CoActiv EXAM-PACS Components
The versatility, ease of use, simplicity and affordability of the CoActiv EXAM-PACS® is made possible, in part, by the product’s modular design. Several of the key components were originally designed as add-on enhancements for other PACS or teleradiology solutions lacking essential functionality and features. This component, or modular, initial development, provided the foundation for what has developed into an exceptionally versatile, flexible, scalable and affordable PACS. The key modules of this revolutionary PACS include:
This module is essentially the control center of the PACS. It is the first, and in some cases, the only screen that all users see. The EXAM-Console has multiple functions and comes in several versions to accommodate user requirements.
- Selection of the various sites, or sources, of exams to be viewed.
- Quick-and-easy search of any number of sites for a specific exam, or series of exams to be viewed or read.
- Automatic and "background mode" reception of "assigned" or "pending" exams. These are exams being sent to a sub-specialty radiologist’s Worklist from any number of local or remote modalities. This routing can be manually performed by the user of an administrative version of the EXAM-Console or automatically sent to a specific Radiologist’s Worklist as soon as the exam leaves the modality.
- Instant viewing of the "history" of an exam.
- Instant viewing of any "related" or "attached" files.
- Launching of the EXAM-Viewer for either a "diagnostic read" or a "clinical review" of an exam, depending on the version of the EXAM-Console used.
- Transmission of any exam to another authorized user of the EXAM-PACS. This other user can be selected from a pick list and could be another diagnostic radiologist, a referring physician, or virtually anyone worldwide with the need and authorization to view the exam. The transmission of the exam to this user is automatic, encrypted, secure and performed in a "background mode". Users will receive a pop-up message on their desktops when the exam has arrived, calling attention to it. They can then automatically launch a local copy of the EXAM-Console and perform any of the above functions. The images viewed are always and only at full resolution.
- Tracking of all access to, and movement of, every exam and updating of the exam "history file" with each transaction.
- Monitoring all "MOD" files and "attached" or "related" files associated with every exam and forwarding all of these files whenever the exam is sent or received.
- Transmitting all exams to and fetching all exams from any IMAGE-Server, EXAM-Server or ARCHIVE-Server.
- Direct and automatic burning of an EXAM-CD™.
The EXAM-Console is available in several versions with different functionalities:
The Diagnostic EXAM-Console, designed for the radiologist, has full functionality and privileges including the Diagnostic version of the EXAM-Viewer which allows an exam to be marked as "Read". This version is also available with the CD-Burning Option.
The Clinical EXAM-Console, for technologists, referring or consulting physicians, has the same functionality as the Diagnostic Viewer, but includes the Clinical version of the EXAM-Viewer without the ability to mark an exam as "Read". This version is also available with the CD-Burning Option.
The Administrative EXAM-Console has the same functionality as the Clinical version and is available either with or without a viewer and is intended for administrative personnel to assist in the sending and fetching of exams as well as adding attached or related files to the exam. This version is also available with the CD-Burning Option.
This module consists of the EXAM-Server software as well as PC Server hardware appropriately configured for the size and scope of the imaging center. This server is the backbone of the EXAM-PACS network.
The EXAM-Server receives images either directly from the various modalities or from a CoActiv IMAGE-Server and adds the exams to the PACS database, begins the history and creates the MOD associations, as well as the related or associated file configurations. The EXAM-Server also packages and encrypts the exam for transmission and storage.
The EXAM-Server, the initial repository for all harvested exams, is the first of the four redundant locations of the exams, and oversees all database functions for the PACS.
The EXAM-Server also serves as the interface for RIS, HIS and Information Scanning and Filing Systems as well as Dictation Systems.
The CoActiv EXAM-Sender is a revolutionary concept in both the transport and configuration of all information from the modern imaging center. This product was developed based on a genuine industry need for a fast, easy, reliable, secure and affordable means of getting radiological exam images, reports and related information to referring physicians as quickly as possible. Film is expensive, difficult to transport and store and requires space. CDs can be useful, but still present delivery delays and expense. On-line viewing of images via the Internet is often slow, cumbersome, not secure, and requires that exams be greatly compressed (typically 8x-10x) which provides images that are of considerably less-than-diagnostic quality, and of questionable value.
The CoActiv EXAM-Sender, described in detail in both a separate document and a white paper, is the obvious solution. Because the EXAM-Sender is so unique and innovative, a Patent has been applied for. The EXAM-Sender system sends only full-resolution, uncompressed images, reports, voice clips, and any associated documents and information relative to the exam directly to the referring physician’s desktop - quickly, securely, reliably - and in a "background" mode. The referring physician gets a pop-up message after the completed exam has arrived in his computer. No wasting time waiting for questionable images to slowly appear online slowly, no fuzzy exams, no restarting when a connection fails, no complex logins or forgotten passwords! All images are always and only displayed at full resolution. Everything is automated, and access is hard-coded for maximum security and privacy. Your referring physicians will appreciate it - and appreciate you for using it! And, best of all, the EXAM-Sender can be integrated into many existing PACS systems.
This server is a limited capacity EXAM-Server and serves as a modality, or image caching server in multi-site, multi-modality environments.
This Server is comprised of a very powerful PC server platform typically with huge amounts of storage space. The CoActiv ARCHIVE-Server is configured with redundant power supplies and RAID drive storage appropriate to the size and scope of the imaging center. ARCHIVE-Servers are available in a wide selection of size, performance and storage capacities from hundreds of gigabytes to multiple terabytes capable of storing hundreds of thousands and even millions of exams. For full archival redundancy, reliability and true disaster recovery capability, CoActiv always recommends two ARCHIVE-Servers, at least one located in our Tier-IV redundant datacenters. This second ARCHIVE-Server is backed up to tape for true archival storage.
DIAGNOSTIC (Reading) WORKSTATION
The Diagnostic Workstation, or the radiologist reading station, is the user interface for the system. This workstation is available in a large variety of hardware configurations determined by the specific needs, size and budget of the imaging center. Single and multi-processor computer workstations are available with virtually any size local storage capacity and in single or multi-monitor configurations. We can provide multiple monitor combinations for multiple workflows and spaces and configure systems with up to 4 monitors of various size and resolution including the newer color high-resolution LCDs. The Diagnostic Workstation includes the diagnostic version of the EXAM-Console and the Diagnostic EXAM-Viewer. This workstation is available with the CD-Burner Option.
CLINICAL (Viewing) WORKSTATION
The Clinical Workstation, or the viewing station, is the exam viewing interface for non-diagnostic use. This workstation is also available in a large variety of hardware configurations determined by the specific needs, size and budget of the imaging center. These workstations are typically less powerful and significantly less expensive than the Diagnostic Workstations. CRT or LCD flat panel displays for these are available in a variety of sizes, resolutions and prices. The Clinical Workstation includes the clinical version of the EXAM-Console and the Clinical EXAM-Viewer. This workstation is also available with the CD-Burner Option.
The Administrative Workstation is the PACS interface for non-viewing, or basic reference viewing access. This workstation is typically less than $1000, and has much less demanding hardware requirements than other viewing stations. CRT or LCD flat panel displays are available in a variety of sizes, resolutions and prices. The Administrative Workstation includes the administrative version of the EXAM-Console and is available with or without a viewer. This workstation is also available with the CD-Burner Option.
CoActiv PACS technicians and engineers have been working for several years with a number of our consulting radiologists on various PACS products using a variety of DICOM viewers. Different radiologists have expressed different viewer preferences. Our EXAM-Viewer development team analyzed the preferences and studied the large collection of available reviews, opinions and white papers on DICOM viewers. They also spent hundreds of hours testing many available PACS viewers for functionality, ease of use, speed, flexibility and configurability. We then incorporated all the preferred features and functionality into a design and proceeded to develop what we believe to be the most functional, easiest to use, full featured, reliable and accurate DICOM viewer available today, the CoActiv EXAM-Viewer.
The EXAM-Viewer allows the radiologist to use both keyboard shortcuts and mouse controls to perform most normal viewer functions such as:
- Image Scrolling
- Series Scrolling
- Windowing & Leveling
- Print Image
- Copy to Clipboard
- Overlay On/Off
- Ruler On/Off
- Reset Image
- View DICOM Header Information
- Smoothing (pixel interpolation) On/Off
- Win/Lvl Presets – 10 Fixed CT and unlimited user defined presets
At the unanimous request of our consulting radiologists we added some highly desirable and virtually never found controls to EXAM-Viewer such as:
- Series Localizers, Non-Active-Window Localizers and Pop-Up Localizers
- Single Key Series Layout Selection
- Single Key Image Layout Selection
- Single Key Report Viewing
- Single Key Voice Clip Playing
- One-Click Series Layout Customizing (Hanging Protocols)
- One-Click Fixed-Zoom-Level Selection
- One-Click Apply-To-All Selection
EXAM-Viewer has exceptionally versatile and flexible annotation capabilities including:
- Measurements – six per image in six different colors. – movable and relocatable
- Regions-Of-Interest Annotation:
- Up to four per image, in four different colors – relocatable
- Square, rectangular, circular, elliptical and freehand – in four colors, relocatable
- Arrows, pointers – unlimited number per image – relocatable
- Text annotations – unlimited number per image – selectable type style, size and color – relocatable and editable
Unique new features add to EXAM-Viewer functionality:
- Innovative and Automated Series Image Synchronization
- Auto-Load of all images and all series in preselected series and image layouts
- Images are displayed only at full resolution. CoActiv does not use any progressive JPEG or any other interlaced image technology. While this progressive technology, used by others, can make downloads “appear” to arrive faster, it can lead to images being viewed and interpreted at much less than full resolution. In reality, displaying an image at full resolution takes no longer than waiting for a progressive or interlaced image to reach full resolution. It also completely eliminates the possibility of making an erroneous interpretation by reading an image that has not reached full resolution.
- Fast, easy and flexible creation of collage of selected images – added to series list
- Ability to save and recall multiple MOD files:
- Any number of different MOD files can be created and recalled for viewing without changing the original DICOM Images. MOD files with different Win/Lvl, Zoom, Rotation, and Annotation can be saved for instructional purposes, teaching purposes or additional reference. Each MOD file is displayed with history of creator, date, etc.
- New MOD files can even be created after an exam is marked as "Read". However, the "Read" MOD file cannot be altered.
- Exclusive ability to easily save any number of associated or related files with each exam. These files can be reports, first impression voice clips, transcription audios, video clips, scanned prescriptions, scanned insurance card, insurance pre-certs, or any other images or documents that add to the completeness of the exam and that may be of interest to referring or consulting physicians. A complete history file is automatically maintained with all related files and information about them.
- All MOD files and associated files are kept with the exam image files for posterity.
CoActiv EXAM-Viewer is available in three versions:
- Diagnostic EXAM-Viewer - for the radiologist, including the ability to mark an exam as having been "Read".
- Clinical EXAM-Viewer - for the technologist, referring or consulting physician, or any authorized user. It is full featured, but without the ability to mark an exam as "Read". This version can, however, add additional MOD files to the exam for later reference, and can also add associated files.
- CD EXAM-Viewer - This is the version of the viewer that is included for free on every EXAM-CD created by the CoActiv EXAM-Filer system. This version of the viewer has many of the features of the Clinical EXAM-Viewer, but cannot add MOD or associated files and cannot make any annotations.
While the CoActiv EXAM-Viewer was designed for use within the CoActiv EXAM-PACS solution, it is available for OEM integration and licensing into other PACS or tele-radiology products, however it is not currently available as a free-standing viewer.
The CoActiv EXAM-Filer — With minimum technologist or clerical input, this product allows for the quick, simple and inexpensive production of radiological exam CDs for use by referring physicians and patients, and for inexpensive and fast archival storage. The EXAM-Filer is a complete system, consisting of a custom DELL high-end workstation and one of several models of fully automated CD burning and label printing “robots”. Once your staff hits the “create CD” button, all they have to do is take the printed CD out of the unit - no stickers, no labels - and graphics are customized with your facility logo and a full HIPAA warning.
It is far less expensive and much quicker to burn an EXAM-CD than to produce copies of hard-film studies. It is also much more convenient for the doctor to file the small CD in the patient’s file jacket than to store large, cumbersome and bulky film studies.
In addition to exam images, the EXAM-Filer can also include the voice clips available from within some PACS solutions, as well as image-montages and the radiologist’s diagnostic report, either in a first-impression form or in a final report form, on the actual CD with the required appropriate access software. The EXAM-Filer is the only system that produces a completely self-contained study CD that can be accessed from virtually any CD or DVD equipped PC.
Your referring physicians and patients alike will be impressed with the EXAM-CDs created by the EXAM-Filer. These CDs auto-run when they are inserted and require that nothing be installed on any PC accessing the CDs. The splash screen is customized with your practice’s logo and has a direct URL link to your website, and also includes a HIPAA sensitive privacy notice which must be agreed to before the exam(s) can be viewed. The viewer included on each EXAM-CD is the new CoActiv Clinical EXAM-Viewer, which is the ideal clinical viewer for use by the referring doctor or the patient - it is exceptionally fast, intuitive and can be used with no training with only a few minutes of practice. This new viewer, written especially for the EXAM-CDs includes the most desired DICOM viewer features including: Slice, Window and Level, Series, Zoom, Pan, Reset, Fit-To-Window, Inverse, W&L Presets, Rotate, Flip, Overlay, Copy-To-Clipboard (for saving or printing) and a host of additional useful functions. All basic viewer functions can be instantly accessed and controlled from either mouse or keyboard. And, moving from series to series is a single keystroke operation.
The custom full-color CD graphics that are automatically and instantly printed on each EXAM-CD that you produce include your practice name, logo, address, phone, website address, creation date, referring doctor name, patient name, exam(s) description, HIPAA privacy notice and other useful information.
The cost of this CD is under $1.00, and takes less than two minutes of clerical time to produce. Each CD, in addition to the CoActiv Clinical EXAM-Viewer, also includes the necessary applications to access any reports, voice clips, dictation files, scanned information or other included data.
The complete CoActiv EXAM-Filer system, including all hardware and supplies, is competitively priced for the first unit, with substantial discounts for multiple systems going into the same practice. While the EXAM-Filer is capable of easily receiving from multiple modalities and/or a PACS, the typical installation includes interfacing with either one DICOM compliant modality or with your existing PACS or teleradiology system. Interfacing with non-DICOM modalities requires the addition of a DICOM gateway, available separately.
The EXAM-Vault module of the CoActiv EXAM-PACS consists of a special version of the CoActiv EXAM-Server module which provides for the automatic archiving of exams into the most reliable, redundant and secure storage facility provided by current technology. Every exam is stored four times within the CoActiv EXAM-PACS System. Online exam storage is located on your local EXAM-Server and on two redundant-mirrored multi-terabyte RAID arrays located in two separate datacenters; one in Tarrytown, NY, and the other in Stamford, CT. The primary datacenter in Tarrytown is housed in a facility built by IBM as the former datacenter for Union Carbide World Headquarters. Now under private management, this Tier-IV datacenter is located several stories underground with redundant power, generator fail-over, multi self-healing OC3 direct fiber connections to the Internet, a biometric entry security system and a 7x24x365 fully manned NOC (network operations center). This site is safe, secure and audited for HIPAA privacy and security.
As soon as an exam is received from any DICOM compliant modality, it is stored on the local EXAM-Server and is instantly, and automatically, sent from the practice’s EXAM-Server to the primary datacenter archive in New York and is simultaneously mirrored to the redundant archive site in Connecticut. Exams in both sites reside on huge disk drive RAID arrays with hot spare redundant drives, redundant power supplies, redundant cooling fans and high-speed data transfer facilities. These arrays are outfitted with automatic remote monitoring, as well as local technical staff monitoring. All exams are also permanently archived to digital optical media. So, within seconds after the exam is finished on the modality in your imaging center, or hospital imaging department, it is stored on your local EXAM-Server for any time period specified by your facility, instantly archived for permanent online storage on the redundant RAID units in the two datacenters, and is then backed up to two copies of digital optical media, one of which is sent to your facility while the second is kept in secure, bonded storage.
Restoration of any of hundreds of thousands of exams from the archive for comparison purposes is instantly available from any workstation in any location on your CoActiv PACS Network. This exam retrieval can be either manually or automatically pre-fetched by an integrated RIS system.
You no longer have to be concerned about maintaining local archives, clumsy tape drives or easily scratched local archive CDs or DVDs. And of course, expensive, clumsy and hard-to-store film is history. All exams are also instantly available for automatic transmission to your referring physicians, and all exam retrieval from the archive is performed utilizing our huge bandwidth resources rather than your expensive and usually limited local practice bandwidth - a tremendous cost savings to the practice.
This quad-redundant exam archiving is available for as little as pennies per exam per year. Compare this to the cost of film or local archiving!