243VistA Imaging Gateways: Behind the Scenes

1
243 VistA Imaging - Gateways Behind the Scenes

• Dave Massey
• Greg Bosak

2
         Objectives

• References
• DICOM
• HL7 (in terms of VI)
• Text Gateway
• Image Gateway
• Present limitations of Vista Imaging
• Imaging patch 69 and Cache
• Questions?

3
VistA Imaging

• VistA Imaging Homepage
• http//vaww.va.gov/imaging/default.htm
• VistA Imaging Training
• http//vaww.vistau.med.va.gov/VistaU/VistAImaging
  /default.htm
• OI Health Systems Design and Development
• http//vista.med.va.gov/
• VistA Documentation Library
• http//www.va.gov/vdl/

4
Text Gateway
5
Image Gateway
6
DICOM

• Digital
• Imaging
• COmmunications in
• Medicine

7
Purpose of DICOM

• To create a standard to allow a common set of
  rules and protocols between vendors in the
  medical field, specifically Radiology (at least
  initially).
• Originally called ACR-NEMA 1.0 (85) and then 2.0
  (88), and finally DICOM 3.0 (93).
• DICOM Standard available at
• http//medical.nema.org/dicom/

8
Parts of DICOM Standard

• 1-Introduction and Overview
• 2-Conformance
• 3-Information Object Definitions
• 4-Service Class Specifications
• 5-Data Structures and Encoding
• 6-Data Dictionary
• 7-Message Exchange
• 8-Network Message Support for Message Exchange
• 9- RETIRED
• 10-Media Storage and File Format for Media
  Interchange
• 11-Media Storage Application Profiles
• 12-Media Formats and Physical Media for Media
  Interchange

9
Parts (cont.)

• 13- RETIRED
• 14-Grayscale Standard Display Function
• 15-Security Profiles
• 16-Content Mapping Resource
• 17-Explanatory Information
• 18-Web Access to DICOM Persistent Objects (WADO)
• Additional Supplements continuously added to the
  base standard as needed.
• PS 3.9 RETIRED (FORMERLY POINT-TO-POINT
  COMMUNICATION SUPPORT FOR MESSAGE EXCHANGE)
• PS 3.9 of the DICOM Standard previously
  specified the services and protocols used for
  point-to-point communications in a manner
  compatible with ACR-NEMA 2.0. It has been
  retired.
• PS 3.13 RETIRED (FORMERLY PRINT MANAGEMENT
  POINT-TO-POINT COMMUNICATION SUPPORT)
• PS 3.13 previously specified the services and
  protocols used for point-to-point communication
  of print management services. It has been
  retired.

10
Common Buzzwords

• SCP-Service Class Provider
• SCU-Service Class User
• SOP-Service Object Pair
• UID-Unique IDentifier
• Object-The collection of information that
  represents the modality.
• VR-Value Representation
• Message-Describes Command and Data Sets. The
  Data Set generally contains the demographic
  header and the assigned image(s).
• Little Endian -byte Order. Least Significant
  Byte first.
• Big Endian -byte Order. Most Significant Byte
  first.
• Group/Element-Address representing each piece of
  information stored in the message header.

11
Buzzwords (cont.)

• DIMSE DICOM Message Service Element
• ULS Upper Layer Service
• ACR-American College of Radiology
• NEMA-National Electrical Manufacturers
  Association.
• ACR-NEMA-The group who maintains the DICOM
  Standard.
• AET Application Entity Title.
• PACS Picture Archiving and Communications
  System

12
DICOM Spans Most of Medical Imaging
13
ISO Layer Model for DICOM
Inside DICOM Application Entity Layer
Medical Imaging Application
DICOM Application Entity
DICOM ULS
TCP
IP
Physical Network
14
SCU and SCP

• Service Class User
• Client

• Service Class Provider
• Server

Some devices can take on both roles.
15
Objects

• An entity in DICOM representing a collection of
  information. Usually includes an image.
• CR
• CT
• MR
• US
• Any other DICOM conformant modality
• Structure Reports
• Information Model (patient/study)

16
Type of Objects

• Normalized
• Represents single entity in the DICOM Object.
• Usually used for command exchange.
• i.e. N-EVENT, N-GET

• Composite
• Represents parts of several entities in the DICOM
  Object.
• Usually used to exchange data.
• i.e. C-FIND, C-STORE

17
Service

• Action(s) taken upon the Object.
• Storage storing an image.
• Print printing an image.
• Move moving an image.
• Find finding patient/study information.

18
IODs

• IOD Information Object Definition
• IOD determines what information is used to define
  an Object.
• Part 3 of the DICOM Standard

19
Data Element Tags

• A Tag represents a single piece of information.
• Tags are unique identifiers denoted with a Group
  and Element number.
• Group and Element numbers are in Hexadecimal
  format.
• Part 6 of the DICOM Standard Data Dictionary.

20
Data Element Tags (cont.)
Patient Name
0010,0010
Accession Number
0008,0050
Bits Stored
0028,0101
Slice Thickness
0018,0050
Image Orientation
0020,0037
Device Serial
0018,1000
21
Example of Part 6
22
Private Data Element Tags

• Uses Odd Group numbers. (i.e. 0009,xxxx)
• Not recognized or defined by the DICOM Standard.
• Generally used for vendor propriety information.
• VI cannot use any of this information.

23
Data Element Type

• Not all Tags belong in all Objects.
• This attribute determines if the Tag is part of
  the Object.
• Types

24
SOP Class

• Service combines with Object to create a SOP
  Class.
• Each SOP Class has an unique UID. This UID
  notifies the peer what is happening.

CR Image Storage
1.2.840.10008.5.1.4.1.1.1

25
Transfer Syntax

• Implicit VR Data Elements do not contain VR
  field.
• Explicit VR Data Elements contain VR field.
• Little Endian Byte order. LSB first.
• Big Endian Byte order. MSB first.
• VR Value Representation (character string,
  integer, etc.).

Explicit VR Little Endian
1.2.840.10008.1.2.1
Ex

NOTE ALL UIDs currently known to Vista Imaging
can be found in the UID.dic (..\DICOM\DICT)
26
3 things needed for connections

• AET
• IP Address
• Port

27
Send DICOM Message
Associate-Request
SCU
SCP
Associate-Accept
Message
Release-Request
Release-Response
28
Associate-Request
On the DICOM Gateways, the below log excerpt can
be found by going to option 4-1-2 (DICOM Message
Log).

• 
  
• Connection with 127.0.0.1 on AUG 06, 2002 at
  080113
• 
  
• Recving PDU Type 01H (A-ASSOCIATE-RQ) PDU
  len206
• d\DICOM\DATA1\LOGDCM.292\INCOMING.PDU
• 
  
• Receiving A-ASSOCIATE-REQUEST on AUG 06,
  2002 at 080113
• 
  
• PDU Type 01H (A-ASSOCIATE-RQ)
  Length206
• Version1 Called AE "DICOM_STORAGE"
  Calling AE "DICOM_ECHO"
• ITEM Type 10H (Application Context Item)
  Length21
• Application Context 1.2.840.10008.3.1.1.1
  (DICOM Application Context Name)
• ITEM Type 20H (Presentation Context Item)
  Length46
• Presentation Context ID 1 Result0
• -- Transfer Syntax(es) --
• SUBITEM Type 30H (Abstract Syntax Sub-Item)
  Length17

29
Associate-Accept

• 
  
• Sending A-ASSOCIATE-ACCEPT to DICOM_ECHO
  
• 
  
• PDU Type 02H (A-ASSOCIATE-AC)
  Length177
• Version1 Called AE "DICOM_STORAGE"
  Calling AE "DICOM_ECHO"
• ITEM Type 10H (Application Context Item)
  Length21
• Application Context 1.2.840.10008.3.1.1.1
  (DICOM Application Context Name)
• ITEM Type 21H (Presentation Context Item)
  Length25
• Presentation Context ID 1 Result0
  (acceptance)
• -- Transfer Syntax(es) --
• SUBITEM Type 40H (Transfer Syntax Sub-Item)
  Length17
• Transfer Syntax 1.2.840.10008.1.2 (Implicit VR
  Little Endian)
• -- End of Transfer Syntax(es)
  --
• Sending PDU Type 02H (A-ASSOCIATE-AC) Length
  177
• d\DICOM\DATA1\LOGDCM.292\OUTGOING.PDU
• Recving PDU Type 04H (P-DATA-TF) PDU len74
  PDV hdr3, pc1, len68
• d\DICOM\DATA1\LOGDCM.292\INCOMING.DCM

30
Data/Release

• Sending PDU Type 04H (P-DATA-TF) Length 90
  (90)
• d\DICOM\DATA1\LOGDCM.292\OUTGOING.DCM PDU len96
  PDV hdr3, pc1, len90
• Recving PDU Type 05H (A-RELEASE-RQ) PDU len4
• d\DICOM\DATA1\LOGDCM.292\INCOMING.PDU
• Sending PDU Type 06H (A-RELEASE-RP) Length 4
• d\DICOM\DATA1\LOGDCM.292\OUTGOING.PDU

Whichever entity initiates a connection must
also close it.
31
Instance UIDs (Unique Identifiers)

• Every single image contains all three of these
  Instance UIDs.
• The Instance UIDs are the key to the relationship
  of each Image within a Series and each Series
  within a Study.
• The Study IUID should be generated by the VI Text
  Gateway (will contain the VI root of
  1.2.840.113754)
• Series and Image are generated by the modality
  vendor (or creator of the image).

Study Instance UID
Series Instance UID
Image Instance UID
32

Image_in directory

• Images that are in this folder and have older
  dates are there for two main reasons
• They are Undefined Modalities need to be
  added to the modality.dic.
• They need to be corrected (MAGD FIX w/in Vista)
  because of mismatch between information in the
  Image Header and the Radiology Order (Patient
  Name, SSN, Accession Number).

33
DICOM Correct (MAGD FIX)

• You have 3 new messages. (Last arrival
  11/01/05_at_0839)
• Select Systems Manager Menu Option correct
  RAD-DICOM File Entries
• Select one of the following
• P Patient
• L Loop thru file
• D Specify a Date Range
• Update entries by Loop thru file
• Processing entry
• PATIENT Patient, One
  SSN 000000000
• RADIOLOGY CASE 1110105-8401
• Equipment CEMAX
  Model CT
• Date Processed NOV 1,2005
  Problem with BAD CASE
• Comment
• Correcting file on Image gateway server ID A

34
DICOM Correct (Cont.)

• Please review the following
• Previous name Patient, One
• New name Patient, One
• Previous ssn 000000000
• New ssn 000000000
• Previous case 1110105-8401
• New case 110105-8401
• Radiology case number different. Update?
  (Y/N/D/Q/P)// y
• Will change the following
• Please review the following
• Previous name Patient, One
• New name Patient, One
• Previous ssn 000000000
• New ssn 000000000
• Previous case 1110105-8401
• New case 110105-8401
• Are you sure you want to correct this entry? ?
  No// y (Yes)
• Updating the file....

35
Site-Specific Master Files

• The contents of the files in this section need to
  be customized to reflect the actual attributes
  used at the site.

36
Text Gateway

• 2 Main functions
• DICOM Modality Worklist
• Modality Worklist availability controlled by the
  worklist.dic.
• DICOM N-Event Messages to a PACS Broker
• N-Event messages controlled by portlist.dic.

37
Text_Gateway_1_1
38
Reading an HL7 message
39
Option 1-6 short format
40
Option 1-6 Long Format
41
Long Format (cont.)
42
Long Format (cont.)
43
Long Format (cont.)
44
MAGDHL7 (on VistA)
Last Entry

• Global MAGDHL7 -- NOTE translation in effect
• MAGDHL7(2006.5,0)PACS MESSAGES2006.5D29130
• MAGDHL7(2006.5,110,0)3011123ORM3011123.103622
  460,
• MAGDHL7(2006.5,110,1,0)773011123.103622
• MAGDHL7(2006.5,110,1,1,0)MSH\ORDER
  ENTRY660CONSULTS66020011122140408-0500ORM
• MAGDHL7(2006.5,110,1,2,0)PID000000001460ON
  E,CPRSPATIENT19290000M853844831
• MAGDHL7(2006.5,110,1,3,0)PV1I241001-7
  
• MAGDHL7(2006.5,110,1,4,0)ORCNW8291OR
  R200111221403-05001261262001112214040805
  00EELECTRONICALLY ENTERED99ORN
• MAGDHL7(2006.5,110,1,5,0)OBR3625STAT
  ECHO99PRCB126
• MAGDHL7(2006.5,110,1,6,0)ZSV2MEDICINE99CON
  
• MAGDHL7(2006.5,110,1,7,0)OBX1TX2000.02REASON
  FOR REQUESTAS4Pain in the
• neck

of entries
45
Modifying HL7 pointer
46
PACS Interface
Defined in portlist.dic
U and V should match. W and X should match.
47
MODALITY_WORKLIST_STATUS_1_4
Calling AET
Number of Matches on LAST query number of
active orders.
Number of Queries for the Day
48
Sample Worklist.dic entries and field
explanations.

• TOPCON123CONOPHTHLONGTOPCON Eye Camera
• Picker_1RADMRISHORTPhilips RF room 1
• ECAM1123RADNMLONGSiemens Rm. 3A118
• XR1CR950123RADRADLONG/NODASHKodak CR1
• Field 1 Application Entity Title of Modality
  (Calling AET).
• Field 2 Site code or Location.
• Field 3 Imaging Service (Either RAD or CON).
• Field 4 Imaging Type (Do not confuse this
  with modality codes).
• RAD General Radiology
• CT Computed Tomography
• MRI Magnetic Resonance
• Field 5 Accession Number Format/dashes or no
  dashes in SSN
• Accession number SHORT radiology case number
  only (1234)
• LONG datecase number
  (031106-1234)
• Field 6 Description

49
Update Worklist.dic

• Option 4-2-7

50
MODALITY_WORKLIST_STATUS_1_4
File path of Query messages.
51
MODALITY_WORKLIST_STATUS_1_4
Incoming query message.
Outgoing Worklist response.
52
MAGDWLST (on Text GW)
MAGDWLST(2006.55) contains PATIENT information
53
MAGDWLST (cont.)
MAGDWLST(2006.56) contains STUDY information
54
Purges
Option 10 purges MAGDWLST
55
Purges (cont.)
Option 11 purges the Data1/2/etc. directories and
subsequent sub-folders and files.
56
Purges (cont.)

• Option 11 purges MAGDHL7
• Option 12 purges MAGDAUDT
• Global MAGDAUDT -- NOTE translation in effect
• MAGDAUDT(2006.5761,0)DICOM MESSAGE
  STATISTISTICS2006.57610
• MAGDAUDT(2006.5761,3030520,1,0)2006.5761133
• MAGDAUDT(2006.5761,3030520,1,1,0)ORDER
  ENTRY3123030520.102056
• MAGDAUDT(2006.5761,3030520,1,2,0)APPROVED
  REPORT473030520.102031
• MAGDAUDT(2006.5761,3030520,1,3,0)EXAM
  CHANGE123030520.102051
• MAGDAUDT(2006.5761,3030520,1,"B","APPROVED
  REPORT",2)
• MAGDAUDT(2006.5761,3030520,1,"B","EXAM
  CHANGE",3)
• MAGDAUDT(2006.5761,3030520,1,"B","ORDER
  ENTRY",1)
• MAGDAUDT(2006.5761,3030711,1,0)2006.5761111
• MAGDAUDT(2006.5761,3030711,1,1,0)Modality
  Worklist Query13030711.140307
• MAGDAUDT(2006.5761,3030711,1,"B","Modality
  Worklist Query",1)

Note - Both these globals are located on VistA.
Dont recommend purging either one of these very
often (yearly).
57
Image GW - Instruments
58
Instrument.dic

• Computed Radiography
• CR1Kodak CR642RAD60100A
• CR2Kodak CR642RAD60101A
• DR1Kodak DR642RAD60110A
• DR2Kodak DR642RAD60111A
• Ultrasound
• US1Philips iu22642RAD60300A
• US2ATL642RAD60301A
• CT
• CT1642RAD60500A
• MR

Port
Imaging Type
Mnemonic
Description
Site Code
Machine ID
59
Processing Images
000-00-0000
PATIENTONE
GMRC-123
60
MAGDINPT

• Global MAGDINPT
• MAGDINPT(2006.571,0)DICOM RAW
  IMAGE2006.57138381567
• MAGDINPT(2006.571,37815,0)C\DICOM\IMAGE_IN\C003
  7815.DCMCDIMPT1
• MAGDINPT(2006.571,37816,0)C\DICOM\IMAGE_IN\C003
  7816.DCMCDIMPT1
• .
• MAGDINPT(2006.571,38379,0)C\DICOM\IMAGE_IN\C003
  8379.DCMCDIMPT1
• MAGDINPT(2006.571,38380,0)C\DICOM\IMAGE_IN\C003
  8380.DCMCDIMPT1
• MAGDINPT(2006.571,38381,0)C\DICOM\IMAGE_IN\C003
  8381.DCMCDIMPT1
• MAGDINPT(2006.571,"ACOUNT")37814
• MAGDINPT(2006.5711,0)DICOM M2MB RPC
  QUEUE2006.5711348070
• "ACOUNT")34807
• MAGDINPT(2006.5712,0)DICOM FIXED
  QUEUE2006.5712P7990
• "ACOUNT")799

Last Entry
Total of Entries
Instrument Mnemonic
Pointer for next Image Number to be processed.
61
Undefined Modality
62
Modality.dic

• KODAKKESPRCRb12 f0 c4095 R8/b12 f0
  c4095LONGCASEMAGDIR3data_cr.dicRAD
• KodakCRCRb12 f0 c4095 R8/b12 f0
  c4095LONGCASEMAGDIR3data_cr.dicRAD
• KodakCR950CRb12 f0 c4095 R8/b12 f0
  c4095LONGCASEMAGDIR3data_cr.dicRAD
• KodakCR950b12 f0 c4095 R8/b12 f0
  c4095LONGCASEMAGDIR3data_cr.dicRAD
• DeJarnette Research SystemsImageshare CRCRb10
  f0 c1023 R8/b10 f0 c1023LONGCASEMAGDIR3data_cr
  .dicRAD

DCMtoTGA parameters .tga / .big
Manufacturer
Accession Number extraction point
Model
Imaging Service (only RAD or CON)
Modality Code
Hounsfield adjustment (only CT entries)
.txt file format
63
Gateways Configuration File

• Option 4-2-2

64
Configuration global MAGDICOM(2006.563)

• Global MAGDICOM(2006.563,
• MAGDICOM(2006.563,0)DICOM GATEWAY
  PARAMETER2006.56311
• MAGDICOM(2006.563,1,"ASCII DICOM TEXT")YES
• "COMMERCIAL PACS")N/A
• "CONFIG DATE/TIME")3070130.0
  81846
• "CONSOLIDATED")NO
• "CSTORE CONTROL PORT")60000
• "CURRENT IMAGE DESTINATION")\\VHAWIMC
  LU2A\IMAGE10\WIM0\00\03\41\3\
• "CURRENT IMAGE FILE
  NAME")WIM00003413825.TGA
• "CURRENT IMAGE POINTER")
• "CURRENT IMAGE
  SOURCE")C\DICOM\IMAGE_IN\C0038381.DCM
• "DAILY
  REPORT")60705,to 250 ltET.Phone.Home_at_WILMINGk
• MAGDICOM(2006.563,1,"DATA PATH",0)2006.563111
  
• MAGDICOM(2006.563,1,"DATA PATH",1,0)C\DICOM\DAT
  A1
• MAGDICOM(2006.563,1,"DICT PATH")\\VHAWIMCLU2A\Q
  \DICOM\DICT
• "DOMAIN")WILMINGTON.MED.V
  A.GOV
• "EMED_C_MOVE_DELAY")0
• "FREE DISK SPACE")15
• "IMAGE GATEWAY")YES

65
MAGDICOM(2006.563) (cont.)

• "LOCATION")460
• "LOCATION NAME")WILMINGTON VAMC
• "LOGIN PROGRAMMER ACCESS")5007061268
• "M-to-M BROKER ADDR")hl7.wilmington.m
  ed.va.gov
• "M-to-M BROKER BGND ACCESS")2dQNvzM51
• "M-to-M BROKER BGND VERIFY")'a2Ow6U5,-
• "M-to-M BROKER PORT")14810
• "MACHINE ID")C
• "MAILGROUP")wilmingtonpacsad
  ministrators_at_med.va.gov
• "MESSAGE LOG")YES
• "MODALITY WORKLIST")NO
• "MOVE DESTINATION AE TITLE")
• "MULTIFRAME COUNTER")0
• "PACS EXAM COMPLETE")NO
• "POST OFFICE")smtp.va.gov
• MAGDICOM(2006.563,1,"PROFILE",1,0)211711.(D7My
  gpX472xgp1!3?DAWEltfkD(
• MAGDICOM(2006.563,1,"ROUTING PROCESSOR")NO
• "ROUTING RULES")NO
• "SCRATCH")C\DOCUM
  E1\vhawimia\LOCALS1\Temp

66
Master File Build - MAGDMFB

• Option 4-2-8

67
Files read into appropriate Globals

• Ready to build all of the DICOM Master Files?
  YES// yes
• Building the DICOM Element Dictionary --
  MAGDICOM(2006.51)
• Ready to read dictionary file "C\DICOM\DICT\ELEME
  NT.DIC"? y// yes
• Building the DICOM Message Template Dictionary --
  MAGDICOM(2006.52)
• Ready to read dictionary file "C\DICOM\DICT\TEMPL
  ATE.DIC"? y// yes
• PASS 1 STARTED
• PASS 2 STARTED
• - DONE -
• Building the DICOM UID Dictionary --
  MAGDICOM(2006.53)
• Ready to read dictionary file "C\DICOM\DICT\UID.D
  IC"? y// yes
• Updating the extended SOP negotiation table...
  done!
• Updating the PDU TYPE table... done!

68
Master File Build (cont.)

• Building the Instrument Dictionary --
  MAGDICOM(2006.581)
• Ready to import the Instrument Table
  (C\DICOM\DICT\INSTRUMENT.DIC)? YES//
• 1 instrument entered into database.
• Building the Modality Type Dictionary --
  MAGDICOM(2006.582)
• Ready to import the Modality Table
  (C\DICOM\DICT\MODALITY.DIC)? YES//
• Suspect conversion parameter(s)
• B12 F0 C4095 R8/B12 F0 4095
• Difference C4095 only in FULL
• Difference 4095 only in BIG
• Press ltEntergt to continue
• Warning Imaging Service "RAD " is not defined
  and will be ignored.
• 5 modality entries in database.

69
Master File Build (cont.)

• Building the CT CONVERSION PARAMETERS dictionary
  in MAGDICOM(2006.5821).
• Ready to read dictionary file "C\DICOM\DICT\CT_PA
  RAM.DIC"? y// yes
• Building the Modality Worklist Dictionary --
  MAGDICOM(2006.583)
• Ready to import the Worklist Table
  (C\DICOM\DICT\WORKLIST.DIC)? YES//
• 2 entries added to Worklist database.
• Building the TCP/IP Provider Port Dictionary --
  MAGDICOM(2006.584)
• Ready to import the Provider Port Table
  (C\DICOM\DICT\PORTLIST.DIC)? YES//
• 1 entry added to database.
• Building the User Application Dictionary --
  MAGDICOM(2006.585)
• Ready to import the User Application Table
  (C\DICOM\DICT\SCU_LIST.DIC)? YES//
• 2 SCUs entered into local database.
• On VistA System 2 updated

70
Common Errors

• 1) The writing of image file "\\VHACANCLUC\IMAGE3
  \J0\85\88\J0858809.TGA"
• failed"
• "The error message was "-53 (Unknown Error
  Code)""
• "Imaging entry 858809 successfully removed"
• Resolution
• Gateway was temporarily unable to access the
  share - probably due to some network "bobble".
  Site restarted DICOM Process window and image
  processed.
• Other possible causes
• Permission problem VHAxxxIA (account on
  gateways) is not getting access to the cluster
  shares.
• Steps
• Ping share
• Map share using IA account.

71
Common Errors (cont.)

• 2) Error ,ZltDKFULgtSAVE7MAGDFCNS7343,
• ZEltDKFULgtINT14ET7343
• Or a similar one
• ZEltDKRESgtINT14ET
• Meanings
• ltDKFULgt --- disk full message
• ltDKRESgt --- disk resource message
• Steps
• Use D SP to determine free space in dicom.msm
  database (norm 40 or gt).
• Run purge options 1-10, and 1-11 on Text Gateway
  to free up space.
• Site may not be performing Status tracking of
  patient (Examined) ---That status change causes
  the patient to be dropped from MAGDWLST ---if it
  is not done the MAGDWLST global will fill up.

72
Common Errors (cont.)

• DICOM IMAGE PROCESSING ERROR
• The writing of image file
  "\\VHABHSCLU2A\IMAGE1\Q7\53\10\Q7531063.ABS"
  failed
• The error Message was "1"
• Imaging entry 7531063 successfully removed
• 
  Please call Support Personnel
• Routine MAGDIR2B
• Meaning
• The error message describes a scenario in which
  the Image Gateway is unable to completely process
  the image successfully. This can be caused by
  numerous reasons (network, corrupt image,
  permission problem to the shares, etc.).
• The entry removed is actually the deletion of
  MAG(2005,IEN) initially created within Vista.
• Steps
• CTR-C DICOM Process Window first.
• Restart Process_DICOM_Images_2_3

73
Common Errors (cont.)

• If it still fails, you may need to bump the Image
  Pointer value past that image.
• Run option 2 - Image Gateway, then 4 - Increment
  DICOM Image Input pointer
• VistA DICOM Image Gateway -- TEST MACHINE
• 1 Receive PACS Exam Complete Messages
• 2 Send PACS Request Image Transfer Messages
• 3 Process DICOM Images
• 4 Increment DICOM Image Input Pointer
• 5 Display Real-Time Storage Server Statistics
• 6 Display Cumulative Storage Server
  Statistics
• 7 Display Daily Image Processing Statistics
• 8 Send DICOM Images to Another Storage Server
• 9 Display a DICOM Image Header
• OPTION 4
• The last image in the "C\DICOM\IMAGE_IN"
  directory is number 294.
• There are no images waiting to be processed.

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Displaying a DICOM Image header
75
DICOM header (cont.)
76
DICOM header(cont.)
77
DICOM header(cont.)
78
DICOM header(cont.)
79
Using the Viewer to dump the header
80
Using the Viewer to dump the header
81
Limitations of VI

• Image Gateway
• Does not store overlay data group 6000 in the
  DICOM header.
• Cannot display images that contain a Photometric
  Interpretation of Palette Color.
• Only stores .dcm images for NM, US, and OT
  modality codes (controlled by the element.dic).
• Cannot handle DICOM presentation states.
• Cannot handle DICOM Structured Reports (SR).

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Limitations (cont.)

• Can only properly display .tga files that contain
  unsigned data values (no negative values).
• Cannot handle images that contain embedded icon
  sequences (thumbnail images). If they are in tag
  0088,0200 they are discarded by the Image Gateway
  (MAGDIW3). If present in any other groups the
  image will not display properly or may not even
  process.
• Does not support DICOM Storage Commitment.

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Limitations (cont.)

• Text Gateway
• Does not support DICOM MPPS (Modality Performed
  Procedure Step part of Modality Worklist).

84
Changes with Caché (Patch 69)

• Menus remain pretty much the same.
• You will use a Cache Terminal versus MSM console.

85
Caché Cube

• When Caché is inactive, this icon is grey
• When Caché is active, this icon is blue
• This icon can be used to start and stop the
  Caché server. Under normal circumstances, the
  Caché server is started automatically when the
  computer is restarted, and users only need to
  stop and restart Caché when this is needed for
  maintenance purposes.

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Caché changes (cont.)

• Gateway options will be added to the Windows
  Start Menu.

87
Caché Control Panel

• GUI based management tools.

88
Caché Control Panel (cont.)
89
Caché Control Panel (cont.)

• Log Files

90
Q and A

• Thank you.
• Questions?