Test PACS Setup with Bahmni PACS Simulator

Refer Radiology and PACS Integration. Bahmni PACS module talks to modality while creating/modifying/cancelling orders, and expects the modality to send the images taken to a DICOM server (DCM4CHEE/Orthanc). To test any functionality in development/testing environments, we need a modality emulator that mimics this behaviour.

None of the modality emulators and HL7 simulators, we looked at, fit the bill. So we created an emulator for simulating this specific behaviour. This is where you can find the code.

How it works

1. Accepts order HL7 message (ORM^O01)
2. Uploads one DICOM image, with certain DICOM tags modified (patient id, name, accession number, study id and study date). This enables a DICOM viewer (Oviyam2) fetch the image from DICOM server (DCM4CHEE/Orthanc) for that patient and order.
3. Returns acknowledgement to the caller.

Instructions to run the Bahmni PACS emulator.

1. Checkout code from repo .
2. Download https://sourceforge.net/projects/dcm4che/files/dcm4che2/2.0.28/ and extract it in /var/lib/bahmni folder.
3. Build Bahmni PACS emulator using build.sh
4. You can configure the emulator to run
   1. at a particular port,
   2. customize the timeout,
   3. customize which DCM4CHEE/Orthanc instance to upload the DICOM file to.
5. Run using run.sh. 
   1. By default the emulator runs on port number 9000, with a timeout of 30 secs. It will try to upload DICOM image to DCM4CHEE@192.168.33.10:11112

   2. A sample customized way to run the emulator, 

      java -jar target/pacssimulator-1.0-SNAPSHOT-jar-with-dependencies.jar 8087 20000 orthanc http://172.18.2.98:8042/instances
      java -jar target/pacssimulator-1.0-SNAPSHOT-jar-with-dependencies.jar 8087 20000 dcm4chee DCM4CHEE@192.168.33.10:11112

6. Update the modality's ip in 'modaliity' table to point to the machine which is running the simulator.

7. In the above examples, the location of the "dcmsnd" script is assumed to be at "/var/lib/bahmni/dcm4che-2.0.28/bin/". However, you may override that with system parameter (dcmsnd_path) passed like below

   java -Ddcmsnd_path=/path-to-dcmsnd-cmd/ -jar target/pacssimulator-1.0-SNAPSHOT-jar-with-dependencies.jar 8087 20000 dcm4chee DCM4CHEE@192.168.33.10:11112

Different Modes to run the Simulator

1. Default (use run.sh)
   1. Runs on port 9000. Accepts Order message, uploads to Dcm4chee at DCM4CHEE@192.168.33.10:11112 and returns an acknowledgement message.

2. Post to specific Orthanc/Dcm4chee

   java -jar target/pacssimulator-1.0-SNAPSHOT-jar-with-dependencies.jar 8080 30000 orthanc http://myorthancUrl:8051/instances
   java -jar target/pacssimulator-1.0-SNAPSHOT-jar-with-dependencies.jar 8087 20000 dcm4chee DCM4CHEE@mydcm4cheeUrl:11113
   java -jar pacssimulator-1.0-SNAPSHOT-jar-with-dependencies.jar 9000 30000 dcm4chee DCM4CHEE@172.18.2.27:11112 > /dev/null &

   1. Runs on specified port (8080 in above example), timeout is 30000 milleseconds, uploads to Orthanc at http://myorthancUrl:8051/instances and returns an acknowledgement message.

3. Do not post to Orthanc.

    java -jar target/pacssimulator-1.0-SNAPSHOT-jar-with-dependencies.jar 8080 30000

   [Useful if you do not have Orthanc setup]

   1. Runs on specified port (8080 in above example), timeout is 30000 milleseconds, uploads to Orthanc at http://myorthancUrl:8051/instances and returns an acknowledgement message.

Uploading DICOM File directly to DCM4CHEE

One disadvantage of running the simulator is that, the order will not appear in the "Modality Worklist" of DCM4CHEE. When configured properly, Bahmni pacs-integration will send the ORM message to the simulator directly. Follow the steps below if you want to have the order appear in DCM4CHEE modality worklist and if you subsequently want to upload a DICOM file against that order (Accession) 

1. Follow the steps described here, as well as setting up PACS-Integration module, and mapping the orderable concept codes. 
2. If you now order the relevant "Radiology" order (e.g. CHEST PA) it should appear in the DCM4CHEE's modality worklist. If not, go back and try to get the configuration right - mapped codes, Bahmni pacs-integration, DCM4CHEE configuration especially setup as modality worklist.
   • You can see the log of pacs integration module (/var/log/pacs-integration/pacs-integration.log) and DCM4CHEE log (/var/lib/bahmni/dcm4chee-2.18.1-psql/server/default/log/server.log)
   • You may also find useful information in Bahmni pacs integration's postgres database table bahmni_pacs.failed_events

3. Once you have the order showing in the "Modality Worklist", generate a DICOM file first using the same Simulator jar above. Identify the patientId, givenname, familyname and the accession number first. 

   > java -cp pacssimulator-1.0.0-jar-with-dependencies.jar org.bahmni.pacssimulator.DicomFileGenerator GAN123 Gajendra Singh ORD-309 [dicom file path | 0-1]

   The above should tell you the location of the generated file.  You can then take the file and use "dcmsnd" command manually to send the file. But before that

4. In DCM4CHEE, create an AE (Application Entity) with name "DCMSND" and port "11113" (can be anything, make sure AE and port is not already in use)

5. Run the following command with your generated file

   ./dcmsnd <scp[@host][:port]> -stgcmt -L <aet[@host][:port]>

   Note, ensure the correct path of the "dcmsnd" command. Example

   ./dcmsnd DCM4CHEE@192.168.33.10:11112 /tmp/3bd0d47c-7794-4095-9170-357591454cbd.dcm -stgcmt -L DCMSND:11113

   Check the output for potential errors. It might show errors like "A801H" - Google to understand what that means. Resolve the errors first - usually dcmsnd manual helps.  

6. Now check either in DCM4CHEE web interface "Folder" tab → search for study. Or in Oviyam (https://your-server-address/oviyam2/ → search. You will see a small image in the OVIYAM2 viewer. From Bahmni Patient Dashboard, clicking the Radiology Order, should launch the full OVIYAM2 viewer.   

Using the docker image of PACS Simulator

The PACS Simulator has been dockerized and is uploaded to docker hub here. You can run the image in two ways.

1. Listen for orders and post DICOM image to PACS Server
   This is done using docker-compose where pacs-integration service and dcm4chee are running.
   
   
2. Manually upload DICOM image for a Modality Worklist item of DCM4CHEE
   
   1. Follow the steps described here, as well as setting up PACS-Integration module, and mapping the orderable concept codes. 
   2. If you now order the relevant "Radiology" order (e.g. CHEST PA) it should appear in the DCM4CHEE's modality worklist. If not, go back and try to get the configuration right - mapped codes, Bahmni pacs-integration, DCM4CHEE configuration especially setup as modality worklist.
      • You can see the log of pacs integration module (/var/log/pacs-integration/pacs-integration.log) and DCM4CHEE log (/var/lib/bahmni/dcm4chee-2.18.1-psql/server/default/log/server.log)
      • You may also find useful information in Bahmni pacs integration's postgres database table failed_events
   3. Now identify the patientId, givenname, familyname and the accession number first. 

   4. Run the following command with the above values replaced.

      docker run --rm -it bahmni/pacs-simulator ./upload.sh <PACS_SERVER_URL> <PATIENT_ID> <PATIENT_FIRST_NAME> <PATIENT_LAST_NAME> <ACCESSION_NUMBER>

      Example command would look like: 
      ` docker run --rm -it bahmni/pacs-simulator ./upload.sh DCM4CHEE@192.168.33.10:11112 GAN203010 Test Radiology ORD-330 `