基于DCMTK的DICOMMPPS服务实现

目的：在医院放射科的操作流程中,从影像设备通过设备工作列表（ModalityWorklist,MWL）获取病人资料到病人影像信息的存储,往往侧重于影像数据的获取,而缺失设备执行过程期间的检查状态信息。为了能够及时获知影像设备的检查状态,为临床医生提供更多实时和丰富的信息,从而能够有效地调度放射科病人检查过程。方法：本文对DICOM3．0标准中MPPS（ModalityPerformedProcedureStep,MPPS）H~务规范进行了研究,详细分析了MPPS携带的信息以及它的时序与状态,利用VisualStudio2008开发工具和开源软件包DCMTK3．6．0设计并实现了MPPS服务的SCP和SCU,在Windows平台下进行了模拟测试。结果：实验结果表明利用MPPS服务不仅可以完整地记录病人的检查信息,而且可以实时地查询影像设备在执行过程中的检查状态,弥补了放射科当前工作流无法及时获取检查设备状态,不能高效管理病人检查的缺陷。结论：基于DCMTK的DICOMMPPS服务实现了图像传输与归档系统与影像设备之间无缝的信息交流,有效地加强了放射科日常业务流程的管理,对实现数字化医院建设有积极的促进作用。     

Real-Time Patient Radiation Dose Monitoring System Used in a Large University Hospital

Radiation dose monitoring in medical imaging examination areas is mandatory for the reduction of patient radiation exposure. Recently, dose monitoring techniques that use digital imaging and communications in medicine (DICOM) dose structured reports (SR) have been introduced. The present paper discusses the setup of a radiation dose monitoring system based on DICOM data from university hospitals in Korea. This system utilizes the radiation dose data-archiving method of standard DICOM dose SR combined with a DICOM modality performed procedure step (MPPS). The analysis of dose data based on a method utilizing DICOM tag information is proposed herein. This method supports the display of dose data from non-dosimeter-attached X-ray equipment. This system tracks data from 62 pieces of equipment to analyze digital radiographic, mammographic, mobile radiographic, CT, PET-CT, angiographic, and fluorographic modalities.     

Optimisation of medical equipment replacement using stochastic dynamic programming

Abstract

In this paper, the medical equipment replacement strategy is optimised using a multistage stochastic dynamic programming (SDP) approach. The outcome is an optimal path which shows whether to keep an existing piece of medical equipment (defender) or replace it with a more economical alternative (challenger). We assume that each decision can result in a number of different possible outcomes, each with a known probability. Contrary to deterministic dynamic programming, the state at the next stage is not completely determined by the state and policy decision at the current stage. Instead, the next stage depends on the operation and maintenance cost which is modelled as a stochastic variable. A Keep-Replace sequence of the highest returns (lowest costs) is the result of solving the problem using forward decision making. The benefit of the SDP solution versus that of keeping medical equipment until the end of its expected life is investigated for three scenarios: (1) no revenue for the defender and the challenger, (2) equal revenues for both, and (3) higher revenue for the challenger. The percentage of benefits relative to the current acquisition cost for the three scenarios are 616.9%, 728.2%, and 789.29%, respectively. Each percentage represents the relative difference between the equipment life cycle cost of the optimal sequence and that of the conventional sequence.     

DICOM versus HL7 for modality interfacing

Digital modalities such as CT, MRI, Ultrasound and Computerized Radiography systems, generating softcopy images to be used by a Picture Archiving and Communication System (PACS), need to identify the images properly in order to retrieve and manage them. In many cases, a technologist re-enters patient demographic and study related information at the modality, even although it is usually already present somewhere in the hospital Information System (IS). In order to achieve a higher level of efficiency and uniquely identify the created image objects, it is obvious that an interface between the IS and modality to exchange this information is highly desired. There are two options for a modality vendor to implement an IS interface, either using the Health Level (HL7) or Digital Imaging Communication in Medicine (DICOM) communication standard. This paper will explain characteristics of both protocols, and demonstrate that it is preferred to use DICOM versus HL7. In addition, it will show that DICOM is, supported by most modality vendors, based on the result of a poll of their Modality Worklist versus HL7, support.     

Enhancement of declarative memory performance following a daytime nap is contingent on strength of initial task acquisition

STUDY OBJECTIVES: In this study we examined the benefit of a daytime nap containing only NREM sleep on the performance of three declarative memory tasks: unrelated paired associates, maze learning, and the Rey-Osterrieth complex figure. Additionally, we explored the impact of factors related to task acquisition on sleep-related memory processing. To this end, we examined whether testing of paired associates during training leads to sleep-related enhancement of memory compared to simply learning the word pairs without test. We also examined whether strength of task acquisition modulates sleep-related processing for each of the three tasks. SUBJECTS AND PROCEDURE: Subjects (11 male, 22 female) arrived at 11:30, were trained on each of the declarative memory tasks at 12:15, and at 13:00 either took a nap or remained awake in the sleep lab. After the nap period, all subjects remained in the lab until retest at 16:00. RESULTS: Compared to subjects who stayed awake during the training-retest interval, subjects who took a NREM nap demonstrated enhanced performance for word pairs that were tested during training, but not for untested word pairs. For each of the three declarative memory tasks, we observed a sleep-dependent performance benefit only for subjects that most strongly acquired the tasks during the training session. CONCLUSIONS: NREM sleep obtained during a daytime nap benefits declarative memory performance, with these benefits being intimately tied to how well subjects acquire the tasks and the way in which the information is acquired.     

基于Matrox设备超声视频信号采集方案

提出了一种超声图像数字化采集的方案。ALOKA超声只能存储很少的图像资料,且无法进行图像后处理。本文运用Matrox设备制作模数转换接口,设置图像采集参数,结果是成功地将模拟的视频信号进行数字化采集,说明利用Matrox设备开发小型超声图像采集工作站,实现图像后处理和数字化存储,是一种具有实用价值的方案。     

A design for a Picture Archiving Communication System central storage facility

A Picture Archive and Communication System (PACS) as it is to be used in a Hospital will consist of a number of workstations, data acquisition stations and output stations, connected to a central storage facility. In this paper the architecture of the central storage facility is studied, and an implementation is proposed. Simulation studies have been performed on the proposed implementations, showing their feasibility. The simulation studies show that the central storage facility can store over 500 sets on a daily basis, while simultaneously handling the review and output activity associated with such a production. On the average, each set is assumed to consist of 3 images of 4 Mbyte each. Simulation results are presented for a number of alternative systems. Special attention is given to the implications of prefetching on the protocols to be used in the PACS system. It is shown that prefetching, in particular in combination with a pipelined system, can yield significant performance benefits. We believe that prefetching of images is a prerequisite for good system performance. The implementation assumes that a high-speed communication protocol is used to interconnect the PACS components. The paper will not go into details on the network considerations. The central storage facility is designed using a general purpose System/370 machine, with the peripherals commonly used for such machines. This implies that it can be realized with currently available equipment. Several alternative implementations using interconnected workstation based systems are suggested.     

The design and development of a physician-oriented PACS for the enhancement of e-hospital facilities

Recent advancements in modern medical diagnoses have required a huge increase of the use of equipment such as CT and ultrasound machines. Correspondingly, the storage and dissemination of these medical images have become an important issue to medical professionals. Unfortunately, management of these images has traditionally been slow and cumbersome. With the prevalence of the personal computer, however, along with increased network bandwidth, it is now possible to handle this information electronically as well as wirelessly. The Picture Archiving and Communication System (PACS) is at the forefront of this revolution. Yet, commercially available PACS software is generally prohibitively expensive for hospitals with limited financial resources. A dilemma among many hospitals is deciding how to acquire and implement the proper PACS system without unduly affecting the budget. In this paper, a full function, efficient, and economical PACS system is presented as a viable, non-compromising option for many small and medium-sized hospitals. This system, designed and developed mainly by the physicians and technicians of Puli Christian Hospital (PCH), with the assistance from academia, allows for customization to fit the needs of individual hospitals. This system can be used as the foundation of a hospital's health information infrastructure and to enhance e-hospital service.     

Eye-hand coordination when the body moves: Dynamic egocentric and exocentric sensory encoding

We investigated whether the human brain encodes and memorizes object orientations with respect to external references, such as gravity and visual landmarks, or whether it uses egocentric representations of the task. To this end, we applied a new analysis to a previously reported experiment on a reach-to-grasp-like movement, in which we used sensory conflict to identify how the CNS encodes target and hand orientation. Whereas in the preceding study deviations of responses provoked by the conflict provided evidence for the simultaneous use of visual and kinesthetic representations of target and hand (Tagliabue and McIntyre, 2011 [20]), here we used an analysis of response variability in the presence of conflict to test for ego- versus exo-centric encoding within each sensory modality. Our results show an increase of response variability with the amplitude of the head rotation, indicative of errors that accumulate when updating egocentric representations during head movements. In addition, the effect of conflict on error accumulation showed that the brain selects different information about the head movement for the updating, depending on the modality of the egocentric representation (visual or kinesthetic) that is retained. In particular, the CNS appears to privilege the sensory information about head movement that can most easily be combined with each internal representation. Moreover, a combined analysis of response variability and response deviations induced by the conflict suggests the coexistence of independent ego- and exo-centered internal representations within each sensory modality.     

数字医学图像传输协议(DICOM)分析及在远程放射系统中的应用

数字医学图像传输协议 ( Digital image comm unication in m edicine,DICOM)主要是由 ACR和 NEMA联合提出的旨在解决医疗设备之间互连的一种通讯标准 ,目前已成为业界公认的标准。把 DICOM应用于远程放射系统具有很重要的意义 ,特别是在幅员辽阔的我国有更加突出的意义。简要地概述了 DICOM3 .0的主要内容及突出特征 ,并就其在 PACS、远程放射系统的开发策略、组成结构和几个关键问题进行了讨论     

Patient Dose Management Solution Directly Integrated in the RIS: “Gray Detector” Software

On X-ray modalities, the information concerning the dose delivered to the patient is usually available in image headers or in structured reports stored in the picture archiving and communication system (PACS). Sometimes this information is sent in the Modality Performed Procedure Step message. By saving the information inside the Radiological Information System, it can be linked to the patient and to his/her episode/request. A software, “Gray Detector,” implementing different and complementary extraction methods was developed. Query/retrieve on images header, Modality Performed Procedure Step message analysis, or the combination of the two methods were used. In order to avoid erroneous dose-protocol association, every accession number is linked to its unique report code, allowing multiple-protocols exam recognition. The adoption of different methods to extract dosimetric information makes it possible to integrate any kind of modality in a vendor/version neutral way. Linking the dosimetric information received from a modality to the patient and to the unique report code solves, for example, common problems in computed tomography exams, where the dosimetric value related to multiple segments/studies on the modality can be associated by the technician who performs the exam only to one accession number corresponding to a single study/segment. Analyses of dosimetric indexes’ dependence on modality type, patient age, technician, and radiologist were performed. Linking dosimetric information to radiological information system data allows a contextualization of the former and helps to optimize the image-quality/dose ratio, thereby making it possible to take a clinical decision that is “patient-centered.”     

医学影像存档与通信系统存储系统的探讨

由于PACS系统需要一个高性能的存储系统的支撑，本文重点讨论了PACS的存储管理系统方案、PACS对计算机存储体系的要求、如何选择适当的存储架构以及PACS设计原则和分析方法.     

Percutaneous excretion of iron and ferritin (through Al-hijamah) as a novel treatment for iron overload in beta-thalassemia major,hemochromatosis and sideroblastic anemia

Iron overload is a big challenge when treating thalassemia (TM), hemochromatosis and sideroblastic anemia. It persists even after cure of TM with bone marrow transplantation. Iron overload results from increased iron absorption and repeated blood transfusions causing increased iron in plasma and interstitial fluids. Iron deposition in tissues e.g. heart, liver, endocrine glands and others leads to tissue damage and organ dysfunction. Iron chelation therapy and phlebotomy for iron overload have treatment difficulties, side effects and contraindications. As mean iron level in skin of TM patients increases by more than 200%, percutaneous iron excretion may be beneficial. Wet cupping therapy (WCT) is a simple, safe and economic treatment. WCT is a familiar treatment modality in some European countries and in Chinese hospitals in treating different diseases. WCT was reported to clear both blood plasma and interstitial spaces from causative pathological substances (CPS). Standard WCT method is Al-hijamah (cupping, puncturing and cupping, CPC) method of WCT that was reported to clear blood and interstitial fluids better than the traditional WCT (puncturing and cupping method, PC method of WCT). In other word, traditional WCT may be described as scarification and suction method (double S technique), while Al-hijamah may be described as suction, scarification and suction method (triple S technique). Al-hijamah is a more comprehensive treatment modality that includes all steps and therapeutic benefits of traditional dry cupping therapy and WCT altogether according to the evidence-based Taibah mechanism (Taibah theory). During the first cupping step of Al-hijamah, a fluid mixture is collected inside skin uplifting due to the effect of negative pressure inside sucking cups. This fluid mixture contains collected interstitial fluids with CPS (iron, ferritin and hemolyzed RBCs in thalassemia), filtered fluids (from blood capillaries) with iron and hemolyzed blood cells (hemolyzed RBCs, WBCs and platelets). That fluid mixture does not contain intact blood cells (having diameters in microns) that are too big to pass through pores of skin capillaries (6–12 nm in diameter) and cannot be filtered. Puncturing skin upliftings and applying second cupping step excrete collected fluids. Skin scarifications (shartat mihjam in Arabic) should be small, superficial (0.1 mm in depth), short (1–2 mm in length), multiple, evenly distributed and confined to skin upliftings. Sucking pressure inside cups (−150 to −420 mmHg) applied to skin is transmitted to around skin capillaries to be added to capillary hydrostatic pressure (−33 mmHg at arterial end of capillaries and −13 mmHg at venous end of capillaries) against capillary osmotic pressure (+20 mmHg). This creates a pressure gradient and a traction force across skin and capillaries and increases filtration at arterial end of capillaries at net pressure of −163 to −433 mmHg and at venous end of capillaries at net pressure of −143 to −413 mmHg resulting in clearance of blood from CPS (iron, ferritin and hemolyzed blood cells). Net filtration pressure at renal glomeruli is 10 mmHg i.e. Al-hijamah exerts a more pressure-dependent filtration than renal glomeruli. Al-hijamah may benefit patients through inducing negative iron balance. Interestingly, Al-hijamah was reported to decrease serum ferritin significantly (by about 22%) in healthy subjects while excessive traditional WCT was reported to cause iron deficiency anemia. Al-hijamah is a highly recommended treatment in prophetic medicine. In conclusion, Al-hijamah may be a promising adjuvant treatment for iron overload in TM, hemochromatosis and sideroblastic anemia.     

Benefits of the DICOM Structured Report

Recently, the digital imaging and communications in medicine (DICOM) standard introduced rules for the encoding, transmission, and storage of the imaging diagnostic report. This medical document can be stored and communicated with the images in picture archiving and communication system (PACS). It is a structured document that contains text with links to other data such as images, waveforms, and spatial or temporal coordinates. Its structure, along with its wide use of coded information, enables the semantic understanding of the data that is essential for the Electronic Healthcare Record deployment. In this article, we present DICOM Structured Report (SR) and discuss its benefits. We show how SR enables efficient radiology workflow, improves patient care, optimizes reimbursement, and enhances the radiology ergonomic working conditions. As structured input significantly alters the interpretation process, understanding all its benefits is necessary to support the change. Biography Rita Noumeir is a professor at the Department of Electrical Engineering of the University of Quebec, école de Technologie Superieure in Montreal. A founding member of the Imaging, Vision, and Artificial Intelligence Laboratory (LIVIA), her main research interest is the Healthcare Information Technology, specifically, Interoperability, Electronic Patient Record, Security, Information Confidentiality, and Image Processing. As a member of both Technical and Planning International IHE Radiology Committees, Dr. Noumeir took part over the last 5 years in developing many Integrating the Healthcare Enterprise (IHE) Integration Profiles in Radiology and in organizing several Integration Demonstrations. She is a cofounder of IHE Canada. Dr. Noumeir contributed to many research and development projects in collaboration with several Canadian and international companies in medical imaging and healthcare information. Currently, she collaborates with the Diagnostic Imaging Team of Canada Health Infoway to define the principles and architecture for sharing imaging information between multiple healthcare institutions. She plays a leading role in the development of this solution that is published as an IHE Integration Profile for which she is the editor. Rita Noumeir holds a Ph.D. and a Masters degree in Biomedical Engineering from école Polytechnique of Montreal specializing in Medical Imaging. She is a professional engineer, and a member of the Ordre des ingénieurs du Québec.     

Transaction logfile analysis in health communication research: challenges and opportunities

Objective

To investigate the individualized nature of eHealth communication, it is necessary for us to go beyond the conventional approach to explain the effect of eHealth initiatives. The current article proposes transaction logfile analysis as a unique method to probe the process by which individuals locate needed information and obtains benefits out of it.

Methods

This article discusses the background of logfile analysis along with practical and methodological issues related to the analysis of log data.

Results

This article recommends potential solutions to resolve issues discussed in the Section 2.

Conclusions

This article discusses how transaction logfile analysis could benefit eHealth researchers, along with its relevance and application in health communication research. Logfile analysis could provide rich knowledge on how eHealth applications and tools work if performed on a regular basis, incorporated with appropriate measurement techniques and research design, and interpreted carefully.

Practice implications

Logfile analysis can point toward important design implications for more effective eHealth applications. Further, interventions employing logfile analysis require not only well-designed research models but also interdisciplinary research team to handle the multifaceted work involved in the process.     

Data interchange and related technologies in transfusion medicine

The transfusion medicine data interchange needs involve varying types of equipment and systems including blood collection and processing systems, component separation automation, laboratory instruments and automation systems (e.g. the ones used for screening of infectious markers), and various information management systems (e.g. laboratory information management systems donation/production management, and invoicing systems). Interfacing challenges and extra costs arise due to a lack of a common and open definition for the instrument interface, and a lack of a common conceptual framework for data interchange between systems and instruments. Standardization of data interchange is a need recognized by the end users and vendors. This is why the ISBT has launched a new Automated System Interface Task Force in September 2006 to establish a standard specification for transferring information between equipment and information management systems.     

西门子AXIOM Artis系列X线机摄影参数的研究

主要研究和分析了AXIOM Artis系列X线机的摄影参数,参数之间的相互关系,以及获取最佳图像的参数选择。总结了一组心血管X线造影检查较完整的曝光参数放置值。     

Intersubunit signaling in RecBCD enzyme, a complex protein machine regulated by Chi hot spots

The Escherichia coli RecBCD helicase-nuclease, a paradigm of complex protein machines, initiates homologous genetic recombination and the repair of broken DNA. Starting at a duplex end, RecBCD unwinds DNA with its fast RecD helicase and slower RecB helicase on complementary strands. Upon encountering a Chi hot spot (5'-GCTGGTGG-3'), the enzyme produces a new 3' single-strand end and loads RecA protein onto it, but how Chi regulates RecBCD is unknown. We report a new class of mutant RecBCD enzymes that cut DNA at novel positions that depend on the DNA substrate length and that are strictly correlated with the RecB:RecD helicase rates. We conclude that in the mutant enzymes when RecD reaches the DNA end, it signals RecB's nuclease domain to cut the DNA. As predicted by this interpretation, the mutant enzymes cut closer to the entry point on DNA when unwinding is blocked by another RecBCD molecule traveling in the opposite direction. Furthermore, when RecD is slowed by a mutation altering its ATPase site such that RecB reaches the DNA end before RecD does, the length-dependent cuts are abolished. These observations lead us to hypothesize that, in wild-type RecBCD enzyme, Chi is recognized by RecC, which then signals RecD to stop, which in turn signals RecB to cut the DNA and load RecA. We discuss support for this "signal cascade" hypothesis and tests of it. Intersubunit signaling may regulate other complex protein machines.     

A proposed computer-assisted preventive maintenance system

This paper describes a proposed Computerized Documentation System for effectively controlling all biomedical equipment preventive maintenance (PM) and repair functions to be effected by hospitals. There is a critical need for such a system to strengthen the management tools of hospital-based Biomedical/Clinical Engineering programs. The system's design objectives, implementation, and evaluation method are explained and the benefits attributable to such a computerized control system are summarized.