How to input brain CT scan images into a PACS (Picture Archiving and Communication System) or RIS (Radiology Information System)?

How to Input Brain CT Scan Images into PACS/RIS Systems

Brain CT scan images should be input into PACS (Picture Archiving and Communication System) or RIS (Radiology Information System) using standardized protocols that ensure proper image quality, patient identification, and data security while following established technical guidelines for neuroimaging.

System Requirements and Standards

Hardware and Software Requirements

• Use state-of-the-art 3D imaging systems with minimum technical specifications:
  • PET/CT or PET/MRI systems capable of acquiring CT images or MRI sequences suitable for attenuation correction 1
  • Minimum axial field of view of 15cm to ensure comprehensive coverage of the entire brain 1
  • CT scanner providing ≥64 lines for ESO Stroke Units 1

File Format Standards

• Use DICOM (Digital Imaging and Communication in Medicine) format, which is the standard protocol for formatting and exchanging medical images 2
• Ensure proper header information is included with each image file containing:
  • Patient demographics
  • Scan parameters
  • Acquisition details
  • Orientation information 1

Image Acquisition Protocol

Pre-Acquisition Steps

1. Document patient information according to local regulations 1
2. Verify patient identity and match with order in RIS
3. Check for any contraindications (allergies, implants)
4. Position patient properly to ensure complete brain coverage 1

Acquisition Parameters

• For brain CT scans:
  • Use nested, inframillimetric sections reconstructed with thickness >1mm 1
  • Visualize sections with double fenestration (central nervous system and bones) 1
  • Include complete cerebellum and top of head in field of view 1
• For specialized protocols:
  • Consider CT-angiography for patients with risk factors for vascular injuries 1
  • Follow standardized brain tumor imaging protocol for oncology cases 1

Quality Control Process

Image Quality Verification

• Check for protocol adherence including:
  • Scan parameters (duration, emission acquisition type)
  • Subject positioning and motion
  • Anatomic inclusion (complete cerebellum, top of head)
  • Reconstruction parameters 1

Common Quality Issues to Address

• Incomplete brain volumes due to positioning errors (occurs in ~4% of scans) 1
• Motion artifacts requiring frame realignment
• Misalignment between emission and transmission scans
• CT or MRI-related attenuation artifacts from metallic implants 1

Data Transfer to PACS/RIS

Transfer Protocol

1. Verify image completeness and quality before transfer
2. Use secure network protocols (TCP/IP) for data transmission 3
3. Ensure proper interface between acquisition system and PACS using HL7 standard for text data exchange 2
4. Verify successful transfer with confirmation receipt

Integration Requirements

• Ensure proper HIS/RIS-PACS interface for:
  • More efficient usage of both systems
  • Better integration of data
  • Better consistency checking on shared data
  • Better security and error handling 4

Interpretation and Reporting Workflow

Radiologist Requirements

• Interpreters must be board certified in radiology, licensed in the state where images are obtained 5
• For stroke cases, interpretation must be available within 30 minutes of hospital admission 1
• Radiologists must maintain continuing education requirements 5

Communication Protocol

• Follow established protocols for communicating critical findings
• Results requiring immediate intervention must be verbally communicated in real-time 5
• Document interpretation in RIS with proper linkage to images in PACS

Security and Compliance Considerations

Data Security

• Implement appropriate access controls to protect patient privacy
• Maintain audit trails of all access to images
• Ensure proper backup and disaster recovery procedures 6

Regulatory Compliance

• Follow local regulatory requirements for medical imaging
• Maintain appropriate documentation for compliance audits
• Ensure radiologists are credentialed and have appropriate privileges at the institution 5

Common Pitfalls and Solutions

• Incomplete data transfer: Always verify complete transfer of all image series
• Incorrect patient identification: Double-check patient identifiers before initiating transfer
• Poor image quality: Implement standardized quality control procedures before accepting images into PACS
• System incompatibility: Ensure all systems use compatible DICOM and HL7 versions
• Inadequate storage capacity: Monitor storage usage and implement appropriate archiving policies

By following these structured guidelines, healthcare facilities can ensure efficient and accurate input of brain CT scan images into PACS/RIS systems, supporting optimal patient care and clinical decision-making.