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A Special Report from SIIM 2010

At SIIM 2010, Herman Oosterwijk discussed issues that deal specifically with PACS connectivity. He outlined the following  problems:

• Network Issues: A well defined and managed network infrastructure is essential. Proper IP addressing and port number assignment has to be done. Duplicate IP addresses can create issues and are not always easy to troubleshoot. In case this is suspected, a "netscan" utility will show all IP addresses and potential duplicates. Note that DICOM devices rely on fixed IP addresses, as almost none of the PACS vendors make use of the dynamic configuration capabilities defined by the DICOM standard. Dynamic IP addressing is fine as long as the router does not re-assign them to a different address, e.g. when being re-booted or replaced. Note also that DICOM has an "official" assigned port number, i.e. port 11112, which is more reliable than the often used "well-known" port 104.

Not necessarily falling under the network but related is the need to manage AE titles making sure they are also unique. Realize that some devices have multiple AE's with potential different AE titles. Incorrect net mask definitions and/or VLAN specifications might make certain destinations unreachable. A rather frequent occurrence is the incorrect setting of the switch, e.g. to half duplex or mismatching the device setting, especially when auto-negotiating is configured. Switch issues result in major performance issues and can only be made visible when using a network sniffer.

• DICOM Header Issues: The DICOM image header is generated through mapping RIS data, generation of the modality and manual input by a user. Either one of these sources can potentially generate incorrect and/or invalid data in the image header. Problems are unfortunately not always detected. For example, an incorrectly identified study might be archived in the PACS and get "lost", only appearing when the data is migrated, which could be years later. Some PACS systems are more conservative than others and check every attribute, while other are more liberal and don't necessarily complain. A header with an Institution ID exceeding the maximum length of that field might be stored by vendor A while being rejected as an invalid image when being migrated years later.

In this particular instance, the Institution ID could have been mapped from the RIS using a worklist, while not checking for any length violations (note that the source of the data, i.e. the HL7 data elements might not have the same restrictions). Missing and/or incorrect patient demographics can be caused by the RIS being down, or a technologist not using the worklist. This will cause a study to be unverified or "broken" at the PACS. Some PACS applications sort and display images according to image and/or series number instead of according to slice orientation and body part causing the images to be displayed in the incorrect order. When retrieving comparison exams, one can run across some of the older date and time formats in the header, which might cause issues as well.

• Hanging Protocol Issues: Hanging protocols not working is almost always related to incorrect header information or the wrong interpretation of the headers. A common mismatch is related to the way CR and DR systems organize their images into series. Some create a new series for each view (e.g. a Chest PA and LAT), some group them together in a single series. If the viewing software can only be configured to show different series next to each other, there will be some really unsatisfied radiologists. Another frequent issue occurs when some modalities modify automatically series and study descriptions, not taking the values from the worklist and therefore causing these descriptions not matching the hanging protocol configurations at the view station.

• CD import issues: These issues almost always can be traced back to non-compliance with the DICOM standard and/or corresponding IHE profile. Frequent issues are the absence of DICOM image files because the vendor is only providing their proprietary format, a missing directory file, mismatch of the so-called meta-file header with the actual data content, incorrect transfer syntaxes such as compression, and several others. A recent issue has also been splitting up studies over multiple CD's. In many cases, one can convert the images to an acceptable format that can be imported; however, in some cases it is impossible to read the proprietary information, causing a repeat exam. One also need to make sure that patient identifiers are replaced, including the Accession Number otherwise the integrity of the PACS database could be compromised.

Full Source:

http://www.healthimaginghub.com/component/content/article/2417-conference-covereage/1321-a-special-report-from-siim-2010.html

About the Author

Health Imaging Hub was initiated by radiologists, health imaging technologists, and internet media experts to promote Health Imaging & IT Globally with an emphasis of regional coverage

Does the PA state police still issue the 38 special?

Does the Pennsylvania State Police still issue the 38 special or any other revolvers?

No revlovers that stopped in the early 80's, they are on third different kind of semi auto right now.
The .45 GAP Glock Model 37

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Five Tips for Successfully Mainstreaming Your Special Needs Child

1. Be sure your child's IEP describes what he needs, who will provide it, and how his progress will be evaluated. The goals should cover a variety of areas, such as social skills, and daily living skills, in addition to educational goals. Your child's success in mainstreaming is dependent on more than whether he can read or write. In fact, it is possible for a child to be doing well educationally but fail at mainstreaming because of social adjustment problems, or through poor hygiene or grooming issues.

The goals need to be solution focused: they should state what your child needs to do, not what he is doing wrong. They also need to be broken down into small steps, so that your child will be able to accomplish them. Do not allow a goal that says, "Cassandra will stop fighting with other children in the classroom." When does she fight? How often? What should she do instead of fighting? How much of her day do you expect to be free of fighting? Is that a reasonable expectation? What consequences (positive or negative) will take place when she fights, or when she chooses to find another solution to the problem?

Be sure it is very clear who will work with your child to achieve the goal. Be very specific; writing "a staff member" can lead to the "everyone was supposed to do it, so no one did it" problem. The goal should say "main teacher, recess monitor, etc." Ideally it would be even better to have the names of those responsible written into the goal.

Make sure there is some sort of system set up for making sure the goal will be worked on. When will the aide practice role-playing with your child? For how long? And even more importantly, how will she know when your child has accomplished the goal? Again, being specific is the key. Usually a goal is accomplished when a child can perform a particular action 80-90% of the time. Some things might require 100% compliance, like physical aggression towards other students.

Usually you shouldn't go lower than 80% in terms of accomplishment. Anything less than that is either frustrating for the staff and child to work on, or doesn't really need to be worked on right now. If you think your child will not be able to make it that far after 3-6 months, then you need to rework the goal to one that she will be able to accomplish.

2. Make sure the IEP contains information about what has helped your child succeed in the past. This can be based on what you have seen work at home, or on what other teachers have found is helpful in past years. If you know a teacher who was particularly successful with your child, ask them to write a few paragraphs about what they did with your child. Ask if they will allow other teachers to consult with them. Bring it with you to the IEP meeting; this way anyone who works with your child will also have access to this valuable information.

Again, always be specific. If your child has crying spells and responds well to comforting, write exactly how she needs to be comforted, and about how long she needs to be comforted. It may seem unnecessary, but it isn't. Different people have different ways of doing things, and what you thought was obvious may be completely foreign to someone else.

3. Make sure to maintain regular contact with the people that work with your child. This means teachers, teacher's aides, therapists, pull-out specialists, etc. This doesn't mean that you need to be in contact with the speech therapist as often as you need to speak to your daughter's teacher. Nor does it mean you need to speak with your child's teacher every other day.

In the beginning of the year you will need to give the teacher about two or three weeks to get everyone settled and to get to know your child. After this it's a good idea to maintain weekly written contact, through a notebook or e-mail. You should also speak personally to the teacher at least once a month; twice a month if there are more critical issues going on. It's sometimes disconcerting and a little scary, but it has to be doen, since you need to hear how the teacher feels about your child. Does she talk about him with a warm, caring tone? Or is she dismissive? Sometimes this only comes out in a one-on one conversation.

Monthly contact with other specialists is most likely enough. During these phone calls, your goal is not only to find out how your child is doing-again refer to specific goals-but also to share information that you've gleaned from your talks to other professionals. This helps everyone work together.

If you have a case manager that does this for you, that's great. You will still need to be in contact with the teacher, but you can leave the other professionals to the case manager, who you will contact on a monthly basis for updates.

4. Remember that your child's teacher is your ally. It's not easy being a teacher. Today's teachers are faced with large classes, and are dealing with children with all types of issues, many of which they may have received little or no training in.

Whenever an issue comes up with your child, always try and see it from their point of view. This doesn't mean you have to excuse unacceptable behavior, but it does mean you approach the situation determined to find a solution, without blaming and judgment calls. Show your appreciation by showing up at the school (your child will probably object to bringing it) once or twice with a delicious desert, accompanied by a short note of appreciation for all the work she does. It's also nice to give a teacher- appropriate gift at the end of the year, with a note of thanks. Visit a teacher supply store for ideas.

5. Be supportive, not overbearing, to your child. Sometimes parents are so worried that their child will be successful at school that they micromanage their child. When their son or daughter gets home, they may pepper the child with questions about his day in an attempt to gauge how things are going. If something goes wrong, they may overreact, or give advice, or try too hard to smooth things over.

If you have good channels of communication set up with the school, you won't need to rely on your child to find out how things are going. If something does go wrong, and your child is at fault, then you will need to address the situation. If the teacher is at fault, be careful not to rant and rave about the teacher in front of your child.

First of all, you probably don't have all the details of what happened. Second of all, even if you despise the teacher, if your child sees or hears you badmouthing the teacher, she will very likely do the same, which will only cause more problems.

The most important thing to remember is that your child is more than the sum of her deficiencies. She is a special person; not because of her disabilities, but because she has something special to give to those around her.

About the Author

Overcoming Learning Disabilities

Rachel Speal is an educational consultant who specializes in helping children and adults with auditory processing disorders, PDD, and autism. She has nearly 20 years of experience working with adults and children with learning disabilities, developmental disabilities, behavior disorders, and mental illness. She finds that her experience in both the public and private sector as a school principal, parent trainer, and curriculum developer have given her a breadth of experience that she constantly draws upon. However, she is convinced that parenting five biological children and two recently arrived foster children is the most demanding job of all-but also the most rewarding and enduring.

 

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