Guide to Transferring Imaging

Fujifilm Mix System (Hub and Spoke)

The MIX Digital Imaging Transfer system (Hub and Spoke) is an electronic transfer service born out of the need for faster review of imaging for patients. Run by Fujifilm (the company behind Synapse), the system is designed to replace paper-based imaging requests and reduce the need for USB or CDs being physically sent between institutions.

It's important to understand the physical process behind a Hub and Spoke request because whilst for the clinician it requires minimal effort, it still requires a physical presence between the institutions (dispatching and receiving) to be able to transfer the images. Therefore there is still a lead time between the request of the images from the clinician and the images arriving at the requested institution's PACS.

A simplified flow of how this process works:

Clinician requests the Hub and Spoke images and sends it to receiving institution PACS team
The receiving institution PACS team sends the signed Hub and Spoke request to the dispatching institution PACS team
The dispatching PACS team submits a DICOM transfer request on Synapse
Communication to the receiving PACS team to find the imaging folder
Receiving PACS then merge the files with the existing patient folder

As you can imagine, this requires quite a bit of manual labour in between steps which explains why it's not instantaneous. It also means that parts of this step will be delayed if it's out of hours, particularly if one of the institutions does not have a 24 hour workforce that can act on the request immediately.

This is a decent system to transfer imaging between institutions who are on the MIX system. Originally these were essentially only public hospital imaging departments with only a select few private imaging departments. Western Health played a key role in pushing for this system to expand to include more private imaging departments and this has led to more accessibility of images for patients performed in the private setting.

Not all imaging providers are on the Hub and Spoke system or sometimes you may need a transfer of imaging in a shorter time frame than the current system. In these cases you may want to consider doing the transfer via a manual method.

Upload H&S template

Manual - DICOM upload

I've frequently found myself in need of uploading patient imaging into the system at short notice. This may be because there's an upcoming radiology meeting, needing to transfer the images to another institution for a second opinion or to be sure that the patient's imaging is being added to their record. This process is the best way to do the transfer of images in these circumstances.

The steps are as follows:

Obtain the DICOM file
- Most imaging viewers allow you to download the DICOM file (you will need to log in) using their desktop application.
  - These include InteleViewer, Visage, Synapse and Voyager Imaging
- ZED Link online viewer is a "lite" version of PACS and does not have the option to download a DICOM file
Save the DICOM file to a USB
- Footscray and Sunshine medical imaging font desk have a specific USB for you to upload to. When you ask for the USB, there will be a form that goes with the USB that you need to fill out with patient details, imaging details and reason for upload.
Hand the USB into the medical imaging front desk with completed details
Pick up the USB after upload (if you're using your own USB) & delete the DICOM file
Check Synapse to make sure imaging uploaded

Manual - CDs or USBs

How to upload images at WH

Manual - Physical Films

Physical films still exist, particularly within specialties who require the films for templating prosthesis etc. It's also still a method some radiology providers use to provide images to patients to be brought to the doctor. '

These films need to be scanned in which uses a specific equipment only available at Sunshine Hospital and Footscray Hospital. If you're at another Western Health site, the film will need to be physical brought over to these sites to be scanned.

Whilst physical films are better than no imaging, the preference is to use digital radiography. Sometimes a simpler method to add these images to our hospital record is to use the Hub and Spoke method (described above) if the provider is part of the MIX network, or to use the DICOM upload method if a DICOM is accessible. Particularly for anatomic imaging where individual slices can be reconstructed and viewed as a three-dimentional image.

If these methods are not available, scanned physical films are still better than not having any imaging at all and so we encourage you to scan these in.

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