The University of Texas Health and Science Center at San Antonio (UTHSCSA) was ready for an improvement to the digital imaging technology currently in place at its Dental School. This was no small task. They needed an enterprise-level, digital dental imaging system that was scalable, reliable, upgradeable, and maintainable.

The University’s Dr. Brent Dove, Director of Innovation & Technology and Dental Diagnostic Science, realized the need for a softwareproduct that would solve these problems. Dr. Dove serves as the American Dental Association’s representative to the DICOM International Standards Committee so he knew the importance of implementing a DICOM-compliant system for digital radiography in any dental school. In addition, the School needed a solution that offered a single application for interfacing with every type of imaging device and also resolved the issues mentioned above.

Dr. Dove approached LEAD Technologies, Inc. to collaboratively develop a complete digital imaging solution that would take care of the Dental School’s needs. Dr. Dove knew that LEAD had the technical expertise to create this type of system and guided us to develop a solution that fits the real world enterprise level needs of dental institutions.

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Situation

UTHSCSA faced many challenges moving from their old system to a complete digital solution. They did not have a standard interface to capture, edit, and review images and were using a different application for every type of X-ray capture. Students and faculty members alike were faced with learning multiple programs instead of a centralized method involving only one program. Another main concern was that none of the applications that were being used had support for DICOM and were using a proprietary format only known to their own system.

This system needed to have support for all types of dental images, i.e. grayscale X-ray and color images. These imaging modalities consisted of intra-oral radiography, panoramic radiography, cephalometric radiography, tomography, intra-oral/extra-oral photography, and histology/surgical microscopy. Since going from analog to digital, image quality was vital and needed to improve, as were the tools for quality control and diagnostic and image review. To ease the transition to the digital system for users, they needed a way to display the images on a familiar film mount. This lead to the template concept for displaying dental radiographs using different hanging protocols used in the dental discipline.

The University’s current patient management software had virtually no imaging support, allowing images of limited types to only be stored in a proprietary format. This prevented the transfer of patient data from one system to another. The imaging system was unstable and un-proficient with multiple storage locations, no link with electronic records, and no standard format for images.

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Solution

MiPACS Dental Enterprise Solution is the result of this collaboration, incorporating an open architecture software package including a DICOM server and a multipurpose DICOM Viewer.

Open System Architecture
For UTHSCSA, MiPACS Dental Enterprise Viewer is a significant upgrade from their old method of capturing. The viewer was able to take the place of the various applications that captured from direct digital sensors to digital panoramic devices to phosphorous plate scanners. This is because of MiPACS’s open architecture. MiPACS Dental Enterprise Viewer supports nearly every digital imaging device available, unlike the proprietary programs provided by the hardware vendors.

MiPACS Storage Server also incorporates the idea of open architecture by using the DICOM standard. All DICOM compliant devices or applications, whether they are Image Viewers or network-based X-ray or scanning devices, can communicate with the server regardless of the vendor.

DICOM
UTHSCSA adopted the DICOM standard when moving to MiPACS. This detailed specification defining a means of formatting images and associated information was an essential part of the upgrade. Because DICOM is an international standard, it instantly offered them compatibility with thousands of other devices, schools, hospitals, and software. After implementing MiPACS, the university no longer has to store images in a format proprietary to the hardware vendors plus it gives them the flexibility to purchase hardware from multiple vendors. Since the communication between the MiPACS Dental Enterprise Client and the MiPACS Storage Server uses DICOM protocol, dentists have the ability to retrieve Digital X-Ray and CT images from Hospital PACS system. The radiologist at the hospital also has instant access to the patient’s radiograph from the dental school.

Storage Server
A robust, reliable, and scalable server was provided to UTHSCSA with MiPACS Storage Server. Supporting the DICOM 3.0 standard, MiPACS Storage Server can be used with any DICOM device that the school may purchase in the future. The server uses a proven database technology in Microsoft’s SQL Server and even if the database is lost, it can be recreated from the existing DICOM files. Security features protect the Dental School’s database and images by only allowing verified clients connecting from a particular subnet to connect.

Integration with Patient Management System
MiPACS offered the Dental School a way to connect their current patient management system with their digital imaging software. This link enabled patient demographics, such as name, patient ID, date of birth, and sex to be passed to MiPACS Dental Enterprise Viewer. This removed the risk of clerical errors when inputting patient information and associating the images with patient records.

System-to-System Communication
Users have the ability to export to DICOM Media in order to transfer patient image records from one location to another. The DICOM Media, created with Medicor Imaging PMR, includes a viewer right on the disk so that images can be transported to and viewed at any PC with Microsoft Windows OS without the need of additional software. The included viewer on the Media also has ability to store the content to any PACS system using DICOM C-STORE service.

The Idea of One Application for All Stations

In addition to providing capture stations with a single program, MiPACS Dental Enterprise Viewer performs the functions needed on all other stations in a clinic. For diagnostic, review, interpretation, and quality control stations, MiPACS Dental Enterprise Viewer is UTHSCSA’s single solution. This cut the cost of training by a great deal because there was only one application for students and faculty to learn instead of multiple. The ease of maintaining only one application greatly reduced the cost of maintenance, support, and upgrading as a new version of the viewer became available.

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The Future

The Dental School at the University of Texas Health Science Center at San Antonio is now prepared for future growth with a solution that is expandable and scalable. With the addition of future client stations, the Dental School can be assured that MiPACS will grow with them, offering the ability to configure multiple servers in a network load balanced cluster. As the addition of new hardware becomes available, MiPACS will expand its list of supported devices to continue to operate in an enterprise environment.

The University authority has a peace of mind knowing that all their dental images are stored in the international standard format (DICOM) and the database is in industries proven MS SQL format. They finally have full control of their precious data. MiPACS has been up and running for about 2 years with approximately Fifteen Thousand (15,000) patients processed.