Duke Health, based in Durham, NC, is consistently ranked among the top 10 American hospitals by US News and World Report. Duke Health operates three main hospitals: Duke University Hospital, Duke Regional Hospital, and Duke Raleigh Hospital. In addition to its hospitals, Duke Health has an extensive, geographically dispersed network of outpatient facilities that include primary care offices, multi-specialty clinics, urgent care centers, and outpatient surgical centers.
Since 2018, Duke has used the Candelis ImageGrid Plus DICOM routers to provide efficient image transfers throughout their entire hospital system. Before Candelis, Duke had a growing number of modalities sending directly to their multiple PACS systems, review workstations, and post-processing applications. After implementing the Candelis ImageGrid Plus, it provided a single point of change, thus allowing all 400+ of their CT, MR, Vascular, Ultrasound, Diagnostic, Nuclear Medicine, and Powershare equipment to route through the ImageGrid Plus to access their former PACS system.
In 2020, Duke consolidated onto a single Visage PACS. The implementation of the Visage PACS normally would require a complete reconfiguration of all modalities in their health system.
Moving from one PACS system to another one would require Duke to change the IP addresses for all 400+ modalities connected to the PACS system in order to properly route images. Without changing the IP address, the modalities would not recognize the new destination, hindering workplace functionality.
Duke was burdened by this daunting task of manually touching each modality to program an IP address change. When new modalities were configured, it often took several visits to the individual modality to ensure all the needed destinations were added and tested. Additionally, the technologists often had to send images to multiple locations from the scanner, which took time away from patient care duties.
In addition, Duke receives outside images from other facilities that need to be routed to their PACS system. Last year, Duke had more than 1.3 million outpatient visits, with 75% of all their outpatient business involving imagery.
The Candelis team worked closely with the Duke Image Management and Radiant Services team to replace Duke’s old ImageGrid Plus routers with updated equipment. With ImageGrid Plus, each modality is configured on a central server along with all the destinations. Routing rules are created on the ImageGrid Plus and used to distribute the images to all the assigned destinations automatically, saving the technologists valuable patient care time. When IP addresses need changing or new modalities are added, only the modality and ImageGrid Plus configurations need to be edited. ImageGrid Plus also takes care of any query/retrieve requests and functions as the single point of change and the setup of new modalities is streamlined.
Clinical Engineering (CE) sends the Duke Image Management team the configuration parameters, who can configure the routing rules on the Candelis ImageGrid Plus. CE then sends test images to ensure they have the correct settings on the modality and the task is completed.
“With Candelis’ ImageGrid Plus we can instantly detect issues with particular device connectivity and address those issues quickly,” said Eric A. Williams, Team Lead, Application Analyst III from Duke University’s Image Management and Radiant Services. We have been able to notify other support teams that images are not flowing to their device before they even realize it.
ImageGrid Plus maintains a log of failed transfers that allows the Duke Image Management Team to review and reconcile any issues that arise.
“ImageGrid alerts our team when there is an image transfer backlog so we can investigate even before the issue may cause patient care delays,” added Williams.
ImageGrid Plus also allows for customization of rules that need to include tag morphing of the DICOM header information, so that Duke can resolve issues where certain tags need to be added, removed or modified at the router level with ease.
ImageGrid routes can be complex and robust. This allowed the Duke team to create some complex routing rules to make complex transfers automatic instead of relying on manual methods.
Because ImagGrid also receives an HL7 feed, the data coming over the feed is available for DICOM tag morphing.
“We went from a task of updating 400 modalities to only updating one server. We can update IP addresses and AE titles from one location,” said Williams.
“The ImageGrid Plus servers are very powerful and can handle the transfers of several hundred thousand images per day,” added Williams.
Due to the use of the ImageGrid Plus system, Duke’s entire healthcare system runs effectively, efficiently, and virtually error-free, as well as saving personnel time and costs that would have been spent updating all of their systems.
“We solved the issue of IT being burdened by needing to make changes at multiple facilities, numerous modalities, and sometimes dealing with multiple sets of patient data, by streamlining the problem to a single data center with a central ImageGrid Plus to make the modifications efficiently, so that Duke can run efficiently and focus on optimal patient care,” said Robert Van Uitert, Candelis Vice President.
“The Candelis team has been very supportive and instrumental to the success of our informatics system. I can't imagine managing all the image data transfers Duke processes every day without the Candelis ImageGrid Plus routers,” added Williams.
With Candelis’ ImageGrid Plus we can instantly detect issues with particular device connectivity and address those issues quickly. ImageGrid alerts our team when there is an image transfer backlog so we can investigate even before the issue may cause patient care delays.
Duke University Medical Hospital
Durham, NC
We went from a task of updating 400 modalities to only updating one server. We can update IP addresses and AE titles from one location.
