DICOM Modality Installation Checklist.

One of the typical responsibilities of a PACS administrator is adding a new image acquisition modality to
the PACS system. It is also one of the more challenging tasks as it is often hard to predict how the device
will interact as these are still not quite “plug-and-play.” To make it worse, this is often a visible and
highly anticipated task, as in many cases the new modality has been expected for a long time. So, when
it finally arrives at the loading dock, users want to see it up and working as soon as possible.

With proper preparation prior to and during the actual installation, the success rate of the install can be
increased and the time to get it up and running can be greatly reduced and frustration kept to a
minimum.

This is the check list I recommend prior to the install:

1. Do a “paper validation” between the modality and its connections, i.e. DICOM worklist provider,
DICOM destination(s) for image Store, Storage Commitment, Modality Performed Procedure Step,
and Structured Reports. Get the DICOM conformance statements for these devices and compare
them against each other. Make sure you get the right version of these conformance statements as
functionality can differ substantially between different releases. Specifically look for the following in
these documents:
a. Make sure that there is support for the type of DICOM files (SOP Classes) you will be
exchanging. Be aware of and look for support of the new “enhanced” SOP Classes such as
for CT, MR, Angio, RF, breast tomosynthesis, IV-OCT and others.
b. If you want to compress the images at the modality, make sure there is support of the type
of compression at the source and destination(s) (JPEG lossless, lossy, Wavelet, MPEG for
video, etc.)
c. If you want to use Storage Commitment, make sure its behavior between the SCU and SCP
matches with regard to the handling of the associations for the reply.
d. If you want to use Modality Performed Procedure Step (MPPS), make sure that the
implementation matches your workflow, for example, you don’t want to have MPPS report
the study being complete if there are still images to be sent, processed, or imported.
e. Match the worklist attributes between the modality and worklist provider and look for
alternate mapping in case attributes might be missing on the modality side. An example
would be to map missing patient weight or allergies in a Patient Comment field if that is
required at the modality but not displayed.
2. Do a “file validation” by asking the vendor to send you a CD with images, making sure that each type
of image is on the CD. In addition, get sample Structured Reports, such as dose reports for CT or
measurements for ultrasound and echo. Import these files on a test PACS, Voice Recognition and
Dose management system and verify proper display of the images and measurements. Make sure
that the hanging protocols work at the workstations and if not, troubleshoot it to find what the
cause is (study descriptions, body part, etc.)
3. Do an “install validation” by using a modality simulator that is able to query a worklist using the
same attributes as used by the new modality and simulate Store for the various file type to the test
PACS. Simulate the Storage Commitment and MPPS. There are open source validators available such
as DVTK. When doing the simulation, use the same IP address, port and AE-Title that the new
modality would be using. It is strongly recommended to use best practices for the AE-Titles and port
 numbers, i.e. use an all caps AE-Title that indicates the institution, location and modality, and use
the standard port number (11112) as assigned by IANA to DICOM devices. Work with IT so that you
get a new, fixed IP address assigned for the new modality and make sure they configure the VLAN
and routers to allow access.

If you have taken all these precautions, you should be able to swap out the simulator for the actual
device, and the chances are that it might be “plug-and-play” assuming you addressed all the issues
during the pre-install phase.

However, if it still does not work, you might want to do some troubleshooting using the tools as we
teach in the SIIM DICOM training coming up, see schedule here.