Hengelo PACS Migration via Nexus

The radiology department at ZGT in the Netherlands ( recently migrated all of the PACS data from their current PACS to a new PACS.  Previously the department had utilised Pukka-j’s DICOM products to migrate their data from their previous PACS so when the time came to move their data again, they came to Pukka-j to find the fastest way to move it.  With the new Nexus software, the department was able to take greater control over their own migration process with the help of some input from the experts at Pukka-j.  This article describes the process followed to successfully move to another PACS provider.

The first stage, as with all migrations was to analyse the current situation.  The data was compressed as JPEG2000, with ~30Tb spread across 11 network storage locations.  As with many PACSs, the DICOM information in the header was out of sync with the information in the database, in this case a SQL server cluster which the department had access to.  There were also references on disk that had been deleted from the database, or the references had been changed to point at different files after a study merge process, thus leaving “orphaned” files on the storage.

In order to maximise the speed at which the data could be transferred, it made sense to maintain the JPEG2000 compression as this was also supported by the destination PACS.  This meant only 30Tb of data would be transferred over the network, as opposed to approximately 100Tb if it were decompressed.  It was also decided that it would be optimal to read the files directly from the file system and use Nexus to reconcile the header information with that in the database, rather than relying on a query/retrieve via the PACS, that could have impacted on the service being delivered.

Using Nexus, it was possible to rapidly read the data using parallel processing to build a database of the contents of the file system.  This highlighted that some data that contained no pixel data was stored as implicit or explicit little endian which would be required to be sent to a different port on the destination PACS.  There were also some SOP classes that either weren’t supported or weren’t required on the destination PACS and would need to be filtered out.  Data that also couldn’t be found in the database or couldn’t be reconciled for any other reason was also filtered out.  In order to store the filtered data, Pukka-j’s Dicom Explorer PACS was set up as a “Sin Bin” archive where the department could review the filtered data and decide what needed to be done with it.

There were a number of studies that needed to be excluded from the migration process, either because they were studies that weren’t required or they would require specific processing.  This was handled by the reconciliation node such that, if a study UID was identified (after reconciliation) that matched the exclusion list, it was sent to the Sin Bin.  The image shows the Nexus network that was created to first read the data from the file system using multiple processing threads.  This input node fed into the reconciliation node to fix up the DICOM information in the header.  A database node was used after the reconciliation to keep a record of the data that had been found and whether it was to be sin-binned.  The data was then filtered down the appropriate pipelines based on SOP class and transfer syntax to the appropriate DICOM port on the destination PACS.


There were a number of test runs where this pipe line was simulated by sending the data to a terminator node with and without reconciliation to get a handle on the maximum speed at which the data could first be read from the file system and then be reconciled with the database.  This benchmarking process allowed the department to assess the storage capabilities of the destination PACS once the destination nodes were configured to send to the new system.  Once the first trial runs of the migration were done to iron out the configuration on the destination side, some interesting effects were seen.  Due to the way in which the current PACS stored studies, in which studies were “striped” across folders and due to the way the data was read by the processing threads, long delays could be seen between images in a study arriving at the destination.  The destination PACS implemented a process which after a period of time, or amount of data, moved images to a slower long term archive.  The result of these facts was that once delayed images were sent, then the speed at which the data could be moved started to decrease because of having to write to the slower storage.  After discussion, Pukka-j were able to create a new mode of operation for reading the data from the file system, by reading the data as a stripe rather than a whole folder at time, thus minimising the time between images in a study.

Some analysis of the test runs was performed to verify the performance of the reconciliation and the routing of the data to the required ports on the PACS and after a few configuration tweaks, the migration configuration was able to be deployed across four virtual servers, each running a version of Nexus.  The 11 file locations were split so each had it’s own pipe line as shown in the diagram.  This allowed the processing to be done in parallel across multiple resources.  When the configuration was deployed, the migration was started in earnest and ran non-stop for around 3 weeks in which time it maintained around 300,000 images per hour into the destination PACS.  The whole process was able to be monitored by the department, who simply referred to Pukka-j in the event that there were any questions over any entry in the logging files.

Following the migration, some of the excluded files that were not sent because they required some further processing could be dealt with.  These were files that in the database had transformations recorded against them such as “rotate clockwise 90 degrees”.  These were handled by a new node produced by Pukka-j to allow the department to load a list of SOP Instance UIDs and the required transformation.  The data was then sent via a DICOM CMOVE through a Nexus pipeline and as they passed through the transformation node, the pixel data was modified accordingly. The network below shows the image transformation pipeline used.


Sander ten Hoeve (Functioneel Applicatiebeheerder sr) at ZGT, who managed the Nexus services throughout the migration told us:

“We decided to contact Pukka-J because of the previous successful migration and over the years we experienced that Pukka-J is able to develop software based on the needs of a client. The software is flexible, highly configurable and intuitive in use. Furthermore we have direct contact with the developer and any issues or wishes is solved and delivered very quickly.”



You can download the Nexus specification document here [Download not found]
You can see more on Nexus here

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Radiotherapy DICOM Interoperability at Raigmore

As part of the recent service upgrade and data migration at the Radiotherapy department in Raigmore Hospital, Pukka-j recently installed and configured the Nexus DICOM streaming service to facilitate the process.  Following the successful migration, Nexus was left in place with a view to the department being able to streamline the work processes in place.


Following some testing, it was apparent to the department that there was some inter-connectivity issues between the new CT scanner and the planning / processing workstations in the department.  In particular, the way in which the Y value in the patient position information was calculated differently between the scanner and the workstation.  This resulted in issues with planning.  In order to help the department solve the immediate problem, Pukka-j implemented an extension to the DICOM tag manipulation node within Nexus to allow the department to specify how the Y value of the patient image position should be modified between the two systems.


A second workflow issue was also found by the department in that some values in a scan were potentially incorrect but wouldn’t be noticed until after a patient had left the department.  In order to alert the department as quickly as possible to any potentially incorrect settings, a new notification node was added to the Nexus service that has the ability to notify users via email if DICOM studies with a specific pattern are observed.  The service has been configured to email the users with information on the potentially incorrect values in the DICOM header so that it can be reviewed before the patient has left the department.


Raigmore Radiotherapy DICOM Archive Migration

Pukka-j recently migrated the existing Radiotherapy DICOM service at Raigmore Hospital in Inverness to new hardware and performed the DICOM migration.  The update was performed as part of a recent upgrade to the CT scanner in the department and involved a replacement of the primary and secondary archive servers, updates to the DICOM services and connectivity with the new equipment being installed in the department.

In order to move the data, Nexus, Pukka-j’s DICOM streaming service was used to rapidly read all the data and reconcile any DICOM files with the entries in the database.  The Nexus service is able to rapidly read data due to it’s multi-threaded processing, which allowed the entire archive to be migrated and reconciled to the new server in just a few days.

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Contact us to find out more on the Pukka-j PACS migration services or the capabilities of the Nexus DICOM service or to arrange an online demonstration

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Pukka-j reports a positive response to its recent ‘test drive’ of the company’s new service for parents-to-be

Pukka-j has created a new and innovative way for pregnant women to be able to access and share digital pictures and video from their ultrasound scans.

Recently, the company carried out a pilot run of the software and found the reactions from those involved in the trial to be extremely positive, with one mother-to-be commenting, “MeetmiBaby was so easy to use and the pictures are great quality; it makes it so much simpler to share with family and friends.”   

The new service, which is being marketed under the brand “MeetmiBaby™, has been developed in response to a request from an NHS Trust to help them streamline their procedure for supplying pregnant women with pictures of their baby scans.   Pukka-j ,by supplying an e-commerce solution, removes the need for the hospital to deal with direct payments, as a selection of images after the diagnostic scan are sent direct from the modality to a MeetmiBaby picture processing service, which resides in the Trust’s IT environment.  The images are uploaded to a secure ‘cloud’, where parents-to-be are able to find their baby scans via a unique identification code and preview their gallery to select which ones they would like to buy.

The pictures and video are delivered in a variety of ways to make life as simple as possible for users.   After purchase they can be downloaded directly from the website, and the purchaser also receives a personalised email with their chosen baby scan products attached.   

Initial results have shown the baby products to be available for purchase within minutes of the scan and because they are digital, they can be copied and shared with grandparents and friends via social networking or email or print.   The emails to mothers-to-be are an easy way for them to access their purchases from any device they have available, on which they can receive emails; smart phones, tablets and PCs.   Access to download the baby scans from the internet provides great flexibility in delivery of the product.

Another mother-to-be taking part in the trial responded enthusiastically with the comment, “Taking a good photo of a baby scan is really difficult!  MeetmiBaby was so easy to use and the pictures are great quality.   Being able to print my baby scan was such a bonus; it made sharing our wonderful news with my loved ones so much easier by giving them one of my special pictures to keep forever.”

Pukka-j is working with the NHS to develop innovative maternity social imaging services for their mothers-to-be.

Pukka-j launches a new service for maternity scans: “MeetmiBaby”™ is predicted to revolutionise the process and experience of ultrasound scanning

Pukka-j, a UK based specialist medical technology company, announces that it will be offering a new service for pregnant women.    ‘MeetmiBaby’ has the potential to revolutionise the process and experience of ultrasound scanning for mothers-to-be who attend the hospital for scans and would like to have a personal record of the scan.   Pukka-j has outstanding reputation for ‘outside the box’ solutions, and the launch of this new service fits with the company’s IT skills.    MeetmiBaby is a technology service that has been developed to improve the experience for the mother-to-be and quality of the baby scan pictures supplied for social use.

The procedures at present for mothers-to-be to obtain an image of their scan vary from site to site.  Sometimes, they are supplied by the sonographer completing the scan and at other sites a token is provided which can be exchanged for a thermal print.  During discussions regarding implementation of a new system, it was decided not to improve the existing service, the coin machine that provided a token or a photo booth that printed off the copies, and instead to replace it with a ‘high tech paperlight’, digital option. 

Pukka-j’s e-commerce solution removes the need for the hospital to deal with direct payments as the images are sent from the modality to a MeetmiBaby picture processing service, which resides in the Trust’s IT environment.   On receipt of diagnostic images, the picture processing service redacts data by blacking out the burnt-in study details to anonymise the data for the maternity social pictures (Jpegs) and video (Mpegs).  Once in a social format the MeetmiBaby, picture processor service creates a unique code and QR code which is printed by hospital staff and handed to the mother-to-be.

The social pictures and video are packaged and sent to a secure MeetmiBaby cloud ready for the mother-to-be, to log-in to a MeetmiBaby e-commerce web shop, to view her ‘bespoke’ baby gallery, from which she can choose and purchase on line, ready to share the baby scan ‘high resolution’ pictures and video with family and friends. 

Louise Crossley, Business Development/Commercial Director at Pukka-j says, “MeetmiBaby™” is a brand new way of receiving and paying for a baby scan picture and obviously the way forward.    It is designed to assist parents-to-be to get the very best out of their hospital scans.   We think it has great potential and we are hoping to develop this service through hospitals and ultrasound vendors”  

One of the main advantages of the service is that the technology enables easy sharing to popular social networking sites including FACEBOOK, INSTAGRAM and TWITTER.   Other benefits include the availability of premium baby scan pictures and choice of pictures, a user-friendly website, and the possibility to purchase scans for up to ninety days, providing secure online payment options.   The images can be downloaded to a smart phone, tablet, laptop or PC.    

Pukka-j anticipate being able to implement a pilot project using the new software in the next two to three months.

A successful organisation-wide RIS PACS for GP Care

Pukka-j has recently successfully installed and upgraded PACS imaging and RIS reporting systems to support GP Care’s rapidly expanding Community Ultrasound Service.

GP Care has multiple contracts with NHS commissioners and delivers a range of community-based services that are both efficient and convenient for patients and that offer cost savings to the NHS.   Although GP Care provides a small number of services to patients on a private basis, where NHS care is unavailable, the company’s real focus is on delivering high quality care to NHS patients.   Provision of its ultrasound services to NHS patients is via a network of community settings such as health centres and specialist clinics using a growing team of expert sonographers with consultant radiologist overview.

The new PACS/RIS systems facilitate delivery of ultrasound scanning services from a network of community locations that are close to patient homes.  The linkage of each delivery location to central hub servers means that ultrasound images and reports can not only be generated locally and immediately issued to patients (where appropriate), but can also be immediately transferred to other NHS clinical teams where onward care is required.

Roger Tweedale, GP Care’s Chief Executive comments that, “Even non-urgent ultrasound scans are now being seen within two to five days of referral with immediate reporting available to both patients and referring GPs, as well as to hospital clinicians, where patients require further care.   The implementation of our new and upgraded PACS/RIS systems has significantly increased the speed and efficiency with which we can operate.”       

Pukka-j’s unique RIS-PACS acts as a complete ‘end-to-end’ solution for optimising patient case management workflow for diagnostic imaging services.  It supports a mix of community-based health services for ultrasound, CR/DR, ECHO, MRI, CT and DEXA and is utilised by NHS Clinical Commissioning Groups and private healthcare providers, including treatment centres, minor injury units, community hospitals, general practice services, musculoskeletal services, clinical and treatment assessment services and prison services.  It features advanced IT solutions, services and tools to connect and communicate diagnostic orders, scheduling, images and reports, eliminating duplicate entry with other systems; CaB (Choose and Book) referral systems and PAS (Patient Management Systems), GP management systems and remote reporting provider systems, using Pukka-j’s proven industry standards for HL7, DICOM and web services.   In addition, it is fully compliant with the ISB requirements for Health and Social Care Diagnostic Imaging Dataset.  .

Pukka-j is a UK based, specialist medical technology company offering smart software solutions for enterprise imaging and reporting in healthcare, with particular expertise in all imaging related “ologies”; cardiology, neurology, oncology and radiology.   Established in 2001, Pukka-j prides itself on the ability to tailor its solutions precisely to meet the needs of each healthcare provider.   

Vacanices for self-driven passionate people to join our team

Founded in 2001, Pukka-j is a UK, specialist medical technology company offering smart software solutions for imaging and reporting in healthcare. We have vacancies for self-driven and passionate people to join our team. 

Application Specialist

The successful applicant will have experiences of working in the healthcare sector and medical imaging and devices.  Experience of technical support, systems training technical writing is expected. Knowledge of DICOM, HL7 and the relevant technologies would be an advantage.

Software Developer

The successful application will have strong software application development skills with a relevant degree qualification. Experience with Java and HTML5 together with database experience is required.  An interest in working in medical imaging within the healthcare sector is essential.

If you are interested, please send your CV to or tel:  01380 860044

For further info, please visit

Community Healthcare benefits from Pukka-j’s unique Case Management System

In recent months, Pukka-j has been working closely with ultrasound providers to deliver an integrated pathway for prompt diagnosis and a seamless patient journey across the healthcare system.  Ultrasound provision is a service that falls within the ‘Any Qualified Provider’ (AQP)* scheme within community-based services.  It gives patients the choice about the location of a scan and reduces the time between referral and outcome, thus ensuring patients receive the correct diagnostic test in a timely manner and in the most clinically appropriate setting.

Achieving these high standards can present a challenge for providers and identifying this need, Pukka-j has developed a unique Case Management System (CMS) that helps providers deliver their services more efficiently.   The Case Management System uses the latest innovative RIS PACS technology to manage patient records, scheduling, and text message appointment reminders, allowing reporters to complete and share results with the health community, all of which assists the provider in the provision of a first class experience for the patient.    In the case of RIS, Pukka-j can assist providers in realising the full potential of medical informatics in ways that work for them.   Easy to interface into a new or existing department, it helps optimise workflow and securely manage patient information throughout the facility. 

One of the challenges Pukka-j faced was to tailor the workflow to fit with the provider’s rota of ultrasound clinic locations, many of which lacked the communications needed to run web-based services.   The Pukka-j ‘Return to Base’ model enables a Health Care Assistant (HCA) to utilise an encrypted laptop to synchronise data to and from the provider’s central RIS PACS, over a dedicated broadband running a Virtual Private Network (VPN).   From a HCA’s home, appointments and exam orders are downloaded to the laptop, which then accompanies the portable ultrasound scanner to the different clinic locations.  At the clinic, the laptop connects to the portable ultrasound scanner populating it with a worklist, allowing the acquisition of images on the scanner without the need for manual entry of patient, and order details. Once acquired, images are transferred from the scanner to the laptop and the sonographer completes the report.  At the end of each clinic session, the HCA takes the laptop home to upload images and report to the central RIS PACS system, which, in turn, downloads a worklist to the laptop, allowing orders to be accessible for the following clinic session. 

Louise Crossley, Business Development, Pukka-j comments …”Pukka-j’s product has evolved over 12 years of continual development and we pride ourselves on high levels of customer satisfaction.  From deployment support through to patient case management, our team is focused entirely on making sure providers get the support they need.  Our customisable workflows enable us to build a system that reflects individual requirements and which is also adaptable to current needs and future growth, regardless of how many diagnostic services and sites providers wish to run.”

An additional CMS module includes Key Performance Indicator (KPI) reports, enabling providers to make decisions on immediate response to the demand and capacity of their services.  KPI reports fulfil providers’ contractual obligations to allow them to present their outcomes to healthcare commissioners.  The Pukka-j solution fully complies with the Information Standards Board (ISB).

Pukka-j Donates PACS Equipment to Hospital Project In Pakistan

Pukka-j has recently donated a PACS loaded server and software for installation in a MDAUK hospital in North Kashmir, Pakistan (Midland Doctors Association UK).

Pukka-j made the donation through Tanweer Arif of Care UK.   Care UK has been a customer of Pukka-j for many years, with Tanweer being responsible for RIS/PACS and system interfacing products across the whole UK organisation.  Commenting, Tanweer says, “Pukka-j is the preferred RIS/PACS supplier for Care UK and delivers a first class product and support for our company.   I thought that the MDAUK hospital should be equipped with the same product we offer for diagnostic services at Care UK and I therefore approached Pukka-j for the donation.”  Tanweer and his family, through arranging the donation, have provided a strong IT base for the MDAUK hospital, with Tanweer giving up his spare time to set up the system in Pakistan.    Without a robust IT and communication to handle medical data, the hospital infrastructure would lack organisation and process.   The server and equipment will be installed shortly on-site at the near-complete hospital, ready for the forthcoming inauguration later in the spring.

 The Pukka-j PACS will be used initially for radiology, CR, DR and US, and it is anticipated that it will be expanded to other systems later on.   

 MDAUK was initially created to serve a simple purpose: the construction and running of a charitable national medical institution in the earthquake-hit region of Pakistan in order to provide free healthcare at the point of delivery and serve as a major training centre for local health care professionals as well as acting as a focal point for any future relief operations should other natural disasters occur again.

 The catastrophic earthquake measuring 7.6 on the Richter scale struck Northern Pakistan on 8th October 2005.   A trauma team from Nottingham and Derby flew into the region one week after the tragedy and worked in a field hospital consisting mainly of tents.   Over one thousand patients were treated in the five and a half days the team was there, with 134 major surgical procedures being carried out under general anaesthetic.   At any one time, 70 inpatients were being treated.

 The trauma team returned and made a long-term commitment to help the people affected by the earthquake.   This escalated to into the development of a health infrastructure.   The team initially consisted of doctors from the Midlands, but as the scale of the needs became apparent, a range of professional disciplines spanning both the private and public sectors became involved.   

For further information on the MDAUK project go to

Pukka-j’s Enterprise Anonymisation Service at St James’s University Hospital, Leeds

Pukka-j recently installed its Enterprise Anonymisation service at St. James’s University Hospital, Leeds. St. James’s, affectionately known as “Jimmy’s”, is internationally famous as Europe’s largest teaching hospital. The new software was supplied to St. James’s Institute of Oncology. Housed in the purpose-built, state-of-the-art Bexley Wing, the Institute provides a world-class service to cancer patients from across the local area and beyond. 

 It is important for teaching and research establishments that images for clinical trials are de-identified and exported to another system, outside the institution’s security network. In addition, before data from research can be shared with other researchers or archived, it may be necessary to anonymise it so that individuals, organisations, or businesses cannot be identified.  

 As part of its extensive portfolio of products for healthcare imaging and reporting, Pukka-j offers an anonymiser designed to be used either as a stand-alone anonymised research store, or as a portal through which data is passed to be anonymised and forwarded to dedicated research stores, at the same time, keeping a log of the anonymised record. It is applied to all DICOM files arriving on the server, or HL7 messages containing a patient details section.

 Together with the anonymisation function is the ‘pseudonymisation’ process, where the true identifier, such as name or patient ID number is replaced by a pseudonym that is unique to the individual concerned, but bears no relation to the person ‘in the real world’. The pseudonym, therefore, cannot be used as a means of identification. This is because in the ‘pseudonymisation’, the information that reveals who the pseudonym relates to, will be held securely and separately from the data being processed. Used along with the original patient ID, the new anonymous patient details can be tracked via a database table on the server. In the case of the St. James’s project, the Pukka-j software meets all the criteria and handles the pseudonymisation procedure with ease.

 Dr. Isobel Bond, Trainee Clinical Scientist at St. James’s Institute of Oncology, says, The service is being developed to be used in radiotherapy, MR and nuclear medicine at St. James’s to prepare data for clinical trials and teaching purposes. Anonymisation of the many different types of data we use is an extremely complex task. The Pukka-j system is flexible and will give us control over how the data is altered to best meet our requirements.”

 The software can be configured in general, or for a specific research trial, and will create anonymisation records automatically upon receiving data. It is independent of the order or nature of the data, and it is possible to pre-define an anonymisation record for trials where the patients and their required trial IDs are known.  

 Dez Wright, Technical Manager at Pukka-j comments, With the legal and ethical obligations in place for patient confidentiality, this is an area of vital importance to hospitals and research institutions. It can also pose problems for the software programmer. Pukka-j specialises in being able to customise and solve to the client’s satisfaction these types of delicate issues, often not tackled by the larger IT suppliers.”