Medical Image Sharing in Japan

This paper reports the history, background including politics, current status of Japan’s health imaging study and other information sharing. Its realization was slow until the Ministry of Health, Labour and Welfare (MHLW) started paying digital image storage at the same rate as films in 2008. Information sharing was initiated in early 2010s, which was before vendors became ready for Integrating the Healthcare Enterprise (IHE) cross-enterprise document sharing (XDS), with the result that most of 34 large regional sharing systems are in non-standardized protocol. One standardized example is the Hamamatsu area where inexpensive online PDI (portable data for imaging) was introduced.     

Current Status of Standardization of Inhalant Allergen Extracts in Korea

Allergy diagnosis and immunotherapy in Korea rely mostly on imported allergen extracts. However, some allergens that are not important in Western countries are not commercially available, and even the same species of allergen source often displays differences in allergenicity due to amino acid sequence polymorphisms. Therefore, it is essential to prepare allergen extracts that reflect regional characteristics. Allergen standardization has been performed since 2009 with the support of the Korea Center for Disease Control and Prevention. Here, we summarize the current status of allergen standardization, focusing on the house dust mite and cockroach. Pollen allergens that are under investigation are also briefly described.     

Toward Clinically Relevant Standardization of Image Quality

In recent years, notable progress has been made on standardization of medical image presentations in the definition and implementation of the Digital Imaging and Communications in Medicine (DICOM) Grayscale Standard Display Function (GSDF). In parallel, the American Association of Physicists in Medicine (AAPM) Task Group 18 has provided much needed guidelines and tools for visual and quantitative assessment of medical display quality. In spite of these advances, however, there are still notable gaps in the effectiveness of DICOM GSDF to assure consistent and high-quality display of medical images. In additions the degree of correlation between display technical data and diagnostic usability and performance of displays remains unclear. This article proposes three specific steps that DICOM, AAPM, and ACR may collectively take to bridge the gap between technical performance and clinical use: (1) DICOM does not provide means and acceptance criteria to evaluate the conformance of a display device to GSDF or to address other image quality characteristics. DICOM can expand beyond luminance response, extending the measurable, quantifiable elements of TG18 such as reflection and resolution. (2) In a large picture archiving and communication system (PACS) installation, it is critical to continually track the appropriate use and performance of multiple display devices. DICOM may help with this task by adding a Device Service Class to the standard to provide for communication and control of image quality parameters between applications and devices, (3) The question of clinical significance of image quality metrics has rarely been addressed by prior efforts. In cooperation with AAPM, the American College of Radiology (ACR), and the Society for Computer Applications in Radiology (SCAR), DICOM may help to initiate research that will determine the clinical consequence of variations in image quality metrics (eg, GSDF conformance) and to define what constitutes image quality from a diagnostic perspective. Implementation of these three initiatives may further the reach and impact of DICOM toward quality medicine.Originally printed at the DICOM 20th Anniversary Conference, Baltimore, MD, Sept. 2003.     

DICOM SR原理及其在PACS中的设计与实现

本文首先分析目前国内医院信息化现状,然后针对弊端结合对DICOM SR和IHE原理解析,通过对业务流程和软硬件系统按照国际标准进行规范,提出了符合DICOM和IHE的结构化诊断报告的模型实现,并阐述该模型实现的在全院PACS的设计与实施的具体应用.关键字:DICOM SR;IHE;PACS;HL 7;RSNA;HIMSS     

How Carequality,The Sequoia Project,and eHealth Exchange Support the Interoperable Exchange of Health Data in the USA

Every organization in the health IT industry plays an important role in overcoming barriers to health information exchange in the United States. It is important to understand imaging interoperability in the overall context of Health Information Exchange (HIE). The rapid evolution of storage, bandwidth and network transport technologies has made the handling of imaging data converge with the primarily text-based healthcare data. The radiology community must understand the overall environment and become a tightly integrated part of it. As the health IT ecosystems continue to evolve, it became clear that there would not be a single health information exchange network to service the nation. Rather, like other industries such as telecom and banking, there would be multiple networks that would need to interconnect. To support compliance to interoperability standards and specifications, The Sequoia Project began collaborating with industry to create testing programs and tooling that supports transport, security and content testing requirements for four production testing programs today. These testing programs validate compliance to standards for transport and security as well standards for the payloads such as clinical documents and imaging data. While once operating under the same umbrella, The Sequoia Project, Carequality and eHealth Exchange (https://ehealthexchange.org/) have been separate companies since 2018. Each plays a unique role in helping patient information move where and when it is needed, each working with a framework of standards published by IHE, DICOM, and HL7 to enable health information exchange.     

Multi-series DICOM: an Extension of DICOM That Stores a Whole Study in a Single Object

Today, most medical images are stored as a set of single-frame composite Digital Imaging and Communications in Medicine (DICOM) objects that contain the four levels of the DICOM information model—patient, study, series, and instance. Although DICOM addresses most of the issues related to medical image archiving, it has some limitations. Replicating the header information with each DICOM object increases the study size and the parsing overhead. Multi-frame DICOM (MFD) was developed to address this, among other issues. The MFD combines all DICOM objects belonging to a series into a single DICOM object. Hence, the series-level attributes are normalized, and the amount of header data repetition is reduced. In this paper, multi-series DICOM (MSD) is introduced as a potential extension to the DICOM standard that allows faster parsing, transmission, and storage of studies. MSD extends the MFD de-duplication of series-level attributes to study-level attributes. A single DICOM object that stores the whole study is proposed. An efficient algorithm, called the one-pass de-duplication algorithm, was developed to find and eliminate the replicated data elements within the study. A group of experiments were done that evaluate MSD and the one-pass de-duplication algorithm performance. The experiments show that MSD significantly reduces the amount of data repetition and decreases the time required to read and parse DICOM studies. MSD is one possible solution that addresses the DICOM limitations regarding header information repetition.     

基于深度卷积网络的结直肠全扫描病理图像的多种组织分割

结直肠全扫描图像处理困难,原因在于图像的数据量大、结构复杂、信息含量多。目前对于结直肠癌组织病理图像的研究通常包含肿瘤和基质两种组织类型,只有一小部分研究可以解决多种组织的问题,但又不是处理全扫描的结直肠病理图像。提出一种基于深度卷积网络的结直肠全扫描病理图像进行多种类型组织分割的模型。该模型使用的网络层数有8层,利用深度卷积网络学习结直肠全扫描图像中典型的8种类型的组织,利用训练好的模型对这8种类型的结直肠组织进行分类测试,其测试集分类准确率达92.48%。利用该模型对结直肠全扫描病理图像中的8种类型组织进行分割,首先对全扫描图像进行预处理,分成5000像素×5000像素大小的图像块,然后标记出每一张中的8种类型的组织,最后将所得到的标记结果进行拼接,从而获得整张结直肠全扫描病理图像的8种类型组织的标记结果。该方法对8种类型的组织分割的准确率比较高,有一定辅助诊断的帮助。     

基于深度级联网络的乳腺淋巴结全景图像的癌转移区域自动识别

淋巴结癌转移区域的自动识别是乳腺癌病理分期的重要前提。但由于全景图像尺寸巨大, 组织形态复杂多样, 在乳腺淋巴结全景图像中自动检测和定位癌转移区域具有很大的难度。设计一种基于深度级联网络的方法, 实现对乳腺淋巴结全景图像癌转移区域的自动定位与识别。采用由粗定位到精定位的两个深度网络模型级联的方式, 首先基于医生标记的癌转移区域, 提取阳性与阴性图像块训练粗定位网络VGG16得到粗定位结果, 然后对比粗定位结果与医生标记提取阳性和假阳性区域的图像块, 再训练精定位的ResNet50网络用于识别阳性和假阳性区域。为了验证所提出深度级联网络的有效性, 选用Camelyon16公开的共400张乳腺淋巴结全景图像数据集用作训练和测试。结果表明, 所提出的VGG16+ResNet50级联网络模型的定位指标FROC得分达到0.891 2, 分别比单个深度网络模型VGG16和ResNet50的FROC得分高0.153 1和0.147 0, 比AlexNet+VGG16级联的网络模型FROC得分高0.028 8, 显示深度级联网络模型对淋巴结癌转移区域可以实现更加精准的识别。     

Standardization of House Dust Mite Extracts in Korea

Purpose

House dust mites are the most important cause of respiratory allergy in Korea. Standardization of allergen extracts is essential for improving diagnostics and immunotherapeutics. This study was undertaken to evaluate the allergenicity of standardized house dust mite allergen extracts from Korean house dust mite isolates.

Methods

Allergen extracts were prepared from cultured Korean house dust mites (Dermatophagoides farinae and D. pteronyssinus). Allergenic activities of Korean house dust mite extracts were compared to standardized extracts from a company in the United States whose allergen concentrations were expressed as Allergy Units (AUs). Specifically, we compared group 1 and 2 major allergens using two-site enzyme-linked immunosorbent assay (ELISA) kits and an in vivo intradermal test.

Results

Major allergen concentrations were 17.0 µg/mg (5.0 µg/mg of Der f 1 and 12.0 µg/mg of Der f 2) for a D. farinae extract and 24.0 µg/mg (11.6 µg/mg of Der p 1 and 12.4 µg/mg of Der p 2) for a D. pteronyssinus extract. Using chloramphenicol (CAP) inhibition assays, AUs were 12.5 AU/µg for a D. farinae extract and 12.8 AU/µg for a D. pteronyssinus extract. Allergenic activities were 3- to 4-fold stronger when assessed by intradermal skin tests for in vivo standardization.

Conclusions

Allergen extracts were prepared from Korean house dust mites and the allergenicities of the extracts were estimated using AU measurements. House dust mite extracts prepared in this study could be utilized as a reference material, which will be useful for the development of diagnostic and immunotherapeutic reagents in Korea.     

数字彩超标准化（DICOM）接口的研究开发

结合在研发全数字彩色Doppler超声成像系统的DICOM接口过程中的实践,全面地分析了数字化超声设备中符合DICOM标准的图像通讯接口的需求,阐述了利用面向对像及层次方法设计及实现该DICOM接口的过程,最后,进行了相关的总结。     

CTN中Archive_Server类库的二次开发与应用

目的：利用CTN类库和数据库技术,构建简单实用、具有个性化特点的PACS。方法：对CTN中Archive_Server类库进行二次开发和重新封装,编译后生成Win32平台下的运行库Archive_Server.dll,利用此库文件和SQL数据库构建PACS。结果：使PACS构建简单、管理容易、经济实用,为各医院打造个性化的PACS提供了一个行之有效的解决方案。结论：利用CTN类库可以很轻松地构建PACS,可减少PACS建设成本,加快PACS在我国的普及进程。     

Evaluation of Free,Open-source,Web-based DICOM Viewers for the Indian National Telemedicine Service (eSanjeevani)

The Digital Image and Communications in Medicine (DICOM) viewer is a very useful component in telemedicine applications. Owing to increased demand, adoption, and prospects of browser-based software in the recent past, web-based DICOM viewers have gained significant ground. There are myriad web-based DICOM viewers which are open source and are available free of cost as stand-alone applications. These freely available tools have rich functionality like the commercial ones. To find an optimal DICOM viewer for integration with a web-based telemedicine solution is quite a challenge, and no research has gone into assessing these freely available DICOM viewers. This research assessed a range of web-based, open-source, and freely available DICOM viewers from the perspective of their integration with the Indian National Telemedicine Solution (eSanjeevani). To introduce teleradiology module in eSanjeevani, a study is carried out to enable viewing of radiological images through DICOM viewer. eSanjeevani is being prepared for a national roll-out at 155,000 health and wellness centers across rural India by the Ministry of Health and Family Welfare (Government of India) under the Ayushman Bharat Scheme (the world’s largest health insurance scheme). In total, 13 free, open-source, and web-based DICOM viewers were identified for evaluation; however, only six were shortlisted as assessed. This study can serve as a one-stop source for researchers looking for a suitable DICOM viewer for their healthcare IT applications.     

Translating the IHE Teaching File and Clinical Trial Export (TCE) Profile Document Templates into Functional DICOM Structured Report Objects

The Integrating the Healthcare Enterprise (IHE) Teaching File and Clinical Trial Export (TCE) integration profile describes a standard workflow for exporting key images from an image manager/archive to a teaching file, clinical trial, or electronic publication application. Two specific digital imaging and communication in medicine (DICOM) structured reports (SR) reference the key images and contain associated case information. This paper presents step-by-step instructions for translating the TCE document templates into functional and complete DICOM SR objects. Others will benefit from these instructions in developing TCE compliant applications.     

美术治疗的发展与应用现状

美术治疗（arttherapy）是利用美术媒介、美术创作来帮助个人或团体达到身心整合目的的一种艺术疗法。美国美术治疗协会（AATA）将其定义为：“利用美术媒介、美术创造过程、当事人（client／patient）对所创作美术作品的反应，实现对个人的发展、能力、个性、兴趣以及内心关注点与冲突点的反思的服务。”作为心理学、艺术学等学科相互交叉的产物，美术治疗弥补了谈话心理疗法的不足，帮助当事人通过象征性的意象这一安全、可接受的方式释放情感，从创作中获得快感和满足感，进而整合身心、和谐人格，从精神或情绪紊乱中获得康复。     

Standardization of Weed Pollen Extracts,Japanese Hop and Mugwort,in Korea

PurposeJapanese hop (Humulus spp.) and mugwort (Artemisia spp.) are notable causes of autumn pollinosis in East Asia. However, Japanese hop and mugwort pollen extracts, which are widely used for the diagnosis, have not been standardized. This study was performed to standardize Japanese hop and mugwort pollen extracts.ResultsThe IgE reactive components of the extracts via IgE immunoblotting were similar to those of commercial extracts. A 11-kDa allergen showed the strongest IgE reactivity in Japanese hop, as did a 28-kDa allergen in mugwort pollen extracts. Allergenic potencies of the investigatory Japanese hop and mugwort extracts were essentially indistinguishable from the commercial ones. Sums of erythema of 50 mm by the intradermal skin test (ΣED50) were calculated to be 14.4th and 13.6th three-fold dilutions for Japanese hop and mugwort extracts, respectively. Therefore, the allergenic activity of the prepared extracts was 90827.4 BAU/mg for Japanese hop and 34412 BAU/mg for mugwort.ConclusionWe produced Japanese hop and mugwort pollen extracts using a standardized method. Standardized Japanese hop and mugwort pollen extracts will facilitate the production of improved diagnostic and immunotherapeutic reagents.     

HEP versus PNU Standardization of Allergen Extracts in Skin Prick Testing

During 1 year, all patients referred to an allergy outpatient clinic for adults were skin prick tested with a panel of standard allergen extracts from two manufacturers using different methods of standardization. One company referred to the histamine equivalent prick (HEP) and the other used the more traditional protein nitrogen units (PNU). Standard extracts and five-fold dilution were tested. The results indicate that the ratio of concentration between two extracts of the same allergen should be measured by the absolute difference of the wheal diameters. We found significant differences between corresponding extracts from the two manufacturers.     

Zero Watermarking: Critical Analysis of Its Role in Current Medical Imaging

Medical image data plays a critical role in health care today. Whatever the context of image processing (research and educational activities, diagnostic or forensic purposes, etc.), they are supposed to be treated as highly sensitive. Unfortunately, currently available image-processing tools also enable very sophisticated malicious modification of their content.This paper is focused on the assessment of the effectiveness of selected so-called zero watermarking methods (ones that do not cause any modification of an image sample), in the protection of the integrity, and proving authorship, of these medical image studies. We have studied many zero watermarking methods and selected one representative from each type of known algorithms for comparison.We have conducted a series of simulations over a huge research database of anonymized medical image studies (patient examinations).