TRIAD Setup Overview
This article presents the steps involved to set up and configure TRIAD for participation in the Dose Index Registry (DIR). TRIAD enables the collection, de-identification, and transmission of radiation dose data securely from modality workstations or PACS to the DIR database. A single TRIAD Site Server can support all facilities within a NRDR Corporate Account.
Download and Install TRIAD
You can begin the TRIAD installation process once DIR registration is complete for each facility contributing radiation dose data. TRIAD software must be downloaded, installed, configured, and maintained on either a dedicated physical or a virtual server behind the facility’s firewall. The setup and maintenance is often performed by someone with a service user NRDR profile (see NRDR Accounts and Profiles article).
The basic system requirements are presented below and the TRIAD installation website provides detailed installation instructions.
TRIAD System Requirements
Intel Core2 Duo or above
At least 4 GB
At least 50 GB; 200 GB recommended
Windows 10 - 32/64 bit
Windows Server 2008 SP2/R2 – 32/64-bit
Windows Server 2012 SP2/R2 Enterprise Edition – 32/64-bit
.NET Framework 4.5.2, full version
Connect CT Scanners, Fluoroscopes, PET/CT or PACS to the TRIAD Site Server
The Digital Imaging and Communications in Medicine (DICOM) Standard defines the Radiation Dose Structured Report (RDSR) to record and store radiation dose information from imaging scanners and systems. The DICOM RDSRs from designated modalities at participating DIR Facilities are transferred to the local TRIAD® Site Server, where they are anonymized before being forwarded to the DIR Central Server at ACR.
Basic Data Flow Between Facilities and the ACR
TRIAD® Scanner and Systems Configuration
Any CT scanner or fluoroscope from which a facility wishes to send a RDSR to the DIR must be configured locally in the TRIAD Site Server configuration console using the respective Station Name. Facilities can filter out specific systems from sending data to the registry by not configuring these in the TRIAD Site Server configuration console. RDSRs received from systems that are not configured are stored on the TRIAD Site Server for 14 days, after which they are deleted.
Imaging modalities can be connected to the TRIAD Site Server using several different configuration paths which are described below. While sending data directly from the scanner or device to the local TRIAD Site Server is preferred, other configuration paths, i.e., PACS, third-party Radiation Dose Index Monitoring system (RDIMs), are allowed and may be more efficient for managing multiple modalities, scanners or devices across DIR Facilities.
As you review the options, please be aware that creating and transferring the Radiation Dose Structured Reports (RDSR) to another DICOM node may require service level access and is typically performed by the local service engineer under the guidance of the medical physicist.
Direct Connection to the TRIAD Site Server
The simplest and preferred configuration is to establish a direct DICOM connection between each scanner or system and the local TRIAD Site Server, and then configure each to automatically create and transfer the RDSR to the Site Server after each procedure as shown in the figure 1.
Transfer to the TRIAD Site Server through a Radiation Dose Index Monitoring (RDIM) System
Facilities that have systems already connected to a RDIM may elect to have the RDIM automatically forward RDSR to the TRIAD Site Server as shown in figure 2. If you elect this type of configuration, contact your RDIM vendor early in the start-up process to ensure proper configuration and avoid potential pitfalls. Consult the list of DIR-certified software partners to see if the ACR has confirmed that your vendor has the capability to send RDSRs on your behalf.
Auto routing to the TRIAD® Site Server from the facility’s Picture Archiving and Communication System (PACS)
Facilities with in-house PACS administrator expertise may elect to configure their PACS to automatically forward all RDSR from specific modalities or Station Names to the TRIAD Site Server (see figure 3a). This simplifies DICOM configuration as only a single DICOM destination is needed for each scanner or device. Further, this destination likely already exists and is used to archive images. It is also possible for the PACS system to forward only to the TRIAD Site Server (see figure 3b) or in parallel to the TRIAD Site Server and an RDIM (see figure 3c) using this architecture.