding a priorstudy statement after the conditions for the rule Do or Do Not include Prior Studies send KANSAS when MODALITY CT priorstudy YES send BACKUP when MODALITY CT priorstudy NO When priorstudy Is set to YES images from prior exams will be included based on routing specific settings in the MAG RAD PRIOR EXAMS LOGIC File 2006 65 Settings in this file are described in detail on page 40 When priorstudy Is set to NO or if the priorstudy statement is absent images from prior exams will not be included A Using priorstudy in a routing rule can significantly increase network traffic If a rule of this sort is implemented be sure to monitor the network to ensure no problems arise 22 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Defining Routing Rules Routing Rule Tips The following tips may be useful while creating or editing routing rules When defining multiple conditions for a rule list the most restrictive condition first This will reduce the amount of time needed to process the rule The number symbol can be used for comments or to disable a rule When disabling a rule precede each line in the rule with Spaces and line breaks can be used as needed for legibility Route dic must end
83. rent Data See also PARENT DATA FILE IMAGE POINTER PARENT _GLOBAL ROOT_DO and PARENT GLOBAL _ROOT_D1 PARENT DATA FILE IMAGE POINTER In the file identified by Parent Data a multiple valued field may exist that identifies groups of images When there is such a multiple the value of this parameter is the entry number in this multiple that points back to the parent image of the current image PARENT GLOBAL_ROOT_DO The internal entry number in the file identified by PARENT_DATA PARENT GLOBAL ROOT_D1 The value of this parameter is defined only for laboratory images to record the third subscript of LR DO SP D1 as a backward pointer for use in report display and image deletion PATH ACCESSION_NUMBER The Anatomic Pathology accession number the identifying number for the slide PATIENT The name of the patient PROCEDURE An abbreviation for the procedure as stored in the PROCEDURE field 2005 6 This field is set automatically by Imaging Typical values are COL for colonoscopy SUR for surgery SP for surgical pathology or XRAY for radiology PROCEDURE_OR_EVENT The name of the procedure or event for which the image was created as stored in the PROC EVENT INDEX field 2005 43 18 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Defining Routing Rules PROCEDURE_ TIME The date time of the procedure or the examination For more information see page 21 PROCEDURE_TIME can be used to compare th
84. route all images from a specific modality to a printer using the DICOM protocol for transmission and giving these transmissions a low priority Send LaserShare When MODALITY CT Priority Low Example 8 auto route all images from a specific modality to a DICOM t repository using the DICOM protocol for transmission and including images from prior studies send ER FilmAppla cation When MODALITY CT PriorStudy Yes April 2006 VistA Imaging V 3 0 Patch 18 71 Appendix A Routing User Guide Routing Setup Checklist Imaging Destination Setup a Username and password available for each destination b Folders created and shared for each destination c Ability to access and write to each storage folder verified d Network location entry defined for each destination e VistARad site parameters set up at sending site f CacheLocationID set on workstations at receiving sites DICOM Destination Setup a Destination information added to SCU_List dic b SCU_List dic updated on DICOM Gateway Destination application accessible DICOM Gateway Setup a Image Gateways configured properly b Routing Gateway configured properly Routing Rule Setup a Rules defined in Route dic b Route dic imported successfully Routing Activation a Image Gateways processing images b Routing Gateway evaluation processor activated c Routing Gateway transmission processor s activated d Images routed successfully
85. routing factors affecting 66 April 2006 Index storage folders defining 28 30 described 84 VistARad and 48 49 Studies see exams support 65 T time of day routing rules and 11 21 transmission processor described 5 84 drives mapped by 66 log files for 53 starting 52 55 Stopping 54 55 transmission queue populating 5 55 population of 7 purging 56 57 re queuing failed entries in 57 size of 53 56 troubleshooting routing 65 U Z unprocessed trans queue entries purging 57 user names 28 29 values in rule conditions 20 verifying routing rules 45 VistARad configuring for routing 47 49 described 85 displaying routed exams with 5 59 on demand routing and 7 61 63 using for multiple destinations 49 weekend weekdays routing rules and 11 21 wildcards 11 20 worklists see exam lists worksheets configuration 78 destination 71 73 routing rule 74 VistA Imaging V 3 0 Patch 18 89
86. ssor install lt Enter gt e Close the command window 5 Activate the decompression service as follows a Inthe Control Panel double click Administrative Tools b Double click Services On some versions of the Windows operating system this icon is labeled Component Services c Inthe window that opens locate the entry for the MAG J2K Decompressor Service d Right click on the entry and select Start Wait until the status display shows that the service 1s started e Right click again on the entry and select Properties f In the Properties wndow select Automatic as the startup type then click OK g Verify that the status display shows that the service is Automatic h Close all remaining Control Panel windows Y our system is now ready to start decompressing files that were routed in compressed form Note when parameters need to be modified the steps listed above can be used to establish new values for the parameters However it will be necessary to reboot the computer before the new values of the parameters will become effective MAG_Decompressor Logging The decompression software will run automatically when needed If problems are encountered review the log files generated by the MAG_Decompressor software Log files are stored in the location specified in the DECOMP_LOG_FSPEC system variable The ten most recently generated log files are retained Sample log entry 2005 04 19 16 59 01 April 2006 Vi
87. stA Imaging V 3 0 Patch 18 81 Appendix B Using MAG_Decompressor Routing User Guide 2005 04 19 16 59 01 S TAR TED Directory Watch Decompression Service over C test_img_cache 2005 04 19 17 01 10 C test_img_cache MAG_EyeClot J2K Status gt SUCCESS 0 2005 04 19 17 01 11 C test_img_cache MAG_Skull J2K Status gt SUCCESS 0 2005 04 19 17 01 19 C test_img_cache MAG_Spine J2K Status gt SUCCESS 0 2005 04 20 13 32 59 C test_img_cache MAG_Spine J2K Status gt OutFile Already Exists InFile Removed 2005 04 21 13 34 32 S TOPPED Directory Watch Decompression Service over C test_img_cache status ok Selected log file error codes 1 999 Aware JPEG2000 library errors 1000 Application errors 82 2006 3000 3001 3003 3004 EIFILEREMOVE input file remove error access violation EOFILEEXISTS output file already exists EOFILEOPEN error while opening the output file EOFILEWRITE problem attempting to write the data to the output file EOFILERENAME error while renaming output file from tmp to lt ext gt VistA Imaging V 3 0 Patch 18 April 2006 Glossary This manual uses the following terms autorouting The automatic transmission of selected images to one or more destinations Autorouting functions are managed using the Routing Gateway destination An intended recipient of routed images Destinations can be Imaging destinations such as VistARad workstations or DICOM destinations such as
88. t to different types of users All users The Routing Overview and the Glossary The Index can also be used to find information about specific topics in this document The Using VistARad in a Routing System chapter Users responsible for The Using the Routing Gateway chapter You may also DICOM Gateway find useful information in the Troubleshooting Routing operation and and Defining Routing Rules chapters maintenance Users responsible for The Defining Routing Rules and Configuring Routing installing or configuring chapters a routing system Installation worksheets are available in Appendix A Conventions This manual uses the following conventions Examples are shown in Courier Useful or supplementary information is indicated by a Y icon VA File Manager file names are shown in SMALL CAPS The first time a FileMan file is referenced in a topic the file number is indicated in parentheses Menu options buttons and other controls found in a graphical user interface are indicated by title case Menu sequences are indicated by vertical bars Cross references are underlined If this document is being used online cross references are shown in blue and are active links Sidebars shown in margins indicate new or revised content Acknowledgements This document is based on the Autorouting Tutorial authored by Ed de Moel Special thanks to Brian Belleau Craig W Hunter Cheryl Marland Arnold Pfenninger
89. tal Microscopy DS Digital Subtraction Angiography ret DX Digital Radiography EC Echocardiography ECG Electrocardiography Defining Routing Rules Px Panoramic X Ray RF Radio Fluoroscopy RG Radiographic Imaging conventional RTDOSE Radiotherapy Dose RTIMAXGE Radiotherapy Image RTPLAN Radiotherapy Plan RTRECORD RT Treatment Record RTSTRUCT Radiotherapy Structure Set EPS Cardiac Electrophysiology ES Endoscopy SM Slide Microscopy SMR Stereometric Relationship FA Fluorescein Angiography SR SR Document FS Fundoscopy ST Single Photon Emission Computed GM General Microscopy Tomography SPECT HC Hard Copy TG Thermography HD Hemodynamic Waveform US Ultrasound TO Intra oral Radiography VF Videofluorography IVUS Intravascular Ultrasound VL Visible Light VA extension LP Laparoscopy XA X Ray Angiography LS Laser Surface Scan XC External camera Photography NOW Date and time that the rule is being processed For more information see page 21 SOURCE Name of the site that originally acquired the image The value for this field is determined as follows If the ACQUISITION SITE field 2005 05 has a non empty value the value of this field is used otherwise If the end user credentials have a non empty value for the current division i e the location code for the DICOM Gateway from which the evaluation processor was started the number of this division will be used otherwise As a
90. tallations Executing this option will remove entries for files that have been transmitted successfully This option is intended for use at test sites If this option is used routed images will be orphaned at a destination rather than being deleted automatically after the defined retention period the images will remain until deleted manually To purge completed entries without orphaning routed images use the option described in the next section 56 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Using the Routing Gateway 7 Purge completed and expired entries in the Transmission Queue Use this option to control the size of the transmission queue Executing this option will remove entries if both of the following conditions are met The status of the entry indicates that an image file has been transmitted successfully The entry is older than the RETENTION PERIOD number of days for the applicable destination This option should be run once a month as part of a Routing Gateway s periodic maintenance cycle 8 Re Queue all failed entries in the Transmission Queue Use this option to try to re send routed images that could not be sent within the number of attempts specified for that destination This option should be run periodically as part of a Routing Gateway s maintenance cycle Sites that route a large number of exams or that route high priority exams should run this option daily Sites that
91. ter 4 to select System Maintenance from the DICOM Gateway Menu MAGDMENU Enter 2 to select Gateway Configuration and DICOM Master Files Enter 5 to select Update SCU_List dic When you are prompted to update the file enter Y Ready to read dictionary file lt x gt DICOM Dict SCU_List dic y y lt Enter gt 10 The file will be updated If the operation 1s successful you will be prompted to return 38 to the menu If you encounter any errors record the information and then press Enter You will need to correct the offending information and repeat the ten steps above VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Configuring Routing Field Definitions Fields defined in SCU_List dic and used in the DICOM TRANSMIT DESTINATION File 2006 587 are described below These fields are listed in the order that they are defined in SCU_List dic Application The name that will be used to identify the receiving application and to identify the destination in a routing rule The value for this field may be up to 31 characters in length is case insensitive and punctuation can be used Called AE The Application Entity Title of the application that is being called The value of this field is dictated by the system that will be receiving the DICOM transmission Calling AE The Application Entity Title of the application that initiates the call 1 e the Transmit DICOM Images to a DICOM SC
92. the DICOM Gateway and on the VistA Host The three following sections explain in detail how each general step is performed A destination definition worksheet is located on page 73 Note A DICOM destination must be a DICOM Storage SCP Service Class Provider For information about defining Imaging VistARad destinations see page 26 Naming Conventions for DICOM Destinations The first step in defining a DICOM destination is determining what to name the destination and how to identify the sender of DICOM images When selecting a destination name entered as the Application in SCU_List dic be sure that the name is 31 characters or less in length case insensitive punctuation is allowed and that the name does not match any name defined for an Imaging destination The sender of DICOM images Calling AE in SCU_List dic is the Transmit DICOM Images to a DICOM SCP function of the DICOM Gateway The name used to identify this function needs to be agreed on by the sender and receiver of the DICOM transmission The remaining information needed to define a DICOM destination is determined by the system that will be receiving the routed images This information is described in detail on page 39 DICOM Destination Definitions in SCU_List dic This section explains how to update SCU_List dic specifically for the purposes of routing and how to load the contents of SCU_List dic into the DICOM and VistA system databases The steps belo
93. ting software will use to log into the shared folder defined in the PHYSICAL REFERENCE field This username must include permission to read write and delete on the physical storage space for this destination PASSWORD The value of this field is the password that is used with the username above to log into the destination The password is case sensitive and is stored in an encrypted format MAINTAINCONNECTION This field is not used for routing and should be left blank MAX RETRY ON CONNECT Indicates the maximum number of successive attempts that will be made by the routing software to connect to this destination A typical value is three attempts If a successful connection cannot be made the destination will be marked off line After 15 minutes the destination will be marked on line and the routing software will begin trying to connect to this destination again MAX RETRY ON TRANSMIT Indicates the maximum number of successive attempts the routing software will make to transmit a file to this destination A typical value is five attempts When it is not possible to make a successful copy of an image within the number of attempts the entry for the image in the transmission queue will be marked as failed There is a Routing Gateway menu option to re transmit failed queue entries SYNTAX The value of this field is a code that indicates the format for the name of the physical location Currently only UNC Universal Nami
94. to the computer you will be using to test the folder on Open a command prompt window choose Start Run then enter CMD Enter the following command to map the folder to a local drive Parameters shown in bold will need to be replaced with valid values established by the receiving site gt net use x VHAxxxxxx sharename password u username After mapping the drive copy a test file to the folder and then delete the file If the file is successfully copied and deleted the routing software should be able to use the folder gt copy any file x lt path gt gt delete x lt path gt any file When you are satisfied that the above parameters can be used to successfully access the folder delete the test file then terminate the test connection gt net use x delete Be sure to terminate the test connection Letting a connection linger may prevent the routing software from establishing its own connection to the folder VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Configuring Routing Imaging Destination Definition Imaging Destination Definition using FileMan The following steps explain how to create an Imaging destination using FileMan For information about values for specific fields refer to page 32 A destination definition worksheet is also located on page 71 Editing the Network Location File at the sending site 1 Log into the VistA Hospital Information System 2 Use FileMan to select the NETWO
95. to the provided value EXPORT REQUEST STATUS The value of this field if defined indicates if MailMan will send or has sent the image to another site Possible values are 1 EXPORT REQUESTED O EXPORTED 16 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Defining Routing Rules FILE REF The unique image filename of the image as stored on the magnetic server and or jukebox IMAGE _ SAVED The date and time the image was captured as opposed to the date and time of the procedure or exam For more information see page 21 IMAGE_SAVED can be used to compare the save date time of the image at hand to the provided value IMAGE_SAVED_FIRST can be used to compare the save date time of the earliest oldest image in the exam to the provided value IMAGE_SAVED_LAST can be used to compare the save date time of the latest newest image in the exam to the provided value IQ A flag that indicates whether or not an image has questionable integrity as specified in the IQ field 2005 13 This field is either empty or equal to YES Note that images with questionable integrity will be transmitted but may not be displayed by the software on the receiving system On VistARad workstations a warning is displayed if a user opens an image with questionable integrity and only a user with the proper security key can actually display the image LAST ACCESS The date and time the image was last viewed or accessed F
96. uch as a film printer or an external PACS A properly implemented routing system can streamline a site s imaging workflow Scenarios where routing can be used include Workload sharing between institutions or service providers Rapid access of exams at remote clinics or other facilities Remote specialist interpretation or consultation Off hours holiday or emergency services Off site contract radiology services for primary interpretation April 2006 VistA Imaging V 3 0 Patch 18 1 Routing Overview Routing User Guide What is a Routing Gateway A Routing Gateway locates routable images determines where the images are to be routed to and sends copies of those images to other locations Routing is a function of the DICOM Gateway software When properly configured any DICOM Gateway can function as a Routing Gateway Typically a Routing Gateway runs on a dedicated computer At sites where only a small volume of images are produced a Routing Gateway can coexist on the same computer as an Image Gateway or a Text Gateway Routing Prerequisites For a site to be authorized to use a routing system An executed Site Agreement must be filed with the VistA Imaging HSD amp D group Note An updated site agreement must be filed if the routing system is altered for example if site information changes if a new destination is added or if routing volume increases by 50 or more A contingency plan must be implemented at a
97. uring 37 39 described 1 5 in SCU_List dic 37 naming conventions 37 DICOM destinations cont on demand routing to 61 worksheet 73 DICOM Gateway 2 see also mage Gateway Routing Gateway DICOM SCPs routing to 5 37 DICOM TRANSMIT DESTINATION File 2006 587 39 83 displaying routed exams 5 59 displaying routing rules 57 drives transmission processor and 66 evaluation processor described 4 83 log files for 53 multiple instances 46 starting 51 56 Stopping 54 56 exam lists filtering at receiving site 47 RC column in 36 59 67 using for on demand routing 62 exam locks 60 83 exams routed compression 34 79 deleting 5 36 60 DICOM SCPs and 5 displaying 5 59 dividing between destinations 12 prior 5 22 40 priority of 8 22 representative images in 67 expired trans queue entries purging 57 exporting exams to DICOM SCPs 5 F failed trans queue entries re queuing 57 filtering exam lists 47 folders storage described 84 for Imaging destinations 28 30 VistARad and 48 49 formatting routing rules 23 April 2006 VistA Imaging V 3 0 Patch 18 87 Index H I help desk 65 hidden shares creating 29 historical exams routing 5 22 40 holidays routing rules and 11 21 IMAGE BACKGROUND QUEUE File 2006 03 4 83 Image Gateways 4 42 67 images representative 67 Imaging destinations compression 34 79 configuring 26 36 described 1 5 in NETWORK LOCATION File 31 36 naming conventio
98. usual pattern lt drive gt lt path gt DECOMP DELAY MS the number of milliseconds that the service will wait after detecting a compressed file before beginning the decompression process default is 50ms Click OK on the various dialogs until all dialog windows for setting up System parameters are closed Keep the Control Panel open it will be needed for a later step 4 Activate the MAG_Decompressor program as follows 80 a b Open a command line window click Start Run then enter cmd Enter the following command to switch to the MAG_Decompressor installation folder cd Program Files VistA Imaging MAG Decompressor lt Enter gt Enter dir at the prompt and verify that the files shown below are present Directory of C Program Files Vista Imaging MAG_Decompressor 05 0272005 TOOR TA lt DIR gt 05 02 2005 093ta lt DIR gt oe 0471372005 07elb6a 856 064 aw32k dl1l 0570272005 Des oda 53 248 MAG Decompressor exe 2 File s 909 312 bytes 2 DET CS 58 401 358 848 bytes free CEN 2 2 Be VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Appendix B Using MAG_Decompressor Note If the DLL file is not present contact the Imaging Group for information about acquiring a toolkit license The decompression software will not work without the DLL file d Enter the following command to activate the program The command will complete without any warning or error messages Mag Decompre
99. uto route all images from a specific modality to a contractor who reads this type of images using standard copy for transmission Send ContractingReader When MODALITY CT Example 2 auto route all images to an archive using standard copy for transmission Send Archive When MODALITY Example 3 auto route all images from a remote site back to local storage at that site using standard copy for transmission Send LocalJukeBox When MODALITY SOURCE StElseWhere 76 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Appendix A Example 4 auto route all important studies to an internal workstation using standard copy for transmission Send LogBook When MODALITY URGENCY STAT Example 5 auto route all images from a specific modality to three contractors balancing the load so that each contract receives a pre determined fraction of the studies and leaving a pre determined fraction for interpretation by local staff using standard copy for transmission OS Balance Contractor1 20 Contractor2 40 Contractor3 20 lt LOCAL gt 20 When MODALITY XA Example 6 auto route all images from a specific modality to a contractor who reads this type of images using standard copy for transmission and giving these transmissions a t high priority Send ContractingReader When MODALITY XA PPro y High Example 7 auto
100. w assume that a single instance of SCU_List dic 1s used by all DICOM Gateways at a site Adding DICOM Destinations to SCU_List dic 1 Stop all active DICOM processes by waiting until they reach an idle state and then terminating them April 2006 VistA Imaging V 3 0 Patch 18 37 2 Configuring Routing Routing User Guide On the DICOM Gateway use a text editor to open x DICOM Dict SCU_List dic where x is the name of the drive used by the DICOM Gateway to store dictionary files Add the information for each DICOM destination as shown below comment lines are preceded by Specific fields are defined in the next section User Application List Format line 1 App Name Called AE Calling AE Destination IP Address Socket line 2 Presentation Context Name Transfer Syntax Name line 3 Transfer Syntax Name if there are more than one Se SF SF OSE H MERGE EFILM VistA_Storage VistA_Send_Image 111 222 33 44 4006 Modality Worklist Information Model FIND Implicit VR Little Endian Verification SOP Class Implicit VR Little Endian Save the file into the directory noted in Step 1 gt When using programs such as Microsoft Word make sure that the file is saved in text only mode Confirm that the file extension is not changed by the text editor The file will only be imported if it is named SCU_List dic and if it is stored in the proper directory Open a terminal window and log into the DICOM Gateway software En
101. way cannot be autorouted For more information see page 44 Each image referenced in the rule evaluation queue is checked against a set of site specific routing rules If the rules indicate that the image should be routed the evaluation processor creates an entry in the transmission queue Entries in the rule evaluation queue are deleted after they are checked The rule evaluation queue is a subset of the IMAGE BACKGROUND QUEUE file 2006 03 The transmission queue is stored in the SEND QUEUE file 2006 035 4 VistA Imaging V 3 0 Patch 18 April 2006 Routing User Guide Routing Overview Autorouting Images from Prior Exams Autorouting offers the option to include images from prior exams When this option is used in a routing rule the Routing software will use the VistARad prefetch logic defined at acquisition site to create a list of prior exams Images from the prior exams will be routed using same priority as the newly acquired image and when appropriate will be purged based on the same retention period as the newly acquired image For more details about autorouting priors see page 22 Sending Images to Destinations The transmission of routed images is based on entries in the transmission queue Each entry in the transmission queue identifies the image to be routed and the destination of the image The transmission queue is continually checked by the Routing Gateway transmission processor For each entry in the queue
102. window and log into the Routing Gateway software 5 Enter 3 to select Routing Gateway from the DICOM Gateway Menu MAGDMENU 6 Enter 5 to select Import Routing Rules 7 When you are prompted to build the Routing Table enter Y Ready to build the Routing Table y y lt Enter gt 8 The file will be imported If the import is successful the following will be displayed You will be prompted to return to the menu nnn rules stored in the database Press lt Enter gt to continue If you encounter any errors record the information and then press Enter You will need to correct the offending rules and repeat these steps Verifying Imported Rules When new routing rules are imported it is important to double check that the new set of rules corresponds to the intent of the end user To verify imported rules Open a terminal window and log into the Routing Gateway software 1 Enter 3 to select Routing Gateway from the DICOM Gateway Menu MAGDMENU 2 Enter 10 to select Display Routing Rules 3 The current set of Routing Rules will be displayed April 2006 VistA Imaging V 3 0 Patch 18 45 Configuring Routing Routing User Guide Routing rules SEND IMAGPROVIDER1 If MODALITY CT SEND IMAGPROVIDER2 If MODALITY CR SEND BAL2 If MODALITY XA Priority HIGH Press lt Enter gt to continue 4 After the rules are displayed and double checked press Enter to return to the menu R
103. with a line feed To ensure proper termination of the last meaningful line add a comment line after the last routing rule such as last update on 1 April 2003 end of file When rules are imported as described on page 44 the routing software will check the syntax used and will report on any problems detected April 2006 VistA Imaging V 3 0 Patch 18 23 Defining Routing Rules Routing User Guide This page is intentionally blank 24 VistA Imaging V 3 0 Patch 18 April 2006 Configuring Routing This chapter assumes that routing software has been installed and that an initial set of routing rules have been defined This chapter explains how to configure a routing system The following table lists the configuration tasks described in this chapter Configuration Task Performed By Set up Imaging destinations Set up DICOM destinations Review edit route priors logic Image Gateway configuration Import routing rules Sending site VistARad site parameter setup Sending site VistARad workstation setup Alter configuration In response to Miei siivolved 50 changes in routing system Routing Gateway configuration Sending site A configuration checklist is also available in Appendix A April 2006 VistA Imaging V 3 0 Patch 18 25 Configuring Routing Routing User Guide Defining Imaging Destinations The following sections explain how to define an Imaging non DICOM destination for routing In general terms defini

Vista Imaging Routing User's Manual

Contents

Download Pdf Manuals

Related Search

Related Contents