Frequently asked Questions - MJS version
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ClinPACS / Ortho-Access:
1. What is ClinPACS?
Picture Archiving and Communications System, more commonly known as PACS, enables images such as x-rays and scans to be stored electronically and viewed on screens rather than on photographic type screen or analog film as previously. PACS has led to a significant improvement in access and manipulation of images in the Radiology Department, but attention to access within the clinical environment has often not been adequate.
PACS within an enterprise, such as a hospital (EntPACS), comprises the network in the Radiology Department (RadPACS), as well as the network in the wards and clinics (ClinPACS) - plus the Laboratory image and data storing process (LabPACS). Each has very different specifications in terms of access, image resolution and manipulation within each of these distinct areas. ClinPACS refers to the component of the PACS environment beyond Radiology, but for effective enterprise PACS it must include:
ClinPACS.com attempts to address the needs within the clinical environment and suggest solutions to image access for optimal patient care.
- Cost effective, fast and full function workstations
- that are as readily available as a light box,
- AND as easy to use.
2. What is Ortho-Access?
Ortho-Access is a system of software programs that have inter connectivity and can function as complimentary technology to provide the tools needed specifically for the Orthopaedic Surgeon working within a digital environment. Clin-Access (currently under development) refers to those imaging access and manipulation tools for other clinical areas. The Ortho-Access Orthopaedic Imaging System currently includes:
iQ-VIEW is the commercial version of the well-known free ware DICOM viewer K-PACS.
This software enables the user:
- True Life Anatomy (TLA Generator)
OrthoView allows for 2D arthroplasty templating and virtual surgical planning.
- to receive and retrieve (dicom Q/R) medical images via STORE SCP
- to view and manipulate images,
- to do image processing,
- to store images in a local patient database,
- to prepare and send the data to, and launch other programs, such as OrthoView and TLA,
- to receive the processed image data for the third party programs and send it back to PACS.
True Life Anatomy provides a suite of software tools to allow 3D image creation,
visualization and manipulation. Access to CT and MRI data within a PACS environment
can be difficult and has been a major issue in allowing clinicians access to this 3D
3. What is wrong with the current PACS?
Picture Archiving and Communications System, more commonly known as PACS, enables images such as x-rays and scans to be stored electronically and viewed on screens, so that doctors and other health professionals can access the information and compare it with previous images at the touch of a button. For the past 100 years, film has been almost the exclusive medium for capturing, storing, and displaying radiographic images. Film is a relatively fixed medium with usually only one set of images available. PACS technology allows for a near film less process, with all of the flexibility of digital systems. It also removes all the costs associated with hard film and releases valuable space currently used for storage.
Current PACS however is designed to provide optimal work flow conditions within a Radiology environment, and specific requirements within the clinical environment are less well addressed. While it can remove much of the storage and processing cost of film, it has an obligate very expensive and under appreciated problem of delivery of diagnostic quality image data in the clinician environment. PACS beyond Radiology is likely to be a much larger network that within the confines of the Radiology Department and as such, the issues of patient care and image access need to be addressed before any wide roll-out of PACS occurs - but this is rarely the case!
Download an overview of the merits and problems of PACS from a clinical perspective - "Network Delivery of Digital Data: the Good, the Bad, and the Ugly".
4. Are there any performance specifications required for my Computer?
System Requirements - because of the size of files required in diagnostic imaging minimum system requirements are:
For optimum performance recommended system requirements are:
- Pentium III or IV CPU > 1.6 GHz (ideally > 2GHz), or comparable AMD processor
- 500 MB main memory, depending on the demands and CT / MRI file size; 2 GB for large files
- Network connection with at least 10Mbit/s to access PACS if required
- 20 GB hard disk, depending on the volume of the data to be saved
- Graphics card resolution of 1024×768 or more, 16 bit color or at least 8 bit grey output
- Analogous colour monitor, 17" or 20" inches for demonstration, high-resolution monitor for diagnoses
- Windows 2000 or Windows XP
- CD-R drive
- Pentium IV CPU > 2 GHz, or comparable AMD processor
- At least 1024 MB main memory, depending on the demands; 2 GB for cardiology and large Musculosketal images
- Network connection of at least 100 Mbit/s
- 20-120 GB fast local hard disk, depending on the volume of the data to be saved
- Graphics card, resolution of 1280×1024 or more, in True Color mode (24 bit) or 32 bit color output, nVidia GeForce >=6xxx or ATI >= 6xx for 3D postprocessing
- Analog color display, 17" or 20" for demonstration, high-resolution monitor for diagnoses
- Windows 2000 or Windows XP
- CD-R drive and mouse with scroll wheel
- CD- or DVD writer for creating patient CD-ROMs
- PostScript Printer
- Up-to-date anti-virus software
- Uninterruptible power supply (UPS)
5. Why are the current images on PACS less clear then I got previously with film?
Image resolution of analog (screen) film was approximately 600 dpi. Computed Radiography generally captures at a minimum of 127 dpi, and if it is viewed on a standard commercial LCD monitor, the typical image resolution is around 60 dpi. That means there is a 10 fold decrease in the resolution of the image. Typical visual acuity is about 300 dpi. If you view the images on a high resolution monitor (5MP) the resolution will be about 125 dpi.
While there are advantages in contrast adjustment, magnification and access by using digital capture and visualization, the resolution of the images is at best 25% of what it was on "old" film, and if using "commercial" grade LCD monitors, about 10% of what it was. If the images are printed, the resolution reflects the original capture plus the printer resolution. As there are no requirements to achieve a level of image quality this can be at about capture (125pdi) or worse, and there are often variations in magnification, image distortion and artifact.
6. I do not understand the concept of Ortho-Access?
Ortho-Access is basically a collection of software programs that have interconectivity to allow the image data to be retrieved from the PACS , viewed in a simple and intuitive format and then the required manipulations performed for surgical planning, and 3D image creation. The Ortho-Access web site is designed to provide a single point of access for a set of complimentary imaging software programs that can link to each other, and address a range of imaging needs for the Orthopaedic Surgeon working within a digital environment.
7. Are these three different software packages?
Yes, iQ-VIEW, OrthoView and TLA Generator are three separate software programs from three separate companies. They each offer complimentary functionality to allow improved access, visualization and manipulation by the Orthopaedic Surgeon working within a digital environment.
8. How do I purchase the software after the 30 day trial?
You will need to contact each of the software companies to purchase the software, and details are available either within the program interface, or via the respective web sites or telephone / email contacts.
TLA Sales follow up FAQs or go to the RuBaMAS site for payment options.. RuBaMAS is the sole distributor of TLA technology.
iQ-VIEW Sales follow up - contact iQ-VIEW
OrthoView Sales follow up - contact OrthoView
A process is under development to facilitate this and allow a single point of purchase, but for the moment, each company handles the sales side of things.
9. Who do I contact if I have got a problem?
Problems related to downloading or the integration of the programs should be directed in
the first instance to the ClinPACS contact or help line.
- Telephone (24 hours / day answering service):
1300 558 659 (for call within Australia)
Int + 61 8 8239 8126 (International calls)
- Facsimile: Int + 8 8221 6766
For information on using the individual programs:
iQ-VIEW is installed with an extensive manual on use for both iQ-View and iQ-3D, and similarly OrthoView has help files and demo tutorials as part of the installed program.
Under the help menu in TLA Generator and TLA Viewer there are tutorials in PowerPoint ™ as well as help files.
Problems specific to a particular program that cannot be resolved by reference to the provided information and instructional material should be directed to the appropriate
contact that is indicated below, or on the relevant program or web site.
IMAGE Information Systems – iQ-VIEW / iQ-VIEW PRO / iQ-3D
OrthoView - Meridian Technique Limited
USA (08.00 – 12.00 EDT) +1 213 221 20 89
United Kingdom (10.00 – 1600 GMT) +44 207 183 47 20
Germany (09.00 – 17.00 CET) +49 40 600 201 296
True Life Anatomy (RuBaMAS Pty Ltd) – TLA Generator, TLA Viewer
+ 44 (0) 870 3831462
Problems of printer performance, monitor configuration and hardware upgrade should be
directed to an appropriate hardware vendor.
- Telephone (24 hours / day answering service):
1300 558 659 (for call within Australia)
Int + 61 8 8239 8126 (International calls)
- Facsimile: Int + 8 8221 6766
10. Are there updates?
These will occur regularly from the various software vendors. You should ensure you are on the contact and mailing list to receive regular news and update information.
11. Where do I find out what monitor needs I have?
This is a difficult question, and relates to the specific requirements of the location, the existing equipment and the PACS capability. However, the only monitor that achieved ACR (American College of Radiology) image resolution minimums for diagnostic quality is a 5MP Dicom compliant (and very expensive) gray scale monitor. Commercial grade LCD screens vary between 50 and around 100dpi. It is a big problem, but for clinical work the compromise is perhaps a 20" monitor with at least 2MP resolution. More information on this will be linked from ClinPACS.com when available.
12. My Radiologist can not understand why I need such functionality?
Perhaps explain that your patients believe that the surgeon or doctor who is treating them should have diagnostic quality images - and that the report alone may not be enough. The clinician should have diagnostic quality, high resolution, scalable images at all points of patient care and they should be accessible in a simple and inexpensive format - like was available with analog film! If the Network manager or Radiologist still can not accept this, ask them if they would be happy if you were assessing and fixing a difficult fracture on one of them using images of non-diagostic quality and where you could not accurately measure the size of fragments nor accurately plan the size of implant.
13. Our Central PACS provider will not grant us access to the patient files?
Ask the hospital administrators, who are funding the PACS provider, if they think it would be appropriate that you offer treatment to patients that is of non-diagnostic quality (i.e. low resolution, non-scalable, and inconvenient access). Better still, ask them if the standard of care they would personally accept (or for one of their relative) was where the the doctor treating them for their fracture only had access to non-diagnostic quality images. ACR (American College of Radiology) guidelines state that diagnostic quality images should be at least 127 dpi, and minimally compressed (ideally LOSSY).
While it is important that the Radiologist has optimal image access to interpret the images, it is difficult to see why the actual clinician treating the patient should have any less, particualy as the benckmark set by analog film x-rays provided high resolution, full size, convenient and cheap access, not withstanding the issues and cost to the enterprise of film processing and storage.
If a (cost based) decision is made by the enterprise to move to a digital image access environment (PACS), the diagnostic quality of images at the patient care interface must be maintained. Savings in capture and storage of images in digital format rather than film are in large part offset by the requirement to maintain this image access quality by the clinicians, and patients should perhaps be made aware of the potential downgrading of their care if the clinician does not regard the diagnostic image access and quality as optimal.
1. What TLA software is currently available?
At the moment the TLA Generator that creates
3D models from CT or MRI scan data and the TLA
Viewer program that allows passive viewing of
the created model are available. There is a
free 30-day demo version of each program available
for download or ordering, and the full version
can be purchased. Details are available from
the distributors RuBaMAS (www.rubamas.com).
The full version requires registration and an
authorization code to work after an initial
30 day installation period.
2. How do TLA Generator and TLA Viewer work?
TLA Generator and TLA Viewer work together to
create and then view three-dimensional models
created from two-dimensional scan slice data.
The TLA Generator is the program that creates
the three dimensional models from the 2D slice
data. It imports the slice data obtained from
the CT scan and creates a three dimensional
model which can be saved to a file. This file
(.tla) can be viewed within the viewer. The
TLA Generator creates the models and can then
segment, hide and delete components of that
model. That model can then be saved as a 3D
file to be viewed in the TLA viewer. The TLA
Viewer is unable to further modify the models
but can hide and recolor the components of the
model as they have been created within the TLA
3. Can I get the program that will move the
object independently and do the virtual surgery?
At this time the program to allow independent
manipulation of the individual components of
a scanned region, as well as virtual surgery
and arthroplasty templating is still under development.
The programs that are currently available are
the TLA Generator that created the model from
the CT scan data, and the TLA Viewer which allows
passive viewing of the model created in the
TLA Generator program. Details of availability
will appear on the web site for the distributors
- www.rubamas.com and in update information.
There are links to record your interest and
add your details to the mailing list to receive
regular update on progress.
4. How do I install TLA Generator or TLA Viewer?
Software can be installed using the installation
wizard on the CD or from downloadable files.
The installation wizard should take through
the install process and you can exit the process
at any stage.
5. How do I register TLA Generator or TLA Viewer?
You do not need to register the demo versions initially,
as they will work after installation for 30
day before being disabled on the computer on
which they were installed. If you wish to continue
to use the program, you will need to purchase a licence.
As part of the installation process an information file
(info.dat) will be created
which identifies the computer in which the program
has been installed. This is generally stored
within the "program files" with a particular
software program such as TLA viewer or TLA generator.
All details are in the "Install Wizard". Based
on the data file that you send us, we will provide
an authorization code by a downloadable file
or email attachment that you will need to run
on your computer to provide ongoing access to
the program on that computer. You do not need
to register the program to start using it as
the program will continue to run for 30 days
after installation after which time you will
need to run the authorization code to continue
to use the program. You can activate the registration
process at anytime through the programs section
of the start menu.
6. Do I need to register both the TLA Viewer
and TLA Generator?
The Demo versions of the software do not need
to be registered, but will only work for 30
days on any computer. It can not be reinstalled
on that machine. The full versions require registration
and an authorization code (that we supply after
you send us the registration code that created
during the install process) to allow ongoing
access. Each full version of the TLA Generator
and TLA Viewer software is regarded as a separate
program and you will need to go through a separate
registration process for each. Free full function versions
of the TLA viewer are supplied with a full licence of TLA generator.
7. How do I get a permanent licence?
During the installation process a registration
code is created that needs to be forwarded to
the specified address and once payment details
have been confirmed, an authorizing code will
be forwarded. After you have installed the full
version it will work for a further 30 days after
which time you will need to run the authorization
code to achieve ongoing access. More details
can be obtained at the website www.rubamas.com
or by telephoning within Australia 1300 558
659 or internationally +61 8 8239 8126.
8. How do I purchase TLA Generator or TLA Viewer?
Details on the purchase price and payment means
are available on line at www.rubamas.com or
by calling our hotline within Australia 1300
558 659 or internationally +61 8 8239 8126.
Payment can be made by credit card, bank check
or electronic funds transfer.
9. How do I move TLA Generator or TLA Viewer
from one PC to another?
Because each program is installed on a specific
computer you are unable to easily move the program
to another PC. You can install the Demo program
on another machine and it will then work as
a demo for 30 days. Although you can install
the full version on another computer, it will
only work for the 10 day grace period until
a new license is purchased for the new computer.
In particular situations where you need to uninstall
a program on a computer and move it to another
computer you should contact technical help desk
who should be able to provide a program to allow
you to uninstall and then reinstall the program.
It is therefore important that before buying
the licence (and providing the registration
data file) for a particular computer that the
computer is appropriate to the task as uninstalling
it and reinstalling is not an easy process.
A statutatory declaration from a head of clinical
department and of the relevant IT service
will serve as evidence that you are not attempting
to obtain another license without the licence
fee. You should simply then reinstall the program
as the registry will have been cleared. It is
not possible to extend the life, or reinstall
a trial version.
10. How do I get the current version?
The most current versions will be available
on line at www.rubamas.com . You also have the
option of a yearly service contract you will
be automatically provided with the update version
and the news on the current version plus some
on the older version will be available on line.
Once you have purchased the TLA generator program, you will
be regularly updated on developpments and new versions.
11. How would I get help for TLA Generator or
Help is available for True Life Anatomy Software
on line at www.rubamas.com or via our hotline
on (within Australia) 1300 558 659 or internationally
+61 8 8239 8126 at anytime you can email the
technical support team on email@example.com
. A tutorial and help files are available in
the help folder in the programme.
12. Does TLA Generator support MRI scan images?
TLA generator does support MRI scans if the
data is supplied in as standard DICOM format
and the slice data is uncompressed. CT scans
are generally scanned at between .5 and 1mm
intervals. Majority of current MRI scans however,
scan at approximately 4mm intervals. The result
in the surface rendered model is therefore much
less smooth with an MRI scan compared to the
CT scan and also the specific surfaces are often
less distinct. Bone for example is shown very
clearly on a CT scan but less distinctly on
a MRI scan. The TLA viewer and TLA generator
therefore does read in MRI scan data, but the
images created are often of poor quality due
to the slice spacing and indistinct surfaces.
It is possible however, to import an MRI scan
and then manually identify particularly feature
required within the generator on the 2D slice
modifying tools at the current time the CT scan
data particularly when you are looking at bone
is much more accurately assessed within the
TLA software where there is ongoing development
within the software.
13. Does it support MAC and UNIX?
At the moment True Life Anatomy software does
not support MAC or UNIX.
Definitions (Dicom and image rendering):
1. What is a DICOM file?
DICOM (Digital Imaging and Communications in Medicine) is an application layer network protocol for the transmission of medical images, waveforms, and ancillary information. It was originally developed by the National Electrical Manufacturers Association (NEMA) and the American College of Radiology for CAT and MRI scan images. It is now controlled by the DICOM Standards Committee, and supports a wide range of medical images across the fields of radiology, cardiology, pathology and dentistry. DICOM uses TCP/IP as the lower-layer transport protocol.
The impetus for the development of a common data sharing protocol was the need to
allow sharing of digital
data between imaging equipment and workstations
from the various different manufacturers. This
means that the imaging data created by a CT
scan from one manufacturer will be able to be
read by the workstation of another manufacturer.
Part 10 of the protocol relates to how the actual
2D slice data is represented. Each slice is
represented as a separate DICOM file (.DCM)
and this file contains a header within the file
which contains the unique data of that slice
in terms of the name of the patient, the time
and details of the scan as well as this position
of this slice being relative to the other slices
plus a standard image file such as JPEG, TIFF
or BITMAP. The scan from a patient may contain
100 or more of these separate DICOM files. The
process of reading these files into a program
into a TLA generator or a TLA viewer is aided
if there is an attached DICOM DIR file which
is a summary of the files within the patient
data set. TLA software can create its own DICOM
directory but many CT scan workstations will
create this directory as a routine. More details
on the DICOM protocol are available on the links
page at www.rubamas.com
2. What is DICOM Dir?
The scan Data is saved as a DICOM file. The
entire scan series can involve many hundreds
of DICOM files which represent each CT or MRI
slice. To load these (slice) files, the computer
program must look at each file and from the
data contained in the header load the data in
the correct order. To facilitate the loading
of the scan data however, most scanner workstations
can create a DICOM Dir or scan data directory.
DICOMDIR acts as a "Directory" for DICOM file sets
and holds a full 4 level hierarchy
(PATIENT --> STUDY --> SERIES --> IMAGE)
Similar to most imaging programs, TLA software requires a DICOM Dir to
load the data. If the scanning workstation does
not create this Dir file TLA software can create
this as part of the loading sequence. The best
way to see how to do this is work through the
tutorial in the help file on the programme. iQ-VIEW as part of Ortho-Access however can create the needed DicomDir and launch TLA Generator, improving the efficiency and ease of data access and model creation.
3. What is volume rendering?
Volume rendering is a technique where all the
data points within a scan area are loaded into
the computer workspace and those points are
given a variable transparency and colour. This
provides a type of hologram of the image required
but it cannot be saved as a three dimensional
model. All the data points are kept within the
workspace and those tissues that do not wish
to be imaged are made transparent but are retained.
This means that the entire data set needs to
be loaded every time the image needs to be viewed
and therefore is very heavy on resources. It
is not possible to truly separate the various
bony components and as the model cannot be saved
as a specific three-dimensional model it is
not possible to interact with them using various
cutting or manipulation tools. Most current
proprietary CT workstations use Volume rendering
technology as the main image creation technique.
This means you can only get 2D screen shots
from your radiologist. This is the critical
point of difference between the current Radiology
image access and TLA technology. Using the TLA
Generator, a surface rendered model is created
that can be exported to the clinician as a truly
interactive 3D object, which therefore allows
for a wider range of options to manipulate the
image and select the view required. Later software
development will allow virtual surgery and arthroplasty
4. What is surface rendering?
Surface rendering identifies points on the surface
of a 3D object that is to be imaged and creates
small facets or polygons that join up like points.
This creates a single layer surface over the
object that needs to be visualized then discards
all other data points. Within the surface rendered
model it is only that surface that we are particularly
interested in that is kept which means that
the images themselves are quite small, they
can be saved and as it is a discrete three dimensional
virtual object there is potential to interact
with this object in a graphics environment for
surgical planning, object manipulation and templating
surface modelling is a number of significant
5. What is PACS?
PACS stands for Picture Archiving and Communication
System. It refers to a computer network that
is set up to share image data. There is typically
has a larger central computer, which is networked
to other computers that can access a central
data base. The issues of who has access to the
network, file back up and prevention of inappropriate
use means network requires careful monitoring
and control. There are many systems available
and most provide a range of software that resides
on the central server and that the networked
computers can utilize to enhance the functionality.
Most large hospitals will has a PACS system,
and may be possible, with the permission of
your system administrator, to access scan data
directly off the PACS network. At the moment
you will need some third part software such
as Conquest, but in the future TLA software
will allow this - see ClinPACS and Ortho-Access.
6. What is a memory error?
Like a number of other 3D graphics programs
information stored within the RAM during the
creation of some models it is not entirely cleared
when that image file is closed. Some residual
memory may remain in the RAM, which may reduce
the resources available for the next image creation.
If the program is running unexpectedly slow
it may help to close the program and then reopen
it. This will clear the memory and allow you
to use the entire capacity of your RAM for creating
the new model. Sometimes if there is a very
large model which is likely to get to the limits
of your computer resources it is often worthwhile
loading the CT data onto the desktop temporarily
which avoids having to reload the entire data
set should you close the program and wish to
reload the original data set. It may be quite
helpful to open the Program Manager in Windows
XP that can tell you the amount of CPU and Memory
use by the various loaded programs, and if there
is significant retained memory when you "close"
TLA Scan Data obtaining / Loading:
1. How do I get the image data from my Radiology
The scan data either CT or MRI can be exported
from the radiology workstation as DICOM
files. This can be either via a network or on
a CD. The data needs to be saved in a particular
format and at the moment the files should be
in uncompressed BITMAP form and a request form
specifying the form of image saving is available
line. Alternatively a request form is available
in the docs section on the installation CD. The big issue in the past has been getting access to the dicom data on the PACS network. Using the Ortho-Access concept as a way to tap into the PACS data repository, the issues of integrating with your existing hospital PACS paltform can be overcome. iQ-VIEW can retrieve the dicom data form the PACS store (with the appropriate gateway permission) and even lauch the TLA Generator program at the load data level.
2. Can I get the data from my CT scanner on
our hospital network?
At the moment, the best way to get the CT or
MR scan data is on a CD. There are some third
party programmes such as Conquest the will allow
you to in receive the data from a network, but
this will need to be set up by your systems
administrator and requires knowledge of your
particular network arrangements. iQ-VIEW as part of
Ortho-Access can retrieve the data off the network, but you will need this to be set up
formally by the Network Administrator. This is part of the Ortho-Access concept.
In many situations, unless you have installed the Ortho-Access System, data burnt to a CD by the scanning workstation is the easiest way. There is a request
form on line and on the software installation
CD that you can attach to a standard Scan
request form that will tell the Radiology
Department how the data needs to be saved.
3. Does the Scan data need to be saved in any
The data need to be DICOM
3 compatible, and needs to be saved in an uncompressed
form. Many workstations and Scan reading software
will by default save the data to a CD in a compressed
form to save disc space. This compression may
degrade the data and compromise the quality
of the image that can be created. At the present
time the TLA software will only read data that
is uncompressed. If the programme crashes or
will not load w