Enabling simplified clinical imaging with Mach 7 Technologies Keystone Suite

Transcription

1 Enabling simplified clinical imaging with Mach 7 Technologies Keystone Suite On IBM Storwize V7000 Unified and SONAS systems Prashant Avashia IBM Systems and Technology Group ISV Enablement November 2012 Copyright IBM Corporation, 2012

2 Table of Contents Abstract... 1 Introduction: Mach 7 imaging applications... 2 Introduction: IBM Storwize V7000 Unified and SONAS... 5 IBM Storwize V7000 Unified: Overview... 5 IBM SONAS overview... 7 Differences: IBM Storwize V7000 Unified and SONAS as NAS systems... 8 Architectural assumptions IBM SONAS: Configurations, tests, and results Solution delivery recommendations Recommended Keystone Server hardware prerequisites Recommended Keystone Server software prerequisites Recommended file systems layout best practices Recommended storage sizing guidance for Keystone Suite Solution benefits and summary Acknowledgments Appendix A: Use case Radiology department solution Appendix B: Use case Imaging services in a single hospital Appendix C: Use case Imaging services in a hospital system network Resources About the author Trademarks and special notices... 23

3 Abstract Every minute spent finding and preparing radiological images is a minute taken away from making a diagnosis, and keeps the radiologists from doing their real work. With the evolution of sophisticated electronic medical record (EMR) systems, clinicians are faced with three key challenges. The first challenge is the presence of disparate Picture Archiving & Communication Systems (PACS) that span departments, sites, and regions. The second challenge is the inability to share Digital Imaging and Communications in Medicine DICOM, and non-dicom imaging through their central EMR systems, for clinical comparison, communication to specialists, and medical practitioners. The third challenge is the requirement to store all image information in a non-proprietary format, understood by the community, at large. IBM has now partnered with Mach 7 Technologies to address these three challenges, and offers simplified Enterprise Clinical Image Management, as a practical PACS and VNA-based medical archive solution. This joint solution combines the Keystone Suite, a vendor neutral Enterprise Clinical Imaging Platform (ECIP), together with IBM Storwize V7000 Unified and IBM Scale Out Network Attached Storage (SONAS) systems. With this joint solution, clinicians are able to leverage best-of-breed PACS capabilities and other department specific imaging across departments, sites, and regions. This paper documents that IBM Storwize V7000 Unified and SONAS work cohesively with the Keystone Suite to deliver a flexible, scalable, interoperable solution. As tested, this solution is well suited for any medical environment that processes 200,000 annual studies per year to 4 million annual studies per year. The application performance, virtualization, availability and scalability capabilities are easily supported, for a small radiologist office, a radiology department, or a large hospital network, under the following circumstances: Access to images on Short Term Storage (STS) and Long Term (Archive) Storage is configured on a Storwize V7000 Unified or a SONAS system. The Mach 7 Technologies Keystone applications are configured on Microsoft Windows 8 R2 servers. The Common Internet File System (CIFS) services are configured and delivered over the Internet Protocol (IP) network. 1

4 Introduction: Mach 7 imaging applications Mach 7 Technologies (Mach7) is a global provider of clinical image management solutions. Keystone Suite, a vendor neutral ECIP from Mach7, enables healthcare enterprises across the globe to improve clinical imaging workflow and patient care through direct integration with an organization s EMR system. The core components of the Keystone Suite ECIP include: Keystone Engine a flexible, fast, scalable imaging workflow engine that efficiently improves medical imaging workflow based on customer-defined instructions Keystone Archive a world class, scalable, hardware agnostic, PACS vendor neutral medical image archive. Keystone Clinical Viewer a multispecialty web viewer that easily integrates with upstream electronic health record (EHR) systems, enabling a single access point for viewing all imaging studies related to a patient. Keystone Management Studio a centralized tool for configuring, monitoring, auditing, and administering various components across the Keystone Suite. Keystone Study Split Utility a technologist s workstation utility supporting reading specialists through the splitting of studies across accession numbers. Keystone Study Import-Export Utility a workstation utility that enables studies and non-dicom artifacts to be imported and exported between systems and CD/DVDs. Keystone Rapid Migration Utility a utility to migrate imaging data through both traditional and rapid mechanisms. Figure 1 provides a simplified overview of the component interaction between different healthcare information systems with the various application elements of the Keystone Suite ECIP. 2

5 Figure 1: Interaction of different healthcare Information systems with Keystone Suite ECIP (simplified illustration) As outlined in Figure 1, the key functional elements of the Keystone Suite ECIP are described in the following points: 1 Keystone Engine: Various modalities, other DICOM nodes, and PACS stations communicate with Keystone Engine. Keystone Engine provides advanced imaging workflow improvement capabilities that enable the sharing of images across traditional boundaries. Enabling sophisticated rules-based routing logic, image data can be systematically routed to where interpretations need to be performed from off-hours coverage support to intelligently routing specialty procedures to routing at the series level, or simply solving modality and PACS routing limitations. 2 Keystone Archive: Serving as the foundation to the Keystone Suite, the Keystone Archive delivers a PACS vendor neutral archiving solution for the medical facility. It stores the data and images in a standard DICOM file. This specific consolidated archive easily supports departmental facility in a hospital, or a regional hospital network. 3

6 3 Keystone Management Studio: Centralized tool for configuring, monitoring, auditing, and administering the various components across the suite. As a PACS administrator s toolkit, the Keystone Management Studio enables graphical configuration of image routing rules, advanced custom reporting, auditing of DICOM normalization activities, a real-time monitoring dashboard, and more. The Keystone Management Studio ensures administrator-level control and monitoring capabilities for all imaging traffic in the medical enterprise. 4 - Keystone Clinical Viewer: Facilitate image viewing on a Hospital Information System (HIS), EMR, physician portal, patient portal, and mobile devices. Using URL launch, the web-based EMR rortal launches the Keystone Clinical Viewer that displays the image data for the specified accession number on the user s workstation. With the Keystone Clinical Viewer, a user can simplify enterprise image enablement through a single, web-enabled clinical viewer across departments (such as radiology, cardiology, dermatology, and so on) and sites. 5 - Keystone Study Import-Export Utility: Simplifies the process of importing and exporting medical imaging studies through an intuitive interface with advanced functions. With the Keystone Study Import-Export Utility, studies can be imported from patient s CDs, DVDs, drive locations, and directly from external PACS solutions through standard DICOM communications. After studies are acquired by the Keystone Study Import- Export Utility, the utility can update patient and exam metadata through standard DICOM Modality Worklist (DMWL) queries to your local information system. Based on the results of the query, users can quickly select the appropriate patient and exam data to be systematically updated on the study. The result is an efficient, accurate, and centralized approach to import outside imaging data and export imaging data to a CD/DVD. 6 - Keystone Study Split Utility: Provides an advanced tool for managing image acquisition workflow. With the Keystone Study Split Utility, studies acquired from the modality can be checked for quality, updated based on standard DMWL queries, and split as required (for example, chest, abdomen, and pelvis) across defined accession numbers to enable specialist workflow and ensure accurate downstream billing. An accession number is a unique identifier for an order, used in medical information systems such as HIS or radiology information system (RIS). Image data generated as a response to the order usually contain the accession number, making it possible to link images with orders. Through this process, a technologist monitors and controls the image acquisition workflow through an intuitive worklist displaying the status of each study, including warnings, exceptions, and the verification of images as to being fully acquired by the receiving PACS system. The Keystone Study Split Utility provides an advanced set of technologist tools for greater workflow efficiencies and improved quality. 4

7 As the workhorse of PACS, the Keystone Engine enables interoperability across departments, sites, and regions. This medical imaging workflow engine enables sharing of medical image data between disparate PACS, imaging modalities, and post-processing workstations, by facilitating rules-based processing of routing and prefetch logic, and delivering advanced processing capabilities for transfer syntax conversion, DICOM transformations and proprietary vendor DICOM conversion, compression, and more. Serving as the foundation to the Keystone Suite, the Keystone Archive delivers a PACS vendor neutral archiving (VNA) solution. Keystone Archive offers a consolidated access to medical image repositories across departments, sites, and regions. It enables easy sharing of DICOM, and non-dicom imaging through central EMR systems, for clinical comparison, and communication to specialists and medical practitioners, in addition to addressing the requirement to store all image information in a non-proprietary format, understood by the community, at large. Introduction: IBM Storwize V7000 Unified and SONAS This section provides details and highlights for the storage components of the joint medical archive solution The IBM Storwize V7000 Unified and IBM SONAS systems. IBM Storwize V7000 Unified: Overview Many users have deployed storage area network (SAN) attached storage for their applications requiring the highest levels of performance while separately deploying network-attached storage (NAS) for its ease of use and lower cost networking. This divided approach adds complexity by introducing multiple management points and also creates islands of storage that reduce efficiency. The Storwize V7000 Unified system provides the ability to combine both block and file storage into a single system. By consolidating storage systems, multiple management points can be eliminated and storage capacity can be shared across both types of access, helping to improve overall storage utilization. The Storwize V7000 Unified system also presents a single, easy-to-use management interface that supports both block and file storage, helping to simplify administration further. The Storwize V7000 Unified system builds on the functions and high-performance design of the Storwize V7000 system and integrates proven IBM software capabilities to deliver new levels of efficiency. The Storwize V7000 Unified system provides the following software capabilities: Massive scalability: Supports billions of files in a single file system Supports up to 64 file systems per single platform Flexibility: Allows access to data in a single global namespace, allowing all users a single, logical view of files through a single drive letter, such as a Z drive Provides efficient distribution of files, images, and application updates and fixes to multiple locations quickly and cost effectively Provides multiple storage tiers for flexible, efficient management of millions of files 5

8 Supports industry-standard protocols: CIFS, Network File System (NFS), File Transfer Protocol (FTP), Hypertext Transfer Protocol Secure (HTTPS), and Secure Copy Protocol (SCP) Performance: Uses two dual-port (all ports active) 10 GbE interface cards offering high bandwidth and additional connectivity in each Storwize V7000 Unified interface node to simultaneously manage multiple data streams and functions (for example, backup, replication, antivirus). Real-Time Compression: Storwize V7000 Unified system supports integrated IBM Realtime Compression, enabling storage of up to five times as much active primary data in the same physical space for extraordinary levels of efficiency. IBM Real-time Compression is designed to improve efficiency by storing up to five times as much active primary data in the same physical disk space. By significantly reducing storage requirements, you can keep up to five times more information online, use the improved efficiency to reduce storage costs, or achieve a combination of greater capacity and reduced cost. Solid-state drive (SSD): SSD supports applications that demand high disk speed, quick access to data, and requirements for tiered storage environments. Thin provisioning: Supports business applications that need to grow dynamically, while consuming only the space actually used. Data protection: File system and fileset-level snapshots (up to 256 per file system) provide a way to partition the namespace into smaller, more manageable units. Management: Command-line interface (CLI) and browser-based, simple, intuitive, and state-of-the-art administrative GUI provide icon-based navigation and informative graphics that streamline storage tasks and display real-time capacity, performance, and system health. Antivirus: Integrates with McAfee and Symantec Antivirus, enabling users to secure data from malware and use the most commonly deployed independent software vendor (ISV) antivirus applications. Cloud features: Self-managing, autonomic system enables capacity, provisioning, and other IT service management decisions to be made dynamically, without human intervention or increased administrative costs. IBM Active Cloud Engine enables ubiquitous access to files from across the user s domain space (or network) quickly and cost effectively. Operational savings and total cost of ownership (TCO): Consolidates multiple individual filers and their management, thereby avoiding problems associated with administering an array of disparate NAS systems Automates file placement by transparently moving files to another internal or external storage pool, optimizes storage resources, and offers significant time and cost savings in administering petabytes of files Helps conserve floor space (up to a petabyte of data in less than a square meter), is highly scalable, helps reduce capital expenditure, and enhances operational efficiency; its advanced architecture virtualizes and consolidates file space into a single, enterprise-wide file system, which can translate into reduced TCO 6

9 IBM SONAS overview The IBM SONAS system is designed to manage vast repositories of information in enterprise environments requiring very large capacities, high levels of performance, and high availability. SONAS uses a mature technology from IBM high-performance computing (HPC) experience. SONAS is based upon the IBM General Parallel File System (IBM GPFS ), a highly scalable clustered file system. SONAS is an easy-to-install, turnkey, modular, scale out NAS solution, and provides the performance, clustered scalability, high availability, and functionality that are essential for meeting strategic multi-petabyte and cloud storage requirements. SONAS currently offers the following features and capabilities: Massive scalability: Supports billions of files (up to 21 petabytes of storage) in a single file system Supports up to 256 file systems per single SONAS platform Flexibility: Allows access to data in a single global namespace, providing all users a single, logical view of files through a single drive letter such as a Z drive Provides efficient distribution of files, images, and application updates and fixes to multiple locations quickly and cost effectively Provides multiple storage tiers for flexible, efficient management of petabytes of files Supports industry-standard protocols: CIFS, NFS, FTP, HTTPS, and SCP Performance: Uses two dual-port (all ports active) 10 GbE interface cards offering high bandwidth and additional connectivity in each SONAS interface node to manage multiple data streams and functions (for example, backup, replication, antivirus). Data protection: File system and fileset-level snapshots (up to 256 per file system) provide a way to partition the namespace into smaller, more manageable units. Management: CLI and browser-based, simple, intuitive, and state-of-the-art administrative GUI provide icon-based navigation, informative graphics and SONAS visualizations streamline storage tasks and display real-time capacity, performance, and system health. Antivirus: Integrates with McAfee and Symantec Antivirus, enabling users to secure data from malware and uses the most commonly deployed ISV antivirus applications. Cloud features: Self-managing, autonomic system enables capacity, provisioning and other IT service management decisions to be made dynamically, without human intervention or increased administrative costs. IBM Active Cloud Engine enables ubiquitous access to files from across the globe quickly and cost effectively. 7

10 Operational savings and TCO: Consolidates multiple individual filers and their management, thereby avoiding problems associated with administering an array of disparate NAS systems. Automates file placement by transparently moving files to another internal or external storage pool, optimizes storage resources, and offers significant time and cost savings in administering petabytes of files Helps conserve floor space (up to a petabyte of data in less than a square meter), is highly scalable, helps reduce capital expenditure, and enhances operational efficiency; its advanced architecture virtualizes and consolidates file space into a single, enterprise-wide file system, which can translate into reduced TCO Differences: IBM Storwize V7000 Unified and SONAS as NAS systems While many NAS capabilities between the IBM Storwize V7000 Unified and IBM SONAS systems appear to be similar, there are a few important differences in functional capabilities, between these two systems. The IBM Storwize V7000 is a Unified system and can simultaneously support Fiber Channel (FC) SAN and NAS application workloads. The IBM SONAS is a NAS machine. In terms of features, the Storwize V7000 Unified system supports real-time compression of data, has SSDs, and can scale up to 1.44 PB SONAS supports 256 file systems and can scale up-to 21.6 PB. Due to the difference in the functional capabilities, there is a visible difference on the observed workloads that each system can support. The Storwize V7000 Unified system can support smaller and medium-size workloads, while the SONAS system has the scalability to deliver extremely large application workloads and capacities, typically for the entire healthcare enterprise. 8

11 Table 1 offers a high-level product comparison of differences between the Storwize V7000 Unified and SONAS systems: No. Attribute Storwize V7000 Unified SONAS 1 2 Maximum number of interface nodes Maximum number of storage nodes 2 30 N/A 60 3 Maximum raw capacity of file storage 360 TB (3 TB drives x 12 drives per expansion unit x 10 expansion units) 21.6 PB (3TB drives x 240 drives x 30 controllers) 4 Maximum size of a single shared file system (GPFS) 8 PB 8 PB Maximum number of file systems within a single storage frame Maximum size of a single file Maximum number of files per storage system PB 8 PB 4 Billion 4 Billion Maximum number of dependent file sets per file system Maximum number of independent file sets Maximum number of independent file sets Table 1: Comparative product positioning of Storwize V7000 Unified and SONAS systems 9

12 Architectural assumptions The following architectural assumptions and caveats apply to the technical content of this paper. This paper: Offers information and recommendations for tuning adjustments to achieve good performance in normal NAS production environments. Allows a non-technical customer or user to quickly tune their NAS environment by using recommendations, observations, tips, and best practices, as documented. Provides information from a non-technical user point of view for fast implementations. This paper does not: Explain various technologies and solutions to establish or publish any benchmarks. Guarantee a specific performance of any technical element of the solution architecture. Provide or offer any information to supersede previously established benchmarks. Explain or explore newer technologies, standards, and concepts such as 40 GbE connections, NFS V4, cloud multi-tenancy and so on. Offer any guidance on how to determine hardware sizing or capacity planning for your installation. Caveats: For this paper, the tests were run on different IBM equipments located at different IBM data centers. Note that the performance results might vary, depending on unique server and client conditions, architectural configurations, network behaviors, application dependencies, and operational environments. Your performance might vary from the test results herein. Check with an IBM representative for the latest information and any updates on this solution. Recommended best practices sometimes differ from the test configurations. The test configurations were set up to observe certain behavior in specific test situations. The best practices are recommended to run live applications and operations in production environments. 10

13 IBM SONAS: Configurations, tests, and results Configurations and tests The solution architecture includes the following configuration. An IBM SONAS system was configured, and tested with Mach7 Keystone Suite applications, running as clients on virtual machines. The servers were configured on a two IBM HX5 blades (2), residing on an IBM BladeCenter H chassis. Both the HX5 blades were loaded with the VMWare ESX software. Three separate virtual machines were created with Microsoft Windows 2008 R2, over each HX5 blade. In total, there were six(6) VM machines. The Keystone Suite applications were installed on Windows 2008 R2 virtual machines. For the purposes of this enablement effort, a single virtual machine was configured as a Keystone Database Server, running Microsoft SQL 2008 R2. The other virtual machines were configured as Keystone Application Servers. The required file systems residing on the SONAS system (installed with j code) were made available to the applications as CIFS shares, as shown in Figure 2. Figure 2: NAS (CIFS) attached SONAS configuration with Keystone Suite ECIP 11

14 In this test, the shares were exported from the SONAS system using CIFS protocols. In terms of network security, Active Directory (AD) security services were configured in the network. The SONAS system was configured to be a member of the AD services, and the same Domain Name Services (DNS) as the client Windows 2008 virtual machines on their network. Test results Keystone Suite and the IBM SONAS integrated easily with no extra coding/specialty API s needed. Keystone Suite successfully archives and routes all images from and to the SONAS, with a maximum of 10 studies in the archiving queue at any point. Keystone Suite successfully completes archiving and routing studies to SONAS, within (less than 10 seconds) of receiving the last image. SONAS successfully maintains a minimum throughput of at least 50 large images per second (typically, more than 100 CT or MR scans, each with over 512 KB image sizes), when the connectivity to SONAS is configured as 10 GbE interfaces. SONAS successfully keeps up with the archiving and routing functions under typical load scenarios when studies are sent continuously from multiple senders for at least more than 3 hours. Also observed, that the there was no presence of any archive queues. The joint solution specified will conservatively handle 2.15 million exams per year, and it is safe to recommend that the solution can sustain higher image volumes from several image sending sources (modalities, PACS, and other sources), and without significantly stressing processor CPU s, and memory resources of the Windows 2008 R2 servers. Keystone Suite can successfully scale out by easy addition of virtual machines (as new Windows 2008 R2 nodes) into the environment. These virtual machines can easily be created by inserting new BladeCenter HS-5 blades into the IBM BladeCenter H chassis. IBM Storwize V7000 Unified and SONAS work cohesively with the Keystone Suite to deliver a scalable, interoperable solution. As tested, this solution is well suited for any medical environment that processes 200 K annual studies per year to 4 million annual studies per year. The application performance, virtualization, availability, and scalability capabilities are easily supported for a small radiologist office, a radiology department, or a large hospital network. Solution delivery recommendations To ensure a smooth installation of the complete solution, this section offers the following recommendations, and best practices: Recommended Keystone Server hardware prerequisites Recommended Keystone Server software prerequisites Recommended file systems layout best practices Recommended storage sizing matrix for Keystone Suite 12

15 Recommended Keystone Server hardware prerequisites This section provides the minimum hardware specification for implementing Keystone Suite. For enterprise environments, hardware specifications must be scaled appropriately. The following hardware configurations are recommended for enterprise servers. It would support an enterprise producing 2000,000 imaging exams per year: Two redundant servers Four processors 16 GB RAM 1 TB free space local receiver temporary storage locations must minimally be capable of supporting 1 day s worth of storage. NAS for long-term archive storage (archive only) For configurations larger than this, or for customer configurations or architecture designs, you can contact Mach 7 Technologies, or IBM. Recommended Keystone Server software prerequisites On the server, ensure that the following software prerequisites have been implemented before running the installation of Keystone Suite. Operating system: Windows 2008 R2 Framework:.Net Framework 4.0 Web server (IIS): Required features on Internet Information Services (IIS) include ASP.NET and the supporting features that you be prompted to include when selecting ASP.NET. Register ASP.NET 4.0 on IIS using the following instructions: 1. Open the command prompt window. 2. Go to <WindowsDir\Microsoft.NET\Framework64\<version number>\ 3. Run the aspnet_regiis.exe -i command and press Enter. SQL Server 2008 R2 Database software Install SQL Server software In the SQL Server Configuration Manager, make sure that the TCP/IP protocol has been enabled. Recommended file systems layout best practices For defining best practice recommendations, a distinction is made between online storage (short-term storage or STS) and archive storage (long-term storage or LTS), as follows: STS: New images sent from the modality to Keystone Archive are registered in the database and stored in the STS (refer to the Glossary of Terms located at URL link: The STS has a limited storage capacity, but allows direct access to the images, for example, during image post processing and reporting. Images can be archived for approximately 3 to 12 months. 13

16 LTS: Images are copied from the STS to the LTS based on specific rules and policies. This step is the actual archiving. The LTS provides a very large storage capacity. Images can be archived there for many years. IBM Storwize V7000 Unified and SONAS systems fulfill the following requirements for electronic archiving systems, as outlined by Keystone Suite ECIP: Access to STS and LTS storage with CIFS protocols Database-supported image management Consolidated access to image repositories across departments, sites, and regions Easy sharing of DICOM and non-dicom images through central EMR and EHR systems for clinical comparison and communication to specialists and medical practitioners Easy addressing of the requirement to store all image information in a non-proprietary format, understood by the community at large. For improved performance in a normal and a typical production environment, layout the file systems for Keystone Suite applications as per the following guidelines and best practice recommendations: IBM Storwize V7000 Unified system simultaneously supports STS and LTS through simultaneous use of SAN and NAS capabilities. IBM SONAS system simultaneously supports STS and LTS through the 10 GbE and CIFS enabled NAS capabilities. Create the GPFS file systems on SONAS or Storwize V7000 Unified by using the cluster method of creating the block allocation maps to achieve a uniform disk performance across all storage capacities. Create the GPFS file system on SONAS or Storwize V7000 Unified by using the logfileplacement value = striped to stripe the log file of the file system across all metadata disks. Recommend using the block size = 256 K for both STS and LTS storage. As a best practice, run all Windows servers with dual 10 GbE bonded network channel connections, with MTU = For Mach7 Keystone Suite applications, a minimum of two interface nodes are recommended on Storwize V7000 Unified or SONAS for increased availability. Recommended storage sizing guidance for Keystone Suite Table 2 highlights a typical storage sizing information for the Keystone Suite. As summarized in the table, a typical study uses about 100 MB of storage, irrespective of the modality type be it CT, MR or X-Ray, and others. If a radiology department processes about 200,000 images annually, then the estimated storage for 1 year, 3 years, and 5 years are extrapolated linearly across the row. For such an environment, a typical recommendation is to use two Keystone servers running Keystone applications, and connected to an IBM Storwize V7000 Unified or an IBM SONAS storage system. 14

17 Estimated Storage (1 year) Estimated Storage (3 years) Estimated Storage (5 years) No. Estimated MB per study Annual Studies (estimated) (TB) (TB) (TB) , , ,000, ,500, ,000, ,500, ,000, ,500, ,000, Table 2: Typical storage sizing matrix for Keystone Suite Assumptions: Estimated Keystone servers 2 Segregated multiples Recommended storage IBM Storwize V7000 Unified IBM SONAS Decimal values have been rounded to the nearest integer value. Storage values are computed using marketing terabytes, and not engineering terabytes 1 marketing terabyte = 1000 marketing gigabytes (not 1024 GB) 1 marketing gigabyte = 1000 marketing megabytes (not 1024 MB) Storage numbers based on raw storage computations. Redundant Array of Independent Disks (RAID) protection is not assumed in these computations. Depending on specific RAID protection required, these estimates will need to be increased and adjusted appropriately. (Some clients might prefer RAID-5 and some might prefer RAID-6). IBM Storwize V7000 system specifications available at the following website: ibm.com/systems/storage/disk/storwize_v7000/specifications.html IBM SONAS system specifications available at the following website: ibm.com/systems/storage/network/sonas/specifications.html Irrespective of the modality, it is estimated that each new study results in an average of 100 MB of new images and data per study. For example, if a radiology group only does US studies, but processes 100,000 annual estimated studies, then, extrapolate the estimated numbers by using the following computations: Storage (1 year) = 100,000 x (100 MB per study) x 1 = 10 TB Storage (3 years) = 100,000 x (100 MB per study) x 3 = 30 TB Storage (5 years) = 100,000 x (100 MB per study) x 5 = 50 TB Dual-node servers are always recommended for high availability. One pair of dual node Quad core servers with 16 GB of RAM, each processes about 1.85 million studies per year. A pair of two Keystone Suite servers is recommended for up to 2 million annual studies. Each server does archiving, routing, and web transactions. 15

18 For very large sites, it is recommended to segregate the application components (shifting the web server off to handle client load separate from archive and routing backend processing) to improve efficiencies. From the storage perspective, a Storwize V7000 Unified system is recommended for up to 720 TB of total storage. For very large sites, beyond 720 TB, a SONAS system is recommended. While Table 2 provides approximate estimates, it offers a good starting point for further discussions on fine tuning the requirements of a specific client situation or opportunity. Solution benefits and summary Keystone Suite ECIP coupled with either IBM Storwize V7000 Unified or SONAS storage systems provides a comprehensive solution for deployments in radiology offices, departments in a hospital, or regional sites spanning a hospital network. The solution includes additional utilities that facilitate easy data import and export, and data migration functional capabilities. The solution includes the following benefits. Enables to achieve easy interoperability across departments, sites, and regions Enables easy sharing of medical image data between disparate PACS, imaging modalities, and post-processing workstations Facilitates simple rules-based processing of routing and prefetch logic and delivers advanced processing capabilities for transfer syntax conversion, DICOM transformations and proprietary vendor DICOM conversion, compression, and more capabilities. Simplifies enterprise-image enablement and consolidates disparate information centrally into a single VNA, and enables to achieve a simple, consolidated access to medical image repositories across departments, sites, and regions Enables easy sharing of DICOM and non-dicom imaging through central EMR systems for clinical comparison and communication to specialists and medical practitioners Addresses the requirement to store all image information in a non-proprietary format, understood by the community at large The tested joint solution and included results validate that IBM Storwize V7000 Unified and SONAS work cohesively with the Keystone Suite to deliver a flexible, scalable, and an interoperable solution. As tested, this solution is well suited for a medical environment that processes 200,000 annual studies per year to 4 million annual studies per year. The application performance, virtualization, availability, and scalability capabilities are easily supported for a small radiologist office, a radiology department, or a large hospital network under the following circumstances: Access to images on STS and long-term (archive) storage is configured on Storwize V7000 Unified or a SONAS System The Mach 7 Technologies Keystone applications are configured on Windows 8 R2 servers. The CIFS services are configured and delivered over the IP network. 16

19 Acknowledgments Special thanks go to the Mach 7 Technologies team in the USA for running the proof-of-concept tests with the Keystone Suite of PACS and VNA applications on the IBM SONAS system. The IBM team also acknowledges by mentioning special thanks to Larry Garibay for his invaluable help and assistance, without which the software validation of Keystone Suite of applications would not have been successful. Many thanks to the IBM Client Executives, IBM Systems and Technology Group members, and other IBM team members who contributed with their recommendations during the test run and review process and enabled successful completion and validation so that Keystone Suite applications can be successfully recommended for clinical imaging environments using IBM Storwize V7000 Unified and SONAS systems. 17

20 Appendix A: Use case Radiology department solution Use case scenario There is a small radiology office that manages one or two modalities, and manages 5 GB to 8 GB of image data per day. Refer to Figure 3. Figure 3: Use case - radiology department solution Benefits: Reduces future PACS switching costs Resolves PACS and Modality limitations Migrates rapidly to new PACS solutions Enables specialty reading workflows (study splitting, series level routing, and so on) Provides clinical efficiencies (hanging protocols) Manages DVD/CD imports and exports Appendix B: Use case Imaging services in a single hospital Use case scenario 18

21 There is a single hospital with multiple departments, each department capturing different multiple images across several modalities. It processes about 200,000 images per year. Refer to Figure 4. Figure 4: Use case imaging services in a single hospital Benefits: Consolidates storage (VNA) Simplifies enterprise image enablement Prefetches relevant images from the archive. Enables best-of-breed departmental specialty reading (PACS) solutions Provides consolidated reporting capabilities Appendix C: Use case Imaging services in a hospital system network Use case scenario 19

22 There is a single hospital system network with multiple hospitals. Each hospital has several departments, each department capturing different multiple images, across several modalities. It processes about 2,000,000 images per year. Refer to Figure 5. Figure 5: Use case imaging services in a hospital system with multiple hospitals Benefits: Resources Facilitaes a regional image repository Allows to share images across sites Provides clinical viewing access Enables access to relevant priors The following websites provide useful references to supplement the information contained in this paper: Mach 7 Technologies Keystone Suite Installation Guide, version 11.3 Contact Mach 7 Technologies ( for a recent copy of this guide. 20

23 Management Studio Administration User Guide Contact Mach 7 Technologies ( for a recent copy of this guide. Management Studio Monitor User Guide Contact Mach 7 Technologies ( for a recent copy of this guide. Management Studio Tracking and Auditing User Guide Contact Mach 7 Technologies ( for a recent copy of this guide. Management Studio Archiving User Guide Contact Mach 7 Technologies ( for a recent copy of this guide. Management Studio Engine User Guide Contact Mach 7 Technologies ( for a recent copy of this guide. Clinical Viewer User Guide Contact Mach 7 Technologies ( for a recent copy of this guide. Glossary of Terms, compiled by the American College of Radiology and the Radiological Society of North America IBM Redbooks ibm.com/redbooks IBM Publications Center IBM Scale Out Network Attached Storage Architecture, Planning, and Implementation Basics [SG ] ibm.com/redbooks/abstracts/sg html?open IBM Scale Out Network Attached Storage Concepts [SG ] ibm.com/redbooks/abstracts/sg html?open IBM Storwize V7000 Introduction and Implementation Guide [SG247938] ibm.com/redbooks/redpieces/abstracts/sg html?open About the author Prashant Avashia is a software engineer in IBM Systems and Technology Group ISV Strategy and Enablement Organization. With more than 15 years of experience in Storage Technologies, he has 21

24 successfully architected, engineered, and implemented enterprise infrastructure solutions for key global clients in healthcare, financial, and software industries. He earned his master's degree in Industrial Engineering from Kansas State University, and a bachelor's degree in Mechanical Engineering from Osmania University, India. You can reach Prashant Avashia at pavashia@us.ibm.com. 22

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26 presented here to communicate IBM's current investment and development activities as a good faith effort to help with our customers' future planning. Performance is based on measurements and projections using standard IBM benchmarks in a controlled environment. The actual throughput or performance that any user will experience will vary depending upon considerations such as the amount of multiprogramming in the user's job stream, the I/O configuration, the storage configuration, and the workload processed. Therefore, no assurance can be given that an individual user will achieve throughput or performance improvements equivalent to the ratios stated here. Photographs shown are of engineering prototypes. Changes may be incorporated in production models. Any references in this information to non-ibm websites are provided for convenience only and do not in any manner serve as an endorsement of those websites. The materials at those websites are not part of the materials for this IBM product and use of those websites is at your own risk. 24