[dwinn5]

I’ve set this up many times. The VPN is going to be your problem if you cannot get the throughput increased. Is your pacs able to launch from a URL rather an IP?

[Unknown Member]

Is the radiologist reading from the PACS? Once you get the VPN issue resolved, you’ll still have slower performance due to the latency in internet connections. With our PACS, it’s possible to reserve cases for the radiologist at home and as long as he is logged into the app and the local instance of the app is configured to do it, the act of reserving them will trigger the caching locally of the current and 1 prior. At that point, it’s more about ensuring enough time has passed before he reads. 

[kaldridgewv2211]

Sectra can local cached in the a background and put the image data local to the remote PC.

[ruszja]

Quote from Flats

We have a radiologist that will be reading breast tomo’s and breast MRI’s only.  She currently has a 900Mpbs up/down fiber circuit directly connected to her PC at home.  When connected to our VPN she is getting 50-70Mbps down/ 10Mbps up.  Needless to say, 1 Tomo takes about 35 mins to load and that is without priors.  We are just trying to figure out what type of speeds do we need to be able to read these tomo’s and a fairly reasonable rate?  We know it’s never going to be as fast as in House so I’m hoping there is somoen else that is doing this that could at least give me a starting point.  IS it on a VPN?  Is it a dedicated circuit?  Any help at all would be appreciated.

 
Who controls the settings on your VPN ? 
 
No amount of speed increase on the rads side is going to fix your problem unless you find the guy in your IT department who can turn up the throughput on that rads login you are going to be stuck. We have different hospitals we deal with and each one required some prodding and negotiating to get this done (sometimes, the way to get it done is informal, sometimes it needs a phonecall from the hospital CEO). The VPN overhead alone does not explain that level of performance degradation, there is either an artificial quota or a bottleneck on the hospital network side. 
 
We have a dedicated fiber connection at a reading office and after multiple rounds of escalation, IT at the hospital was finally willing to turn up the volume on our VPN connection to give us 250/250mbps. With that, it takes about 4min to load a tomo screener with one prior. Their PACS is a heaping piece of sh!t and doesn’t have a way to configure pre-caching, so we are stuck with that type of mediocre performance.  
 
Merge (like Sectra) also allows you to pre-cache the contents of a particular worklist locally. The rad can easily see which ones are cached already and stay away from those that are are not.
 
 

[Unknown Member]

Of note, VPN overhead can be a little misleading. Sure, the firewall at the site hosting the VPN can get overloaded, especially with the number of staff working from home now. 
The other part to realize is that by using the VPN, your route to the data is going to change. When you do your speedtest without the VPN, the data packet will go from your PC to the closest hop and measured from there. 
With a speedtest using VPN, the data packet will travel first to the VPN host, and then on to the next hop. This adds distance and results with added latency.
Our radiologists read for multiple facilities and use 2 different PACS. PACS1 is on the same network as our VPN host. The PACS2 was accessed via SSL, so PACS1 was very fast because of the direct shot over the VPN, but PACS 2 had to go the additional distance from the VPN to the site hosting PACS2 via internet, so it was much slower. 
We were able to fix that since our office has a fiber connection to the site hosting PACS2. Once we added a route so the application could be accessed from our network, the speed issue was resolved since it took away that extra hop out to the internet.