Concept explainer
Imaging
Describes how studies reach the Pensieve imaging store over DICOMweb, attach to their order and patient, and open in the image study viewer.
Pensieve keeps imaging studies in its own imaging store, which the hospital's imaging source fills over DICOMweb on a connection separate from the bridge. This page follows a study from its worklist entry to the viewer, and sets out what the record keeps and which copy is authoritative.
What flows
The imaging source is the hospital's PACS or RIS-PACS, which receives each study from the modalities and sends it on to Pensieve. Forge holds the imaging order, Atlas records each study against it, and the image study viewer opens the study in the browser. orophin, the bridge, carries the worklist entries and the study references.
| Exchange | Direction | Standard | Owning tool |
|---|---|---|---|
| A scheduled imaging order | Out of Pensieve, through the bridge to the modalities | An entry on the DICOM modality worklist | Forge |
| The study's images | From the imaging source into the Pensieve imaging store | DICOMweb STOW-RS over HTTPS on port 443 | Atlas, which records the study |
| The study's reference | Into Pensieve, through the bridge | A reference naming the study by its Study Instance UID | Atlas |
| The report | Into Pensieve from a RIS, or written in Pensieve | ORU^R01 from a RIS | Forge |
| Reading the study | From the imaging store to the viewer | DICOMweb QIDO-RS to find and WADO-RS to retrieve | image study viewer |
The imaging path
The imaging source stores each study in the Pensieve imaging store with STOW-RS, over HTTPS on port 443. The path is DICOMweb from end to end, so an imaging source joins it by speaking STOW-RS.
The viewer finds studies in the store with QIDO-RS and retrieves them with WADO-RS. The firewall rule for the imaging source is listed in network requirements.
Pixels keep to the imaging path
Each study's pixels cross the hospital's edge on the imaging source's own authenticated connection, so traffic on the bridge link stays independent of the size of any study.
When an imaging order is scheduled, Pensieve sends it as a command on the bridge link, and the bridge passes it to the modality worklist on the hospital network. The modality takes the patient and the order from that entry, so the study it produces is tied to the right patient and order.
The study on the order
Each study attaches to its imaging order and to the patient's record in Atlas as an imaging result. The record keeps the study's identity and where it is held.
The Study Instance UID, from which the record derives its own identity.
The imaging order the study was performed for, required on every study.
Mapped from the study's DICOM modality code.
Where the study's report stands, with each change written to the audit trail.
Where in the Pensieve imaging store the viewer retrieves the study.
The connection and the message the study's reference arrived on.
The modality code maps to one of a closed set: CT, MR, US, DX, CR, RF, NM, PT, MG and XC. A study whose code sits outside the set is stored with its modality left blank, so the record shows only modalities it can name. The imaging order shows whether its study is awaited or available.
From receipt, a study's authoritative copy is the one in the Pensieve imaging store, which the viewer opens and export and exit returns in DICOM. Its standing beside any copy the hospital's PACS keeps is set out in system of record.
Reports
A radiologist's report is a result on the imaging order. A RIS that reports over HL7 v2 sends each report as an ORU^R01, which reaches the imaging order the way a laboratory result reaches its order. A report written in Pensieve is recorded against the order, as open a study describes.
Either way the report moves from received or entered to verified, along the same track a laboratory result follows in laboratories and analysers.
The image study viewer
The viewer opens a study from its order or from the patient's record, in the browser, beside the rest of the record. Cirith Manager decides whether a person may open it, as it decides every read of the record. The viewer then fetches that one study from the store through a request scoped to it.
The tools for moving through and reading a study are in reading a study.
Configuring imaging
The imaging connection starts from the RIS-PACS preset in Westron and carries the worklist entries and study references over the site's bridge. Defining it takes Westron's capability for connections. The imaging source, the hospital's own system, is pointed at the imaging store address supplied at installation.
Common confusions
What happens when the imaging source sends the same study twice?
The record takes its identity from the study's Study Instance UID, so the second delivery updates the study Pensieve already holds and adds no second entry to the order.
Does the report status on a study replace the report itself?
The status marks the report as preliminary or final. The report is a result on the imaging order, read and verified on the order like any other result.
Does Pensieve take the place of the hospital's PACS?
The hospital's PACS or RIS-PACS stays in place as the imaging source, taking each study from the modalities. It stores each study in the Pensieve imaging store, whose copy the record and the viewer use.
Read how each leg of the imaging path is protected in networks and trust zones, and where the imaging path sits among the other routes in the integration architecture.