JiveX Enterprise PACS

Modern Image Management in Radiology

Imaging is the linchpin of medical care in the independent sector and in in-patient establishments because the rapid and precise diagnosis of the image data plays a central role for therapeutic progress and ultimately for the success of the treatment. The continuous development of imaging modalities and the resulting, additional image information, as well as the increasing necessity of interdisciplinary and cross-sector exchange, however, daily bring diagnosticians face-to-face with new challenges. In order to provide the highest level of diagnostics despite the increasing demands, intelligent IT solutions are in demand, which offer the user customized support in his daily routine. 

Flexibility through standardization 
Here, together with a wide variety of functions, the functional depth, interoperability and good scalability of a system are crucial. JiveX Enterprise PACS fulfills these requirements and is designed to fit in perfectly with the respective IT environment, regardless of whether it‘s in a hospital, a practice, a department or a network. The consistent application of internationally recognized standards such as DICOM, HL7 and the implementation of a considerable number of IHE profiles, such as XDS, enables the accessibility of all imaging modalities, regardless of the vendor, as well as bidirectional integration into leading systems such as RIS or KIS. As a result, seamless and trouble-free communication and the cross-system consistency of sensitive patient data is guaranteed. This is not only true within the boundaries of a department or facility, but over and above this as well: subsidiaries or external partners can be integrated firmly into the workflow via JiveX Multi-Site-Query or DICOM e-mail and hence benefit from all the advantages of rapid image and diagnosis communication.

Increased efficiency in your daily routine
Various DICOM conversion tools also ensure that the data relevant to the findings, which are not traditionally available in DICOM format (PDF, JPG, Video or EKG data), can be imported into the PACS. In addition, external exposures, which a patient supplies on CD or DVD, for example, or which are transferred online via DICOM communication, can be easily incorporated into the PACS. In order to avoid inconsistencies in the data mapping, JiveX matches various patient characteristics (e.g. the name or date of birth) with the data in the KIS and thus recognizes that the data pertains to an existing patient ID. Using the error list display, however, the program also assists the user to allocate the data easily by hand, where there is a different spelling, for example.

JiveX Enterprise PACS stands for secure and intelligent image allocation and archiving and optimizes each individual process step within the diagnostic process: from rapid image selection, even where there is a large volume of data, using the communications server, through powerful support tools for the evaluation, to simplifying interdisciplinary, interdepartmental or cross-institution communication, for example, using intelligent calendar and presentation tools.

Customized workflow support
JiveX Enterprise PACS can be adapted to the requirements of its users. Whether by individually configurable workstations, for example, providing hanging and reading protocols, or by specialist tools. Along with radiology, the application and functional range also includes radiotherapy, teleradiology and specific solutions for mammography and tomosynthesis. 

Functional Highlights Diversity for reliable and rapid diagnosis

Regardless of whether the diagnosis is made in the practice or in the hospital radiology department, one thing is clear: Time is a deciding factor and, because of increasing numbers of cases, time is becoming more and more scarce. So, to guarantee an excellent and reliable diagnosis in spite of this, JiveX provides a variety of functionalities, which optimize the work of the radiologist and organize it more efficiently.

Multimodal viewing / intelligent hanging and reading protocols
Thanks to the option of setting up user-specific hanging protocols, users can configure their workstations individually and adapt to the demands of their diagnosis workflow. This also includes a setting for opening image data with different modalities on one screen in parallel (multimodal viewing), together with intelligent downloading of previous examinations. What‘s more, work steps can be usefully linked by so-called reading protocols. As a result, the hanging and reading protocols provide maximum flexibility, and that means JiveX can be adapted to any working environment.

Multiplanar reconstruction and cutlines
The user is also supported in the processing of multiplanar reconstructions (MPR): thanks to the interactive cutlines, views can easily be offset or turned, thus enabling observation on a variety of three-dimensional spatial planes and precise navigation to certain image elements. Setting the slice thickness and intervals for reconstructions and the option of saving sequences as new DICOM series in the PACS round off the area of operation. 

Image registration and integrated 3-D processes

Image registration is a powerful method of simplifying the radiology workflow. This enables current images and previous examinations to be coordinated with one another so that individual anatomic structures in both image batches can be identified and compared directly. This function is augmented by the 3-D cursor: if the user highlights a feature in the current examination, the cursor automatically moves to the same location in the previous examination image batch, and vice versa.

Both functionalities, image registration and the 3-D cursor, also harmonize excellently with in-house developments of the 3-D rendering. Volume rendering has default settings for a variety of diagnostic queries, is fully integrated into the workflow and can be automatically created, for example, via the hanging protocol. Analogously to MPR, imaging and three-dimensional sequences can also be written back into the PACS. 

Vascular analysis at the touch of a button
The module for vascular analysis calculates the vascular midline and the contour of the vessel. As a result, constrictions or the dilatation of a vessel can be calculated. The vascular analysis assists the user to localize suspicious vessel sections rapidly, reliably and at the touch of a button. The operating concepts and views for vascular analysis are seamlessly integrated and are displayed uniformly with the other diagnostic tools on the JiveX user interface. The evaluation process incorporates a digital diagnostic report in the form of a .pdf file, which is then automatically saved in JiveX.

Capture functions (display fixing)
Working through the image batch devours an enormous amount of time in the daily radiology routine. Repeatedly scrolling through one and the same examination is not just irritating but also makes for delays across the entire workflow. With two equally helpful options, the intelligent capture functions of JiveX help the user with display fixing. On the one hand, using a memory function, the diagnostician can skip applying the hanging protocols on reloading a previously saved examination. In this case, JiveX memorizes the exact presentation and the settings for a diagnostic image and reproduces these automatically, for example, following the temporary selection of another patient. The diagnostic settings only expire when JiveX is closed. Transferring the settings to another work station, however, is not possible using this function.

In this case, a second capture function, namely deliberately and actively saving the state of a diagnosis, comes into play. This is then written into the data base and can be reproduced on any workstation. So, the daily interdisciplinary meetings can be prepared quickly and conveniently. Instead of the tedious search for suspicious findings within an examination, the previously tagged and saved image series can be displayed during the meeting. 

Efficient presentation workflows with calendar control 
With the capture function, JiveX is equal to the increasingly interdisciplinary work in hospitals. In addition to this, the system has further tools available: using the capture function, examinations are able not just to be systematically compiled, for example during diagnosis, for a variety of meeting scenarios. On the contrary, the demonstration computer can also be provided with scheduling features and automatically populated in accordance with certain criteria. By presorting and filing the studies, the user can tailor clinical meetings, so that no valuable time is wasted in searching for the appropriate patient data during the presentation. JiveX provides users with the option of setting both individual and recurring appointments for regular conferences. As well, not just the current patient data but also the previous examinations can be displayed at the touch of a button. This function is combined with a history which documents exactly what case was discussed on what day. To save the conference moderator from changes to the agenda at overly short notice, a schedule folder can be closed off at a predefined time. 

Specific requirements in the image management

Along with the extensive functionalities for image management in radiology, JiveX Enterprise PACS is also equipped with tools for intelligent data handling in the fields of mammography, radiotherapy, telemedicine and for mobile applications.

JiveX in mammography
Radiology facilities, which are a part of the national mammography screening program, are characterized by high demands of the documentation and the networking of different IT systems in different locations. However, the expectations of image logistics and display are also high in therapeutic mammography.

Workflow support and ­diagnostic support
The basis for creating, processing and archiving digital images of the breast is the information system: here, not only are the patient data managed, but also the examination planning and requirements. The work lists automatically created with this information guarantees the data consistency required. Hence, it is ensured that all data pertaining to a case can always be located. After generating the image and the quality inspection, JiveX automatically transfers the data from the MTRA workstation to the physician‘s workstation and thus provides a smooth workflow within the team. Routine work steps in the diagnosis are then automated using highly specialized hanging protocols, which have been created and programmed under the guidance of a wide range of experienced diagnosticians. The hanging protocols can also be customized to the working user interface.

The main support for the diagnostic process takes place via the automatic preloading of previous examinations and their standardized on-screen display. In this way, the physician can perform the diagnosis reliably and quickly. In so doing, he is aided by the versatile image processing options, such as zooming, grayscale windowing, brightness and contrast adjustments or inversion. Advanced support can be achieved by integrating computer-aided detection systems (CAD). To maximize the ergonomics, the application can be controlled both via the keyboard and via an additional keypad.

The diagnosis is documented in a structured manner using international standards (ACR schema and BI-RADS classification). On the one hand, the categorization defines the breast density (ACR) and, on the other hand, assesses the carcinoma risk (BI-RADS). JiveX is highly compatible with MammaSoft and MaSC and also supports mobile units, as well as a structured diagnosis in different locations.

Tomosynthesis data for the evaluation of the breast have also been able to be displayed, evaluated and managed regardless of the modality vendor and based on the DICOM breast tomosynthesis object image type since JiveX version of 4.6. Alongside all mammography functions, there is also the data option of MIP display, important for tomosynthesis. With this, for the first time, the diagnostician achieves the independence of evaluating and managing the diagnostic data from his workstation using the proven JiveX tools for breast diagnostics.

JiveX in radiotherapy
In order to optimize the processes and the quality of tumor follow-up, JiveX also makes possible the display and archiving of planning data for radiotherapy. JiveX is capable of saving and displaying the planning software results filed in DICOM objects. Thus, the significant treatment information for the distribution of the radiation dosage into the target area can be downloaded simultaneously with the images and the treatment plans. 

The visualization of the required and expected dosage distribution in certain regions of the body can be configured and works with the DICOM output for products by a variety of planning software vendors.

JiveX in telemedicine
JiveX provides versatile options for establishing efficient communication between the various care providers in the chain of provision. All solutions guarantee the delivery of teleradiology services in accordance with (German) X-ray Regulations (RoeV). As well as obtaining a second or expert case-related opinion, a medical backup service can also be implemented with JiveX.

Synchronous point-to-point connection is the classic system in the teleradiology process. Here, two DICOM nodes are linked and communication is via a secure line in a VPN tunnel. This variation requires broad bandwidths and is suitable in scenarios with a manageable number of partners and VPN tunnels.

DICOM e-Mail
is a standard recommendation of the German Radiological Society. Based on the DICOM standard, it enables the secure, encrypted transmission of medical image data and other information by e-mail. DICOM e-mail can be easily integrated into the existing IT infrastructure and enables the establishment of a multivendor (in extreme cases, worldwide) telemedical network. The communication and image viewing components can be integrated into any PACS without a problem. Each authorized user can send an e-mail containing an entire examination or individual images directly at the click of a mouse. Analogously to DICOM data from other external sources, images in the incoming DICOM e-mails can also be automatically checked for consistency with the existing patient ID and are also highlighted on the user interface.

JiveX Web and JiveX Mobile
JiveX Web enables the rapid selection of images and findings via a web browser. All image data are automatically prepared based on standards and can be interactively processed. The application is provided via a web server. JiveX Web provides the users with the essential imaging functions such as smooth magnification and grayscale windowing.

Many users wish to view patient data, even on the move. With its mobile viewer, JiveX Enterprise PACS satisfies this wish. JiveX Mobile is based on HTML 5, a technology, which enables access to the application from any browser, whether it’s from a desktop PC, a laptop or from a mobile terminal device.

There is no need to install software; the program is entirely web-based and can be launched as a stand-alone application or in combination with a mobile KIS application. In order to fulfill data protection guidelines, the image data is not stored locally on a device, but on the web server. Working with a central data pool also ensures that users at each workstation can access identical and invariably up to date data.

JiveX in networked scenarios

A rapid and simple image distribution, even across organizational boundaries, not only optimizes the work processes but also noticeably improves the quality of patient care. 

For this reason, JiveX provides versatile functions for smart image distribution, which are oriented towards the particular requirements of the establishment. For practices or hospitals with multiple sites, for example, JiveX provides the Multi-Site-PACS version, in which the data of all sites are held, maintained and archived audit-proof, centrally on the JiveX Communication Server. In order to guarantee rapid downloading of the data, this is compressed on the server during saving. With its Sync Manager server, JiveX also ensures that the data is always up to date and rapidly accessible at all sites. Another advantage of the function: user settings are also synchronized in the system so that the physician can access his individual settings from any workstation, even at a different site. 

Flexible and Secure Archiving

The archiving solutions of JiveX Enterprise PACS are flexible and can be tailored to the individual customer‘s requirements. The options for saving and archiving data range from online storage in a central computer center, through to highly available network storage solutions (Storage Area Network, SAN), right up to unlocked hard disk systems in the network (Network Attached Storage, NAS) or hard disk systems attached to the server (RAID, DAS). Of course, offline archiving systems on DVDs, Blu-Ray disks or computer tape are also supported.

How ever the solution is technically implemented: thanks to the archive status messages, these are always transparent for the user. Thanks to the alignment with the order communication of the leading information system, the process quality is guaranteed on all levels of image circulation.