Laurel Bridge Navigator: DICOM Workflow Orchestration Platform

Technical Brief: Laurel Bridge Navigator

1. Product Overview

Laurel Bridge Navigator is a robust and highly configurable DICOM workflow orchestration platform that automates the retrieval and movement of prior imaging studies (priors) in clinical environments. It integrates seamlessly with legacy and modern imaging systems, solving the challenges of interfacing, fetching, filtering, and routing DICOM objects across distributed networks and multiple systems.

It operates as a middleware application to fetch relevant historical imaging studies, based on configurable workflows triggered by real-time events like HL7 messages, RESTful API calls, or DICOM MWL queries.

2. Core Capabilities

2.1 Priors Fetching Automation

Navigator automatically identifies, filters, and transfers relevant prior exams for new imaging studies. The fetching logic is based on user-defined criteria and system-defined workflows.

2.2 Workflow-Driven Architecture

Navigator uses a modular architecture comprised of:

• Triggers (MWL, HL7, RESTful, CSV)
• Rules (conditional logic for when to act)
• Sources (DICOM Q/R SCPs)
• Destinations (DICOM Store SCPs)
• Workflows (define what to fetch and where to send it)

Each component is independently configurable, allowing fine-grained control over the data flow and behavior.

3. System Architecture

3.1 Components

• Navigator Service: Windows Service that handles the backend logic.
• Navigator Web UI: Web-based configuration and monitoring interface.
• SQL Server Database: Stores all configuration and runtime metadata.
• DICOM Engine: Handles C-FIND, C-MOVE, and C-STORE services.

3.2 Deployment

• Supports Windows 10, Server 2012 R2+.
• Requires Microsoft SQL Server 2012+ (Express or full).
• Can run on dedicated hardware or virtual machines.
• TLS support for secure DICOM, HL7, and Web communications.
• LDAP/Active Directory support for enterprise authentication.

4. Trigger Types

Each trigger supports:

• Advanced duplicate detection
• Custom property mapping
• TLS and secure transmission options

5. Rule Engine

Rules define conditions that must be satisfied for a workflow to be created. Conditions can use:

• Trigger type/name
• Common properties
• Raw HL7/DICOM/REST/CSV data
• Schedule/time-based logic
• Custom scripts

Rules are processed top-down, and can optionally stop on first match to optimize performance.

6. Workflow Execution

6.1 Priors Workflows

The central concept in Navigator. Each priors workflow:

• Specifies which Sources to query.
• Applies filtering logic to narrow down relevant priors.
• Defines Destinations to which selected priors are sent.
• Uses custom C# scripts to handle complex decisions.
• Supports date-based constraints (e.g., sliding date windows).
• Can be configured to fail or continue on partial success.

6.2 Move Requests

Navigator sends DICOM C-MOVE commands from Source to Destination, monitors their success, and logs detailed results.

7. System Features and Customization

7.1 Logging & Auditing

• Configurable log size, verbosity, and rotation
• Audit logs follow DICOM PS3.15 standards
• Tracks events like config changes, logins, and DICOM transfers

7.2 Notifications

• Email alerts for errors, daily summaries, and recipient groupings
• Configurable mail server integration

7.3 Custom Code

Custom scripts can be injected into triggers, rules, and workflows to handle:

• Advanced filtering
• Custom logic
• Conditional workflow states

7.4 Retention & Cleanup

• Trigger event retention policies per trigger type
• Control over completed/failed workflow lifespan
• PHI management requires user-initiated cleanup for full removal

8. Security and Compliance

8.1 Data Privacy

• Navigator temporarily stores PHI
• Data is not encrypted at rest by default
• Full disk encryption (BitLocker) recommended
• Audit trails and logs may contain PHI

8.2 User Access Control

• Supports local accounts and Active Directory
• High-security password options
• Role-based access: Admin, Regular, View-only

8.3 Communication Security

• TLS 1.0–1.3 support (configurable)
• Secure DICOM and HL7 interfaces
• Web interface supports HTTPS with custom certificates

8.4 Regulatory Notes

• GDPR compliance is the user’s responsibility
• Not subject to PCI standards
• No service backdoors or unauthorized access mechanisms

9. Troubleshooting and Maintenance

• Automatic crash recovery and service restarts
• Generates crash dumps for diagnostic use
• PowerShell scripts for TLS configuration and hardening
• Dashboard view provides a system health summary
• Detailed views for trigger events, workflows, and move operations

10. Licensing and Scalability

• License enforces limits on:
  • Number of Triggers
  • Rules
  • Workflows
  • Sources/Destinations
• No hardcoded limits unless defined in the license
• Designed to scale with enterprise workloads, including multisite deployments via Lighthouse integration

Summary

Laurel Bridge Navigator is a powerful, policy-driven, and customizable solution for automated retrieval of prior imaging studies across distributed clinical environments. Its granular controls, extensibility, security features, and interoperability make it ideal for enterprises seeking intelligent image workflow automation while maintaining compliance with DICOM standards and security protocols.

Let me know if you’d like a visual architecture diagram, comparison with similar products, or an editable version (Markdown, Word, etc.).

1. Automated Prior Exam Retrieval for Radiology Reading Workflows

Problem:

Radiologists require previous imaging exams (priors) for comparison when reading current studies. Manual retrieval is time-consuming and error-prone, especially when images reside in disparate PACS or archives.

Navigator Solution:

• Use HL7 ORU messages or MWL triggers to detect newly scheduled or acquired imaging exams.
• Apply custom Rules and Priors Workflows to identify relevant prior studies.
• Automatically query legacy PACS and move matched priors to the radiologist’s primary workstation or PACS.
• Filter priors by modality, body part, or exam date range to ensure relevance.

Benefits:

• Eliminates manual fetching tasks.
• Reduces interpretation delays.
• Ensures prior studies are available at the time of reading.

2. Cross-Institutional Imaging Integration After a Health System Merger

Problem:

A hospital group that acquired a new facility must provide clinicians with seamless access to historical imaging data stored in a separate, older archive.

Navigator Solution:

• Configure multiple DICOM Sources from both the new and existing archives.
• Use Rules to unify patient identifiers (via Accession Number or MRN).
• Create a Priors Workflow that fetches studies from the legacy site when a new order is placed at the main hospital.
• Support body part mapping and filtering to match exams across sites.

Benefits:

• Enables clinicians to access patient imaging history across institutions.
• Harmonizes data access without migrating entire archives.
• Supports vendor-neutral interconnectivity.

3. Clinical Decision Support via Real-Time Imaging Context

Problem:

Clinicians need real-time access to relevant imaging when making treatment decisions, such as oncology staging or orthopedic planning.

Navigator Solution:

• Use RESTful Triggers to integrate with an EHR or oncology system.
• On demand, the EHR sends patient context (e.g., MRN, body part, modality) to Navigator.
• A Priors Workflow fetches relevant prior CTs, MRIs, or X-rays based on the current clinical query.
• Send the results to a dedicated review station or viewer.

Benefits:

• Accelerates treatment decisions with contextual imaging.
• Reduces reliance on PACS or manual search.
• Enables tighter integration between imaging and clinical systems.

4. Quality Assurance and Data Reconciliation in Imaging Workflows

Problem:

Inconsistent patient metadata, missing studies, or misfiled exams compromise QA and compliance with imaging standards.

Navigator Solution:

• Configure CSV Triggers to ingest lists of studies needing verification.
• Use Rules and Custom Scripts to identify missing priors, mismatched patient names, or incomplete studies.
• Automatically re-query PACS or imaging archives to retrieve the correct data.
• Flag issues in logs or send alerts via email notifications.

Benefits:

• Enhances QA with automated verification workflows.
• Reduces human error in data reconciliation.
• Ensures study completeness and data integrity for audits.

5. Secure Imaging Workflow Support for Clinical Trials or Research

Problem:

A research team conducting a multi-site imaging study needs to aggregate imaging data securely without violating privacy policies.

Navigator Solution:

• Use Trigger + Workflow configurations to automatically fetch imaging for enrolled patients across multiple sites.
• Ensure TLS-encrypted DICOM transfers.
• Store PHI only temporarily and use retention policies to purge old data.
• Integrate with custom scripts to anonymize or de-identify metadata before export.

Benefits:

• Enables compliant, automated data collection across sites.
• Preserves PHI security and audit trails.
• Streamlines imaging logistics for clinical research.