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What do you need load balancing for?

"Today performance, efficiency and customer service matter. The LB team get that. They pick up from one another seamlessly for support issues that take time. They work as a team and that is something important. Great team, great service."

Stephen Winnett

Carestream Health, Inc.

Load Balancing Medical Imaging Systems: PACS, VNA, DICOM, XDS & HL7

Medical imaging provides a non-invasive procedure of taking images with a clinical application, using a variety of imaging modalities to provide a specified diagnostic picture of the body. Various modalities are used, such as CT, MRI, PET, Ultrasound & X-Ray.

A critical element in patient care, access to diagnostic images is crucial at all times, especially when demand is unpredictable. Load balancing provides a fast, redundant and scalable architecture for the transfer, storage and retrieval of images.

Load balancing and high-availability

Failures can be costly to the healthcare system and to patients, so achieving zero downtime is a key consideration. Loadbalancer.org appliances monitor the status of medical imaging storage and applications servers (health checks) and seamlessly directs traffic to the healthy, online or least loaded servers.

Example of a highly available system that utilizes system component and load balancing

Typical Implementation

A standard imaging deployment combines fast, highly available storage with unrestricted retrieval of images using our ultra-fast Layer 4 Direct Routing (DR) mode of operation. In a large hospital environment, peak image retrieval traffic volumes can be more than 5x the volume of storage traffic. The example outlined here demonstrates the benefits of DR and why our products are so well suited to medical imaging requirements.

Imaging Total Images MB/image MB/study (RAW) Number of studies/year Storage per study type (MB)
Cardiology imaging device 22 22.11 486.42 10,000 4,864,200
CT – Multi-slice imaging device 400 0.52 208.00 20,000 4,160,000
CT – 64-slice imaging device 2000 0.51 1020.00 100,000 100,000,000
CT – 128 -slice imaging device 4000 0.51 2040.00 200,000 200,000,000
Fluoroscopy imaging device 24 1.96 47.04 50,000 2,352,000
Mammography imaging device 4 26.00 104.00 20,000 2,080,000
MRI - Magnetic resonance imaging device 400 0.18 72.00 10,000 720,000
Ultrasound imaging device 40 0.75 30.00 30,000 900,000
Total 440,000 315,076,200

In this example of 440k studies/year we have a yearly storage requirement of 315TB, which equates to 863GB per day, or a data rate of 1.9GB/s. The below table demonstrates how the retrieval traffic exceeds 11GB/s but, by utilizing DR mode, traffic on the return path bypasses the load balancer directly to the client, meaning there is no packet flow limitation. In practice, this means our entry-level hardware provides reliable image retrieval on a deployment of this size.

Number of stations Studies/hour Study size MB (avg) Data rate Mbit/s
Reporting stations traffic 45 100 1020 10,200
Concurrent users traffic 1000 10 30 667
CDR PACS users 600 40 60 533
Total traffic 11,400

Systems, standards and protocols

Below are examples of the systems, standards and protocols that support load balancing:

Protocol Description
PACS Picture Archiving and Communication System (PACS) provides storage and access to diagnostic images from multiple modalities.
VNA Vendor Neutral Archive (VNA) is an archival system, capable of storing images in a standard format.
DICOM Digital Imaging and Communications in Medicine (DICOM) is a standard for storing and transmitting medical images.
HL7 Health Level-7 (HL7) is a set of standards for transfer of data between software applications used in healthcare.
XDS Cross-Enterprise Document Sharing (XDS) is a standard for sharing of patient Electronic Healthcare Records.

Load balanced ports and services

The following tables shows the typical ports/services that are load balanced:

Port Protocols Use
104 TCP/DICOM Exchange of images and related information
11112 TCP/DICOM Exchange of images and related information
2575 TCP/HL7/MLLP Communication between healthcare IT systems
443 TCP/HTTPS Client viewer connectivity
17035 TCP/XDS/SOAP/XML XDS repository/registry

Loadbalancer.org specializes in load balancing healthcare applications and are the only vendor with native support. In order to support such an array of different applications, we use a variety of load balancing methods including Layer 4 DR, Layer 4 NAT and Layer 7 SNAT modes.

Experts in load balancing medical imaging applications

You need a vendor who’s experienced in supporting the healthcare industry to the highest standards and who has worked with some of the world's leading medical imaging vendors. We will support you on the way and protect your business not just the load balancer. Our team of application delivery specialists will provide you advice, helping design and simplify your architecture.

Vendors we've worked closely with

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