Vista Imaging Routing Users Manual User Guide
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Routing User Guide-DRAFT
VistA Imaging
V. 3.0, Patch 18
April 2006
VistA Imaging Software Design & Development
Veterans Health Administration
Department of Veterans Affairs
Routing User Guide-DRAFT
Patch 18
April 2006
Property of the US Government
No permission to copy or redistribute the software described in this document is given. Use of unreleased
versions of this software requires the user to execute a written test agreement with the VistA Imaging
Development Office.
This is a controlled document. No changes to this document may be made without the express written consent
of VistA Imaging Development Office.
While every effort has been made to assure the accuracy of the information provided, this document may
include technical inaccuracies and/or typographical errors. Changes are periodically made to the information
herein and are incorporated into new editions of this document.
Product names mentioned in this document may be trademarks or registered trademarks of their respective
companies, and are hereby acknowledged.
VistA Imaging Software Design & Development
Department of Veterans Affairs
1335 East-West Highway 3rd Floor
Silver Spring, MD 20910
(301) 734-0100
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Contents
Introduction........................................................................................................ v
Terms of Use....................................................................................................................v
About this Manual ............................................................................................................vi
Related Documents ......................................................................................................... vii
Routing Overview ............................................................................................... 1
Routing Explained ............................................................................................................ 1
Routing Prerequisites ....................................................................................................... 2
How Autorouting Works.................................................................................................... 4
How On-Demand Routing Works ....................................................................................... 7
How Routing Priority Works .............................................................................................. 8
Defining Routing Rules....................................................................................... 9
Routing Rules Explained ................................................................................................... 9
Rule Destinations ............................................................................................................12
Rule Conditions...............................................................................................................14
Routing Rule Priority .......................................................................................................22
Routing Images from Prior Exams ....................................................................................22
Routing Rule Tips............................................................................................................23
Configuring Routing ......................................................................................... 25
Defining Imaging Destinations .........................................................................................26
Defining DICOM Destinations ...........................................................................................37
Defining “Route Priors” Logic ...........................................................................................40
DICOM Gateway Configuration .........................................................................................42
Importing Routing Rules (Route.dic) .................................................................................44
VistARad Configuration—Sending Sites..............................................................................47
VistARad Configuration—Receiving Sites ...........................................................................48
Changes Affecting Routing System Configuration ...............................................................50
Using the Routing Gateway .............................................................................. 51
Activating Routing...........................................................................................................51
Maintaining Routing ........................................................................................................53
Disabling Routing............................................................................................................54
Routing Gateway Menu Options .......................................................................................55
Using VistARad in a Routing System ................................................................ 59
Displaying Routed Exams.................................................................................................59
VistARad & On-Demand Routing.......................................................................................61
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Routing User Guide
Contents
Troubleshooting Routing .................................................................................. 65
Basic Troubleshooting .....................................................................................................65
Getting Help ...................................................................................................................65
Additional Routing Considerations.....................................................................................66
Appendix A........................................................................................................69
Imaging Destination Worksheet........................................................................................71
DICOM Destination Worksheet .........................................................................................73
Routing Rule Definition Worksheet ...................................................................................74
Routing Setup Checklist ...................................................................................................78
Appendix B: Using MAG_Decompressor ........................................................... 79
Licensing........................................................................................................................79
MAG_Decompressor Setup...............................................................................................79
MAG_Decompressor Logging............................................................................................81
Glossary ............................................................................................................83
Index ................................................................................................................ 87
98H
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Introduction
This manual explains how to configure and use the routing capability of the VistA
DICOM Gateway. This manual also explains how to use the on-demand routing
capability of the VistARad diagnostic workstation software.
This manual is intended for:
Staff at VA Medical Centers who are responsible for setting up and maintaining
Routing Gateways.
Clinical staff who need to use VistARad for on-demand routing.
For technical staff, this manual assumes familiarity with the VistA system, MUMPS, and
Windows networking. For clinical staff, this manual assumes familiarity with the
Windows environment and the VistARad diagnostic workstation software.
Terms of Use
In compliance with FDA and VA policies, authorization to use the software described in
this document is contingent on the execution of a Site Agreement between the VistA
Imaging HSD&D group and the site where this software is installed.
Once a routing system is enabled at a site, an updated Site Agreement must be filed
before significantly altering the configuration of a routing system.
In addition to any restrictions noted in the Site Agreement, the following restrictions
apply:
!
Caution: Federal law restricts this device to use by or on the order of either a
licensed practitioner or persons lawfully engaged in the manufacture or
distribution of the product.
!
No modifications may be made to this software without the express written
consent of the VistA Imaging National Project Manager.
!
The Food and Drug Administration classifies this software as a medical device.
Modifications to the computer where this software is installed, such as the
installation of unapproved hardware or software, will adulterate the medical
device. The use of an adulterated medical device violates US Federal Law
(21CFR820).
!
US Federal regulations and VA internal policy prohibit unencrypted transmission
of patient information outside the VA's intranet.
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Introduction
Routing User Guide
About this Manual
Using this Manual
This document contains material of interest to different types of users.
User
Please read…
All users
The Routing Overview and the Glossary. The Index can
also be used to find information about specific topics in
this document.
Clinical users
The Using VistARad in a Routing System chapter.
Users responsible for
DICOM Gateway
operation and
maintenance
The Using the Routing Gateway chapter. You may also
find useful information in the Troubleshooting Routing
and Defining Routing Rules chapters.
Users responsible for
installing or configuring
a routing system
The Defining Routing Rules and Configuring Routing
chapters.
Installation worksheets are available in Appendix A.
Conventions
This manual uses the following conventions:
Examples are shown in Courier.
Useful or supplementary information is indicated by a  icon
VA File Manager file names are shown in SMALL CAPS. The first time a FileMan file
is referenced in a topic, the file number is indicated in parentheses.
Menu options, buttons and other controls found in a graphical user interface are
indicated by title case. Menu sequences are indicated by vertical bars ( | ).
Cross-references are underlined. If this document is being used online,
cross-references are shown in blue and are active links.
Sidebars shown in margins indicate new or revised content.
Acknowledgements
This document is based on the “Autorouting Tutorial” authored by Ed de Moel.
Special thanks to Brian Belleau, Craig W. Hunter, Cheryl Marland, Arnold Pfenninger,
and Hedy Towan, who provided valuable background information and feedback for
initial drafts of this document.
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Routing User Guide
Introduction
Revision Table
Date
Rev.
Notes
25 Jun 2002
.9
Draft. Based on 23 Sep 1999 “Autorouting Tutorial.” Updated for
Patch 9, test 2 distribution.
20 Mar 2003
1.0
Final version for p9 release. A. McFarren, E. deMoel
22 Sep 2003
1.1
Minor p22 updates in VistARad chapter. Added info about
routing rules and priority that was not included in original rev.
Minor clarifications and corrections throughout. A. McFarren, J.
Christensen.
30 Jul 2005
1.2
Updates for patches 11 and 51. Change bars in margins indicate
updated content. A. McFarren, E. deMoel
03 Apr 2006
1.3
Updates minor updates for patch 18. Change bars in margins
indicate updated content. A. McFarren, J. Christensen
Related Documents
The following documents contain additional information about routing:
Patch Descriptions for patches 9, 11, and 51.
Routing Guidance Document
The following documents contain additional information about components in the routing
system:
DICOM Gateway User Guide
DICOM Gateway Installation Guide
VistARad User Guide
The following documents contain information about the VistA Imaging system in
general:
VistA Imaging System Installation Guide
VistA Imaging System Technical Manual
VistA Imaging System Planning Document & Approved Equipment List
Copies of these documents are available at http://vaww.va.gov.imaging.
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Introduction
Routing User Guide
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Routing Overview
This chapter explains how routing functions within the VistA Imaging system. It covers
the following topics:
Routing Explained
How Autorouting Works
How On-Demand Routing Works
How Routing Priority Works
Routing Explained
In VistA Imaging, routing is the combination of methods and software used to identify
and transmit exams produced at one site to a storage location at another site.
Routing takes two forms: autorouting, and on-demand routing.
In autorouting, automatically selected images are transmitted to one or more
destinations. Images are selected based on a predefined set of routing rules.
Autorouting functions are managed using the Routing Gateway.
In on-demand routing, manually selected exams are transmitted to one or more
destinations. Exams are selected using the VistARad diagnostic workstation and are
transmitted by the Routing Gateway.
Destinations of routed images fall into two broad groups. Imaging destinations are
defined to support remote reading using a VistARad workstation. Images sent to these
destinations are in VistA Imaging’s internal file format. DICOM destinations are defined
to support transmission of DICOM images to a Storage SCP (Service Class Provider),
such as a film printer or an external PACS.
A properly implemented routing system can streamline a site’s imaging workflow.
Scenarios where routing can be used include:
Workload sharing between institutions or service providers
Rapid access of exams at remote clinics or other facilities
Remote specialist interpretation or consultation
Off-hours, holiday, or emergency services
Off-site contract radiology services for primary interpretation
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Routing Overview
Routing User Guide
What is a Routing Gateway?
A Routing Gateway locates routable images, determines where the images are to be
routed to, and sends copies of those images to other locations. Routing is a function of the
DICOM Gateway software. When properly configured, any DICOM Gateway can
function as a Routing Gateway.
Typically, a Routing Gateway runs on a dedicated computer. At sites where only a small
volume of images are produced, a Routing Gateway can coexist on the same computer as
an Image Gateway or a Text Gateway.
Routing Prerequisites
For a site to be authorized to use a routing system:
An executed Site Agreement must be filed with the VistA Imaging HSD&D group.
Note: An updated site agreement must be filed if the routing system is altered (for
example: if site information changes, if a new destination is added, or if routing
volume increases by 50% or more).
A contingency plan must be implemented at all sites in the routing system and filed
with the VistA Imaging HSD&D group. The contingency plan must contain
procedures to be followed should the routing system be unavailable.
General hardware and operational requirements for routing are summarized below. For
detailed information, contact your VistA Imaging Implementation Manager.
Infrastructure Requirements
Routing relies on the following infrastructure:
If remote interpretation is being performed, one or more VistARad diagnostic
workstations for the display of routed exams.
An operational VistA Hospital Information System, an operational Image Gateway,
and an operational Routing Gateway, configured as described in this document.
An operational Local Area Network (LAN).
An operational Wide Area Network (WAN) with sufficient bandwidth to manage the
anticipated volume of routed exams.
Windows-based servers to provide exam storage at each routing destination,
configured as described in this document.
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Routing Overview
Operational Requirements
The medical and IT management at a site implementing the routing system will need to
develop policies establishing:
Locations to which the exams may and may not be routed
Reporting / transcription requirements for routed exams
Bandwidth utilization guidelines and priorities
Storage of routed exams at receiving sites
Management of patient confidentiality and privacy issues related to routed exams
Methods for addressing performance issues and/or misuse of the routing system
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Routing Overview
Routing User Guide
How Autorouting Works
The following figure illustrates the transfer of automatically routed images to a
VistARad workstation for remote reading. The processes outlined in this figure are
explained in more detail below. (Apart from the destination, the same processes are used
when autorouting images to a DICOM Storage SCP).
Image G/W
processes
images, then
archives images
Images
acquired
Images
Patient
data
Routing G/W
compares
image data
to routing rules (1)
Routing G/W
copies
routable images
to destination (2)
VistA
HIS
Images
reviewed
at destination
VistARad login
Sending Site
Destination Site
Modality
Image links
Image Gateway
1
2
Routing Gateway
VistARad
2
1) Eval. Processor
2) Trans. Processor
Local image copies
Images
Image Archive
Remote Storage
Destination
Identifying Images to be Autorouted
Autorouting begins with an Image Gateway. As it is processing newly acquired images, a
properly configured Image Gateway will add routing-specific entries to the rule
evaluation queue. 1 This queue is continually checked by the evaluation processor (which
resides on the VistA Host and is started from the Routing Gateway).
 If the Image Gateway is not configured to add entries to the rule evaluation queue, the
images being processed by the gateway cannot be autorouted. For more information,
see page 44.
Each image referenced in the rule evaluation queue is checked against a set of
site-specific routing rules. If the rules indicate that the image should be routed, the
evaluation processor creates an entry in the transmission queue. 2 Entries in the rule
evaluation queue are deleted after they are checked.
1
2
4
The rule evaluation queue is a subset of the IMAGE BACKGROUND QUEUE file (#2006.03).
The transmission queue is stored in the SEND QUEUE file (#2006.035).
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Routing User Guide
Routing Overview
Autorouting Images from Prior Exams
Autorouting offers the option to include images from prior exams. When this option is
used in a routing rule, the Routing software will use the VistARad prefetch logic defined
at acquisition site to create a list of prior exams. Images from the prior exams will be
routed using same priority as the newly acquired image and, when appropriate, will be
purged based on the same retention period as the newly acquired image. For more details
about autorouting priors, see page 22.
Sending Images to Destinations
The transmission of routed images is based on entries in the transmission queue. Each
entry in the transmission queue identifies the image to be routed and the destination of
the image.
The transmission queue is continually checked by the Routing Gateway transmission
processor. For each entry in the queue, the transmission processor locates the image, and
identifies the destination.
For Imaging destinations, the transmission processor is responsible for copying the image
to the destination. For DICOM destinations, the transmission processor passes the image
and destination information to the ‘Transmit DICOM Images to a DICOM SCP’ function
of the DICOM Gateway, and waits for the function to report the status of the transfer
back to the routing software.
After the image is copied, the appropriate entry in the transmission queue is updated with
the status of the image transfer. Transmission queue entries are retained for tracking and
troubleshooting purposes. Entries can be deleted as described on page 57.
Remote Reading with VistARad
A properly-configured VistARad workstation can be used to display and interpret exams
routed from another site. Radiologists performing remote reading can use VistARad to
log into the site that sent the routed exams, and then use the contents of the RC (Remote
Cache) exam list column to determine which exams have been routed to them. For
additional information about working with routed exams, refer to page 59.
Exporting DICOM Images
In general terms, any DICOM Storage SCP (Service Class Provider) can serve as a
DICOM destination. Apart from transmission logs, images routed to a DICOM
destination are not tracked by the Imaging system. Retention, management, and deletion
of routed images is the responsibility of the destination.
Deletion of Routed Images
For Imaging destinations, the amount of time routed images are retained is based on the
value of the RETENTION PERIOD field in the NETWORK LOCATION File (#2005.2). When
connecting to a destination for the first time on a given day, the transmission processor
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Routing Overview
Routing User Guide
determines if images at the destination are older than the number of days specified in
1
RETENTION PERIOD. Images older than the specified number of days are deleted from
the destination’s storage location.
For DICOM destinations, routed images are retained until they are deleted locally. The
routing software will not delete images sent to DICOM destinations.
 Routed images are copies. The original image files are retained at the site where they
were acquired.
1
The age of a routed image is based on the transmission queue entry for that image, not on the
date of the image file itself. Changes made to the date of the image file (such as those made by
some anti-virus packages) will not affect when the image is deleted.
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Routing Overview
How On-Demand Routing Works
On-demand routing uses the same infrastructure as autorouting. However, in on-demand
routing, exams to be routed are manually selected by a VistARad user, rather than being
identified automatically by a Routing Gateway. With the proper security keys,
on-demand routing is available to any VistARad user in the routing system.
The following figure illustrates the transfer of images between a local and remote
VistARad workstation using on-demand routing. 1 On-demand routing can also be used to
transfer images to a DICOM destination such as a film printer or an external PACS.
Exams available
in VistARad
exam lists
VistARad used to
queue exams for
on-demand routing
VistARad login
VistA
HIS
Routing G/W
copies images
to destination
Images
reviewed
at destination
Remote VistARad login
Sending Site
Destination Site
Route
Request
VistARad (sending site)
VistARad (destination site)
Routing Gateway
(Trans. Processor)
Images
Local image copies
Image Archive
Remote Storage
Destination
Selecting Images for On-Demand Routing
VistARad’s Route Request dialog is used to select the exams to be routed on-demand and
to indicate where exams are to be sent. When a user accepts the settings in the Route
Request dialog, the exams are checked by VistARad to see if they can be routed (images
present, available in short-term storage, etc.). Then entries for each image in the selected
exams are added to the transmission queue.
Once an exam has been added to the transmission queue, on-demand routing functions in
the same way as autorouting.
1
This figure illustrates on-demand routing being initiated from the site with a local Routing
Gateway. On-demand routing can also be initiated from a destination site, as long as the
destination site is logged into the location (division) where the exams to be routed were acquired.
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Routing Overview
Routing User Guide
How Routing Priority Works
The following factors are used to determine the priority of a routed exam:
Assigned priority
Clinical urgency (autorouting only)
Time in transmission queue
Priority and Autorouting
For automatically routed exams, the routing software uses the priority assigned in a
routing rule and the clinical urgency of the exam to calculate a numeric value. Images
with the highest priority value are transmitted first.
Factor
Values
Notes
Assigned priority
Low:
+250
Medium: +500
High:
+750
Priority is set in routing rules as described
on page 9.
If not explicitly set, a default value of
Medium is used.
Clinical urgency
Routine:
Urgent:
STAT:
Values are based on the clinical urgency
defined for the exam in the VistA system.
+0
+10
+20
Priority and On-demand Routing
When an exam is routed on-demand, VistARad’s Route Request dialog can be used to
assign a priority of Low, Medium or High. (The clinical urgency of the exam is not
used). The Route Request dialog is described on page 61.
If a user selects an exam to be routed on-demand that is already in the transmission
queue, the higher priority of the two instances will be used.
Other Priority Factors
If two or more entries in the transmission queue have the same priority value, entries are
processed on a First In, First Out (FIFO) basis.
Because the transmission processor works on an image-by-image basis, it is possible for
the images in a lower-priority exam to be interrupted ‘mid-stream’ by the images in a
higher-priority exam. If this happens, transmission of all lower priority images will
resume after transmission of all higher-priority images is complete.
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Defining Routing Rules
This chapter explains how to define the rules used for autorouting. This chapter covers
the following topics:
Routing Rules Explained
Rule Destinations
Rule Conditions
Routing Rule Priority
Routing Rule Tips
 Routing rules can be defined before the configuration of the routing system is
complete, but cannot be tested until the setup of the routing system is finished.
Routing Rules Explained
The Routing Gateway uses routing rules to determine which images are to be
automatically routed and where the images are to be sent. Routing rules need to be
established as a part of configuring the routing software, and will need to be adjusted if
there is a change of staff availability or workflow.
The definition of routing rules involves:
1
Determining the needs of the staff at the sending and receiving sites.
2
Determining what resources will be used at the receiving site.
3
Translating the resulting information into a rule that can be executed by the routing
software.
 A rules definition worksheet is located in Appendix A.
How Routing Rules Work
Routing rules are defined in a text file and are implemented when the text file is imported
into a local table on the Routing Gateway.
A basic routing rule looks like:
send(“destination”)
when [condition A
condition B...]
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Defining Routing Rules
Routing User Guide
Each routing rule must contain at least one destination and one condition. When the
conditions in a rule are met, the image is sent to the specified destination.
The destination specified in a rule must match an entry in either the NETWORK
LOCATION File (#2005.2) or the DICOM TRANSMIT DESTINATION File (#2006.587).
Routing rule destinations are described in detail on page 12.
A condition is a comparison between a general image property and the specific value
associated with a particular image. Conditions are described in detail on page 14.
Sample Routing Rules
The following pages contain examples of routing rules as they would be entered into the
Route.dic file. For more information about the Route.dic file, see page 44.
A Simple Routing Rule
A common routing scenario is the transmission of images from a particular modality for
remote interpretation.
Send CR images to Kansas City
send("KANSASCITY")
when MODALITY = "CR"
Rules using Multiple Conditions
If a rule contains more than one condition, all of the conditions must be met for an image
to be routed.
Send CR images produced in Wichita to Kansas City
send("KANSASCITY")
when MODALITY = "CR"
SOURCE
= "WICHITA"
Tip: When defining multiple conditions for a rule, list the most restrictive condition first.
Listing the most restrictive condition first will minimize the amount of time needed by
the routing software to process the rule.
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Defining Routing Rules
Rules using Wildcards
Wildcards can be used when you want a condition to be valid for more than one value. In
the example below, all images, regardless of modality, will be routed.
Send all images to Kansas City
send("KANSASCITY")
when MODALITY="*"
Wildcards are described in detail on page 20.
Rules using the “does not match” Operator
A condition can use different types of operators. The previous examples used “=” as an
operator, indicating that the specified image property must match a particular value for a
condition to be met.
The following example uses “!=” as an operator, indicating the image property in
question can be any value except the listed value.
Send non-CR images to Kansas City
send("KANSASCITY")
when MODALITY != "CR"
Operators are described in detail on page 20.
Rules using Date/Time Conditions
A rule using date/time conditions can be used to route images based on date, time of day,
or “type” of day (such as weekday, holiday, and so on).
A rule to send all CR images to a destination on certain days would look like:
Send CR images to Kansas City on Mon/Wed/Fri
send("KANSASCITY")
when MODALITY="CR"
NOW={MON 00:01AM to 11:59PM;
WED 00:01AM to 11:59PM;
FRI 00:01AM to 11:59PM}
The NOW condition is described, along with other date/time conditions, on page 21.
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Defining Routing Rules
Routing User Guide
Rule Destinations
The first parameter in a routing rule contains either the send command or the balance
command, and contains one or more destination names.
The send and balance commands are described in detail below. Destination names are
described on pages 26 and 37.
The SEND Command
Typically, the send command is used to specify a single destination, as in the example
below:
send("KANSASCITY")
when MODALITY="CR"
NOW={MON 00:01AM to 11:59PM;
WED 00:01AM to 11:59PM;
FRI 00:01AM to 11:59PM}
To send similar exams to multiple destinations, multiple rules would be used, as shown
below:
send("KANSASCITY")
when MODALITY="CR"
send("BACKUP")
when MODALITY="CR"
The BALANCE Command
Use the balance command when you want to divide a pool of exams between multiple
destinations. When using the balance command, you must specify what percentage of
exams should be sent to each destination.
In the sample rule below, 25% of the exams are sent to KANSASCITY, and 35% of the
exams are sent to KANSASCITY2. The remaining exams are not routed at all (as indicated
by the =40% portion of the command).
balance("KANSASCITY"=25%,"KANSASCITY2"=35%,=40%)
when MODALITY="CR"
 The total value of the percentages specified in the command must equal 100%.
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Routing User Guide
Defining Routing Rules
How Load Balancing Works
When a rule incorporates the balance command, the routing software uses two things to
determine which destination receives a given exam: the percentages specified in the rule
and internal counters set by the routing software.
When a rule including a balance command is first applied, the routing software begins
distributing exams the same way a deck of cards is dealt: the first destination receives one
exam, the second destination receives the next exam, and so on. Exams are evenly
distributed until the destination with the lowest value specified in the balance command
has received its allotted percentage of exams. Then that destination is skipped until the
counter resets. Since load balancing is based on percentages, the counter is reset each
time 100 exams have been sent.
For example, if a rule specifies…
balance("DEST1"=10%,"DEST2"=40%,"DEST3"=50%)
when MODALITY="CR"
The first 30 CR exams will be distributed evenly, with each destination receiving 10
exams. Once DEST1 has received 10% of the exams, the routing software will skip
DEST1 until the counter resets.
The next 60 CR exams are split evenly between DEST2 and DEST3. After this point,
DEST2 and DEST3 each have a total of 40 exams. DEST2 now has its allotment of 40
exams, and will be skipped until the counter resets.
The remaining 10 CR exams are sent to DEST3, giving that destination a total of 50
exams.
Once 100 CR exams have been sent, the routing software resets its counters to zero,
and starts distributing exams to all three destinations again.
Note that a destination receiving a comparatively smaller percentage of exams will
become idle more often than destinations that receive a greater percentage of exams.
Resetting the Load Balancing Counter
When routing rules are imported, the counters used for load balancing are all reset to
zero. You can take advantage of this trait if you need to fine-tune or troubleshoot
situations where load balancing is used. Note that it is not necessary to change routing
rules to achieve this; you only need to re-import them.
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Defining Routing Rules
Routing User Guide
Rule Conditions
In routing rules, a condition is a comparison between a particular property of an image
and a user-supplied value. The results of the comparison determine if the rule will be
applied to an image or not.
A routing rule can contain multiple conditions. A single when statement precedes all
conditions in a rule.
send("KANSASCITY")
when MODALITY = "CR"
SOURCE
= "WICHITA"
The parts of a condition are:
property operator value
A property is one of the known attributes of an image. Properties that can be used in a
condition are listed the following section.
An operator is a code for a type of comparison. Operators are described on page 20.
A value is a text or date string supplied by the user. A value specifies what is being tested
in the condition. Values are described on page 21.
Properties
The properties listed in this section can be used in routing rule conditions.
 Property names are not case-sensitive. However, properties are typically rendered
in uppercase.
Frequently Used Properties
MODALITY
Abbreviation for the type of modality. Possible values are listed below. Retired
values are indicated by (ret.).
AS: Angioscopy
AU: Audio
BI: Biomagnetic Imaging
CD: Color Flow Doppler
CF: Cinefluorography
CP: Colposcopy
CR: Computed Radiography
CS: Cystoscopy
CT: Computed Tomography
14
MA: Magnetic Resonance Angiography
MG: Mammography
MR: Magnetic Resonance
MS: Magnetic Resonance Spectroscopy
NM: Nuclear Medicine
OP: Ophthalmic Photography
OT: Other
PR: Presentation State
PT: Positron Emission Tomography (PET)
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(continued)
DD: Duplex Doppler
DF: Digital Fluoroscopy (ret)
DG: Diaphanography
DM: Digital Microscopy
DS: Digital Subtraction Angiography (ret)
DX: Digital Radiography
EC: Echocardiography
ECG: Electrocardiography
EPS: Cardiac Electrophysiology
ES: Endoscopy
FA: Fluorescein Angiography
FS: Fundoscopy
GM: General Microscopy
HC: Hard Copy
HD: Hemodynamic Waveform
IO: Intra-oral Radiography
IVUS: Intravascular Ultrasound
LP: Laparoscopy
LS: Laser Surface Scan
PX: Panoramic X-Ray
RF: Radio Fluoroscopy
RG: Radiographic Imaging (conventional)
RTDOSE: Radiotherapy Dose
RTIMAXGE: Radiotherapy Image
RTPLAN: Radiotherapy Plan
RTRECORD: RT Treatment Record
RTSTRUCT: Radiotherapy Structure Set
SM: Slide Microscopy
SMR: Stereometric Relationship
SR: SR Document
ST: Single-Photon Emission Computed
Tomography (SPECT)
TG: Thermography
US: Ultrasound
VF: Videofluorography
VL: Visible Light (VA extension)
XA: X-Ray Angiography
XC: External-camera Photography
NOW
Date and time that the rule is being processed. For more information, see page 21.
SOURCE
Name of the site that originally acquired the image. The value for this field is
determined as follows:
If the ACQUISITION SITE field (#2005, .05) has a non-empty value, the value of
this field is used, otherwise;
If the end-user credentials have a non-empty value for the current division (i.e. the
location code for the DICOM Gateway from which the evaluation processor was
started), the number of this division will be used, otherwise;
As a last resort, the KERNEL SITE PARAMETER field for the number of the
institution will be used.
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Other Properties
ABSTRACT_REF
The network storage location of the image abstract.
ACQUISITION_DEVICE
The name of the device that generated the image as defined in the ACQUISITION
DEVICE File (#2006.04).
BIG_JUKEBOX_PATH
Full file path on jukebox for .BIG images. This field indicates whether this file is
located on the jukebox.
BIG_MAGNETIC_PATH
Full file path for .BIG images. This field indicates on which magnetic server this file
resides.
CLASS
The class of the image, as stored in the CLASS INDEX field (#2005, 41). Typical values
are CLIN, ADMIN, CLIN/ADMIN, and ADMIN/CLIN.
CLINIC
If an image is associated with a patient encounter (visit), the value of this parameter is
the name of the clinic where the appointment occurred.
DESCRIPTIVE_CATEGORY
This is mainly for Document Imaging; it further describes the type of document
image.
EXAM_TIME
The date/time of the procedure or the examination. For more information, see page 21.
EXAM_TIME can be used to compare the exam date/time of the “image at hand” to the
provided value.
EXAM_TIME_FIRST can be used to compare the exam date/time of the earliest (oldest)
image in the exam to the provided value.
EXAM_TIME_LAST can be used to compare the exam date/time of the latest (newest)
image in the exam to the provided value.
EXPORT_REQUEST_STATUS
The value of this field, if defined, indicates if MailMan will send or has sent the image
to another site. Possible values are:
1 = EXPORT REQUESTED
0 = EXPORTED
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FILE_REF
The unique image filename of the image, as stored on the magnetic server (and/or
jukebox).
IMAGE_SAVED
The date and time the image was captured (as opposed to the date and time of the
procedure or exam). For more information, see page 21.
IMAGE_SAVED can be used to compare the save date/time of the “image at hand” to
the provided value.
IMAGE_SAVED_FIRST can be used to compare the save date/time of the earliest
(oldest) image in the exam to the provided value.
IMAGE_SAVED_LAST can be used to compare the save date/time of the latest (newest)
image in the exam to the provided value.
IQ
A flag that indicates whether or not an image has questionable integrity, as specified
in the IQ field (#2005, 13). This field is either empty or equal to YES. Note that
images with questionable integrity will be transmitted, but may not be displayed by
the software on the receiving system. (On VistARad workstations, a warning is
displayed if a user opens an image with questionable integrity, and only a user with
the proper security key can actually display the image.)
LAST_ACCESS
The date and time the image was last viewed or accessed. For more information, see
page 21.
LAST_ACCESS can be used to compare the last access date of the “image at hand” to
the provided value.
LAST_ACCESS_FIRST can be used to compare the last access date of the earliest
(oldest) image in the exam to the provided value.
LAST_ACCESS_LAST can be used to compare the last access date of the latest
(newest) image in the exam to the provided value.
MAGNETIC_REF
The path for the network location of the stored image.
MICROSCOPIC_OBJECTIVE
Free text description of the Microscopic Objective selected by the pathologist. It
identifies the power of the microscope objective used when capturing an image of a
slide.
OBJECT_NAME
The natural language name for the image, usually consisting of the patient name,
social security number, and image description.
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OBJECT_TYPE
The object type (such as still image, black & white image, x-ray) as described in the
OBJECT TYPE File (#2005.02).
PACKAGE
An abbreviation for the name of the package that the image is attached to, as defined
in the PACKAGE INDEX field (#2005, 40). Possible values are: RAD, LAB, MED,
NOTE, CP, SUR, PHOTOID, NONE, or CONS.
PACS_PROCEDURE
The name in the radiology reports file that identifies the procedure.
PACS_UID
The unique 26-character image identifier of the PACS image.
PARENT_DATA
The name of the file that contains the “Parent Data.” See also
PARENT_DATA_FILE_IMAGE_POINTER, PARENT_GLOBAL_ROOT_D0 and
PARENT_GLOBAL_ROOT_D1.
PARENT_DATA_FILE_IMAGE_POINTER
In the file identified by “Parent Data,” a multiple valued field may exist that identifies
groups of images. When there is such a “multiple,” the value of this parameter is the
entry number in this multiple that points back to the parent image of the current
image.
PARENT_GLOBAL_ROOT_D0
The internal entry number in the file identified by PARENT_DATA.
PARENT_GLOBAL_ROOT_D1
The value of this parameter is defined only for laboratory images to record the third
subscript of ^LR(D0,"SP",D1) as a backward pointer for use in report display and
image deletion.
PATH_ACCESSION_NUMBER
The Anatomic Pathology accession number - the identifying number for the slide.
PATIENT
The name of the patient.
PROCEDURE
An abbreviation for the procedure as stored in the PROCEDURE field (#2005, 6).
This field is set automatically by Imaging. Typical values are COL for colonoscopy,
SUR for surgery, SP for surgical pathology, or XRAY for radiology.
PROCEDURE_OR_EVENT
The name of the procedure or event for which the image was created, as stored in the
PROC/EVENT INDEX field (#2005, 43).
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PROCEDURE_TIME
The date/time of the procedure or the examination. For more information, see page 21.
PROCEDURE_TIME can be used to compare the procedure date/time of the “image at
hand” to the provided value.
PROCEDURE_TIME_FIRST can be used to compare the procedure date/time of the
earliest (oldest) image in the exam to the provided value.
PROCEDURE_TIME_LAST can be used to compare the procedure date/time of the latest
(newest) image in the exam to the provided value.
RADIOLOGY_REPORT
The name of the Radiology Report associated with the image.
SAVED_BY
The name of the person who logged in to capture the image.
SHORT_DESCRIPTION
A one-line description of the image or object record.
SPECIALTY
The specialty (or sub-specialty) for which the image was acquired, as stored in the
SPEC/SUBSPEC INDEX field (#2005, 44).
SPECIMEN
The specimen number of the slide given in the LAB DATA File (#63).
SPECIMEN_DESCRIPTION
The description given to the specimen in the LAB DATA File (#63).
STAIN
Free text description of the Histological Stain.
SUMMARY
A flag that indicates whether or not the image functions as a summary for a group.
The value of this property is either empty, or equal to 0 (NO) or 1 (YES).
TRACKING_ID
An identifier for the package that performed the Import (value looks like package
name, semi-colon, ID-code).
TYPE
The type of image, as stored in the TYPE INDEX field (#2005, 42). Typical types are
IMAGE, DIAGRAM, CONSENT, etc...
URGENCY
A code that indicates the clinical urgency of the exam for which the image was
produced. Possible values are: ROUTINE, URGENT and STAT. The value for this
field is determined by the Radiology Package.
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WORM_REF
The network location of the jukebox platter where the image is stored (provided there
is a jukebox in the Imaging system).
Operators
The following operators can be used in routing rule conditions:
Operator
Image property must…
=
Match value in rule.
!=
Not match value in rule.
<
Be less than a numeric value in rule. For date/time values, this
operator can be used for “earlier than.”
>
Be greater than a numeric value in rule. For date/time values, this
operator can be used for “later than.”
<=
Be less than or equal to a numeric or date/time value in rule.
>=
Be greater than or equal to a numeric or date/time value in rule.
Values
Values are the user-supplied part of a routing rule condition. Most values are text strings.
Values are typically enclosed in quotation marks ("). If a value contains both upper and
lowercase characters, or if it contains punctuation marks or spaces, quotation marks are
required.
Two types of wildcard characters can be used in routing rules: the asterisk (*) and the
question mark (?). The question mark allows one single character in a value to be “any
character.” The asterisk allows one or more characters to be “any character.”
The following examples demonstrate how wildcards can be used in text-based values:
PATIENT=“*CRAY*”
To meet this condition, the patient name for an image must contain the characters
CRAY. Any characters may precede or trail these characters. Names like CRAY,
MCCRAY, and CRAYNE will meet this condition, but CREY will not.
PATIENT=“SMIT?”
To meet this condition, the patient name for an image must start with the characters
SMIT, after which exactly one character may follow. Names like SMITH and SMITT
will meet this condition, but SMITHSON will not.
PATIENT=“PETERS?N”
To meet this condition, the patient name for an image must start with the characters
PETERS, then contain one arbitrary character, then end with N. Names like
PETERSON and PETERSEN will match this comparison, but PETERSSEN will not.
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Values for Date/Time Properties
When condition based on date and time is used, the supplied value must adhere to
VA-FileMan conventions. Values for date/time conditions are presented as a range
enclosed in braces { }.
The most frequently used date/time property is NOW. NOW can be used to select the times
that a staff member will be present by specifying certain workdays and times of day. 1
Send CR images to Kansas on Mon/Wed/Fri
send("KANSAS")
when MODALITY="CR"
NOW={MON 08:00AM to 17:00PM;
WED 08:00AM to 15:30PM;
FRI 08:00AM to 17:00PM}
Date/time properties can also be used to specify holidays. In this context, holidays are
those days that are marked as such in the sending site’s HOLIDAY File (#40.5). A rule to
send images on holidays only could be specified as:
Send CR images to Kansas on Holidays
send("KANSAS")
when MODALITY="CR"
NOW={HOL 00:01AM to 23:59PM}
Date/time ranges use a 24-hour clock. While the use of AM or PM indicators is not
required they can be useful when the hours specified are 0:00 AM (midnight) and
12:00 PM (noon). Date/time ranges can be used to express date values from any century
as well as time values for any second in the day.
When the routing software compares a date/time property in an image entry to a specified
value, the date/time value is broken into components:
Day of week
Day of month
Month
Year
Hour
Minute
Second
Which of these components will be used in the actual comparison will depend on the
specified value.
1
The actual value of NOW is the moment when the rule is evaluated.
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Routing Rule Priority
Automatically routed exams are assigned a default priority of ‘Medium.’ This priority
can be changed by adding a priority statement after the conditions for the rule.
Prioritize images based on destination
send("KANSAS")
when MODALITY="CT"
priority HIGH
send("BACKUP")
when MODALITY="CT"
priority LOW
In addition to the priority that is derived from routing rules, the routing software takes the
clinical urgency of an exam into account. For more information, see page 8.
Routing Images from Prior Exams
Images from prior exams can be automatically routed by adding a priorstudy
statement after the conditions for the rule.
Do or Do Not include Prior Studies
send("KANSAS")
when MODALITY="CT"
priorstudy YES
send("BACKUP")
when MODALITY="CT"
priorstudy NO
When priorstudy is set to YES, images from prior exams will be included based on
routing-specific settings in the MAG RAD PRIOR EXAMS LOGIC File (#2006.65).
(Settings in this file are described in detail on page 40).
When priorstudy is set to NO, or if the priorstudy statement is absent, images from
prior exams will not be included.
!
22
Using priorstudy in a routing rule can significantly increase network traffic. If
a rule of this sort is implemented, be sure to monitor the network to ensure no
problems arise.
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Routing Rule Tips
The following tips may be useful while creating or editing routing rules:
When defining multiple conditions for a rule, list the most restrictive condition first.
This will reduce the amount of time needed to process the rule.
The number symbol # can be used for comments, or to disable a rule. When disabling
a rule, precede each line in the rule with #.
Spaces and line breaks can be used as needed for legibility.
Route.dic must end with a line-feed. To ensure proper termination of the last
meaningful line, add a comment-line after the last routing rule, such as:
# last update on 1 April 2003
# end of file
When rules are imported as described on page 44, the routing software will check the
syntax used and will report on any problems detected.
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Configuring Routing
This chapter assumes that routing software has been installed, and that an initial set
of routing rules have been defined.
This chapter explains how to configure a routing system. The following table lists the
configuration tasks described in this chapter.
See
Page…
Configuration Task
Performed By
Set up Imaging destinations
All sites involved
26
Set up DICOM destinations
All sites involved
37
Review/edit route priors logic
Sending site
40
Image Gateway configuration
Sending site
42
Routing Gateway configuration
Sending site
43
Import routing rules
Sending site
44
VistARad site parameter setup
Sending site
47
VistARad workstation setup
Receiving site
48
Alter configuration in response to
changes in routing system
All sites involved
50
A configuration checklist is also available in Appendix A.
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Defining Imaging Destinations
The following sections explain how to define an Imaging (non-DICOM) destination for
routing. In general terms, defining an Imaging destination breaks down into the
following steps:
1
Establish naming conventions that are agreed on by the sending and receiving sites.
2
Define storage folders for routed images at the receiving site and verify that the
sending site can access those folders.
3
Create routing-specific entries in the NETWORK LOCATION File (#2005.2) at the
sending site.
A destination definition worksheet is located on page 71.
Note: Imaging destinations are
defined to support remote reading using VistARad. For
information about defining a DICOM destination, see page 37.
Naming Conventions for Imaging Destinations
Before an Imaging destination is established, the sending and receiving sites should
decide how to identify themselves to routing users.
The values that identify an Imaging destination are stored in the NETWORK LOCATION
File (#2005.2) at the site where the Routing Gateway is installed. The values defined for
the following should be related in some way.
26
Field
Description
Notes
Network
Location
(.01)
The “official”
destination name.
Used by routing rules and the Routing
Gateway at the sending site. Referenced
in VistARad CacheLocationID at
appropriate receiving site.
Cannot match any other name in the
NETWORK LOCATION File or in the DICOM
TRANSMIT DESTINATION File (#2006.587).
30 max, no spaces or punctuation.
The value used should contain the
nationally assigned 3-character site code
and should indicate that the entry in
question is used for routing.
Physical
Reference (1)
The computer and
share name at the
receiving site.
The name used should be meaningful to
both the sending and receiving sites.
Cannot exceed 63 characters in length
Site (25)
Destination as
reported to
VistARad users.
Used in the RC column of VistARad’s
exam lists.
The value used should contain the
nationally assigned 3-character site code.
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When an Imaging destination is established, all the above values should be related in
some way. The following example illustrates destination names for a fictional routing
system.
In this system, the sending site uses autorouting to meet two sets of needs. MRI images
are routed to an off-site specialist for interpretation. Urgent exams acquired in the
evening are routed to an affiliated hospital for after-hours interpretation.
Jonesville
Offsite location (MRI Interp.)
Routing Gateway
Remote Storage
Destination
\\JONESVILLE_MRI_RC
VistARad
Maryvale (off-hours coverage)
Image Archive
VistA
HIS
(Network location file
entries for destinations)
NETWORK LOCATION File
Remote Storage
Destination
\\MRV\JONESVILLE_RC
VistARad
Entries at “Jonesville”
Name field for Destination 1: OFFSITE_MRI_READ
Phys. Ref. field for Destination 1: \\JONESVILLE_MRI_RC
Site field for Destination 1: JVL_MRI
Name field for Destination 2: MARYVALE_RC
Phys. Ref. field for Destination 1: \\MRV_RC1\JONESVILLE_RC
Site field for Destination 2: MRV
Storage Location Names for offsite MRI specialist
Folder name: Exams_from_Jonesville
Computer and share name: \\JONESVILLE__MRI_RC
VistARad CacheLocationID: JVL_MRI_RC
Storage Location Names at for after-hours coverage at Maryvale
Folder name: Exams_from_Jonesville
Computer and share name: \\MRV_RC1\JONESVILLE_RC
VistARad CacheLocationID: MARYVALE_RC
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Storage Folders for Imaging Destinations
This section explains how to create and verify a folder for an Imaging destination on a
Windows-based server. The folder will be used as the storage location for routed images
at a receiving site.
The resulting folder will be referenced in the NETWORK LOCATION File (#2005.2).
Folder Prerequisites
Before creating the folder:
A username and password, to be used by the routing software to copy images to the
folder, will need to be established by the receiving site. The username/password must
be provided to the sending site.
Note: Unannounced password changes are a major cause of routing problems. To
avoid future problems, the sending and receiving sites need to establish a
procedure by which username/password changes can be implemented without
adversely affecting routing.
The sending site and the receiving site must establish naming conventions to use for
the various elements that describe an Imaging destination. For more information, refer
to the previous section.
The sending site should work with the receiving site to estimate the amount of storage
space needed based on the anticipated volume of transmitted images and the planned
retention period.
Folder Creation
When the folder to be used as an Imaging destination is established by the receiving site,
the receiving site will need to choose a logical folder name and share name. The share
name will ultimately be referenced in the sending site’s NETWORK LOCATION File.
Creating & sharing a folder to be used in an Imaging destination
1 Log in as an Administrator to the computer where you will be creating the folder, and
start Windows Explorer (choose Start | Run, then type Explorer).
2
Select the drive (or folder) that you want to create the new folder in.
3
Click File | New | Folder. After the new folder appears in the right side of the Explorer
window, type the name of the new folder and press Enter.
4
Right click the new folder, then click Sharing.
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Configuring Routing
In the Sharing tab, click the option that allows for sharing the folder, then enter the
share name you want used for the folder. 1
 The share name cannot contain punctuation marks or spaces, and the combined
string identifying the computer and the shared folder cannot be more than 63
characters long.
 The share name you enter must match the PHYSICAL REFERENCE field value
(#2005.2,1) defined at the site that will be sending images to this folder.
 It is recommended that you make the folder a hidden share by adding a dollar sign
($) to the end of the share name. A hidden share will be accessible by the routing
software, but will not be visible to users browsing your network.
6
After typing the share name, click Permissions.
7
In the Permissions dialog, click Add, then select the user group / user name that the
routing software will use to access this folder.
 The username and password for the user you choose will need to be included in the
NETWORK LOCATION File entry that references this folder.
 Use the domain name as well as the username. Example: VHAIS\VHAKANIU (note
the absence of leading backslashes).
8
After adding the “routing user,” set the access type for the routing user to Full.
9
In the list of users allowed to access the folder, click the “Everyone” user group, then
click Remove.
10
When you are finished, click OK to apply your changes and to close the Properties
dialog.
Folder Verification
After the receiving site has created the folder, the sending site will need to verify that the
folder can be remotely accessed and that files can be copied to and deleted from the
folder.
 To complete the following steps, you will need the username and password that the
routing software will use to access the folder.
Testing folders from the sending site (Explorer)
1 On the computer you will be using to test the folder, log in as an Administrator.
1
Under Windows NT, the option name is ‘Share As’. Under Windows 2000, it is ‘Sharing’.
Under Windows XP and 2003, it is ‘Sharing and Security’.
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2
Start Windows Explorer (choose Start | Run, then type Explorer), then click Tools |
Map Network drive.
3
In the Map Network Drive dialog, enter the drive letter, path, and username (including
domain name) that the routing software will be using. Then click OK.
 If desired, you can map a drive to the folder to make troubleshooting easier.
However, be aware that the transmission processor will map certain drives as it
sends exams to Imaging destinations. For more information, see page 66.
4
When prompted, enter the password that will be used by the routing software, then
click OK.
 If you cannot map the folder, use the next set of steps below (Testing folders from
the sending site (Command Line)) to provide more detailed information about the
problem you are encountering.
5
Select the folder you just mapped to, copy a test file into the folder, and then delete
the file. If the file is successfully copied and deleted, the routing software should be
able to use the folder.
6
Disconnect the mapped drive.
Testing folders from the sending site (Command Line)
1 Log in as an Administrator to the computer you will be using to test the folder on.
2
Open a command prompt window (choose Start | Run, then enter CMD).
3
Enter the following command to map the folder to a local drive. Parameters shown in
bold will need to be replaced with valid values established by the receiving site
> net use x: \\VHAxxxxxx\sharename\ password /u:username
4
After mapping the drive, copy a test file to the folder, and then delete the file. If the
file is successfully copied and deleted, the routing software should be able to use the
folder.
> copy any.file x:\
> delete x:\\any.file
5
When you are satisfied that the above parameters can be used to successfully access
the folder, delete the test file, then terminate the test connection.
> net use x: /delete
 Be sure to terminate the test connection. Letting a connection linger may prevent
the routing software from establishing its own connection to the folder.
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Imaging Destination Definition
Imaging Destination Definition using FileMan
The following steps explain how to create an Imaging destination using FileMan. For
information about values for specific fields, refer to page 32. A destination definition
worksheet is also located on page 71.
Editing the Network Location File at the sending site
1 Log into the VistA Hospital Information System.
2
Use FileMan to select the NETWORK LOCATION File (#2005.2) for editing.
Select OPTION: E ENTER OR EDIT FILE ENTRIES
INPUT TO WHAT FILE: 2005.2 NETWORK LOCATION (7 entries)
EDIT WHICH FIELD: ALL//
3
When you are prompted to select a network location, enter the name that you want
used for the destination.
Select NETWORK LOCATION: TESTDEST
Are you adding 'TESTDEST' as a new NETWORK LOCATION (the 11TH)? No// YES
 The name must be entered in upper case, cannot contain punctuation or spaces, and
cannot match the name of a DICOM destination.
4
At the next prompt, enter the computer name and share name of the storage location
you want used for this destination. This name references a folder defined as described
on page 28.
PHYSICAL REFERENCE: \\VHAxxxxxx\images$\
5
At each new prompt, enter the desired values for each field. Be sure to enter Y at the
ROUTER prompt.
 Typical values for a routing destination are shown below. For more detailed
information about a particular field, enter "?" at the prompt, or refer to the next
section.
…
STORAGE TYPE: MAG
MAGNETIC
TOTAL SPACE:
SPACE USED:
FREE SPACE:
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OPERATIONAL STATUS: 1 On-Line
HASH SUBDIRECTORY:
ABSTRACT: N
No
FULL: Y
Yes
BIG: Y
Yes
TEXT: Y
Yes
DICOM: N
No
COMPRESSION:
USER NAME:
Source Exif Data:
File Type : PDF
File Type Extension : pdf
MIME Type : application/pdf
PDF Version : 1.6
Linearized : No
Tagged PDF : Yes
Page Mode : UseOutlines
XMP Toolkit : 3.1-702
Producer : Acrobat Distiller 7.0.5 (Windows)
Creator Tool : Acrobat PDFMaker 7.0.7 for Word
Modify Date : 2006:03:30 12:38:30-05:00
Create Date : 2006:03:30 12:33:01-05:00
Metadata Date : 2006:03:30 12:38:30-05:00
Format : application/pdf
Title : Routing User Guide
Creator : Routing User Guide
Description : Patch 18
Document ID : uuid:3c612fb3-3c75-4e19-8112-3fdaa765a8f9
Instance ID : uuid:75e6d3cb-332a-43b5-bdbc-4b76c40610d5
Date 0020completed : D:20060430
Version 002 C0020 Patch : V. 3.0, Patch 18
Has XFA : No
Page Count : 97
Page Layout : OneColumn
Subject : Patch 18
Author : Routing User Guide
Date Completed : D:20060430
Version Patch : V. 3.0, Patch 18
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