Currently, many hospitals already have advanced HIS (Hospital Information System) and/or RIS (Radiology Information System) that centrally store medical records of patient diseases, treatments, test results, doctors' recommendations, etc. and allow access to this data for patient registration desks, emergency departments, X-ray, CT, MRI rooms, neurosurgery and other departments. In those hospitals, computer tomography images of patients along with the image descriptions and the entire medical documentation are immediately available to all authorized departments and doctors.
There are also smaller hospitals or clinics where advanced computer systems are not available, or it is not easy to modify or extend their functionality.
Due to its flexibility, BrainScan CT can support and improve the quality of work regardless of the level of hospital computerization. There are several ways to integrate hospitals with the BrainScan CT solution:
- possibility of connecting BrainScan CT to existing advanced RIS/HIS systems using an API (Application Programming Interface) - that is, an IT protocol through which both systems (BrainScan CT and RIS/HIS) can exchange their medical records data.
- if the hospital does not have RIS/HIS systems or cannot easily customize such systems, PACS servers can send patient studies to an intermediary server (Brainscan proxy). PACS technology is commonly used by all types of scanning devices such as CT, MRI, and X-ray - after sending a CT head scan from hospital PACS to the proxy server, the image is analyzed, and the result is returned as an additional series of the study. The radiologist or doctor will see a list of detected pathologies along with their probability of presence within a few minutes of completing the head scan. In such implementation scenario, the result can optionally be sent in a JSON file format, which hospital systems can use for notifications (e.g. pathology X was detected for patient Y on study Z).
The proxy server can be installed as a physical computer or a virtual machine located at the hospital's premises, or if the hospital does not have capabilities to host servers, proxy server can be installed in BrainScan infrastructure.
Our product can operate both as a cloud solution (in that case, anonymized patient image data is sent to the cloud for processing) or as a fully autonomous system operating at the hospital premises (where compute server is located on-premises). Latter solution is more expensive as it requires to purchase a computer with appropriate computing power and to maintain and support it later. On the other hand, it further reduces scan-to-results time, as it eliminates the transfer time over the Internet of studies with a size of approximately 200MB each.
Time is money, and life
The BrainScan CT system significantly speeds up the initial diagnosis of patients in emergency departments - within 3-5 minutes of CT head scan, the system returns information about possible pathologies (strokes, bleeding, etc.), significantly speeding up the process of determining treatment priorities (triage). Such patients can be taken, without having to wait a long time for a radiologist's description, to the neurosurgery department, where doctors are able to interpret the images themselves and start immediate treatment procedures. In case of strokes time is crucial to patients’ health and life.
As mentioned earlier, it is possible to install a computing server at the hospital's premises, which reduces the time to perform the study analysis even more.
How the implementation goes
In the most common "cloud" scenario (when the computing server is located in the cloud, and the proxy server is located at the hospital's premises), from the moment we receive the necessary information (IP addresses of the PACS servers, the address of the proxy server), we are able to prepare the ISO image needed for automatic installation of the proxy server within two days. We send the installation file over the Internet, or on a USB flash drive to the hospital. The installation is fully automatic and does not require any user interaction - after restart, the proxy server is ready to work (receiving studies from PACS and returning results). In scenario with API, where the hospital application sends studies directly to the computing server, within 2 days we can prepare activation keys and provide documentation needed by software developers to establish direct communication between BrainScan CT computing server and the hospital system.
In the third scenario with the computing server located at the hospital's premises, the implementation time depends on the delivery times of a computer with required hardware specification.
In each of the aforementioned scenarios, we treat the first 2-3 weeks after the launch of the system as an implementation test phase. During that time, we collect and analyze abnormal events and verify the configuration of the PACS server, proxy server, network settings, etc. The most common problems that have appeared so far in the testing phase were:
- incorrect autorouting configuration of the PACS server - the BrainScan CT system analyzes only CT head scan - sending a large number of CT scans of other body parts, or MRI studies may cause unnecessary load on the network and the proxy server itself
- too dense grid of slices in the study - such studies are not processed and rejected
- too few slices in the submitted study (at least 20 slices in a study are needed)
- too long interval between study series - analysis is performed on incomplete set of studies if no DICOM files are received within 60 seconds (limitations of DICOM protocol)
BrainScan CT system (both computing servers and proxy servers at the hospital's premises) are constantly monitored for proper operations. Over 90% of issues are detected by BrainScan staff ourselves and appropriate corrective and preventive actions are implemented quickly. Almost all maintenance tasks can be performed remotely.