数字化影像信息系统在医院的移动应用

目的：构建全套完整无线数字化影像信息系统，使各科医务人员能够操作该系统在整个医院范围内安全、快速、简便的进行医疗应用。材料和方法：基于医院现有GE Centricity PACS／RIS的企业级架构和WEB技术向临床发布影像的应用，以多台戴尔PowerEdge服务器分别用作PACS服务器、RIS服务器、HIS服务器和PACS—web服务器。网络连接设备使用戴尔Powerconnect交换机和TP—LINK无线宽带路由器。用户终端移动设备使用戴尔Latitude笔记本电脑。首先依托医院现有的有线网络构架，选择具有代表性的科室，如放射科、神经外科、神经内科、预防保健科、质控科，并将无线宽带路由器通过双绞线连接至以太网接口，设置无线宽带路由器指定IP地址、子网掩码，设置路由器工作模式，MAC地址过滤、SSID并且禁用SSID广播、频道和加密属性。建立起集中控制式无线网络。在用户终端设置无线适配器，设置为与路由器相同的SSID、频道和加密属性。测试终端移动设备和服务器之间的连接，并且交给最终用户使用。结果：用户使用终端移动设备进行医疗工作日常操作移动性便携性明显优于原系统。而医疗软什的使用与原系统相同，无须另外培训。神经外科和神经内科的临床医生可以手持终端移动设备在患者床前边查房边做病程记录，并且同时通过浏览器基于IHE规范要求优先调阅关键帧影像，通过TruRez增量传输技术降低对无线网络带宽的要求，以web浏览的形式快速从GE Centricity PACS—web服务器实时渊用患者的影像资料。预防保健科和质控科通过HIS和RIS查询进行疾病分类、例数统计，快速生成报表，进行传染病监控和质罱控制。放射科医生需要经常从PACS服务器调用大量的DICOM格式文件，由于无线宽带路由器的带宽为54M，是原有线网络100M带宽的一半，调用时间有所延长。结论：使用医用无线网络系统的通信交流方式较传统方式更加迅速便捷。各种医务人员使用终端移动设备可以在医疗机构内任意漫游、高速传输影像、报告、病历以及其他电子文档。当影像浏览信息极大丰富时（如扩展对心电信息、电生理、超声、病理等信息），正确的操作者可以在正确的时间、安全的获得正确的、完善的临床诊断应用需要的综合诊断信息。对操作者而言简单明了，能够在所有医疗通信系统中使用而无需考虑制造商的因素。     

A Mobile Phone Integrated Health Care Delivery System of Medical Images

With the growing computing capability of mobile phones, a handy mobile controller is developed for accessing the picture archiving and communication system (PACS) to enhance image management for clinicians with nearly no restriction in time and location using various wireless communication modes. The PACS is an integrated system for the distribution and archival of medical images that are acquired by different imaging modalities such as CT (computed tomography) scanners, CR (computed radiography) units, DR (digital radiography) units, US (ultrasonography) scanners, and MR (magnetic resonance) scanners. The mobile controller allows image management of the PACS including display, worklisting, query and retrieval of medical images in DICOM format. In this mobile system, a server program is developed in a PACS Web server which serves as an interface for client programs in the mobile phone and the enterprise PACS for image distribution in hospitals. The application processing is performed on the server side to reduce computational loading in the mobile device. The communication method of mobile phones can be adapted to multiple wireless environments in Hong Kong. This allows greater feasibility to accommodate the rapidly changing communication technology. No complicated computer hardware or software is necessary. Using a mobile phone embedded with the mobile controller client program, this system would serve as a tool for heath care and medical professionals to improve the efficiency of the health care services by speedy delivery of image information. This is particularly important in case of urgent consultation, and it allows health care workers better use of the time for patient care.     

Developing a Medical Image Content Repository for E-Learning

The integration of medical informatics and e-learning systems could provide many advanced applications including training, knowledge management, telemedicine, etc. Currently, both the domains of e-learning and medical image have sophisticated specifications and standards. It is a great challenge to bring about integration. In this paper, we describe the development of a Web interface for searching and viewing medical images that are stored in standard medical image servers. With the creation of a Web solution, we have reduced the overheads of integration. We have packaged Digital Imaging and Communications in Medicine (DICOM) network services as a component that can be used via a Web server. The Web server constitutes a content repository for searching, editing, and storing Web-based medical image content. This is a simple method by which the use of Picture Archiving and Communication System (PACS) can be extended. We show that the content repository can easily interact and integrate with a learning system. With the integration, the user can easily generate and assign medical image content for e-learning. A Web solution might be the simplest way for system integration. The demonstration in this paper should be useful as a method of expanding the usage of medical information. The construction of a Web-based repository and integrated with a learning system may be also applicable to other domains.     

DICOM医学图像采集的方法与实践

医学图像采集是PACS的重要环节,也是PACS实用化的关键。本文比较了几种常见的图像采集方法,重点介绍了通过DICOM接口的图像采集,在详细阐明了DICOM网络的概念和DICOM消息交换的规范之后,介绍了我们编写的DICOM医学图像采集软件,本软件是在Windows平台上利用SocketAPI编写而成,提供了DICOM标准定义的验证、存储、查询和检索等服务,测试结果表明,本软件能够顺利地与成像设备连接并采集图像。     

Image formats: five years after the AAPM standard for digital image interchange

The publication of AAPM Report No. 10 was the first attempt to standardize image formats in the medical imaging community. Since then, three other groups have formed (CART--the Scandinavian collaboration for Computer Assisted Radiation Therapy treatment planning; ACR-NEMA, a collaboration whose purpose is to formulate a standard digital interface to medical imaging equipment; and COST B2 Nuclear Medicine Project a European collaboration whose purpose is to define a format for digital image exchange in Nuclear Medicine). The AAPM format uses key-value pairs in plain text to keep track of all information associated with a particular image. The radiation oncology community in the U.S. has been defining key-value pairs for use with CT, nuclear medicine and magnetic resonance (MR) images. The COST B2 Nuclear Medicine Project has also adopted this format and together with the Australian/New Zealand Society of Nuclear Medicine Technical Standards Sub-Committee which has also adopted this format, has defined an initial set of key-value pairs for Nuclear Medicine images. Additionally, both ACR-NEMA and CART have been defining fields for use with the same types of images. The CART collaboration has introduced a database which is available electronically, but is maintained by a group of individuals. ACR-NEMA operates through committee meetings. The COST B2 Nuclear Medicine Project operates through electronic (and postal where necessary) mail. To insure a consistent set of field names in such a rapidly developing arena requires the use of a server rather than a committee. Via a server a person would inquire if a particular field had been defined. If so, the defined name would be returned.(ABSTRACT TRUNCATED AT 250 WORDS)     

Teaching DICOM by Problem Solving

The Digital Imaging and Communications in Medicine (DICOM) is the standard for encoding and communicating medical imaging information. It is used in radiology as well as in many other imaging domains such as ophthalmology, dentistry, and pathology. DICOM information objects are used to encode medical images or information about the images. Their usage outside of the imaging department is increasing, especially with the sharing of medical images within Electronic Health Record systems. However, learning DICOM is long and difficult because it defines and uses many specific abstract concepts that relate to each other. In this paper, we present an approach, based on problem solving, for teaching DICOM as part of a graduate course on healthcare information. The proposed approach allows students with diversified background and no software development experience to grasp a large breadth of knowledge in a very short time.     

An integrated medical image database and retrieval system using a web application server

We developed an Integrated Medical Image Database and Retrieval System (INIS) for easy access by medical staff. The INIS mainly consisted of four parts: specific servers to save medical images from multi-vendor modalities of CT, MRI, CR, ECG and endoscopy; an integrated image database (DB) server to save various kinds of images in a DICOM format; a Web application server to connect clients to the integrated image DB and the Web browser terminals connected to an HIS system. The INIS provided a common screen design to retrieve CT, MRI, CR, endoscopic and ECG images, and radiological reports, which would allow doctors to retrieve radiological images and corresponding reports, or ECG images of a patient simultaneously on a screen. Doctors working in internal medicine on average accessed information 492 times a month. Doctors working in cardiological and gastroenterological accessed information 308 times a month. Using the INIS, medical staff could browse all or parts of a patient's medical images and reports.     

RayPlus: a Web-Based Platform for Medical Image Processing

Medical image can provide valuable information for preclinical research, clinical diagnosis, and treatment. As the widespread use of digital medical imaging, many researchers are currently developing medical image processing algorithms and systems in order to accommodate a better result to clinical community, including accurate clinical parameters or processed images from the original images. In this paper, we propose a web-based platform to present and process medical images. By using Internet and novel database technologies, authorized users can easily access to medical images and facilitate their workflows of processing with server-side powerful computing performance without any installation. We implement a series of algorithms of image processing and visualization in the initial version of Rayplus. Integration of our system allows much flexibility and convenience for both research and clinical communities.     

Visible Light Imaging: Clinical Aspects with an Emphasis on Medical Photography—a HIMSS-SIIM Enterprise Imaging Community Whitepaper

Photodocumentation is a subset of visible light imaging and is an important growing segment of enterprise imaging. Medical videography is another subset of visible light imaging that shares many of the challenges of photodocumentation. Medical photographs are used to document clinical conditions, support diagnosis, guide, and document procedures and to enable collaboration among colleagues. They also play a significant role in patient engagement and are a mechanism for patients to share information with their provider without the need for a clinical office visit. The content of medical photographs raises issues for acquisition, management, storage, and access. Medical photographs may contain protected health information, and these images benefit from the standardized, secure processes inherent in any enterprise imaging program. The ability to securely acquire images on mobile, and sometimes personally owned devices, is a necessity. In addition to containing protected health information, photograph content can be sensitive or gruesome or the images may be used for forensic purposes. These types of images require additional protections. Access to these images should be role-based and auditable. To properly identify photographs and to convey information about their acquisition parameters new metadata requirements and mechanisms for its association with the imaging files are evolving. Institutional policies need to be developed to define the organization’s requirements for medical photography, including consent processes. Existing policies such as those defining the designated record set and legal health record should address the management of medical photography.     

Visible Light Imaging: Clinical Aspects with an Emphasis on Medical Photography—a HIMSS-SIIM Enterprise Imaging Community Whitepaper

Photodocumentation is a subset of visible light imaging and is an important growing segment of enterprise imaging. Medical videography is another subset of visible light imaging that shares many of the challenges of photodocumentation. Medical photographs are used to document clinical conditions, support diagnosis, guide, and document procedures and to enable collaboration among colleagues. They also play a significant role in patient engagement and are a mechanism for patients to share information with their provider without the need for a clinical office visit. The content of medical photographs raises issues for acquisition, management, storage, and access. Medical photographs may contain protected health information, and these images benefit from the standardized, secure processes inherent in any enterprise imaging program. The ability to securely acquire images on mobile, and sometimes personally owned devices, is a necessity. In addition to containing protected health information, photograph content can be sensitive or gruesome or the images may be used for forensic purposes. These types of images require additional protections. Access to these images should be role-based and auditable. To properly identify photographs and to convey information about their acquisition parameters new metadata requirements and mechanisms for its association with the imaging files are evolving. Institutional policies need to be developed to define the organization’s requirements for medical photography, including consent processes. Existing policies such as those defining the designated record set and legal health record should address the management of medical photography.

     

A Parallel Method to Improve Medical Image Transmission

The staggering number of images acquired by modern modalities requires new approaches for medical data transmission. There have been several attempts to improve data transmission time between medical imaging systems. These attempts were mostly based on compression. Although the compression methods can help in many cases, they are sometimes ineffectual in high-speed networks. This paper introduces parallelism to provide an effective method of medical data transmission over both local area network (LAN) and wide area network (WAN). It is based on the Digital Imaging and Communications in Medicine (DICOM) protocol and uses parallel TCP connections in storage services within the protocol. Using the proposed interface in our method, current medical imaging applications can take advantage of parallelism without any modification. Experimental results show a speedup of about 1.3 to 1.5 for CT images and relatively high speedup of about 2.2 to 3.5 times for magnetic resonance (MR) images over LAN. The transmission time is improved drastically over WAN. The speedup is about 16.1 for CT images and about 5.6 to 11.5 for MR images.     

An Integrated Approach to a Teaching File Linked to PACS

To meet the educational needs of a medical imaging department with a strong teaching commitment, a teaching file that uses digital data supplied by the institutional picture archiving and communications system (PACS) was required. This teaching file had to be easily used by the end users, have a simple submission process, be able to support multiple users, be searchable on all data fields, and implementing the teaching file must not incur any additional software or hardware costs. The teaching file developed to address this problem takes advantage of the database structure and capabilities of several components included in the commercial PACS installed at the hospital. MS Access is used to seamlessly integrate with the digital imaging and communication in medicine (DICOM) database of a normal work station that is part of the PACS. This integration allows relevant patient and study demographics to be copied from images of interest and then to be stored in a separate database as the back-end of the digital teaching file. When images for a particular teaching file case need to be reviewed, they are automatically retrieved and displayed from the main PACS database using an open application programming interface (API) connection defined on the PACS web server. Utilizing this open API connection means the teaching file contains only the relevant demographic information of each teaching file case; no image data is stored locally. The open API connection allows access to imaging data usually not encountered in a teaching file, allowing more comprehensive imaging case files to be developed by the radiologist. Other advantages of this teaching file design are that it does not duplicate image data, it is small allowing simple ongoing backup, and it can be opened with multiple users accessing the database without compromising data access or integrity.     

Computer-Aided Detection and Diagnosis at the Start of the Third Millennium

Computer-aided diagnosis has been under development for more than 3 decades. The rate of progress appears exponential, with either recent approval or pending approval for devices focusing on mammography, chest radiographs, and chest CT. Related technologies improve diagnosis for many other types of medical images including virtual colonography, vascular imaging, as well as automated quantitation of image-derived metrics. A variety of techniques are currently employed with success, likely reflecting the variety of imagery used, as well as the variety of tasks. Most areas of medical imaging have had efforts at computer assistance, and some have even received FDA approval and can be reimbursed. We anticipate that the rapid advance of these technologies will continue, and that application will broaden to cover much of medical imaging. Acceptance of, and integration of computer-aided diagnosis technology with the electronic radiology practice is a current challenge. These challenges will be overcome, and we expect that computer-aided diagnosis will be routinely applied to medical images.     

Workflow Challenges of Enterprise Imaging: HIMSS-SIIM Collaborative White Paper

With the advent of digital cameras, there has been an explosion in the number of medical specialties using images to diagnose or document disease and guide interventions. In many specialties, these images are not added to the patient’s electronic medical record and are not distributed so that other providers caring for the patient can view them. As hospitals begin to develop enterprise imaging strategies, they have found that there are multiple challenges preventing the implementation of systems to manage image capture, image upload, and image management. This HIMSS-SIIM white paper will describe the key workflow challenges related to enterprise imaging and offer suggestions for potential solutions to these challenges.     

Medical Image Resource Center–making electronic teaching files from PACS

A picture archive and communications system (PACS) is a rich source of images and data suitable for creating electronic teaching files (ETF). However, the potential for PACS to support nonclinical applications has not been fully realized: at present there is no mechanism for PACS to identify and store teaching files; neither is there a standardized method for sharing such teaching images. The Medical Image Resource Center (MIRC) is a new central image repository that defines standards for data exchange among different centers. We developed an ETF server that retrieves digital imaging and communication in medicine (DICOM) images from PACS, and enables users to create teaching files that conform to the new MIRC schema. We test-populated our ETF server with illustrative images from the clinical case load of the National Neuroscience Institute, Singapore. Together, PACS and MIRC have the potential to benefit radiology teaching and research.     

由DICOM医学图像文件获得设备无关位图的方法

目的:根据临床调查.DICOM3.0医学图像文件格式的解析及解决其显示问题是医学图像处理的基础,对医学影像技术的研究有重要意义.方法:首先针对DICOM3.0标准,系统分析了DICOM医学图像文件格式,主要阐述了文件信息头和数据元素的格式,提出了在Windows平台下利用线性调窗实现DICOM图像的DIB位图显示.结果:利用线性调窗成功实现了CT、MR图像的显示,同时针对默认状态下显示效果欠佳,采用手动调窗改善显示效果.结论:实验证明,该方法能较好地实现DICOM医学图像的显示,满足一定的临床需求,同时也为后续工作奠定基础.     

Development and use of iron oxide nanoparticles (Part 1): Synthesis of iron oxide nanoparticles for MRI

Contrast agents, such as iron oxide, enhance MR images by altering the relaxation times of tissues in which the agent is present. They can also be used to label targeted molecular imaging probes. Unfortunately, no molecular imaging probe is currently available on the clinical MRI market. A promising platform for MRI contrast agent development is nanotechnology, where superparamagnetic iron oxide nanoparticles (SPIONS) are tailored for MR contrast enhancement, and/or for molecular imaging. SPIONs can be produced using a range of methods and the choice of method will be influenced by the characteristics most important for a particular application. In addition, the ability to attach molecular markers to SPIONS heralds their application in molecular imaging.There are many reviews on SPION synthesis for MRI; however, these tend to be targeted to a chemistry audience. The development of MRI contrast agents attracts experienced researchers from many fields including some researchers with little knowledge of medical imaging or MRI. This situation presents medical radiation practitioners with opportunities for involvement, collaboration or leadership in research depending on their level of commitment and their ability to learn. Medical radiation practitioners already possess a large portion of the understanding, knowledge and skills necessary for involvement in MRI development and molecular imaging. Their expertise in imaging technology, patient care and radiation safety provides them with skills that are directly applicable to research on the development and application of SPIONs and MRI.In this paper we argue that MRI SPIONs, currently limited to major research centres, will have widespread clinical use in the future. We believe that knowledge about this growing area of research provides an opportunity for medical radiation practitioners to enhance their specialised expertise to ensure best practice in a truly multi-disciplinary environment. This review outlines how and why SPIONs can be synthesised and examines their characteristics and limitations in the context of MR imaging.     

区域影像信息系统的资源调度研究

目的：资源调度是区域影像信息系统的核心问题。比传统的中心式区域影像信息系统相比,基于数据网格的区域影像信息系统具有更大的优势。本文拟提出一种区域影像信息系统的资源调度算法的设计与实现,以避免中心资源形成系统瓶颈。方法：首先,本文简单介绍了基于数据网格的区域影像信息系统构架的特点,通过与中心化区域影像信息系统构架的比较,证明其在区域医疗建设中的优势及巨大发展潜力。然后,针对网格区域影像信息系统中核心的科学问题,即资源调度问题进行了分析并提出了基于临床路径过程的均衡调度策略并实现。网格模拟器GridSim被用来测试本文所提出的均衡调度策略的有效性。结果：通过与一种现有的资源-时间均衡的调度算法进行比对,实验结果表明本文所提出的算法能更有效地分配区域影像网格的中心资源,并能提高影像网格对临床紧急事件的响应速度。结论：本文所提出的资源调度算法在调度优先级计算中引入了临床路径知识,能较好地区域影像信息系统中资源的分配问题。     

基于Pocket PC的医学图像浏览器

目的：利用绑定精简版．NET开发框架的Visual Studio 2003．NET编程平台开发一个基于Pocket PC的医学图像浏览器。材料与方法：智能移动设备客户端通过安装应用程序，实现对Web服务器端医学信息的查询、提取、更新，以及对医学图像的浏览和处理。结果：在基于Windows CE的智能移动设备端，通过采用C／S（client／server）构架，利用医学图像浏览器，初步实现了医学图像的无线远程共享。结论：与大多数传统的PACS相比，基于Pocket PC的移动PACS组建简单，易于安装和使用。利用其独有的移动上网功能，突破了医学图像浏览的时间性和地域性的限制。