INFINITT Migration

White Paper
INFINITT Solution for Migrating Legacy PACS

Copyright 1998-2009, INFINITT Co., Ltd.

All Rights Reserved

INFINITT Replacement White Paper

1. Introduction
1.1. Overview
PACS has been around for a long time. Now there are many PACS installations around the
world that are two or more years old. As technology evolves, many modalities produce more
images that require high performance PACS, and these old legacy PACS installations are
getting slow, unreliable, and expensive to maintain. It is estimated that more than 20% of
PACS buyers are to replace their existing legacy PACS.
The improvements in hardware such as computers, networks, and storages of media
technology, as well as the software such as PACS and operating system resulted in high
performance PACS. Replacing legacy PACS with new one provides more efficient and costeffective environment in terms of speed, accessibility, functionality, and ease-of-use. To take
advantage of new PACS, one should consider
Price of the vendor's PACS software, future software updates, and service contract
New hardware such as larger servers, storage system, new workstations and monitors
Network upgrade for increased bandwidth
Training and installation of new PACS
Migration of legacy PACS data and the service contract status for the legacy PACS
during migration
Besides purchasing the new PACS software with supporting hardware, one of the most
important factor is the migration of data from legacy PACS to new PACS.
PACS is a complicated system in which many hardware and software are involved. Thus, the
migration is not as simple as one might hope. For a small, relatively new facility with
moderate patient volume, the migration would be less complicated. However, for hospitals
with many years of data, the migration is expensive, cumbersome, time-consuming, and often
labor-extensive.
On the other hand, PACS buyers want to be able to use all the old information in the new
PACS without any loss or restriction in minimal time of migration. They want the new PACS
to be up and running as soon as possible after they purchase the new PACS.

Definition of PACS Replacement

PACS replacement is to replace legacy PACS with new PACS while migrating all the
necessary information including images and data from legacy PACS to new PACS so that all
the information in legacy PACS becomes available in new PACS without any loss or
restriction.

1.2. Migration Data

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There are two types of data in the migration: image data and text data. Text data contains
information about patient, study, report, and other data while image data contains medical
images. The migration data can also be divided into DICOM data and non-DICOM data.
DICOM is an international standard for handling, storing, printing, and transmitting
information in medical imaging. DICOM standards specify standard formats for storing
images and reports such as JPEG, JPEG 2000, MPEG2, SR (Structured Report) Documents,
etc. Most PACS vendors incorporate the DICOM standards into their products. In those
PACS products which support DICOM standards, DICOM images and reports are stored
using the DICOM standard formats. Transferring DICOM data from legacy PACS to new
PACS is not difficult as long as both follow the DICOM standards. But it is time-consuming
because transferring the images using the established DICOM protocol is slow. On the other
hand, the database structure for the text information and non-DICOM data remain proprietary
for each vendor, and it usually takes extra effort to migrate and verify the information
successfully.
Data Type

Data

Characteristics

DICOM data

Images, DICOM SR
(Structured Reports)

Non-DICOM
data

Patient, Study Report,

and other data
information

Internal structure of data is

understood
Easy to migrate
Slow to migrate
Need to analyze and understand the
internal structure of data
Difficult to migrate
Fast to migrate

Table 1 Data Types

Hospitals should prepare for the migration thoroughly and carefully to optimize the
performance and minimize the cost. For successful replacement of legacy PACS, one should
consider
Amount of data to be migrated (amount of primary active data and amount of
secondary data in long term storage)
Type of primary active storage and secondary long term storage
DICOM standards conformance of legacy PACS
Running status of legacy PACS and its archive during migration
Go-live date of new PACS

1.3. Migration Issues

In order to migrate data from legacy PACS to new PACS, hospitals should consider migration
time, accuracy of migrated data, stability of system during the migration, and storage
requirement for migrated data.
Migration Time
Hospitals want to minimize the migration time because the expense for migration
directly depends on it. Many factors affect the length of migration time.
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Amount of data
Compression method used in legacy PACS
Type of primary and secondary long-term storage
System load and possible migration hours

The migration usually proceeds while the legacy PACS is in operation and prior to golive of the new PACS. In INFINITT experience, it typically takes one to three or more
months to migrate 10 TB of uncompressed image data depending on the migration
method and the environment such as system load. The typical migration time for
compressed and uncompressed image data using Direct Migration and Indirect
Migration method is shown in Table 2 and 3.
The above factors affecting the length of migration time are inherent in PACS and the
environment of hospitals. Therefore, it is important to find suitable migration method
and optimize the migration process to minimize the migration time.
Amount of Data
5T Uncompressed
5T Jpeg Lossless
5T Jpeg Lossy

Number of Studies

Time of Migration

150,000
500,000
1,500,000

0.5 ~ 1 Month
2 Months
5 Months

Table 2 Direct Migration

Amount of Data
5T Uncompressed
5T Jpeg Lossless
5T Jpeg Lossy

Number of Studies

Time of Migration

150,000
500,000
1,500,000

1 ~ 2 Month
4 Months
10 Months

Table 3 Indirect Migration using DICOM Q/R

Accuracy of Migrated Data

Hospitals want to move data from legacy PACS to new PACS accurately without any
loss of data. Migrating the legacy PACS data accurately is not easy because
-

The PACS data consists of not only images and related information following
DICOM standard but also other proprietary information such as gray scale
window level, key image selections, etc.
The data format of legacy PACS is different depending on the vendors and
their program versions. It is not uncommon that the legacy PACS data is
incompatible with the new PACS.
There may be corrupted data in legacy PACS.
It is not easy to get help from legacy PACS vendors about their internal data
format.

Therefore, monitoring the migration status and verifying the migrated data for its
accuracy is important.
Stability of System during Migration
The hospitals daily work should not be interrupted while the replacement is taking
place. Many hospitals uses their legacy PACS during migration, and the migration
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may give extra load on the existing legacy PACS which can make the legacy PACS
slow or unstable for normal daily work. Often, the migration is possible only during
off-work hours, not to interrupt the hospitals daily work, but this increases the
migration time.
The replacement should be planned and optimized to minimize the downtime of
system while maintaining the stable system running.
Storage Requirement for Migrated Data
During the migration, both legacy PACS and new PACS are in operation, and
migration creates copies of legacy PACS Data in new PACS. Therefore, hospitals
need extra storage to hold the copies of legacy PACS data. In many cases, the required
extra amount of storage space is as much as the storage space that is required to hold
the legacy PACS data. The shortage in storage space should not hinder the progress of
migration.

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2. INFINITT Migration Process

INFINITT provides fast and accurate PACS replacement and migration services for
transferring diagnostic images and related patient and report data between archives.
INFINITT has over 13 years of experiences in PACS development and has more than 60
replacement and migration sites.

INFINITT PACS Replacement Experiences

INFINITT has replaced 18 different PACS solutions of over 60 sites in many countries such
as Korea, U.S.A., Japan, Taiwan, China, Singapore, Germany and more)
INFINITT knowledge and experience is a valuable asset through all phases of a successful
migration and upgrade in PACS solutions. INFINITT also possesses various migration tools
to support different environments in hospitals for fast and optimized migration. The features
of INFINITT migration solution is
Fast and reliable migration method and supporting tools
Verification and validation of migrated data
Match database information with image information
100% migration of images, reports and patient data
Configurable pre-fetch rules for various hospital environment
Clean up of data
The basic migration workflow of INFINITT migration is shown in Figure 1.

Figure 1 INFINITT Replacement Workflow

2.1. INFINITT Migration Methods

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There are basically two kinds of migration services: Direct (rapid) Migration Service and
Indirect (non-invasive) Migration Service. Direct Migration Service is to migrate data by
accessing the storage file system of legacy PACS directly while Indirect Migration Service is
to migrate data by DICOM standard query/retrieve.
The migration services are further divided by applied tools and methods as shown in Table 4.
Each migration methods are explained in detail in following sections.
Migration Services

Methods

Direct (Rapid) Migration

Indirect (Non-invasive)
Migration

Simple Direct Method

Conversion Method
Corrective Direct Method
Direct DB Migration Method
Query Based Method
Pre-fetch Based Method
Corrective Indirect Method

Tool
INFINITT Smart Convert
INFINITT NetPush
INFINITT Broker
INFINITT Smart Router
INFINITT Broker

Table 4 INFINITT Migration Services

2.2. Direct (Rapid) Migration Service

In Direct Migration Service, Smart Converter directly accesses the database and image
storage of legacy PACS for migration. It is the fastest method to migrate data from legacy
PACS to new PACS. However, to use Direct Migration Service, the structure of database and
storage should be fully understand, and the image data in storage is recognizable.
For some old legacy PACS, the image data in storage may be in the proprietary format or
compressed by non-standard method. In this case, the image data should be analyzed by
INFINITT migration specialists, and Direct Migration Service can be performed if the
analysis is successful. If not, the migration can still be performed in conjunction with Indirect
Migration Service introduced in later sections if the legacy PACS provides DICOM standard
Query/Retrieve operation.
INFINITT provides 4 basic methods for Direct Migration Service:

Basic Phase Method

Conversion Method
Corrective Direct Method
Direct DB Migration Method.

2.2.1 Basic Direct Method

INFINITT NETPUSH is a program which transfers all images in the storage of legacy PACS
to INFINITT PACS Server. INFINITT PACS Server registers and stores the images according
to the information in each images DICOM header.

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Figure 2 Basic Direct Method Workflow

The workflow of Basic Direct Method is as follows:

INFINITT NETPUSH first searches and makes a list of images to be migrated in the
legacy PACS storage.
INFINITT NETPUSH reads the images and sends the images to INFINITT PACS
server by DICOM C-Move operation.
Upon receiving the images, INFINITT PACS server registers and stores the image in
INFINITT PACS.

The advantage of this method is that it is simple, fast and easy. The disadvantages are:

It is impossible to migrate images which are in non-standard format.

It is difficult to cope with migration failure.
If there is wrong information in images DICOM header, migration would not be
performed correctly.
It is difficult to verify the data for correct migration.

The data in database and images are related to each other in PACS. That is, the data in
database and image should be consistent to each other. The Basic Direct Method uses only
the information in images DICOM header. If there is wrong information in images DICOM
header, the migration would proceed with wrong information and would be very difficult to
verify the migrated data.

2.2.2 Conversion Method

Conversion Method uses INFINITT Smart Converter. INFINITT Smart Converter converts
all the images in the storage of legacy PACS to standard DICOM formatted images and
transfers the DICOM images to INFINITT PACS Server. INFINITT PACS Server registers
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and stores the images according to the information in each images DICOM header.
The workflow of Conversion Method is:

INFINITT Smart Converter searches and makes a list of images to be migrated in the
legacy PACS storage.
INFINITT Smart Converter reads the images and converts the images to standard
DICOM formatted images if necessary.
INFINITT Smart Converter then sends the images to INFINITT PACS server by
DICOM C-Move operation.
Upon receiving the images, INFINITT PACS server registers and stores the image in
INFINITT PACS.

The advantages are:

It is easy, fast and simple.

Non-DICOM, non standard images are converted to standard DICOM formatted
images; thus, can be migrated.
It is possible to cope with migration failure. The failed images are reanalyzed and
resend by INFINITT Smart Converter in later time.

Figure 3 Conversion Method Workflow

The disadvantages are:

If there is wrong information in images DICOM header, migration would not be

performed correctly.
It is difficult to verify the data for correct migration.

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The data in database and images are related to each other in PACS. That is, the data in
database and image should be consistent to each other. The Conversion Method also uses
only the information in images DICOM header. If there is wrong information in images
DICOM header, the migration would proceed with wrong information and would be very
difficult to verify the migrated data.

2.2.3 Corrective Direct Method

In Corrective Direct Method, INFINITT Smart Converter not only converts all the images in
the storage of legacy PACS to standard DICOM formatted images, but also modifies the
information in images DICOM header and image format by using the information in
database of legacy PACS before transferring the DICOM images to INFINITT PACS Server.
INFINITT PACS Server registers and stores the images according to the information in each
images DICOM header.
The workflow of Corrective Direct Method is as follows:

Complete analysis of data in legacy PACS is performed prior to the migration.

A list of images to be migrated in the legacy PACS storage is defined.
INFINITT Smart Converter reads the images and converts the images to standard
DICOM formatted images if necessary. The database is searched for the information
corresponding to the current image. The information in images DICOM header and
image format are modified to match the information in database.
INFINITT Smart Converter then sends the images to INFINITT PACS server by
DICOM C-Move operation.
Upon receiving the images, INFINITT PACS server registers and stores the image in
INFINITT PACS.

The advantages are:

It is still fast, but not as fast as basic or conversional phased methods.

Non-DICOM, non standard images are converted to standard DICOM formatted
images; thus, can be migrated.
The information in images DICOM header is consistent with the corresponding
information in database.
Accurate migration of image, patient information and report is performed.
It is possible to cope with migration failure. The failed images are reanalyzed and
resend by INFINITT Smart Converter in later time.

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Figure 4 Corrective Direct Method Workflow

The disadvantages are:

Extra work to analyze the data in legacy PACS is required.

Because of various environment in hospital PACS solutions, it is usually required to
modify the tools.
For images that cannot be recognized because of some reason such as its proprietary
format, it is difficult, if not impossible, to migrate.
It takes extra time for verifying and correcting the information in images DICOM
header and its format.

2.2.4 Direct DB Migration Method

Direct DB Migration Method creates database in INFINITT PACS Server, and uses the
storage of legacy PACS as it is. Since it does not actually copies the image data, it is very
fast, and it requires no additional storage. However, its use is severely restricted depending on
the structure of legacy PACS storage. That is, the structure of legacy PACS storage should be
compatible to INFINITT PACS.

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Figure 5 Direct DB Migration Method Workflow

The workflow of Direct DB Migration Method is as follows:

Complete analysis of data in legacy PACS is performed prior to the migration.

A list of images to be migrated in the legacy PACS storage is defined.
Database of INFINITT PACS is created using the information in legacy PACS
database.
Install legacy PACS storage in INFINITT PACS.

The advantages are:

It is very fast.
There is no additional storage required.

The disadvantages are:

Complete analysis of the data in legacy PACS is required.

Full verification of image data is not performed.
The structure of legacy PACS storage should be compatible to INFINITT PACS..

2.3. Indirect (Non-Invasive) Migration Service

INFINITT Smart Router uses DICOM Query/Retrieve (Q/R) operation to perform migration.
DICOM Q/R is commonly used in migration because it is possible to perform the migration
for any legacy PACS which supports DICOM Q/R SCP. For some old legacy PACS which
does not support DICOM Q/R, this migration service is not possible.
The features of INFINITT Smart Router are:
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The priority of data to be migrated can be configured by various filter condition such
as patient id, study date, study instance uid, etc.
It automatically searches and migrates the data to be migrated by querying
PACS/RIS database or using DICOM queries.
Migration can be perform in one or more legacy PACS at the same time.
Migration status can easily be monitored, and failed studies can be retried
automatically or manually.
Migration time can be configured so that migration is performed only during preconfigured times to reduce the system load.

INFINITT uses Direct Migration Service if possible because Indirect Migration Service is
much slower (two or more times slower) than Direct Migration Service. However, Indirect
Migration Service can be used in conjunction with Direct Migration Service if Direct
Migration Service is impossible for some reason.
INFINITT provides 4 basic methods for Indirect Migration Service:

Query Based Phase Method

Pre-fetch Based Phase Method
Corrective Indirect Method

2.3.1. Query Based Method

Legacy PACS data is migrated to INFINITT PACS using INFINITT Smart Router which uses
DICOM Q/R operation of legacy PACS.

Figure 6 Query Based Method Workflow

The workflow of Query Based Method is as follows:

INFINITT Smart Router requests DICOM C-Find to legacy PACS to find the studies
which match the pre-defined filter condition.
Using the result from the above request, INFINITT Smart Router requests DICOM
C-Move to legacy PACS to transfer the matched study data to INFINITT PACS.
Legacy PACS transfers the data to INFINITT PACS according to the requests.
INFINITT PACS registers and stores the transferred data.

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The advantages of Query Based Method are:

It is the simplest method in Indirect Migration Service.

It can be used not only for migration, but also for data exchange among two or more
different PACS installations.
There is no need to analyze the data and structure of legacy PACS.

The disadvantages are:

There is no way to verify whether the information in images DICOM header is

correct.

2.3.2. Pre-fetch Based Method

INFINITT Smart Router uses a queue table or modality worklist to find the request for data
migration. INFINITT Smart Router examines the queue table or modality worklist
periodically and, if it finds request(s) for data migration, it requests legacy PACS for data
migration.
This method is most useful when migration takes too long to be acceptable. Only the minimal
amount of data is migrated during the migration period, and rest of the data is migrated on the
fly whenever it is needed.
The workflow of Pre-fetch Based Method is as follows:

INFINITT Smart Router finds migration request(s) by sending DICOM C-Find to

modality worklist or querying the request queue periodically.
INFINITT Smart Router requests DICOM C-Find to legacy PACS to find the studies
matching the request.
Using the result from the above request, INFINITT Smart Router requests DICOM
C-Move to legacy PACS to transfer the matched study data to INFINITT PACS.
Legacy PACS transfers the data to INFINITT PACS according to the requests.
INFINITT PACS registers and stores the transferred data.

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Figure 7 Pre-fetch Based Method Workflow

The advantages of Pre-fetch Based Method are:

It can be used not only for migration, but also for data exchange among two or more
different PACS installations.
There is no need to analyze the data and structure of legacy PACS.
Minimal amount of data can be migrated during the migration period, and the rest of
data can be migrated on the fly when it is needed.

The disadvantages are:

There is no way to verify whether the information in images DICOM header is

correct.
Interface to modality worklist or HIS/RIS is required.
Both legacy and new PACS should be in operation.

2.3.3 Corrective Indirect Method

In some cases, it is possible the data in legacy PACS is not compatible with INFINITT PACS.
For example, if the images DICOM header does not contain enough information for
INFINITT PACS, it would cause problem in INFINITT PACS because of the missing
information.
To prevent such incompatibility, INFINITT Smart Router can correct the information in
images DICOM header prior to transferring the image data from legacy PACS to INFINITT
PACS. Corrective Indirect Method can be considered as Query Based Method with DICOM
data cleansing capability.

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Figure 8 Corrective Indirect Method Workflow

The workflow of Corrective Indirect Method is as follows:

INFINITT Smart Router finds migration request(s) by sending DICOM C-Find to

modality worklist or querying the request queue periodically.
INFINITT Smart Router requests DICOM C-Find to legacy PACS to find the studies
matching the request.
Using the result from the above request, INFINITT Smart Router requests DICOM
C-Move to legacy PACS to transfer the matched study data to INFINITT Smart
Router.
Legacy PACS transfers the data INFINITT Smart Router according to the requests.
INFINITT Smart Router modifies the information in images DICOM header and
transfers the data to INFINITT PACS.
INFINITT PACS registers and stores the transferred data.

The advantages of Amendatory Based Phase Method are:

Legacy PACS data is migrated accurately, and the migrated data can be verified for
its accuracy.

The disadvantages are:

It takes more time to migrate legacy PACS data because of the additional time for
correcting the information in DICOM header.

2.3. Which Migration Service is suitable for me?

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The general advantages and disadvantages between Direct and Indirect Migration Services
are shown in Table 5.
Indirect Migration Service

Direct Migration Service

Advantages

No internal knowledge of legacy PACS

required
Minimal dependence on legacy PACS: A
single design serves a broad range of
source systems
Leverages knowledge in target PACS
Information from target system can be
used to trigger corresponding
migration proactively

Data is migrated before go-live

Legacy PACS may be removed sooner
Saves space
Saves maintenance cost
Less risk of breakdown for old PACS
No disruptive delays fetching from old
PACS
Minimal dependence on target PACS

Disadvantages
Migration application should be
customized for each type of source
PACS
Source PACS vendor may obstruct
"reverse engineering" by competitors
Greater hardware requirements for
migration appliance
Requires more processing power
Requires drivers for legacy media
Target PACS must be able to handle
high DICOM input rates
More intensive site presence required
during migration
Table 5 Comparison between Direct and Indirect Migration Services

Requires lengthy period of migration

Legacy PACS archive consumes space
and maintenance expense
Failure risk for aging legacy system
Lengthy business engagement raises
costs and delays receivables for the
vendor
Workflow disruption when studies must
be retrieved in the spot from the legacy
system
Not usable for old PACS that does not
support DICOM query/retrieve interface

Among the seven migration methods explained in the previous sections, Corrective Methods
(Corrective Direct Method in Direct Migration Service and Corrective Indirect Method in
Indirect Migration Service) are recommended. The other methods can only be used for small
institution which has small amount of data for migration. Simple move of data from legacy
PACS to new PACS is not generally enough for PACS replacement. The correctness of
migrated data should be rigorously verified.
There are two sources of errors in the migrated data: One is the inherent errors already exist
in legacy PACS data due to the errors in legacy PACS solution, incorrect use of legacy PACS,
etc, and the other is errors introduced during the migration process. The corrective methods
can correct the inherent errors in the data during the PACS migration and provide means to
verify the correctness of migrated data while the other methods provide simple conversion
and move of PACS data.

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3. Conclusion
PACS migration is time-consuming and labor-extensive process. Existing legacy PACS and
hospital environments should be surveyed and analyzed to decide and optimize suitable
migration process. Careful and through analysis enable to predict and avoid possible
migration pitfalls and bottleneck in advance. Thus, optimized migration process by careful
and thorough analysis of legacy PACS and hospital environments leads to minimizing
migration period and expenses.
How good the best suitable and optimized migration process is, sufficient system and human
resources should be available throughout the migration period so that migration can be
performed smoothly. There may be extra load on legacy PACS for migration, and daily
hospital operation could be compromised for maximum migration efficiency. Those
compromises are unacceptable in many cases because it hinders the daily operation of
hospitals. Thus, it is important to move clinical operation to new PACS as soon as possible.
According to past migration experiences, INFINITT prefers Direct Migration approach to
Indirect Migration approach if possible because

Direct Migration approach shortens the migration period considerably compared to

Indirect Migration approach.
Direct Migration approach generates less load on legacy PACS than Indirect
Migration approach.

Sometimes, it is not possible to apply Direct Migration Service to all legacy PACS data. But
it has been always the case that applying Direct Migration Service was possible for some
portion of legacy PACS data if not all. And combination of Direct and Indirect Migration
Service has been proven to provide reasonable migration performance in terms of time and
cost in those cases.

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